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Conquering Lesotho’s Health-Care Crisis

BU faculty form alliance to train, educate medical personnel


The tiny country of Lesotho, a small nation surrounded by South Africa, has a population of roughly two million people — and the third highest prevalence of HIV/AIDS in the world, at 23.6 percent. Approximately 225,000 people ages 15 to 49 are HIV-positive.

The crisis doesn’t end there. Lesotho’s mountainous terrain limits access to health care. Many patients walk for hours, sometimes an entire day, to reach a hospital or clinic.

And the country has a severe shortage of doctors and nurses (there is only one pediatrician). Lesotho has no medical schools and few nursing schools. Fewer than 20 percent of the students who leave to pursue those careers will return to practice.

But some Boston University faculty and staff members are trying to change that. In 2003, the School of Medicine and the School of Public Health, along with the Lesotho Ministry of Health and Social Welfare, formed the Lesotho-Boston Health Alliance (LeBoHA), which is working to educate and retain physicians and nurses who will then practice in Lesotho.

The alliance is addressing other needs as well, such as hospital and clinic management. “If there’s no syringe or needle when the nurse goes to give the injection, it really doesn’t matter that the nurse is well trained,” says LeBoHA program director William Bicknell, a professor and chair emeritus of international health at the School of Public Health and a professor of sociomedical sciences and community medicine at the School of Medicine.

Since the program’s inception — and with funding from the W. K. Kellogg Foundation, the International Finance Corporation, the U.S. State Department, the U.S. Agency for International Development, and the Dreyfus Health Foundation — 25 LeBoHA faculty and staff from the School of Management and the MED departments of family medicine, obstetrics, emergency medicine, internal medicine, and pediatrics have traveled to Lesotho to work on the project. In addition, 65 SPH and MED students and Boston Medical Center fellows and residents have volunteered in Lesotho for LeBoHA programs or in clinical services at the district hospitals.

“Sending first-class people and having the very highest standards and a long-term commitment are what make a difference,” says Bicknell, “and from that we enrich our teaching and contribute to the knowledge base of how to make health care work in resource-constrained areas everywhere in the world.”

Robin Berghaus can be reached at berghaus@bu.edu.


6 Comments on Conquering Lesotho’s Health-Care Crisis

  • Nathan Emery on 10.06.2008 at 10:44 am

    Healthcare in Lesotho

    This article makes no real mention of sustainability. It simply talks about the samaritan attitude of Boston University in how they send ‘top notch’ people to Lesotho to carry-out health care. There is no mention of governance and infrastructure and how BU plans to help retention. It is my hope that they have a plan otherwise they are just well meaning tourists with an expansive busget.

  • Anonymous on 10.08.2008 at 9:39 am

    Did you watch the video? The whole last part talks about sustainability…

  • Nico Farmer on 10.10.2008 at 2:47 pm

    The goal is...

    sustainability. And helping people take care of themselves. In a dignified way.

  • Anonymous on 10.12.2008 at 12:48 pm

    I don't have to...I live there

    I did watch the video and I am still not impressed. It is easy to say we will train people and give them leadership all within the existing funds available. It is much harder to state the success of a project once its lifespan is completed. The one pediatrician you showed on the video is not even a Masotho. The fact of the matter is the government will be unwilling to compensate Basotho doctors and nurses at a complimentary rate that can challenge compensation in England and South Africa. It is useless to carry out projects such as this when the government has no history of sustaining such initiatives. BU must also look at the institutional history of Lesotho in these repsects and see that another project, that of Village Health Care Workers, has also come to nothing as there is no real government support or will. This training being provided does not secure that these same people will not go outside to seek a better life for themselves and their families once they reach some level of qualification. All the evidence would point to this (just look at the institutional history of skills acquistion through projects and resultant retention in the public or provate work force in Lesotho). Remember this is the same government which supported Robert Mugabe’s second election result as legitimate and of which covered up a substantial corruption case (perhaps resulting in the murder of a Dutch volunteer) revolving around the Bill Clinton Fund and the current Minister of Health. One could make the point that these details do not get at the systemic matters of the issue but this is also what the government would be happy for one to follow so they could continue spewing pro-poor policies in the face of elite building within their own party.

  • Short Term Installment Loan on 11.24.2008 at 5:41 am

    Re: Conquering Lesotho’s Health-Care Crisis

    There are lots of problems that our country is facing today like health care crisis. Health care is important in order to keep us healthy. But because of financial crisis there are some people who refused to seek medication whenever they are sick. That’s why short-term installment loan is one of the things that we need for us to have proper medication. Health is wealth that’s why we must not set it aside.

  • Anonymous on 12.04.2008 at 6:38 pm

    Cultural integration

    How is BU integrating Lesotho culture in their western medical practice?

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