Planning your elective - Lesotho

Anthony Wiskin and Emma Torbé visit the "kingdom in the sky"

Lesotho, the "kingdom in the sky," is a beautiful mountainous country with snow capped mountains in the winter, plummeting waterfalls (taller than Victoria Falls), and fertile plains in the summer. At the hospital where we worked our experience was mainly "hands on" with no formal teaching, which made it both a challenging and worthwhile elective experience.

Culture and people

Apartheid never existed in Lesotho, so racism is not such a big problem as it is in South Africa. Nearly everyone in Lesotho is poor. Lesotho's biggest export used to be men to work in the South African diamond mines, but many are closing or employing local South Africans, so unemployment is a big problem. It has fallen recently due to the Highlands Water Project. This involves building a series of dams that will provide hydroelectric power to Lesotho and water to South Africa. Many men still leave Lesotho in search of work, leaving wives and children, and returning only a few times a year or occasionally sending money home. Many men have second families in South Africa and this adds to Lesotho's poverty and the spread of sexually transmitted diseases.

Traditional Basotho culture consists of customs and superstitions and still exists in the more rural areas. Milestones of birth, puberty, marriage, and death are all celebrated, usually by ceremonies dedicated to the ancestors. Christianity is also practised, as missionaries run many of the schools and hospitals. Thus people tend to mix and match bits of the two religions.

Healthcare system

The country is divided into different health service areas. Each area is covered by a different hospital, which can be either government or missionary run. Most hospitals have satellite clinics for the more rural areas. The Lesotho flying doctor service covers the remotest parts of the country, which are inaccessible by road. There is one referral hospital in the capital to which patients are transferred if their case is too difficult for their local hospital. If the case cannot be handled by the referral hospital then it is often referred to Bloemfontein in South Africa. Patients have to pay for health care but this is usually only a contribution towards the complete cost; the rest is subsidised by the government, even if it is a missionary hospital.

Lesotho has three nursing schools but no medical schools so most doctors are not from Lesotho, and they vary in knowledge and standards. English is the common language used by health professionals in hospitals. This means relying on nurses to translate when talking to most patients. Traditional healers still practise throughout Lesotho, and frequently patients seek both traditional and Western treatments. Healers use a lot of herbs and roots to make medicines and dress wounds, but also "release evil spirits" by cutting the skin at sites of pain.

As in many other African countries HIV and AIDS are prevalent. The exact numbers are not known, mainly because there is no government policy for testing patients. Some doctors believe that there is no point in testing patients as the test is expensive and there is no treatment available, and a significant stigma is attached to the diagnosis. Families and the community may reject patients who are HIV positive. Unfortunately, thismeans that beliefs, such as that AIDS is a myth spread by white people to prevent the young people having fun, still exist. But primary healthcare teams run awareness campaigns, while in hospitals all necessary precautions are taken.

Tuberculosis is common. This is due partly to cramped and poor communal living conditions and also because of the spread of AIDS. However, the incidence is dropping due to education that has increased awareness of the disease. Treatment is free because of a government sponsored initiative which follows standard World Health Organisation protocols.

Visas and travel

The visa situation changes frequently so it is worth checking out before you go. At present people from Great Britain do not need one. The standard entry permit given at passport control usually lasts between two and four weeks. This can be extended by either crossing the border and re-entering Lesotho or by contacting the department of immigration in Maseru. It is very useful to carry a letter of confirmation from your hospital with you. Contact the High Commission of the Kingdom of Lesotho, 7 Chesham Place, London SW1 8HN (020 7235 5686) for more details.

The only ways into the country are to fly to Maseru airport (you can do this only from Johannesburg) or drive across the border from South Africa.

Health and safety

Outside the large towns crime is less prevalent and incidents that do occur are usually domestic or between locals and frequently involve alcohol. However, it is not recommended to walk around after dark, especially in the capital. In the towns you should take the usual precautions and keep your wits about you. One of the hospital minibuses was hijacked but fortunately no one was injured. The only problem we had is that everyone wanted to talk to us as we were white, and they asked us for money or shoes. The recommended vaccinations are hepatitis A and B, typhoid, tuberculosis, polio, and tetanus. There is neither bilharzia nor malaria in Lesotho.

Anthony Wiskin, fourth year medical student, University of Southampton
Email: ejvt197@soton.ac.uk

Emma Torbé, fourth year medical student, University of Southampton
Email: aw497@soton.ac.uk


studentBMJ 2001;09:171-216 June ISSN 0966-6494

Mark Wilson author of The Medics Guide to Work and Electives Around the World and runs www.medicstravel.com, a website designed to help students and junior doctors find work overseas