A P R I L Lesotho Medical Association Journal

1 A P R I L. Lesotho Medical Association Journal 2 0 0 7. V O L U M E 5 N U M B E R 1. C O N T E N T S. Lesotho Medical Association Journal VOLUME 5; NUMBER 1 - APRIL 2007. Table of Contents PRESIDENT'S NOTE .. 2. EDITORIALS. Senkatana Clinic Project .. 3. M Mokete Another Shot in the Arm .. 3. M Mokete HISTORICAL REVIEW. Forty Years of Health Services Development in Lesotho : Successes, Failures & Challenges .. 4. M Mokete FUTURE DIRECTION. Developing a Family Medicine Residency Programme in Lesotho : Training Physicians for the Future - The Time Has Come! .. 9. B Jack, MW Phooko CLINICAL GUIDELINES. HIV/AIDS and Mental Health .. 13. SP Shaikh Medical ETHICS. The World Medical Council Policy .. 17. Declaration of Geneva .. 18. Hippocratic Oath .. 18. Lesotho Medical Association Journal Vol. 5, No. 1 Apr 2007!

2 1. E D I T O R I A L S. From the President's Pen Editors The Lesotho Medical Association , founded in 1973, has to date seen 12,045 days Dr. M. Mokete of light. This has been long enough for to evaluate itself with respect to Dr. Lekhanya what it has achieved as an Association and whether it is aligned with its consti- tutional objectives of promoting peace and unity among its members, while in- stilling in them the spirit of professionalism as they play their part in the van- guard of quality health delivery in our dear nation. How far have we gone and Instructions for Authors where are we today? We need to conduct a retrospective assessment to identify what our individual contributions have been in the life of this fraternity, what The Lesotho Medical Association Jour- they should be, and what they are going to be in the years to come to ensure that nal accepts editorials, original research our goals are realized.

3 Papers, review papers, case discussions, clinical guidelines, letters or Lesotho The challenges facing health care delivery of Lesotho today are underscored by the Medical news reviews. stranglehold of the HIV/AIDS pandemic on our society. These challenges call for a re-dedication to our professional duties and extra vigilance on our part as cus- The author should submit both an elec- todians of health in this country. This vigilance demands information and tronic and hard copy of the manuscript knowledge sharing among us, and the integration and coordination of our efforts to the address below: and activities as individuals and as an Association with those of other health pro- fessionals within the patient care team. This cannot happen if we allow our Lesotho Medical Association Journal hearts and minds to become enslaved with the demonic powers of animosity and Dr.

4 Musi Mokete hatred, the canker that devours the souls of associations away and stands in the Box 588. way of progress in communities. We owe a duty to this nation, which is to en- Maseru 100. sure that the rights and the health of Basotho are protected. Let us remain united in our actions and pronouncements and be supportive of each other in all we do in order to execute this national duty to the level of perfection society demands of us.! I raise my hat in congratulation to the organizers of The Learning and Sharing Forum for creating a platform for knowledge and information sharing among all cadres of the health profession on health matters, particularly HIV and AIDS. Knowledge is power, so the saying goes and sharing knowledge in matters of con- cern in health, no doubt, is one of the few strategies we can adopt in our current battle against the many diseases afflicting our nation today.

5 I entreat you to de- velop the culture of finding out , the culture of research, which prompts us to learn more about the hydra-headed health problems facing us today. We must empower ourselves with the knowledge we need to solve them to ensure a better tomorrow for this generation and those to come. I note here with great satisfaction that the Lesotho Medical Association has now become an integral part of the bigger bodies of the African and World Medical Associations. To underscore what unity can achieve, at this point, let us remem- ber that it is with unity that these august bodies have stood the test of time and grown to the level that we can pride ourselves as being part of them. Strength is indeed in unity and in division, we fall. I salute you all in the name of the Almighty God. He knows what we don't know and he prepares us adequately for the unknown.

6 God Bless you. DR HOEDOAFIA. Lesotho Medical Association Journal Vol. 5, No. 1 Apr 2007! 2. E D I T O R I A L S. which should be replicated else- Editorial: Senkatana Editor's Note: Another where as part of smart partner- Clinical Project ship. Shot in the Arm The Senkatana clinic has been a It would be remiss of me not to The help from Bristol Myers pioneering success in administer- mention a very difficult task right Squibb for printing our Journal has ing antiretroviral therapy. It at the beginning, which was to re- hardly expired and we have gotten serves as a model and is stimulat- cruit and screen staff for Senka- another shot in the arm from Bos- ing the subsequent establishment tana clinic, which has in fact made ton. The help, which we greatly of many other clinics throughout Senkatana effective and efficient in appreciate, will be in the form of Lesotho .

7 Credit for the establish- carrying out the mission of secur- comprehensive printing and mod- ment of the project goes to Bristol ing the future. We are happy with ernizing the Journal . We hope the Myers' initiative enhanced by the our choice of staff from the begin- Journal will be more attrac- tripartite arrangement including ning and throughout the running tive for the readership. There is no the Lesotho Government, which of the project. doubt that our printing skills and has generously, provided the in- networking will also be enhanced frastructure and secondment of We may have not been very regu- in time. some staff members, and the Leso- lar at Senkatana review meetings tho Medical Association (LMA), because of our part-time basis We are looking forward to a fruit- which was charged with recruit- there and our various commit- ful working relationship.

8 Thanks ment and supervision of staff. ments, but Senkatana with its own to the Lesotho -Boston Health Alli- expected problems, has matured ance and the Kellogg Foundation The 's involvement pre- with contributions from all stake- for their assistance. sented the incumbent Executive holders. Committees with quite a challenge Dr. Musi Mokete including: We are aware that the project is Editor, Lesotho Medical Journal ending per schedule, however, we (1) Capacity building of the hope there will be some new mo- itself (establishing and equipping dus operandi which, for the sake the office as well as paying the of the clients, will make Senkatana secretary). We acquired buildings clinic to live long in a sustainable for the office as well as rentable way. outbuildings for sustainability. For this capacity building, we thank For any new initiatives, the Leso- Bristol Myers immensely.

9 Tho Medical Association is still very much prepared to cooperate. (2) Resuscitating our Medical jour- We have learned a lot too and are nal, which has carried the mes- prepared to share information and sages of HIV/AIDS for our col- experience for the sake of us all. leagues and other interested per- Long live Bristol Myers, Govern- sons. Our gratitude goes to Bristol- ment of Lesotho and - Myers. We have also had outreach, Senkatana initiative! through district-level discussions - Dr. Musi Mokete with other colleagues. The above gestures are rare innovations, Lesotho Medical Association Journal Vol. 5, No. 1 Apr 2007! 3. H E A L T H S E R V I C E S D E V E L O P M E N T. Forty Years of Health Services Development in Lesotho : Successes, Failures & Challenges MUSI MOKETE, MD. INTRODUCTION By 1967, Van Graan, from on Secondment with the establishment, agreed with the In 1966, Lesotho 's doctor/patient ratio was still very late Anton Rupert (tobacco Magnate) to establish a low with 1 doctor to 14,000 patients.

10 The number of shuttle service which would be paid for by Anton hospitals is the same as it was then except that satel- for all the technical experts and their boarding and lite clinics have increased in number. Most of the lodging. The shuttle service was launched with or- Graduate Doctors came from: WITS (11) (Makenete, thopaedic surgeons, gynecologists, dermatologists, Nt!ekhe Mphahlele, Makotoko, Mahabane, Cindi, ear nose and throat specialists, anesthetists and Nt!ekhe, Tlale, Maema, Lebona, Nkuebe), Glasgow theatre nurses in 1968. They came on a monthly or (2) (Mokose), Edingburgh (1) (Hoohlo), University quarterly basis, depending on the cases referred of Natal (7) (Maitin, Mohapeloa, Molotjwa, Molapo, from different hospitals and private settings in the Letsunyane, Matthews, Phakisi), and India (2) country.