‘Bringing the subject alive’ for future NCD leaders in Lesotho

As an innovator aiming for scaleable systems change, PCI places equal emphasis on developing leaders as it does on clinical training. And so, PCI’s training team have just returned from Lesotho, where they delivered PCI’s Non-Communicable Disease training package to 11 Family Medicine Registrars, who together serve a population of over 200,000 people (nearly a tenth of Lesotho’s population).

The training is part of the Family Medicine Specialty Training Programme, run by Lesotho Ministry of Health in partnership with the Lesotho Boston Health Alliance (LeBoHA). The programme is the first accredited doctor training programme in Lesotho that attracts native Basotho doctors to return to Lesotho from the different places they have been studying, to complete specialty training. This means they then become high quality district hospital physicians (with a family medicine approach) who are able to provide a range of comprehensive services for their communities. The programme is an important step to retaining highly skilled professionals in their own country, and mitigate the ‘brain drain’ that affects so many of Africa’s poorer countries.  Lesotho’s unusually high literacy rates (82%, average across Sub Saharan Africa is 65%) and abundance of natural resources, including the world’s richest diamond mines, belie the underlying poverty. Average life expectancy is only 48 years of age, the majority of whom live in rural areas far from primary healthcare facilities, and the number of deaths from Non-Communicable Diseases has spiked in recent years.

Monique Keersmaekers, one of PCI’s clinical training team, shares her experiences from the training.

After a two-hour drive from the capital, Maseru, we arrived in Leribe where we were carrying out training with 11 doctors. However, this was not just about ‘training’ in the traditional sense but about drawing out and supporting leadership qualities. The registrars who are trained through this programme are instrumental in planning and delivering healthcare in Lesotho, and so PCI’s expertise will sensitise these key leaders to prioritise resources, implement systems and influence policy to address the impending epidemic of NCDs in the region (above photo is of Dr Lebohang Sao- one of the participants in the training – demonstrating using an inhaler).

PCI’s training brings out leadership in three ways: the pedagogical approach (immersive debates, role plays and discussions on effective approaches to patient care); the trainers as role models (PCI trainers like myself are all Family Medicine Specialists – GPs- in active clinical practice.); and case-based clinical course content with an emphasis on training that equips doctors to train others to tackle patient cases in real-life practice.

The LeBoHA Family Medicine Specialty Training (FMSTP) director and one of the  FMSTP faculty members were at the training most days. They thought the PCI approach would work very well within their curriculum. We shared with participants the messy reality of seeing patients with multiple concerns and conditions, and we understand the inherent difficulty of applying evidence-based guidance in this context. One faculty member reported that the NCD training “is bringing the subject alive.”

As the week drew to a close it was clear that the trainees all valued the changes that the PCI approach can bring to NCD care in their communities. It’s early days to see the impact on patient health outcomes, but they were full of drive and already the registrars are designing a programme to cascade the NCD modules to the nursing sector across Lesotho.  

For me it was a very inspiring week. As the first generation of doctors to be tackling NCDs systematically in their country, the family medicine registrars are demonstrating that this beautiful ‘kingdom in the sky’ is abundant in both human as well as natural resources.