How Nurse Training Saved a Newborn’s Life in Lesotho

Just seconds after birth, a newborn began going into distress and not breathing. Without hesitation, Midwife Malerotholi Rakhooanyana checked the baby's airway in an attempt to resuscitate them at Partners In Health (PIH)-supported Lebakeng Health Center in Lesotho.

There was no time to panic or nearby hospital to rely on. The closest referral facility is four to five hours away by road, across Lesotho's mountainous terrain.

But Rakhooanyana felt prepared and confident, even in the face of a crisis.

Using resuscitation skills she had recently refreshed through the Global Action in Nursing (GAIN) training, she worked quickly and carefully at the bedside. First, she kept the baby's skin dry and warm to prevent hypothermia. Next, she repositioned the baby to properly check its airway. She noticed fluids, so she began removing them with a suction bulb designed for infants. Then, she gently rubbed the baby's back to stimulate breathing.

Finally, the baby began to breathe and the mother was stable.

"I wasn't panicking because I knew what to do," says Rakhooanyana. "The training improved my confidence, preparedness, and ability to provide timely and lifesaving care."

Days later, the newborn returned for its seven-day postnatal visit-healthy and thriving. Before the GAIN training, the last time Rakhooanyana reviewed her resuscitation skills was 16 years ago during nursing school-and was admittedly long overdue for a refresher.

Building lifesaving skills for rural midwives

Through the GAIN program, Rakhooanyana and her colleagues receive advanced clinical and leadership training and hands-on mentorship to prevent unnecessary complications during childbirth. Founded in 2017, GAIN-a women- and nurse-led organization of global health experts-has trained 677 nurse-midwives across Liberia, Malawi, Sierra Leone, and the United States (Memphis, Tennessee).

Malerotholi Rakhooanyana (center) receives her course certificate from PIH Lesotho Executive Director 'Mathemba Radebe (left) and Director of Nursing Joalane 'Mabathoana (right) during a graduation ceremony for nurses and midwives at PIH-supported Botšabelo Hospital in Maseru, Lesotho's capital. Photo by Tsepo Monakalali / PIH

In February, GAIN expanded to Lesotho and trained 29 midwives and nurses from three rural PIH-supported sites-Bobete, Nohana, and Lebakeng Health Centers-and Paray Mission Hospital, the referral facility for those clinics.

GAIN is led by the University of California, San Francisco, and works in collaboration with PIH Lesotho and Lesotho's Ministry of Health. Together, all ensure that nurses and midwives have the skills to provide high-quality care during routine visits and emergencies alike.

"Our mentors work side by side with facility staff at the bedside. This is not just about theory, it's about transferring practical skills that save lives in the moment," says Joalane 'Mabathoana, PIH Lesotho's nursing director.

Reignited passion for nursing

During a five-day training, participants attended presentations, engaged in hands-on demonstrations, had lively discussions, and more. The curriculum included leadership topics, such as how to give feedback and effective presentations; and clinical topics, including how to manage pre-eclampsia and postpartum hemorrhage.

"It has reignited our passion," says Khomonngoe Moea, Bobete Health Center's nurse-in-charge and clinical site director. "It has opened our eyes to things we are not even aware of."

For example, Moea and colleagues learned how to more accurately manage labor using a partograph-a graphical, monitoring tool. It's used to detect risk early before life-threatening complications arise for a mother and her baby. Previously, the midwives used the tool to monitor the active, intense phase of labor. During the GAIN training, they learned how to monitor the latent, or early, phase of labor to detect complications sooner.

"There are so many new things that we learned that we never knew we needed. Now, we are able to prepare for emergencies," says Moea. "It's going to improve patient outcomes."

Providing consistent support and care

Expectant mothers in rural Lesotho often live hours away from the nearest health facility. They take long treks, often traveling over steep slopes across rough terrain, and through harsh weather, in the only country in the world with an elevation entirely above 1,000 meters. The geographical obstacles and long distances to care are among many factors contributing to the country's high maternal mortality rate-approximately 478 deaths per 100,000 live births. To promote safe deliveries and regular care, PIH Lesotho established maternal waiting homes, where expectant mothers live as they await delivery.

While this addresses patient housing, staff housing wasn't available-until recently.

Recognizing that rural Lesotho presents unique challenges for long-term mentorship, PIH Lesotho and GAIN have prioritized infrastructure, with guest houses being constructed at Lebakeng, Bobete, and Nohana Health Centers to provide reliable accommodation for nurse mentors and visiting clinical staff. This will ensure consistent support, instead of irregular visits. Construction materials were difficult to transport by road and required transportation via helicopter, ensuring timely progress of the building projects.

The Global Action in Nursing team, from the University of California San Francisco, and PIH Lesotho staff meet to discuss the mentorship and training program in Lesotho. Photo by Justice Kalebe / PIH

Once complete, GAIN mentors will move into the guest houses and provide ongoing training for at least one year. Prior to the establishment of the guest houses, visiting staff would stay off site, sometimes hours away.

"This project is not just about training or buildings," says 'Mabathoana. "It is about building a stronger, more resilient health system that meets women and newborns with the dignity, safety, and care they deserve."

In rural clinics like Lebakeng Health Center, where help can be hours away, the skills Rakhooanyana used that day meant the difference between life and death for the newborn. With GAIN, now more staff have the skills to provide safe, emergency care for mothers and babies-no matter where they live.