Lesotho’s Mental Health Advocate: Makamohelo Malimabe’s Transformative Journey

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'Makamohelo Malimabe

Section 1: Professional Journey and Experience

1. Tell me about your background and how it led you to pursue various roles in psychology, from working as a Learning Therapist to your current position as Head Psychologist at Leseli Mental & Behavioral Health. How has each experience shaped your approach to mental health treatment and advocacy?

I secured my BA in Pastoral Care and Counselling from NUL, and it took me approximately five years after graduating to secure a role in counselling services. By the time I was absorbed into what we tend to classify as formal employment, cohorts of counselling graduates from the same program were employed and serving as counsellors. This was predominantly in NGOs working in HIV and TB management programs in Lesotho. I am extremely goal-oriented, and when I was mapping out my career goals, my heart sank when I realised that growth potential is near impossible. No amount of high performance is guaranteed to secure you a promotion in settings like that, you have to wait many years for your turn. I tasked myself with following a somewhat different professional trajectory. An encounter with an online certificate program in 2017 led to a series of fortunate events that eventually secured me a fully funded scholarship to study towards a Counselling Psychology graduate degree in America. This, in turn, resulted in internships, learnerships and work in mental health in America, and now in Lesotho. My takeaway from my previous and current roles is that mental health is context-specific. This means we should always take into account the culture, traditions, practices, and way of life of the people we are working with in mental health programs.

2. Transitioning from an Internship at YWCA USA to your current position as a Part-time Lecturer at the National University of Lesotho, how do you balance your academic responsibilities with your practical work in psychotherapy?

As part of fulfilling the requirements of my Master’s at Western Michigan University, I had to complete clinical hours, 600 hours and 240 of those hours had to be direct contact/service with clients. I applied to YWCA Kalamazoo to undertake my field internship. I was struggling to clock my hours and I ended up having to find an additional internship site, Meredith Psychological and Testing Services. I was able to complete my hours and graduate. My internship at Meredith turned into work and this is what led to an extended stay in Michigan. I call it an extended stay because the plan has always been to work in Lesotho, after all this is where I initially identified gaps in mental health services. So, in late 2023 I relocated back home where I assumed a teaching role at the National University of Lesotho as a Part-time Lecturer. The same year, I founded Leseli Mental and Behavioral Health which is a company that provides an array of mental health services to individuals, companies, NGOs, etc. In 2023 still, I led a grant application process that secured me and my colleagues an Alumni Engagement Innovation Fund (AEIF) grant via the U.S. Embassy in Maseru. Now that I think about it, the (AEIF) grant came about because I needed to know what I would be doing when I came back home. Unemployment rates in Lesotho are such that one has to think and plan accordingly. My work week is divided into different roles, there are days when I am on campus lecturing. Other days are reserved for work as Head Psychologist at Leseli, and most days I am assuming the Project Lead role at Mental Health for Public Health Lesotho. Unfortunately, there is no balance. If there was to be a balance, it would mean we can control time. It is usually a case of responding to the most pressing role or deadline at any given point in time. My day can go from designing the project’s training curriculum to having a client-facing suicide ideation walk into my office. I cannot predict what my workday is going to be like. 

Section 2: Global Health and Advocacy

3. Your work with the Elizabeth Glaser Pediatric AIDS Foundation and North Star Alliance demonstrates a commitment to public health initiatives, particularly in HIV/AIDS programs. Tell me about your background in this field how it has informed your understanding of the intersection between mental health and infectious diseases, and how you integrate this knowledge into your current practice?

Indeed, I am committed to public health and equitable health services in general. I was with North Star Alliance for 1 year before joining the Elizabeth Glaser Pediatric AIDS Foundation for 3+ years. One common theme kept coming up in daily interactions with clients and/or patients is they would allude to mental anguish as part of their concerns. It felt like mental health falls outside the scope of work of HIV/TB programs. I really think it was the case because currently NGOs and CBOs that are donor-funded are expected to highlight the mental health component in their grant applications. This has not always been the case. It is this treatment gap in clinical services that made its way to my study of intent when I applied for the Fulbright Scholarship. One that says, Non-Communicable Diseases (NCDs) and Mental health can be integrated into existing primary health care programs, like HIV/AIDS programs. Research has shown that 70% of countries in Africa spend less than 1% of the total health budget on mental health and 90% have less than one psychiatrist per 100,000 population. Lesotho is no exception, therefore it makes financial sense to leverage human resources that are already available to deliver mental health services. The human resources, in this case, is the clinical staff working in HIV/AIDS programs, they can be trained to deliver mental care services as well. In under-resourced countries, where the gold standard is not possible, we have to make use of available resources. For example, with Mental Health for Public Health Lesotho, we recognize Basotho’s strong sense of community hence we are working with traditional/spiritual/religious/faith healers, community leaders/village chiefs, as well as clinicians to scale up mental care & well-being.

4. You hold certifications in Global Health Delivery and Policy Development and Advocacy for Global Health. Can you share a specific instance where you applied these skills to effect meaningful change in mental health policy or service delivery, either locally or internationally?

I usually liken my drive and motivation to that of Forrest Gump, a fictitious character in the film of the same name played by Tom Hanks. In the movie, Forrest runs across America for three years, two months, 14 days, and 16 hours. When he is interviewed on the reason(s) he says, “I just felt like running.” This is usually an attitude I have developed with professional development studies, I tell myself I am just doing it because I might use that set of skills one day. The Global Health Delivery certificate has been helpful when working in a diverse America. It becomes a case of, how you adequately apply your skills and exercise cultural humility when working with Asians, Africans, Americans, Mexicans, etc. Funnily, people see me in public and they’ll say something like, “It is that lady who writes about mental health on LinkedIn and Facebook.” That right there is what Policy Development and Advocacy for Global Health is about, to speak loudly, boldly, and passionately about health equity and health delivery. To commend good work while challenging the outdated laws, as well as policies that have not been formally adopted to guide mental health services. I took another one with the University of Washington, Fundamentals in Implementation Science. I foresaw a career where one day I will be leading mental health projects, and currently one of my roles is Project Lead for a nationwide mental health & community engagement project. Isn’t that something? I just do things as part of a bigger plan.  

Section 3: Specialized Populations and Counseling

5. Working with diverse populations such as factory workers, LGBTQI+ communities, and individuals involved in commercial sex work requires sensitivity and cultural competence. How do you ensure that your counselling approach is inclusive and responsive to the unique needs of each group?

I can think of multiple counsellor attributes i.e., empathy, cultural humility, diversity and inclusion. Professor Kathleen Wong Lau noted, “We are the same despite our differences are different despite our sameness.” This recognizes that we are all human, but our differences are real. In my earlier years, I was a factory worker, I usually resisted the temptation of assuming that I knew what a factory worker was going through, let’s say financially. I try to actively listen to someone’s unique lived experience and tailor make an intervention plan that is specific to their needs. I am also someone who works on their implicit bias so that my biases do not bleed into my work with clients. I provide gender-sensitive and identity-affirming care, I operate from a non-judgmental approach. Dr Wong Lau calls it the prefatory statement, “Because I am someone who has never experienced this, could you please explain to me what you mean by….” acknowledges that people who are positioned differently have different experiences and feelings.

6. As an HTS Counsellor with North Star Alliance, you provided counselling services primarily in HIV Testing Services. How do you approach counselling in situations where there may be overlapping concerns, such as mental health and HIV/AIDS, and how do you navigate the stigma associated with both?

Ironically, this is what led to me enrolling for a graduate program in psychology. When I started recognizing these overlaps, I found myself ill-equipped to address the mental health needs of people living with HIV. I could identify that someone endorses symptomatology for a depressive disorder but my skills to dive deeper were limited. I used to refer clients for mental health to Mohlomi Mental Hospital so that they get mental health care when we prioritize HIV care. This is when I really noticed the gap in clinical treatment & the stigma still surrounding mental health. In situations like this, you try to bridge the gap, and this is what I am currently doing through my few roles in mental health. 

Section 4: Future Directions and Innovation

7. In your role as a Part-time Lecturer at the National University of Lesotho, what innovative teaching methods or curriculum developments do you incorporate to prepare future mental health professionals for the challenges they may face in diverse clinical settings?

My teaching philosophy emphasizes engaging students through interactive learning activities, case studies, presentations, and real-world applications. I strive to create a supportive and inclusive learning environment that fosters critical thinking and intellectual growth. I bring industry knowledge that exposes them to local and international standards pertinent to the field of mental health. As a former student in the same program and department, I sometimes share my lived experiences with them as motivation and preparation for clinical settings.

8. You’ve expressed ambition in scaling up mental health services in low-income countries. What innovative strategies or technologies do you see as potential game-changers in addressing the mental health treatment gap in these contexts?

Culture and healing, as well as community engagement, are top of the list. I have expressed this before, “One’s sense of identity grows when they are living in a foreign culture,” Living in America really heightened my cultural identity. When I am working in Michigan, there are counselling techniques specific to Michiganders. With that in mind, there are healing approaches specific to Basotho hence my current work traditional, spiritual, religious healers, village chiefs, etc. Basotho that are faced with mental challenges are in communities. One of our assets and strengths is that we have a strong sense of community, let us leverage on that. For a long time, we have adopted Western methods of counselling, sometimes they work, other times they do not. Scholars like me are attempting a somewhat different approach to finding culture-specific healing methods and exchanging indigenous knowledge with international partners. The Global South shares knowledge with the Global North. Technology-wise, I provide virtual psychotherapy in my work. Basotho are not too enthusiastic about it though. I am currently talking to two folks, a local digital entrepreneur, and an American digital healthcare strategist for collaboration on a digital mental health app to scale up access to care.

9. Bonus question: If you could have dinner with any historical figure, dead or alive, who would it be and why?

I would be in a room full of the wives and partners of struggle heroes and/or human rights activists. Winnie Madikizela Mandela, Ntsiki Mashalaba, Deborah Johnson (later called Akua Njeri), Betty Shabazz, Coretta Scott King, etc. I would want to talk to them about everything and nothing. These are women who still had to survive, dodged bullets, and raised children while their partners fought for freedom. It couldn’t have been easy for them. 

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Litsitso Sibolla
Litsitso Sibolla, a dedicated writer for Selibeng.com and catalyst for change in Lesotho, possesses an unwavering passion that ignites transformation. His unwavering commitment to empowering the youth and driving positive shifts has established him as a prominent figure youth empowerment. Through his continually growing coffee shop and music company, centered around the aspirations of young people, he has established platforms that uplift and motivate the upcoming generation. Embark on a journey alongside Litsitso Sibolla as he empowers Lesotho's youth and inspires a promising future for everyone.