Quick Update

Hi everyone,

Sorry, I don't have time to leave a through post here. As I said, last week I was in the village of Serowe, which is about a 4 hour bus ride to the north of Gaborone. I stayed with a family for the entire week, and spent my days mostly working in a local clinic. I also was able to see a Health awareness day at a local primary school and then we visited several traditional healers. We also were able to shadow several doctors in the hospital and got to see many interesting things.

Unfortunately I have had several tests and projects due this week, and have not been able to write up a discussion about the week. Next week is our 'Spring Break' and I am leaving early tomorrow morning to spend the week in Namibia. I will work on several posts while I am away and will have plenty of material for you to read when I get back.


Thomas

Urban Medicine in Botswana -- first post

I have been promising a post about this for some time now, and since the title of this blog is Community Public Health -- I feel obligated to provide you with some information about my medical experiences thus far. Unfortunately, I am currently preparing to depart for a week long home-stay in the village of Serowe. The following is a reflection that I wrote for one of my Public Health classes. It is by no means complete, and altogether inadequate by way of my reflections on some issues. Still, here is a taste of my first experiences in a clinic of Botswana.

It is now the beginning of February, and I have visited one of the local clinics on the city of Gaborone three times. In the following lines, I will describe these experiences, as well as provide my own reflections and recommendations of the experiences described.

            Coming into my clinical experience, I wanted to be as open-minded as possible, in order to suppress any preconceptions, and allow for my learning to be solely based on my experience. Still, it was not possible to totally remove the ideas, which I had about healthcare in Africa. Coming into this experience, I expected the health system to be more sophisticated than what is generally depicted for the whole of Africa. I understood that Botswana, while still a developing country, has had great successes, especially in the field of health. Still I know that certain communicable diseases like HIV and TB have not been properly controlled, and I wondered what the reasons for this might be. Knowing this I expected some sophistication in the system, with identifiable flaws, which I would have to be on the look out for.

            When I entered the clinic for the first time, I honestly was not sure if I was in the right place. I saw a lobby that was crowded with people who, at least did not look particularly sick. By this I simply mean that it was not blatantly apparent that these people were here for medical assistance, while it did not seem improbable. In addition, I did not see anyone who looked like a medical professional, or even an area for reception. Assuming we were in the right place, my colleagues and I searched the building for someone who looked seemed to be in charge. Eventually we found a nurse, and were directed to the office of the Matron. The Matron greeted us warmly, and as the conversation progressed, our doubts were quickly eased. The Matron discussed with us the nature of the clinic, and its goals and mission, and then proceeded to ask us about our own goals for our experience. We made it clear that we were not medical students and did not have license to provide direct care to patients. However, our main goal was to learn about the healthcare delivery of Botswana from a perspective on the ground, and then be able to apply our experiences to public health issues facing the country. Once satisfied, the Matron proceeded to introduce us to the head nurse, Cecilia, who then gave us a tour of the clinic. After we were shown the basics of the clinic, we were directed to specific wards to spend the rest of our day. I was appointed to the maternal health clinic. Here I was able to participate in weighing of pregnant women, who come in to make sure the pregnancy is advancing healthily. I also observed as the nurses questioned women about their behaviors, problems, and histories to make sure that they were not doing anything improperly.

            The next week I began in the child welfare clinic, where mothers bring in their children to be weighed, in order to ensure that they are growing properly and healthily. I was able to help the women weigh their babies, and watch as the nurses recorded the information onto the patient charts and made sure the children were healthy. Once the traffic in this clinic began to slow down, I moved to consultation. This is the first area where patients check in, have their vital signs recorded, and then are directed to their appropriate clinics. Here I was able to assist the nurse in taking patient vitals, and recording biographical information onto the patient charts. Here, I was able to observe the various types of people who come into the clinic. It was, however, frustrating that I was not able to see the reason for their visit. Knowing this would have helped me get a more clear view of the reasons for seeking the help of this clinic.

            My initial idea of what healthcare might be like in Botswana was actually very accurate. While there are many serious problems, the set-up of the clinic was relatively sophisticated. I was impressed with the organization and well staffed personnel. While there is only one long-term doctor and one rotational doctor, there are many nurses who are able to handle a great deal of the patient influx. Still, there were many perceivable problems. Firstly, as we were taken around the clinic, there did not seem to be much care taken to protect the privacy of the patients. The nurse took us into various rooms where patients were being seen currently, and talked to us as if the patient was not there. We also were not given any explicit instructions about protecting patient’s privacy during our day-to-day shadowing. This situation is one that should be addressed in this clinic. Another problem that I have observed is the seeming insensitivity of caregivers in the clinic. This is one of the hardest issues to address, since the problem is in large part due to the massive number of patients that need to be seen in a day. Still, it seemed to me that there was no attempt to treat the emotions and fears of the patient. This last issue is one that I will be sure to comment on further as the semester progresses and I learn more and more about the delivery of healthcare in Botswana. 

Take care,

Thomas

Protests and Pastimes

Greetings Everyone,

            Sorry for the delay in updating the blog, things have been rather hectic here, and I wanted to make sure this post was well thought out and complete.

            At this point, I would like to begin to discuss some of the more serious issues I have encountered thus far in Botswana. As I continue to travel and see various things, I will display more of the beautiful land. But the meeting of the mind with the unknown is perhaps more intriguing, if only harder to express.          

            What is a country if not for its people? In the short time that I have been in Botswana, I am beginning to understand some things about the people of Botswana. There are three groups that I would like to discuss here: the sports fan, the student, and the sick.

            Over the past couple of weeks some interesting events have taken place right here on the campus of the University of Botswana. In summary, the students began a protest that resulted in the cancellation of classes for one week as the administration determined how best to move forward and resolve the issues of unrest. But do students really have the power to cause a university-wide shut down? Let me take you back to my first discovery of the possibility of a strike.

            Within the first week of my stay in the dorms, I had an interesting conversation with a local student. After a brief discussion about many things including politics in Botswana and the U.S., we parted ways for the night. Soon our paths crossed again and we began hanging out more frequently. He began to tell me about his anger with the new Vice Chancellor and all of the offenses he had committed against the students of the university. Despite my inherent skepticism, he proceeded to show me the ‘Memorandum’ or simply the ‘Memo’ that was released by the president of the Student Representative Council (SRC). These memos are posted around campus whenever there is any announcement to be made by an organization of the school, the topics are widely variable. This particular memo was one of the most impassioned letters I have ever read, addressed to the student body and spelling out the injustices of the Vice Chancellor, and calling the students to stand up and fight! After I had read the letter, my friend pressed me further, asking my opinion and if I agreed with the SRC president. I did my best to explain to him that it was hard for me to form an opinion based on such an emotional letter. At the time, I assumed this was an issue that would simply blow over with time. I did however find out that protests are not uncommon to this school, and sometimes can even result in violence. Only two years ago there were also campus-wide strikes where students were forced to participate under threat of violence.

            One night, as some fellow students and I were returning to the dorms, we began to hear many voices singing and yelling. Soon a large group of students were convening at the pavilion in the center of the dormitory courtyard. Soon they were all singing a Setswana song in unison and waving branches adorned with bright green leaves. The group continued to sing and dance for several minutes, until finally the SRC president was raised above the crowd (on the shoulders of the student who had shown me the memo) and made a brief announcement. As he was lowered the group of students raced out of the courtyard and continued their march as quickly as they had come. The protests had officially begun!

            Soon the protesters had recruited enough students to their cause to force classes to be disrupted. As soon as this happened, the university quickly decided to cancel classes in order to ensure the safety of all the students. In the meantime, the administration began to address the issues that caused the strike. Here is a summary of the problems addressed:

·      The School of Medicine, which was only established in 2005 has yet to be accredited, and many faculty members were recently fired due to a lack of funding. The students are very upset with the administrations operation of this department.

·      Supplementary examinations. The University of Botswana used to run on a year long system, and recently switched to semester based classes. The effects of this are still being felt. Particular classes are only held during one semester, this means that if a student fails a course that is necessary to move on in a degree track, the student must wait until the next year to retake the course. One possible relief of this problem is the introduction of supplementary exams. This would allow a student who fails to take a second test in order to try to raise his or her grade to passing. Supplementary exams were introduced last year, but were not sustained, and as a result there were record numbers of failing students last semester.

·      411 student bar. Currently the University has a student bar that is run on campus, where alcohol is sold legally. Because of the high prevalence of fights, sometimes resulting in serious injuries, the closure of this bar was up for consideration.

·      Intervarsity games. Recently a partnership was formed between UB and the University of Lesotho and the University of Swaziland, in order to facilitate sporting activities known as intervarsity games. This allowed students to participate in competitions between these three schools. This was discontinued this semester due to the inability of the University of Lesotho or Swaziland to host the games.

After some of the protests resulted in property damage to the university, consisting mostly of broken windows, the members of the SRC were suspended from school, and several of the leaders of the protests were arrested. With a lack of leadership, and the fear of ruining their education, the protests have now subsided and students are returning to school. The administration, however, did promise to address the issues that caused the strike. While the fruits of these protests did not lead to immediate results, they no doubt opened the eyes of officials to the passion of the students to have a successful school.

In the midst of all this excitement on campus, the country of Botswana was also participating, for the first time in the Africa Cup of Nations. It was amazing to see the students and people of Botswana come together and support their team through dancing and singing, and by sporting the blue and black colors of the Zebras! Although, Botswana was eliminated in the first round of the tournament, watching the games in the midst of crowds of Batswana, with the wild cheering and the blasting of vuvuzelas, is an experience I will not soon forget. I find it interesting how sports have the power to bring a people together, even amidst dispute. The Botswana national team accomplished a feat this year that had not been done in its history. The exited atmosphere of the games and the demoralized spirits after the losses reminded me of the roller coaster of emotions one gets from being a Husker football fan. It is comforting to know that sports are one thing that are a nearly universal human experience.

I know I promised to talk about healthcare, but this post has gotten rather long, so I will continue into that discussion in my next post.