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.