Chris Carter, a final-year medical student at the University of Birmingham, is currently undertaking his ‘elective’ in the town of Mahalapye, Botswana. The elective is designed as a way for medical students to develop a wider understanding of their chosen specialism – perhaps through undertaking clinical research, or visiting a different country.
Chris has chosen to look at how HIV is diagnosed and treated in Botswana – and in a regular blog for us over the next few weeks, we hope to learn something, too!
Botswana is widely regarded as an African success story. Having gained independence from Britain in 1966, it has rapidly developed into one of the wealthiest nations in Sub-Saharan Africa. So has the healthcare system grown with it? An elective project for a month in rural Mahalapye, Botswana, seems like the best way to find out.
HIV/AIDS has long been the primary cause of mortality in Sub-Saharan Africa and Botswana is no stranger to the epidemic. In fact, for a long time Botswana had the highest recorded prevalence of HIV/AIDS, some sources quoting over 40% of the population. Recent statistics label Botswana as second only to Swaziland with respect to HIV/AIDS prevalence. It is therefore of great interest to see just how such a country is coping and dealing with the HIV/AIDS epidemic.
To spend one day in the hospital is for it to be immediately clear that HIV/AIDS is at the forefront of healthcare in Botswana; both in terms of importance and resource provision. The inpatient population at the hospital approaches 200, and of these, a reserved estimate would suggest that at least 50% are RVD-positive. What is RVD positive I hear you say? Well, it appears that in Botswana (and perhaps across other areas of the world) Retro Viral Disease (RVD) is being used as a synonym for HIV/AIDS. This is to help combat the stigma that is widely associated with the disease.
With the prognosis for HIV/AIDS incredibly variable in Botswana, it is far more difficult for the local population to maintain a positive outlook on the problem. Horror stories are rife in the area, of ‘alternative’ ways that sufferers find to try to cure themselves of the disease and it is acts such as these which do little to stifle the aforementioned stigma. Patient understanding and outlook is an area of fascination as a medical student in this very different environment. How much do sufferers really understand about their illness?
Well, an inherent problem across the Botswana Healthcare System is the lack of doctors that speak Setswana, the language of the local Motswana people. Therefore, it is difficult to attain an idea of just how much the patients understand, hence leading to difficulty when trying to educate patients about their illness. From my experiences, it would be almost impossible to assess the population’s level of understanding about HIV/AIDS, but in my opinion, the patients that are seen in the hospital are simply not well enough informed about their condition. No matter where you are in the world, there will always be patients who show a lack of care towards their own health, though here in Botswana it seems that patients are almost not given the opportunity to learn about the key aspects of their condition.
One of the most important factors in all this is transmission, and I’ll write more about this tomorrow …
