See if for Yourself

Its safe to say that I learned more about global health this week than I have in 2 years of studying it at Penn.

This week Vernon and I got to go on official inspections. We were supposed to leave on Monday, but there was a logistical issue with our transport. So we arrived at 7 am like we were supposed to, then we heard our combi was in the shop & wouldn't be ready until 10. 10 came and we heard it wouldn't come until 12. At 12 we were told we couldn't go that day so we could just go home. Yet another TIA moment. The lady leading our team, who was very flustered, said, "This is Africa, yes? You are learning! We're in a first world building but there is still a third world mentality. " We just rolled with it.

It was cool to really get out of Gaborone, which is reasonably modern, though not very big. When you get out of the city you can see the real Botswana, which is incredibly rural and very sparsely populated. There are donkeys, cows, and goats, all on the side of the road and you can go forever between seeing houses. We got to see a lot of it on the road to Good Hope, which is a town about 2 hours southwest of Gabs. Its a very small town in a pretty remote area. I think a description of it can best be described by our team leader: "Why would they name this place Good Hope? Look around, the conditions are not good and there isn't really much hope."

We were going on inspections of the Goodhope Primary Hospital and the Digawana Clinic. The purpose of the inspections is to go through the hospital/clinic and see if they are providing care which is up to the standards that the Ministry is trying to establish. The goal is to use them to improve the quality of healthcare being delivered to Batswana. On these inspections the officials from the Ministry meet with the hospital management to discuss all types of issues and then each individual department/aspect of the facility is evaluated.

Vernon and I weren't really sure what our role was going to be in these inspections, but it was an incredible experience because not only did we get to sit in on the meetings with the management and hear what they had to say and go with some of the health inspectorate officials, we actually got to evaluate some of the departments as inspectors and our evaluations are being used in the official report. "This is where I throw you in the ocean and you learn how to swim," is what the team leader said to me. So at the primary hospital I was responsible for evaluating the maternity ward, the operating theatre, and the central supplies and sterilization unit. At the clinic I did the consultation room and the resuscitation trolley.

Things I observed absolutely blew my mind and I learned so much. Its different seeing pictures of hospitals in developing countries and reading about them and actually being there. The lack of resources is appalling and so much is just improvised. They're also incredibly understaffed (the primary hospital only has 2 doctors). We got to talk to a lot of the nurses and hospital management, and it was clear that the staff is trying their best and is extremely dedicated, but they're constrained because there's not a lot of space in the hospital and they don't have a lot of the supplies they need. For example, there's only 1 suction machine in the whole hospital and its shared by the Operating Theatre and the Maternity ward. So God forbid a newly delivered baby needs suction while someone's in surgery.

I was also able to see and hear some really interesting things about "Global Health" as its experienced here. Global health programs are very evident in the health facilities: there's UNAIDS posters on the wall about "The 5 D's of Pallative Care" and things of that sort as well as handouts made by USAID and WHO. We also visited the AIDS center at the hospital, which was in a trailer and was markedly nicer than the facilities in the rest of the hospital. I'm told that its because the center, like so many others here, are built by Americans with PEPFAR money. It makes me wonder more about how programs that are meant to help people are spending their resources and if all the money spent producing these posters (paying the graphic designers, printing costs, shipping costs, etc.) couldn't be better spent on something else the facilities need for primary health care, which would help more of the citizens. They also talked a lot about ways to raise funds, because the only way to address a lot of the issues at the hospital is to expand and relocate it since the facility is inadequate in itself. Also, a lot of the equipment they need is expensive and the Ministry has a limited budget. They're talking a lot about looking for private donors to help boost that. Its not within my job capacity at the Ministry to help with that, but its interesting to see how people are looking for solutions.

Needless to say, I had a lot to reflect on on the 2 hour drive home each day. This week was an emotional roller coaster: from shocking when I first entered the hospital and started to my inspections, to inspiring because of the dedication of the Batswana staff working there and the fact that I think this knowledge will make me better able to help improve the situation in my work in the future. It was a great experience!