So this week concluded my internship at Botswana's Ministry of Health. I've learned a ton here and it's been an amazing experience. Very few American students have the opportunity to work for the government of a developing country, but it really is the best way to gain perspective about issues of development and global health. Every day I was coming into work with Botswana's best and brightest and seeing the challenges they faced. Moreover, I spent most of this internship working for the Office of the Health Inspectorate, which means I got to go with them on inspections and read accreditation reports and help pinpoint and identify all the problems within the health system and the barriers that they face in improving the health care of the citizens of this country.
About 3 weeks ago, Vernon and I had finished our project reading through the accreditation reports of 4 clinics in Botswana and identifying the critical criteria they needed to work on to get accredited. When we went to our boss to get a new project he just gave us some tedious spreadsheet work to do and told us that he would be going on holiday before he retired at the end of the month. We had just come back from an amazing week helping with the accreditation baseline assessment at the mental hospital, so we were frustrated at being stuck in from of Excel again. However, after expressing this frustration to Gill and Nicki, the amazing English mother-daughter pair who run the Botswana-Upenn partnership office in Gabs, the end of our internship took a different turn.
It turns out Gill's husband works for the Minister of Health as the Advisor for Public Private Partnerships. So she had us meet with him to see if he could give us a real substantial project for us to work on. When we went to go see him, he said that this was perfect timing, because he had just been asked to write two grant proposals for PEPFAR and it would be tremendous help to have two Americans working on the project. So that's what we were assigned to do.
PEPFAR stands for the President's Emergency Plan For AIDS Relief. It's hailed by some as the best thing Geroge W. Bush ever did in office, and I'm inclined to agree with that. It provides a huge amount of aid money to the 14 countries most effected by the AIDS epidemic and is a major reason why most HIV+ people in Botswana have access to the anti-retroviral drugs that can save their lives. Anyway, since Obama took office PEPFAR has been looking to expand it's impact beyond just supplying drugs and testing under something called the GHI (Global Health Initiative). This program works on creating sustainable health care systems within the countries PEPFAR is active in so that in the future they will be stronger on their own and eventually not need aid money, which is truely the only solution.
The two grant proposals I wrote last week were directly related to that. Both were about strengthening Botswana's healthcare system overall, rather than just providing quick fixes. The first grant I wrote was for a Healthcare Management and Leadership Training Program. This program will train the management staff of the healthcare facilities, especially hospitals, with leadership and management skills, because right now most of the people in these positions aren't trained; their just doctors who got placed there and have to try to manage the hospital on top of seeing patients. In hospitals where there are only a few doctors, this is really a challenge. In the past, all of the management positions were filled by the British left over from colonization, but they all left a few decades ago, leaving a lot of untrained people filling the void. The hope is that this will be a great way to build capacity within the healthcare system so it has trained people who can both handle the technicalities of health facility management as well as provide visionary leadership to take Botswana's healthcare standards much higher than they are now.
The other grant I wrote these pas two weeks was a grant for a pilot Care Management System at the Princess Marina Hospital in Gaborone. Princess Marina is where a lot of the other Penn interns work and it's the best/biggest public hospital in Botswana. That being said, the standard of care there is still pretty appalling. The wards are opperating at about 120% capacity and patients sometimes wait 7 days before being seen by the appropriate specialist. This is because a lot of the time the Batswana doctors aren't good about filling out the patients files and don't seem to realize how bad it is to have such long waiting times. But when you're in a country where about 1/4 of the population has HIV, this can be really deadly. An AIDS patient who has an opportunistic infection of pneumonia or meningitis will die if they're not seen quickly. So the grant I wrote is to establish a team of care management experts who will audit patient files and hold hospital staff accountable, to make sure that patients are being seen by necessary specialists as quickly as possible and that doctors are providing both a high quality of care and documenting everything correctly in the patients' files.
This project was AMAZING to work on. I'm possibly going to be writing my thesis on PEPFAR and how it's changed US-African relations in the past 2 administrations, so this was a once-in-a-lifetime chance to actually submit a grant proposal to the US government program I'm going to be studying. I also learned a lot from the project. It was a nice way to come full circle, because both of the grants I wrote address deficiencies in the healthcare system that I'd identified during my inspections. It was great to both have a chance to be part of the team pointing out the problem and the team working towards a solution. It was also awesome to be able to apply a lot of what I've learned about the need to build stronger health infrastructure in developing countries and not just try to put a band-aid on the issue. If I ever have a job at the US Agency for International Development or the World Health Organization, this will be a learning experience I will certainly draw on, since most Americans are only ever used to reviewing grant proposals from the governments of developing countries, not actually writing them from their perspective. I'm so greatful for this opportunity and it was an amazing way to end my internship :)
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