One of the most stable democracies in the developing world, Botswana boasts the least corruption in Africa and a post-independence history of unprecedented economic growth. Average life expectancy skyrocketed from 49 years in 1966 to almost 70 years in the mid-1990s, and at that time researchers projected the average life expectancy would reach 70 years by 2009 — almost as high as that in the United States.
Instead, ravaged by the HIV/AIDS pandemic, the average life expectancy in Botswana less than a decade later has been cut in half, falling to 35 years in 2004. From 1998 to 2005, Botswana dropped 35 places on the United Nations’ human development index. Analysts estimate that in 2004 there were 33,000 AIDS deaths, and nearly 40 percent of all Batswana between the ages of 15 and 49 were HIV-positive.
“We are threatened with extinction,” then president of Botswana Festus Mogae warned in 2001. “People are dying in chillingly high numbers. … It is a crisis of the first magnitude.” Mogae’s proclamation did not fall on deaf ears. In 2001, the Botswana government, in partnership with the Bill & Melinda Gates Foundation and the Merck Company Foundation, formed the African Comprehensive HIV/AIDS Partnership (ACHAP).
Heralding a new era, the government launched a program called “MASA,” the word for “dawn” in the Setswana language. It was the first comprehensive national campaign in Africa to provide free anti-retrovirals to all those living with HIV/AIDS. In 2002 Botswana had one clinic, in the capital city, Gaborone. By 2005 it had opened 32 public sites around the country to perform testing, offer counseling and distribute drugs.
As a result of these procedures, according to ACHAP, the percentage of Batswana who knew their HIV status grew from 4.6 percent in 2003 to 56 percent in 2008. By the end of 2008, ACHAP estimates, 84 percent of those in need of drugs were receiving them. Through anti-retroviral treatments targeting pregnant women and the promotion of better feeding practices, the mother-to-child HIV transmission rate has significantly declined, reducing new infections among children by 80 percent.
Making a difference
Despite the enormous advances Botswana has made, the government lacks sufficient medical professionals to serve the huge influx of patients, in part due to the loss of skilled intellectual and technical labor to countries with better resources and higher pay, or “brain drain.”
Many international private and public institutions have responded to this need, working with Batswana health officials to collaborate on research projects and help set up medical training programs. Harvard University, the University of Pennsylvania and the Baylor School of Medicine have begun medical exchange and research programs in Botswana.
Dr. Stephen Gluckman, the director of clinical infectious disease at the University of Pennsylvania (U Penn), arrived in Gaborone in 2001 to work with ACHAP on developing Botswana’s national program. Gluckman said he realized Botswana’s HIV/AIDS program provided a unique opportunity to provide hands-on training for U Penn’s medical students. In 2004, U Penn and the Ministry of Health of Botswana signed a memorandum of understanding that established a partnership for an educational and student-exchange program at the Princess Marina Hospital, now one of the largest HIV/AIDS clinics in the world.
Dr. Harvey Friedman, the director of the partnership, listed U Penn’s main objectives as training, enhancing sustainability and building capacity. “We want our efforts to be long-lasting and sustainable. You can treat a patient, but you can’t build capacity. The goals of our program are long term.”
Physicians and students work side by side with local medical officers and nurses, and develop daily teaching conferences and bedside training in the wards. “It’s beyond looking at medical care in terms of numbers, but rather seeing it in terms of quality,” Friedman said. “Before there were no conferences, and now there are teaching sessions and four conferences a week.”
Lauge Sokol-Hessner participated in 2001 as a medical student concentrating on global public health. He emphasized the collaborative nature of the partnership’s teaching and learning model. “I’ve learned a lot from listening to people,” Sokol-Hessner said, “from asking open-ended questions, being curious, and learning how the people from Botswana view their challenges and the opportunity for improvement.”
The University of Botswana has opened its first medical school, enrolling its first undergraduate class in August 2008. But before the launch of the new medical school, Botswana sent 50 students a year to attend medical schools in other countries; only 10 percent returned. In 2007–2008, 45 Batswana medical students returned to serve medical internships.
“These medical students are Botswana’s future medical leaders,” said Sokol-Hessner, who is working on a collaborative project with the staff of the new medical school to understand physician leadership.”