Clinical Experience in Gabz 1/2

       Since, I'm in Botswana for a public-health program and that's what you typed/clicked on the address bar to get to this blog, you were probably expecting a post about my medical experiences in the country. Likewise, I was too! The following, which I will split up in two posts, is my attempt to visualize to you the profound experience I had at the Broadhurst 3 Clinic in Gaborone. Now this is by no means complete, and solely my interpretation, based on experience, of some healthcare issues in Botswana.  I'm going to share with you my first three days of experiences at the clinic, wherein I observe in four departments: Child welfare care, injecting and dressing, screening and the dispensary (pharmacy). 
          
             On my first day at the clinics, I was observing in the child welfare department. I arrived to the clinic at 7:30am with Shelby, Nikita, and Shireen. The clinic lobby was absolutely filled with people. Most of them  We came in with Batsi, our director, who introduced us to the Matron of the clinic. She gratefully welcomed us and discussed the nature of the clinic along with its goals and missions. She asked us about our goals. Our goal was to learn and observe the manner in which health-care is delivered to Batswana at the grassroots level, then applying our empirical data to a larger context of public-health issues facing the country.  and asked us to sign in what wards we wanted to observe in. I choose the CWC (child-welfare care). Outside in the lobby, there were mostly mothers, who came in with their infants to get a monthly checkup or were due to get immunizations. When I first arrived at the child-welfare room, I was taken by surprise with the number of health care workers in the room. There were two health-care educators and a nurse. Health-care educators play an essential role in the urban clinics of Botswana. They are responsible for educating mothers on how to take care of infants in a country ravaged by diseases in the past. In the room, a mother would come in the room and place her infant child on a hospital bed. While undressing, she would hand a booklet titled, “Child Welfare Clinic Card.” Then she would undress the child for weighing. Weighing is done to see how the child is doing physically. The system to weigh the child was different than the one in the U.S. The weighing system here involved hanging the child on a hook. In the U.S, children are weighed on a flat weigh scale. Similarly, the children, almost naked without their diapers, were put in a hanging bag. The bag was then placed on a hook. The health-educators were mostly responsible for book-keeping and marked each child’s growth in their respective booklets. The clinic card or the booklet is each assigned to babies when they are born. It entails information on schedules for the immunizations, information on breastfeeding incase the mother is HIV positive, and developmental assessment of the child, in which gross motor, fine motor, social skills and language are assessed of the child at 3, 6, 9, 12, 18 and 24 months. Mothers are supposed to bring the clinic card for their children every time they come in for a checkup, which is once every month. However, there were few who failed to come in the previous months. I saw a striking correlation of negligent mothers who failed to come in the past months, having malnourished infants. The health-educator would ask the mother and say something to her in Setswana for a couple of minutes. After the mother left, I ask the worker what she told her. She replied that she ordered her to take care of the child and feed it properly. The educator also asked the mother if the baby formula is being used other than just feeding the baby, to which the mother replied "No"! The health-educator informed me that the mother is HIV positive and was unable to breastfeed the baby. In a situation like this, the government of Botswana provides free food formulas for infants who cannot be breastfed. And for the other months she failed to bring in the child? She was just going to be defaulted for those months and if something were to happen to the child, the mother was responsible for it. There would be two patients at a time in the room. When one infant was removed from weighing apparatus the other was placed in for weighing. We were taking patients in at a considerable pace to beat the rush, allowing for little patient interaction. I asked one of the health-educators that on average, how many patients they see in a day. She estimated about 40-60 depending on how crowded the clinic is.             
            Furthermore, I inquired about the type of vaccination the infants were given. At birth, babies are given hepatitis B and a BCG vaccine. BCG is a common TB vaccine that is administered to newborns mostly in developing countries. My parents were given this vaccine. The only public-health concern with this vaccine is that the cheaper Mantoux skin test would lead to a false positive for people who were given the BCG vaccine. So other diagnostic tests should be done in order to determine if the person has TB. This is very relevant to a country like Botswana. In addition, at 2 to 3 months, infants were given drops of polio vaccine and a pentavalent injection. The pentavalent shot compresses vaccines for diphtheria, tetanus, pertussis, Hepatitis B and the influenza B virus. The pentavalent shot is given to infants a total of three times in a period of 5 months from birth. Another interesting element I learned was that immunizations are all free in Botswana for kids up to the age of 5 no matter what part of the world they come from. However, a child born in a foreign country like Zimbabwe is entitled to no ARVs or food formula if the need may arrive. The free services only apply to Batswana. A Zimbabwean mom came in with her child who was born in Botswana, which is a common trend in Botswana. If the mom was HIV positive, she would have to pay for the formulas to feed her child. It doesn’t matter whether the child was born in Botswana or not. Also, STI drugs, and TB medication are distributed freely to anyone regardless of their identity to reduce the spread of infection in the country.