Looking Back

Here are some questions that I answered for a press release on the BTB program. I thought I would share my complete answers here as a sort of overview of the experience.

  • What do you feel you got out of the trip?

There is no question that I have been changed by this trip. I can spend an entire semester studying about the people and the culture of a place, but it doesn’t compare at all to spending two months living there. When learning about the staggering statistics about AIDS, it is easy to distance oneself emotionally from an almost unfathomable conception of suffering by viewing the public health threat as “over there” and to begin to view Africa as worlds away, even though it is not much further then Europe. But being in Botswana, surrounded by the Batswana and Americans who are working hard to fight this epidemic, I have been re-sensitized to the reality of the situation and the fact that the world cannot passively step aside and let the problem resolve itself. The Botswanan government’s ability to provide such comprehensive health care, including free ARVs and associated services is truly impressive especially considering the country only achieved independence 41 years ago. The progress being made in Botswana has definitely inspired me to believe in the possibility of a more comprehensive, preventative and effective health care in America and beyond if a country’s government sets health as a high priority.

  • How did your project turn out?

In the end, our pictorial dosing guide delivered a better product then our original design, however the ‘program’ to construct the guide was entirely different. We anticipated internet access to be much fast and designed a web based php program around the idea that convenient page loads would make a Microsoft Wizard style compilation of data the easiest way to get the drug information for a guide. But because the internet was slow at times and the doctors were already very pressed for time to see all of the patients before 2pm or so, we decided to abandon our internet program and move to a basic set of ready made guides in word documents. After getting advice from doctors and nurses, our finished product was 12 word documents that had the 12 standard ARV regimens in a table/ guide. All the doctor or nurse has to do is click the word document with the right three drug combination  and copy/ paste or delete drug pictures as necessary to show the correct amount. There was a separate document with a blank template and all the ARV drugs so that a child on a non standard regimen can be accommodated as well.  In addition to this project we did data extraction of about 70 patients who had resistance tests so we could analyze how the virus mutations effected specific ARV’s effectiveness. With this data, doctors can see which drugs should be prescribed in the second or third line regimens if a patient fails the first line. 

  • What did you find most enlightening?

Since our project deals with adherence, I was very interested in the different reasons why patients do not take their ARVs as prescribed. After asking several patients and doctors I found a variety of answers: confusion about new regimens; the death of the mother or primary caretaker and subsequent transfer of care to a new relative who is not always ready to handle the demanding time commitment and responsibility to care for an HIV/AIDS child; older teenagers simply forgetting ( as retold by the mother); a desire by the child to be ‘normal’; a perceived absence of illness and the misconception that the pills are no longer necessary. These are some of the reasons I encountered in this clinic, however in general the Gaborone clinic has a good adherence rate. In light of these reasons I found the information in the Adherence Class for mothers/caretakers taught by the head nurse of the clinic to be very comprehensive; it definitely did a good job of stressing the importance of always taking the ARVs on time.

  • Would you like to repeat this experience next summer?

I would love the opportunity to go back to Botswana to help with HIV/AIDS related projects and with development in general. In many cases I could see how my outsider’s perspective helped me approach a problem from a different route which at times turned out to be quicker or more effective. And of course many times I marveled at how smoothly things were being run by Batswanan administrators. It goes back to the old adage that two heads are better then one, and when those two heads are from very different backgrounds the collaboration has an even better chance for success.

  • Is there something you especially want to tell our readers about your trip or Africa in general?

It is crazy how in this day and age we can step on the plane in a country lavished in technology, convenience and efficiency and step off the plane in a country where unattended chickens, goats and cows wander the streets of the capital city. But Botswana is bounding forward into the twenty first century at a lighting fast pace that can be seen in the ironic juxtaposition of the lady selling cell phone minutes on the dusty corner of a mud roundavel and stick fence village where the people still attend meetings presided by the village chief.  And while Botswana’s government is harnessing the power of one of  the fastest growing economies in the world to fuel technological innovations and build vital infrastrucutre, it keeps the health and education of it’s population as one of its highest priorities, partnering with international organizations to aggressively fight the AIDS  epidemic and providing access to primary and secondary education for all citizens as well as a quality college education for those qualified (and there are also plans to build a medical school soon).
But not all African countries are like this. On a bus ride in South Africa I met a young woman from England who had just spent the summer at an orphanage in Tanzania. She told me many of the children there had AIDS and without ARVs she could only comfort them as they wasted away from the disease that is now treatable for free only a few countries away in Botswana. Nothing on this Earth is fair- Botswana’s economy is fed by the diamond rich land  and the region has been relatively free from the scourge of war; Tanzania’s population is much larger and has been in wars with Uganda- but a child born in Tanzania has the  right to a healthy life just as much as a child born in Botswana. It is up to the government to make the most of its resources and use its power to care for its people. The Botswana government is exemplary in the huge strides it has taken toward a AIDS free future.  Its proactive approach has helped it garner partnerships with Merck and the Bill & Melinda Gates Foundation (ACHAP, AIDS Comprehensive HIV/AIDS Partnerships) as well as funding from Bristol Myer Squibb for the Baylor Center of Excellence Clinic where we worked.  Botswana has also set high, yet achievable goals for itself. In the ambitious Vision 2016, the government hopes that its intervention will be effective enough for  “  the spread of the HIV virus that causes AIDS [to be] been stopped, so that there will be no new infections by the virus in that year.”
Although a lot of the public health responsibility rests on the government of the country, none of the progress in Africa would be possible without international assistance ( the ARV drugs are not from Africa). And just as the government must take care of its citizen’s health, the rest of the world must take care of its fellow countries.  I recently read a book that I found very touching, and I feel like this quote really encapsulates the feeling  that we have to embrace in an increasingly interconnected world, ” There is no nation but humanity.” ( from Mountains beyond Mountains) My experience has  left me more aware of the massive amounts of money and work that has to go toward public health , but also of ability of a country to turn a death sentence into a treatable disease.

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