Today we visited the Botswana-Baylor Children’s Clinical Centre of Excellence (COE), located in Gaborone adjacent to Princess Marina Hospital, which is the largest public hospital in the country. Established in 2003, Baylor is publicly and privately sponsored by the Government of Botswana, Princess Marina Hospital and Baylor’s International Pediatric AIDS Initiative. COE is a well-maintained and spacious facility housing ten exam rooms, a children’s play area and garden, conference facilities, a classroom, a telemedicine room and more. The centre is committed to providing holistic care to patients and families and their services include the following: HIV testing and counseling, health education and prevention for children and their families, psychosocial support, ARV therapy, Teen Club as well as medication adherence counseling and monitoring of side effects. This centre serves as the only HIV/AIDS clinic in the country of Botswana and provides care to 4,000 pediatric patients nationwide whose ages range from birth through 19 years old. This clinic additionally provides treatment for diagnoses secondary to HIV/AIDS such as tuberculosis.
We first met with one of the peer educators for the Teen Club, which provides psychosocial support for adolescents living with their HIV diagnosis. In the meeting we discussed two of COE’s services; the children’s play group and the Teen Club. The children’s play group is a way for the patients to interact and play while they are waiting for their scheduled appointments. Typically, patients come for a monthly check up to monitor their CD4 counts and viral loads, however appointments are tailored to the severity of each child’s illness and can include ARV therapy when necessary. In regards to patient population at this clinic, we learned that the program currently serves 1,000 adolescents but in the next three years will likely serve 3,000 adolescents due to increased identification of positive HIV status in children who were born before the prevention of maternal-child transmission program (PMCTC) began. PMCTC encourages HIV testing for women prior to pregnancy, and mandates HIV testing and treatment as part of prenatal care.
As a group, we felt very welcomed by the COE staff, however we struggled with the ethics of some of the information that was discussed. For instance, the disclosure patterns between parents and their children are similar to those in the United States. We learned that children are not told of their HIV status until they are 13 years old, and prior to that point, parents tend to tell their children that they attend COE for treatment of other conditions i.e. diabetes. As a group, we struggled with the ethics of this perspective. Not only are parents deceiving their children, which can ultimately impact the quality and strength of parent-child relationships, but we also wondered whether it was appropriate to wait until a child turned 13 before disclosing their diagnosis. We were saddened at the thought of these children having to watch their parents die due to HIV/AIDS, particularly when the children are aware that they live with the same condition.
This scenario can trigger a wide range of psychological responses and while COE has a growing psychosocial service team, the psychological component of treatment is not regularly addressed at these children’s appointments. Lastly, we were glad to hear that ARV therapy allows HIV positive patients to live longer more fulfilling lives, but it may also create a false sense of security and lead to high risk behaviors.
We spent the afternoon visiting Botswana’s Ministry of Health where we had the opportunity to discuss the healthcare infrastructure of this country. The Botswana Ministry of Health is the overseer of national health care in Botswana. The ministry is responsible for developing health policies and ensuring that they are implemented and interpreted accurately in public health facilities nationwide. These facilities include 27 hospitals and 101 clinics with 3,699 beds, as well as 171 clinics without beds, 338 health posts, and 844 mobile health stops. The ministry’s operating budget is 375 million dollars which provides all citizens with healthcare services. The only cost to Botswana citizens is $1 for the course of any illness ranging from the common cold to HIV/AIDS. The Ministry of Health (MOH) feels that it is their responsibility to provide services that focus on the consumer at a level comparable to standards set in other leading nations. The “key result areas” that the MOH is focusing on include reducing disease in all age groups, and controlling the prevalence of HIV and TB, lowering the risks of pregnancy and child birth, and providing adequate primary health care for all citizens.
During our visit, we spoke about a lot of interesting topics including the ministry’s transition from a centralized system to 27 individual district management teams, and the construction of one new teaching hospital for which adequate staff and supplies have yet to be allocated. Although the ministry supports the medical education of 35 physicians overseas, only one-fifth of these physicians actually return to work in Botswana. One year ago, Botswana opened its first medical school which has 30 students who are about to complete their first year. It will be interesting to see whether the country’s own medical school will help to retain a larger percentage of physicians within the country.
Posted by Grace Oppenheim, Bridget Sullivan, Randi O’Neill and Linden Spital
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