A New Beginning at BLH

Last Wednesday I started a new rotation at Bamelete Lutheran Hospital (BLH) in Ramotswa, a town about 45 minutes outside of Gabarone. It is different from Princess Marina in countless ways. First, there aren't nearly as many doctors. There are three surgeons (one an Ob/Gyn specialist) and five or so generalists who take round in the female and male medical wards, the pediatric ward, the TB ward, the maternity ward and the outpatient clinics. It's pretty impressive how such a small group can really cover so many patients. But it makes sense understanding the shortage of physicians in the country. In one of our journal clubs we had an interesting discussion about "brain drain" and the loss of qualified health professionals due to immigration in sub-Saharan Africa and other low-middle income countries facing health crises. I would say BLH is a good example of this phenomenon. Not only are there a small number of doctors, each physician is from a different country. There are two German doctors, two Indian doctors, a Chinese doctor, Congolese, Zimbabwean and Nigerian. Morning report is colored by the many different accents, and certainly many different approaches to medicine. Yet it's interesting how medicine is a universal language in itself at the same time, allowing people to communicate pretty fluently about patient care issues.

My first day I rounded in the TB ward, which was fascinating. Botswana has made a commitment of ridding the country of TB by 2016, a goal some here find laughable, but certainly it's important to strive for lofty goals in this fight. The patients ranged from end-stage patients to those making a full recovery, almost all with the same symptoms of fever, night sweats, cough and weight loss. One healthy looking gentleman explained to me through the nurse translating that TB almost took his life, "I was dead" he told me. He was safely on treatment and excited about what lay ahead for him after discharge.

There seems to be a pretty rigorous system in place when new TB cases come in. Case workers go to patient's homes and exposed, at-risk individuals are started on TB prophylaxis treatment. And if patients deny or refuse treatment, they can be sent to a location where they must remain until they finish their regimen. The physician I worked with called it "TB prison" - an interesting concept.

We then went to the outpatient clinic called the IDCC where we saw patients who are currently on HAART for HIV. What I found fascinating about this experience was that it showed how HAART is really amazing and life-saving treatment. People came in being managed for other medical issues such as hypertension and erectile dysfunction, and many wanted to discuss family planning type issues. HIV was just part of their lives, but did not define them. It's a testament to how far a place like Botswana has come, when people who are HIV infected can worry about and focus on other life problems and live long enough to encounter other chronic diseases. The physician I was working with told me "this is how we know it's working, and it makes me happy to see it."

My next three weeks will be interesting because there are no longer teams at BLH, just a physician and myself. Should make for some good learning experiences.