I'd always dreamed of Africa. It was a place I'd always wanted to go to, and as a medical student I had to go there for my 'elective'. Actually deciding which country to go to was more difficult. Through family and friends I could probably have come up with hundreds of Christian 'contacts' across that massive continent so this didn't make my task any easier.
In the end, I chose to make contact with the superintendent of a hospital in Botswana, a country about which I knew very little (not even where it was), but it soon sounded incredible. A country about the size of France, land-locked, in the heart of southern Africa, the wilderness of the Kalahari stretched across it, wildlife in abundance in the Okavango Delta to the north, and a population of only one and a half million people. Up until independence in 1966, Botswana had been one of the poorest countries in Africa, but the discovery of diamonds brought prosperity, and together with true democracy, led to economic growth and political stability. Blended with this promise however, has come the tragedy of HIV and AIDS. I had become very aware of the silent catastrophe happening on the other side of the world, and call it madness or compassion, it compelled me to go and see for myself what we were just not being shown on the news. I find it cruelly ironic that it has only recently come to our nation's attention.
I went to work at the Princess Marina Hospital in Gaborone, Botswana's capital, which although it is small, is growing rapidly. The population of Gaborone is presently 134,000, but as Marina is one of only two tertiary referral (specialist) hospitals in Botswana (the other in Francistown) it is very busy. It has all the general and specialist departments of any UK city hospital. I worked on the two medical wards, which are very busy, with around eight admissions and one death a day. HIV and AIDS dominate the work (an estimated 60-80% of in-patients probably have HIV), and without this, the medical and nursing teams would ably manage the busy workload.
Emotional Roller Coaster
I had very little to do in the evenings in my flat. In the southern African winter, it is dark by 6 p.m. I had no TV, but some friends lent me a radio. For the first time in my life, I had nowhere to go (there is very little to do in Gaborone), no family or housemates to talk to, and nothing to do other than read, listen to God, the radio, read some more, and be content with myself (a very rare, but beneficial experience for anyone). Life slowed down dramatically. Work was the opposite. The lifestyle in Botswana is great; people get up early, in winter before sunrise, so morning report on the medical wards started at 7.30 a.m. every morning. But it feels good - by lunchtime you feel you've done a pretty good day's work!
The elective was an emotional roller coaster and I really appreciate that - sometimes intense loneliness, many hours of joy and fun, offset by sadness as I was seeing much suffering, and AIDS destroying individual lives and possibly a whole country's future. I felt anger too, for the same reasons.
I often felt frustrated that there was so much stigma and myth about HIV and AIDS - it is often referred to in Africa as "slim disease" because of the terrible muscle wasting and weight loss that patients suffer in the latter stages. Because of a serious lack of education amongst adult generations - many are illiterate - people may not even understand what HIV is, and so explaining how to prevent its spread may have little impact. Botswana now has many more schools, and education for the present generation of children and young adults is relatively very good. Unfortunately it is the nature of human beings that knowing the risks or consequences of behaving a certain way does not actually change our behaviour.
Even amongst medical staff, I found a reluctance to face facts, and to talk openly about HIV - most often it was referred to as "clinical immunosupression" or "RVI" (which is code for retroviral illness). Yet I saw enthusiasm and commitment from the senior medical physicians, who were challenging these attitudes and keen to improve patient management.
Local health beliefs could be a source of frustration too. Patients often presented at hospital as a last resort after traditional medicine hadn't worked (or had made things worse). Patients with cancer or AIDS would only come when they were "sick" which was often in the last few weeks of their lives, too late for medical intervention to make a difference. Other health beliefs made me feel sad, angry and frustrated at the same time. For example the belief that if a man slept with a virgin he would be cured of HIV.
Another emotion I had to face was fear. I really appreciated for the first time the fear that a person in Botswana may have if they have some understanding of HIV. Living in Botswana, where a third of people are HIV positive, the fear that you might be one of them if you suddenly become ill, or develop a rash, must be hard to ignore. I experienced a little of this fear for a couple of weeks when I was working at Marina. The fear in my case was completely irrational, but no matter how much I reasoned, I could not convince myself there was not a chance I might have got the deadly virus. I knew that I had not had a needle-stick injury (when you approach a patient in Marina, "HIV" is right at the front of your mind, so you are very careful), not had any blood splashed on me, as I always wore gloves. I had also not been into an operating theatre or delivery unit, etc. I believe God showed me something of the fear and stigma of HIV/AIDS that is rife in southern Africa today.
My elective was also inspiring as I discovered footsteps and stories of great men - the first missionaries to Botswana (Bechuanaland) and Zambia. Livingstone, missionary and later explorer, is of course the most famous, but another missionary Dr Robert Moffat founded the London Missionary Society in Kuruman (in present-day South Africa). His daughter Mary married Livingstone, and my host Dr Howard Moffat is his great great grandson.
Botswana has reasons for hope, despite the ravages of HIV. I visited an SOS Children's village in Gaborone (there is a another in Francistown). The village consists of houses of 6-10 orphaned children (i.e. mother died of AIDS) with a 'mother' and an 'auntie'. It was great to see happy healthy children, in really nice surroundings, some very young, others older and attending schools, some going on to study at the University of Botswana. Children here are nurtured and brought up in a supportive, stable, safe and loving environment, and it is very encouraging to see.
The work at Marina in HIV research is also very promising, as it is increasing momentum for the government to provide anti-retroviral drugs, and hopefully soon on a large scale. The government is committed to addressing the HIV crisis, and possesses much greater financial resources than most African countries through diamonds and thriving tourism. Botswana also has relatively good health infrastructure, and education is improving.
My most lasting memory of Africa will always be just the feeling of wonder, awe, appreciation for the amazing things I saw and experienced, for God and His creation, and the people I met, made in His image. My elective was quite simply the highpoint of my medical school career. Africa surpassed all my expectations, and I certainly hope to go back there some day. I am very grateful to all those who have provided sponsorship for my trip, thank you so much. Many thanks too to all those who have supported me in other ways.
In the end, I chose to make contact with the superintendent of a hospital in Botswana, a country about which I knew very little (not even where it was), but it soon sounded incredible. A country about the size of France, land-locked, in the heart of southern Africa, the wilderness of the Kalahari stretched across it, wildlife in abundance in the Okavango Delta to the north, and a population of only one and a half million people. Up until independence in 1966, Botswana had been one of the poorest countries in Africa, but the discovery of diamonds brought prosperity, and together with true democracy, led to economic growth and political stability. Blended with this promise however, has come the tragedy of HIV and AIDS. I had become very aware of the silent catastrophe happening on the other side of the world, and call it madness or compassion, it compelled me to go and see for myself what we were just not being shown on the news. I find it cruelly ironic that it has only recently come to our nation's attention.
I went to work at the Princess Marina Hospital in Gaborone, Botswana's capital, which although it is small, is growing rapidly. The population of Gaborone is presently 134,000, but as Marina is one of only two tertiary referral (specialist) hospitals in Botswana (the other in Francistown) it is very busy. It has all the general and specialist departments of any UK city hospital. I worked on the two medical wards, which are very busy, with around eight admissions and one death a day. HIV and AIDS dominate the work (an estimated 60-80% of in-patients probably have HIV), and without this, the medical and nursing teams would ably manage the busy workload.
Emotional Roller Coaster
I had very little to do in the evenings in my flat. In the southern African winter, it is dark by 6 p.m. I had no TV, but some friends lent me a radio. For the first time in my life, I had nowhere to go (there is very little to do in Gaborone), no family or housemates to talk to, and nothing to do other than read, listen to God, the radio, read some more, and be content with myself (a very rare, but beneficial experience for anyone). Life slowed down dramatically. Work was the opposite. The lifestyle in Botswana is great; people get up early, in winter before sunrise, so morning report on the medical wards started at 7.30 a.m. every morning. But it feels good - by lunchtime you feel you've done a pretty good day's work!
The elective was an emotional roller coaster and I really appreciate that - sometimes intense loneliness, many hours of joy and fun, offset by sadness as I was seeing much suffering, and AIDS destroying individual lives and possibly a whole country's future. I felt anger too, for the same reasons.
I often felt frustrated that there was so much stigma and myth about HIV and AIDS - it is often referred to in Africa as "slim disease" because of the terrible muscle wasting and weight loss that patients suffer in the latter stages. Because of a serious lack of education amongst adult generations - many are illiterate - people may not even understand what HIV is, and so explaining how to prevent its spread may have little impact. Botswana now has many more schools, and education for the present generation of children and young adults is relatively very good. Unfortunately it is the nature of human beings that knowing the risks or consequences of behaving a certain way does not actually change our behaviour.
Even amongst medical staff, I found a reluctance to face facts, and to talk openly about HIV - most often it was referred to as "clinical immunosupression" or "RVI" (which is code for retroviral illness). Yet I saw enthusiasm and commitment from the senior medical physicians, who were challenging these attitudes and keen to improve patient management.
Local health beliefs could be a source of frustration too. Patients often presented at hospital as a last resort after traditional medicine hadn't worked (or had made things worse). Patients with cancer or AIDS would only come when they were "sick" which was often in the last few weeks of their lives, too late for medical intervention to make a difference. Other health beliefs made me feel sad, angry and frustrated at the same time. For example the belief that if a man slept with a virgin he would be cured of HIV.
Another emotion I had to face was fear. I really appreciated for the first time the fear that a person in Botswana may have if they have some understanding of HIV. Living in Botswana, where a third of people are HIV positive, the fear that you might be one of them if you suddenly become ill, or develop a rash, must be hard to ignore. I experienced a little of this fear for a couple of weeks when I was working at Marina. The fear in my case was completely irrational, but no matter how much I reasoned, I could not convince myself there was not a chance I might have got the deadly virus. I knew that I had not had a needle-stick injury (when you approach a patient in Marina, "HIV" is right at the front of your mind, so you are very careful), not had any blood splashed on me, as I always wore gloves. I had also not been into an operating theatre or delivery unit, etc. I believe God showed me something of the fear and stigma of HIV/AIDS that is rife in southern Africa today.
My elective was also inspiring as I discovered footsteps and stories of great men - the first missionaries to Botswana (Bechuanaland) and Zambia. Livingstone, missionary and later explorer, is of course the most famous, but another missionary Dr Robert Moffat founded the London Missionary Society in Kuruman (in present-day South Africa). His daughter Mary married Livingstone, and my host Dr Howard Moffat is his great great grandson.
Botswana has reasons for hope, despite the ravages of HIV. I visited an SOS Children's village in Gaborone (there is a another in Francistown). The village consists of houses of 6-10 orphaned children (i.e. mother died of AIDS) with a 'mother' and an 'auntie'. It was great to see happy healthy children, in really nice surroundings, some very young, others older and attending schools, some going on to study at the University of Botswana. Children here are nurtured and brought up in a supportive, stable, safe and loving environment, and it is very encouraging to see.
The work at Marina in HIV research is also very promising, as it is increasing momentum for the government to provide anti-retroviral drugs, and hopefully soon on a large scale. The government is committed to addressing the HIV crisis, and possesses much greater financial resources than most African countries through diamonds and thriving tourism. Botswana also has relatively good health infrastructure, and education is improving.
My most lasting memory of Africa will always be just the feeling of wonder, awe, appreciation for the amazing things I saw and experienced, for God and His creation, and the people I met, made in His image. My elective was quite simply the highpoint of my medical school career. Africa surpassed all my expectations, and I certainly hope to go back there some day. I am very grateful to all those who have provided sponsorship for my trip, thank you so much. Many thanks too to all those who have supported me in other ways.
