Meeting the Chief, Ob/Gyn, Setswanan Formalities

Today, Yana and I joined Jodi and Mma Shaibu (head of nursing at UB) to Molepolole, about an hour away to obtain permission from the Deputy Secretary Council and Matron to work in the WHO collaborating center in Mmopane. This clinical site is not one of the original sites but Mma Shaibu suggested it because she thinks it will be a great home-based care experience.

First, we had to obtain 3 copies of a written statement from the University of Botswana to distribute to appropriate council personnel to officially allow us to work as students in the Mmopane community, which is about 15 minutes south of Gaborone. So in Molepolole, we drove around looking for the building which housed the deputy secretary council and matron to drop off our written statements. Mma Shaibu explained how the Setswana way includes many long-drawn out, elaborate steps to accomplish certain tasks, such as obtaining permission for students to work in community clinics. Unfortunately, our written statement failed to mention the dates when we will be working at this clinic. Therefore, Mma Shaibu could not leave the statement with the officials until the dates were entered. A verbal agreement or handwritten agreement did not suffice. Therefore, she decided that she'd return to UB and re-type the statement and fax it to the appropriate people, upon which she will receive a fax'ed document stating that Yana and I have been given permission to work in Mmopane (a completely different town). Needless to say, formalities were endless and out of respect we certainly obliged.

After dealing with the paperwork and chasing councilmen, we decided to pay a visit to the newly built Scottish Memorial Hospital in Molepolole. Mind you, this hospital was exquisite. The interior was more spacious than HUP. We first met the Chief Medical Officer of the hospital who set up a meeting with the matrons (the administrative nursing personnel). We learned that the four nurses who were running the nursing department were transferred (not by choice) from Gabs to Molepolole. We found it very interesting to find that nurses and other “civil service” personnel in Botswana are allowed zero input when discussing job placements and specialty areas. The ministry decides who and what skills are needed at a specific location or site and will send registered professionals to these sites. If one refuses, he/she must resign.

Then we had a tour of the facility. We had time for 4 units – pediatrics, psychiatry, maternity/neonatal, accidents and emergency (ER). Of the 4, I liked seeing the maternity ward. First of all, this ward was huge. It had about 5 different wings or bays, I couldn’t even keep count. Each area of the ward was divided into different care areas, somewhat similar to HUP. I was really interested in seeing the premature babies because in my pediatric clinical, the NICU was my favorite experience. So we were introduced to the OBGYN who explained that most deliveries are done by midwives (!) and the most common pregnancy complication was pre-eclampsia. He went on to explain that a few years ago the survival rate for the premature infants was around 50%. Recently, after changing a few things such as monitoring women at risk for preterm labor and closely following feeding protocols to increase weight of the premies after birth, the survival rate was significantly improved. I found this to be really telling because a few alterations in their approach to care had a significant impact. The nurse and ob/gyn explained that when people are trained in specialty areas, they bring back their expertise and they’re able to improve their health outcomes; however, training of nurses in specialty areas is not a common practice here in Botswana as I mentioned above. This really speaks to the impact that nurses have on health outcomes for patients.

After we concluded our mini-tour of this elaborate facility, we drove to Mmopane, the town in which Yana and I will be participating in home-based care. We had to obtain permission from the town’s chief before providing any type of care or simply being present in the community and interacting with the people. The meeting with the chief entailed sitting in the chief’s office for about 3 minutes. This jovial man, serving as the deputy chief (the real chief’s grandson), told us we were welcome to work in the community. After this good news, we left the community and drove back to Gaborone.