Building a Healthy Future – Medical Education in Botswana
Published on in Global Health Update
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Published on in Global Health Update
Botswana is considered a model sub-Saharan African country. Its government is committed to increasing health access to the entire population of over 2.25 million people. Healthcare in Botswana is organized based on a publicly-funded primary healthcare model that has impressively brought over 95% of the total population to within 5mi (8km) of a healthcare facility.
Historically, Botswana has relied on doctors trained in other countries. This is because, until recently, there was no medical school in Botswana. The Botswana government supported the training of its medical students abroad in places like Australia, Ireland, South Africa, and the United States, but this had an unintended side effect – a significant proportion of young Batswana doctors remained abroad instead of returning to Botswana after graduation. To address this, the first medical school in Botswana, housed within the University of Botswana, opened its doors to students in 2009. Batswana medical students and residents can now be trained in their home country to benefit their people. Botswana partnered with regional and international institutions, including the University of Stellenbosch in South Africa, the University of Pennsylvania (UPenn), and Children’s Hospital of Philadelphia (CHOP) to develop the medical school and residency training curricula for physicians. To date, more than 220 medical doctors and over 15 pediatricians have graduated from the University of Botswana School of Medicine (UB SOM). More than 90% of these graduates are practicing in Botswana.
Now that access to primary care is virtually universal across Botswana, the country faces a new challenge: how to provide subspecialty and advanced training for its medical professionals to improve the quality of care for more complex medical conditions. The long-term goal is to create these training opportunities in-country; in the short-term, outsourcing advanced training to other institutions abroad is laying the foundation for Botswana to develop advanced training programs in the future.
Family physician and clinical researcher Dr. Billy Tsima completed his medical training and internship year in Australia. Before completing residency training, he returned to Botswana and was appointed as a medical officer at Princess Marina Hospital (PMH), the main teaching hospital in the capital city of Gaborone. His family medicine residency included clinical rotations in Botswana as well as didactic course work and exams administered through the University of Stellenbosch. Subsequently, he joined the UB SOM faculty as a Lecturer (Instructor equivalent in the U.S. system). A year into this role, he learned of an opportunity for further training in clinical epidemiology with UPenn through an NIH International Research Training Grant known as a D43. Dr. Tsima immediately applied and was accepted into the two-year Master of Science in Clinical Epidemiology (MSCE) program. The program offers rigorous training in clinical research that positions trainees to become independent investigators. Physician-researchers make up a small percentage of the academic faculty in many low- and-middle-income settings – including Botswana – due to limited opportunities for research training and high clinical burdens. As a result, though it accounts for 12.5% of the world’s population, Africa contributes only 1% of the world’s research output.
D43 students in the MSCE program spend one-year doing coursework in Philadelphia, U.S., and then return to their home country to work on their thesis project. Dr. Tsima graduated from the UPenn MSCE program in 2016 and is now a Senior Lecturer (Assistant Professor equivalent) within the Faculty of Medicine at UB. He credits his career advancement since then to the opportunities that opened up to him during the MSCE program, and to the mentorship, he continues to receive from Robert Gross, MD, MSCE.
Dr. Tsima is passionate about giving back to the trainees that he oversees today. “Now that I have the opportunity to mentor trainees in Botswana, I try to make myself available to them. I value the research mentor-trainee relationship because it is not something I had before I undertook the MSCE program.”
The MSCE program gave him the chance to observe academic medicine in another setting. From this, he has learned some key lessons that he hopes can be adopted in Botswana to build the country’s health research capacity and to promote research collaboration between faculty at UB and between researchers at UB and other institutions outside of Botswana. “My wish and hope is to develop and foster a collaborative working environment at UB such that we as Batswana researchers can contribute to the medical research field at levels comparable to those of our peers in high-income countries.”
For Advanced Practice Nurse Samuel Matula, the fact that there were no pediatric nurses at UB in 2012 spurred him to apply for the Clinical Nurse Specialist in Pediatrics combined Masters and PhD Program at UPenn. Although he already had a master's in nursing degree, he knew he wanted to gain more knowledge and skills in advanced patient management, quality improvement practices, and patient safety. These were all content areas that the UPenn program offered.
During his time at UPenn, Dr. Matula was pleased to learn that nurses were just as critical for providing quality care in the U.S. as they were in Botswana. “[Nurses] aren’t just support staff. Even with the number of specialists in the U.S., nurses are an important component of the healthcare delivery system.” He was struck by how nurses are integrated into every aspect of patient care, especially as:
Dr. Matula graduated with his PhD from UPenn in September 2019. Mentored by Rosemary Polomano, PhD, RN, FAAN, Sharon Irving, PhD, CRNP, FCCM, FAAN, and Andrew Steenhoff, MBBCh, DCH, FCPaed, FAAP, he studied pediatric pain management practices in Botswana with an aim to develop interventions for optimizing children’s pain outcomes. Dr. Matula has since returned home to Botswana with new knowledge and renewed energy to help improve pediatric nursing education and pediatric care. He hopes to be a mentor and role model for other Batswana like him, who are passionate about improving child health. If you are interested in collaborating with Dr. Matula feel free to email him at firstname.lastname@example.org.
Pediatric Neurologist-in-training Dr. Tiny Mazhani is now in her last year of a two-year pediatric neurology fellowship training program at the University of Pretoria in South Africa. Her experiences as a staff pediatrician at PMH revealed the high burden of neurological conditions that were not adequately addressed due to a lack of pediatric neurologists. As a result, Dr. Mazhani established a neurology clinic at PMH in collaboration with CHOP neurologist Laura Adang, MD, Ph.D., who provided guidance and has since become a vital mentor to Dr. Mazhani. Dr. Mazhani is also pursuing an MPhil. in Pediatric Neurology at the University of Pretoria to enhance her research skills. When she completes her training, Dr. Mazhani will be the first Motswana pediatric neurologist in the country. However, she knows that just one pediatric neurologist will not be able to singlehandedly address the need; creating a pipeline of pediatric neurology specialists is the only way to provide excellent care and treatment to all. Ultimately, Dr. Mazhani envisions herself helping to establish a pediatric neurology fellowship program at the University of Botswana. “I hope to inspire other pediatricians to join the fascinating and important field of neurology. I am always looking to identify other passionate trainees who will be committed for the long haul. Many neurological conditions cannot be cured; rather, they have to be managed over an individual’s lifetime.”
The experiences of Drs. Matula, Mazhani, and Tsima highlight the game-changing potential of supporting and investing in advanced training programs for medical professionals in Botswana. Botswana needs partners willing to invest in their vision of developing advanced medical and health research training programs for a fully self-sufficient healthcare system. We invite you to join us as we partner with the University of Botswana and Princess Marina Hospital to develop advanced training programs to train new generations of researchers and pediatric specialists in Botswana. Together we can improve the health of children and families in Botswana while strengthening the country’s healthcare system. Make a gift to the CHOP Global Health Center today!
1. Human resources for health in Botswana: The results of in-country database and reports analysis. African Journal of Primary Health Care & Family Medicine, November 2014
2. Africa generates less than 1% of the world’s research; data analytics can change that. Elsevier Connect, March 2018
3. Health Financing Profile: Botswana, Health Policy Project, May 2016