The Last Summer: Investigating Infant Pneumonia in Botswana, Africa

By: Pandora Chua, Medical student at the Perelman School of Medicine at the University of Pennsylvania

The summer between the first and second years of medical school is the last unscheduled summer that medical students have. As my classmates and I formulated plans for this “last summer,” our advisors repeatedly counseled us to do something we would enjoy, regardless of its relevance to medicine. I decided to spend the summer doing research in Gaborone, the capital city of Botswana, in Southern Africa. At the time, I didn’t realize how much I was going to enjoy and appreciate my summer experience.

Learning at the bedside

While in Gaborone, I worked on a clinical research study investigating the causes and treatment outcomes of severe pneumonia among infants. It was a perfect fit for my interests in vaccines, pediatrics, infectious diseases and global health.

One of my first observations was how different the hospital facilities were compared to those of urban America. And I had never before seen infants that were so sick. In the emergency room, I quickly learned that the children who were strong enough to cry and struggle should worry us less than those who were so weak they could barely move or breathe. Children sick enough to stay in the one-story hospital were assigned to one of many cots in large shared rooms in the pediatric medical ward, where our study team monitored their progress. For the entire ward, which had 30 to 50 beds, there was one computer and X-rays were analyzed by holding them up to the sunlight or room light.

The significance of the study to the community and the concern of the families shone through in my interactions with them. One worried father asked me what causes pneumonia. I answered that we hoped the study would help us learn more about the causes of pneumonia in Botswana. Another mother explained to us how one of her children had been very sick with severe pneumonia, and it was this experience that motivated her to allow another one of her children to participate in the study. She told us she wanted to prevent other families from experiencing what she had experienced when her child had pneumonia. 

National challenges and opportunities

Pneumonia, an infection of the lungs, is the leading killer of children worldwide. It can be caused by infection with viruses or bacteria, but in places like Botswana, illness and death from pneumonia are made worse by the large number of people infected with HIV/AIDS. Botswana’s current HIV/AIDS epidemic is one of the most severe in the world. Whether or not they become infected with HIV, infants born to HIV-positive mothers are at a higher risk of getting sick or dying from many infections, including pneumonia. I doubt that I will see as many patients with HIV during the rest of my time in medical school as I did during one summer in Botswana.

Despite challenges, such as limited medical facilities and supplies and the ongoing HIV epidemic, Botswana has leveraged its economic growth and political stability to respond aggressively, creating ambitious programs to prevent mother-to-child transmission of HIV and providing free treatment medications to infected individuals. The University of Botswana recently established the country’s first medical school, and a new hospital is due for completion in 2013. Interacting with students from the pioneering generation of Botswana-trained physicians was a privilege I will not forget. The work they will face as doctors in Botswana is very different from that which I will as a physician in the United States.

I was fortunate to be present for a remarkable milestone in the country’s fight against pneumonia. In July, two new vaccines were introduced to the national immunization schedule. The pneumococcal vaccine will help reduce the number of cases of pneumonia, meningitis or deaths caused by infection with pneumococcal bacteria, and the rotavirus vaccine will combat diarrheal disease, another major cause of childhood illness and death. It was amazing to see the excitement surrounding these vaccines, especially in contrast to the sometimes complacent attitude toward vaccines in the United States. 

A plane ride away

When first year students ask me about their “last summer” plans, I now give the same advice I received: Do something that you’ll find personally fulfilling. For me, learning about the health needs and priorities of a community outside of the U.S. made for an unforgettable summer. Here in the U.S. it can be easy to forget that a place facing strikingly different circumstances – where HIV is widespread, where families travel for hours to reach the nearest clinic, and where vaccines are treasured and not taken for granted – is only a plane ride away. As I proceed with my career, I am certain that this newfound perspective will make me be a better scientist, clinician and advocate for my future patients.