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Benchmarks: Building Bridges in Botswana: Penn’s Partnership—A Decade of Global Health

February 8, 2011, Volume 57, No. 21


Botswana-UPenn Partnership (BUP) and local medical staff making rounds on a pediatric ward in Botswana. To learn more about the Partnership, visit www.upenn.edu/botswana

This year, 2011, we celebrate ten years of the University of Pennsylvania working in Botswana. In 2001 we started by sending a single infectious diseases faculty member, Steve Gluckman, to Botswana for three months to treat very sick people dying of AIDS and advise an over-burdened and under-staffed cadre of healthcare workers how to treat the disease. Now, ten years later, the Botswana program, working as the Botswana-UPenn Partnership, employs 65 full-time faculty and staff in Botswana. While we are still treating and teaching about HIV/AIDS, we now also have formal clinical programs in tuberculosis, women’s health, and telemedicine (!) and beginning this year we will also work in the area of maternal and fetal health.

Penn’s presence in Botswana has grown in size and complexity in the past ten years, and though Botswana still has the second highest HIV prevalence rate in the world, people are no longer, in the words of then- President Mogae from 2000 “dying in chillingly high numbers.” With the help of a number of outside funders and partners, including Penn, Botswana has made substantial gains against the disease, particularly in lowering mother-to-child transmission and adult mortality rates. The gains have been significant enough that the Government of Botswana has set the ambitious, but not impossible, goal of “no new infections” by 2016, the year the nation will celebrate its 50th anniversary.

The clinical gains have been remarkable in Botswana and while only a small part of the credit for this improvement rests at Penn, we have played, and continue to play, an important role. We have helped to train Botswana’s first group of internal medicine residents. The residents were recruited back to Botswana after attending foreign medical schools to try and staunch the brain drain and nationwide physician shortage. In addition to the faculty Penn has sent to work in Botswana, we are now working with the University of Botswana School of Medicine to recruit faculty to teach their trainees. It is Botswana’s first medical school, a fitting coincidence given that Penn houses this nation’s first medical school. We have also helped the Botswana Ministry of Health develop guidelines for treating HIV-TB co-infected and multi-drug resistant patients. We have established a screening program for cervical cancer in HIV-infected women, and maintain clinics that see and treat cervical lesions in a country where cervical cancer is the most deadly cancer for women. We have conducted research in HIV prevention and management of opportunistic infections in HIV patients. We have a few more accomplishments from the past decade and we look forward to celebrating these successes in the year ahead, particularly when we mark our ten-year anniversary with a symposium this fall.

For all that has been achieved in Botswana, like any great university, the better way to measure our success may not be by what we have “done” in Botswana, but rather what we have learned. We have learned a lot, from basic semantics—the people of Botswana are Batswana; and a single person is a Motswana—to complex biology; slow efavirenz metabolism genotype is common in Botswana.

We have learned that cell phones in the hands of basic healthcare workers make great diagnostic tools. In underserved areas without Internet, the phones can take a picture of a skin rash, a cervix during a gynecologic evaluation, or an oral lesion during a dental visit and then be used to record and send basic patient information to specialists elsewhere in Botswana or halfway around the world for a diagnosis and treatment recommendation.

We have learned to adapt culturally and that when working within a collective culture like Botswana decisions are made by consensus, which takes more time and forces us to slow down. Cultural differences are profound and affect not only decision making, but communication, concepts of time, notions of respect, the place of religion in the workplace, even measures of success. Not understanding the nuance means that one can easily offend. We now know that cultural differences shape everything from simple greetings at the start of a meeting to obtaining familial informed consent for research studies. Although we have erred along the way, we are getting better at building bridges.

We have learned that global health is really popular even beyond the 80-plus students and residents from Penn that travel to Botswana for clinical rotations each year. Global health now has its own nighttime TV drama and even amidst the high-definition schmaltz of a doctor soap opera, they get a few ideas right: it is a good to be aware of the role of traditional healers when working in a global health setting; and it is much easier to provide care to patients when you share the same language.

We have learned the power of networks and everything Career Services says about networking to get the job is true. We may never have gone to Botswana had a former Penn employee, now at Merck, not referred her new boss to speak to Penn about sending doctors to Botswana to help a young nation battle their horrific AIDS problem. The ambitious goal of nationwide antiretroviral therapy was made possible with a big promise of financial support ($50 million each) from the Bill and Melinda Gates Foundation and the Merck Company Foundation and a courageous Botswana government that welcomed outsiders who had the skills to help train local providers.

Most importantly, we have learned the power of partnerships. The Gates, Merck, and Botswana Government partnership referenced above (formally known as ACHAP, the African Comprehensive HIV/AIDS Partnership), became one of Penn’s earliest funders for our work in Botswana. The support from that partnership spurred us to form our own alliances, first with the Government of Botswana (2004) and later the University of Botswana (2006). We then formed partnerships with other funders like PEPFAR and the Tiffany & Co. Foundation, and other schools, like the University of Washington, Baylor School of Medicine and the Harvard School of Public Health. These partnerships multiply what each institution can accomplish alone and allow us together to take bigger strides towards improving the health of the people of Botswana and our understanding of HIV/AIDS. We look forward to what we will learn together in the years ahead.

—Heather J. Calvert, Associate Director

—Harvey M. Friedman, Director, Botswana-UPenn Partnership

Note: There is a collection of Botswana-themed quilts on display now through February 18 at the Burrison Gallery of the University Club at the Inn at Penn. Fiber Revolution and the Kalahari Quilts present their Botswana Collection exhibition of 18 quilts. This collection started out as an exchange of culture between the Studio Art Quilt Associates (SAQA) regional group Fiber Revolution and the collective quilting group of women in Gaborone, Botswana. Fiber Revolution member Cindy Friedman accompanies her husband, Dr. Harvey Friedman, to Botswana several times a year.

Fiber artist Cindy Friedman will give a talk, Penn and Fiber Arts in Botswana, on February 16 at 4 p.m. in the Lenape Room at the University Club at Penn; it is open to the Penn community.

Botswana Quilts
Top Left to Right:
Kevan Lunney, Abundance
Barbara Barrick McKie, Botswana’s Beautiful Bird
Cindy Friedman, Tswana Hope
Bottom Left to Right:
Antoinette Hall, Love Heals
Deb Schwartzman, Tropical Nut
Katharina Litchman Rain Season in Africa


Almanac - February 8, 2011, Volume 57, No. 21