HIV & Internal Medicine Clinical Programs
Written by Dr. Stephen Gluckman, Clinical Coordinator, Botswana UPenn Partnership

UPENN's clinical programs have expanded greatly since we first stepped onto the medical wards of Princess Marina Hospital (PMH) in 2001. At this point UPENN specialists are responsible for five clinical programs.

 

1. Princess Marina Hospital: PMH is the main referral hospital in the country. Situated in the capitol, Gaborone, PMH serves as both a community hospital and as the referral hospital for the Southern half of the country. Our efforts are focused in the Department of Medicine. There are 6 firms in the department. UPENN specialists, students and residents are assigned to 4 of these firms and UPENN specialists are regular consultants on the other two. Our firms are fully integrated into the department with PMH interns and/or medical officers on each firm. The department regularly runs at 150% to 200% census and each firm is responsible for about 20 patients. The bulk of the morning is spent on patient bedside rounds with the firm. Each patient's progress is reviewed in turn, relevant examinations are performed, plans for the day are outlined, and teaching points are reviewed. With the initiation of the internship program PMH is evolving into an academic teaching hospital Therefore, the goals of rounds are both patient care and capacity building. The afternoons are generally devoted to performing procedures and admitting new patients. In addition to the teaching on rounds there are 7 regularly scheduled conferences. These include:

a. Daily intake conference: during this conference all admissions from the preceding 24 hours are presented and teaching/management points are made where appropriate
b. Weekly didactic conference: UPENN specialists or invited lecturers cover a clinical topic.
c. Weekly case management conference: on a rotating basis each firm is responsible for presenting an interesting case and leading a discussion about the evaluation and treatment
d. Weekly HIV journal club: this is a joint conference with the pediatricians of Baylor. A journal article pertaining to HIV is presented and discussed
e. Weekly intern lecture: this is a lecture series specifically designed for the interns (though all are invited) that covers a specific curriculum
f. HIV clinical conference: this is a weekly conference that includes both physicians from the public and private sector who manage HIV infected patients. It is a forum for clinicians to present difficult management problems for discussion with their colleagues
g. UPENN orientation conference: this is a series of 5 lectures that are specifically designed to help orient new arrivals to PMH. Topics include the PMH formulary, cryptococcal meningitis, diagnosis of tuberculosis, treatment of tuberculosis, and the anti-retroviral program in Botswana.

2. Nyangabgwe Referral Hospital (NRH): NRH is situated in Botswana's second largest city, Francistown, about 430 km to the north of Gaborone. NRH is the referral hospital for the Northern half of the country. There are no regularly schedule UPENN trainees at NRH at this time. The UPENN specialist at NRH has a number of specific clinical responsibilities including:

a. Operating the HIV resistance clinic
b. Serving as a phone resource of HIV management questions for the Northern half of the country
c. Organizing and leading the weekly HIV conference
d. Organizing and leading the weekly intern lectures series
e. Rounding with the interns on medicine twice a week
f. Performing weekly outreach to one of four district hospitals

3. Outreach: Directed by Dr. Daniel Stefanski, UPENN has developed a robust outreach program to help with patient care and capacity building at 11 district hospitals. Four are visited by the UPENN specialist at NRH. Five are visited by car by UPENN specialists from PMH. Two are further upcountry and are visited by small plane. The role of the UPENN specialist is essentially one of a visiting professor. A typical outreach day begins with a didactic lecture from a previously designed curriculum, inpatient rounding with the local team on difficult management patients, and finally seeing difficult management patients with a local physician in the HIV clinic.

 

4. TB/HIV Co-infection: UPENN has created and is totally responsible for the co-infection clinic. This is a referral clinic for the management of complicated co-infection problems. In addition, our TB coordinator, Dr. Jeff Hafkin, does outreach education in many of the district hospitals. This program is more fully described in another section on this website.

 

5. HIV/Co-Morbidity clinic: in 2007 UPENN established a clinic where patients being treated for HIV and with other active medical problems could get their care coordinated at one site. Until the establishment of this clinic patients were required to go to two separate clinics on different days to address the management of these problems. Our internal medicine expertise and HIV management ability have allowed us to open the first clinic where patients could be treated more efficiently and with greater safety.

Updated: November 2007