At the end of the day, we belong to the same race, the human race.

“At the end of the day, we belong to the same race, the human race” – Prof. Phaladze

    I mentioned before the benefits and disadvantages to the Botswana health care system, but I don’t think that I truly evaluated my thoughts.  Today we discussed our different experiences in the clinics throughout Gaborone, and I’ve found that although health care is free in terms of money, it comes at a price in relation to patient care.

    Professionalism and confidentiality are completely different from what I am accustomed to.  Privacy does not exist in these clinics.  Workers enter exam rooms as they please, mid vaginal exam and all.  You would expect patients to be uncomfortable or angry, but at least on the exterior, you see none of those emotions; just indifference.  It’s as if they are accustomed to this level of care; who knows if it is because of a different level of confidence and self-awareness or if it is because they have never experienced America’s definition of doctor-patient confidentiality.  Doctors will be on their phones during consultations, yet patients don’t interject or look phased by the blatant disrespect of their time and health. 

    Now there is a caveat to these observations, Botswana’s work force is at the tail end of a worker’s strike which, for the most part, remains unresolved.  Government workers are severely underpaid and have gone years without raises.  I am sure that if I were in the same situation, it would be difficult not becoming apathetic towards my job when there were no benefits to improving.  It is unfortunate that I cannot see what work was like before the strike, and if the nurses and doctors are taking out their frustration on their occupations. 

However, today I worked with an exceptional doctor who gave me more hope.  He actually explained the conditions to the patients rather than sending them on their way with another referral.  He held his patients accountable, which is a quality I think many doctors lack.  I think it is so customary to keep educating patients while never honestly telling them that their lifestyles are to blame.  About 99% of the patients I’ve seen thus far have conditions that are brought on by their own actions.  Although doctors should make suggestions and not force certain choices on patients, they should also point out the blatant truth: we are the primary determinants of our own health. 

    I think today especially strengthened my opinion on the fact that people should be accountable for their health and appreciate it.  About 40% of the patients we saw today were only there to get sick leave from work.  After seeing 2 patients I could already tell the motives behind their visit.  If you are truly worried about your health, work is not on your mind; you immediately address the situation and the doctor offers an off work form.  If you are using your poor health as an excuse, you come in saying your boss sent you for an off work form.  If your boss was honestly concerned about your health, he would not send you to get the form, he would give you a day off. 

    I think that people should realize how valuable their health is.  Not everyone was given an equal chance at good health.  It is not fair to see people making life choices that make negative impacts on their wellbeing, while others are unjustly dealt poor health despite their lifestyles.  While some are doing everything in their power to stay well, others are disregarding a true gift. 

    I would also like to see doctors offering alternative methods to reach a health goal.  It is another trend that they prescribe and move on; patients should know their options.  Sometimes medication is not the best answer, and can even be a worse decision.  The US is facing “super bugs” that are resistant to a cocktail of antibiotics, why?  Because many people are overprescribed antibiotics, are not prescribed the correct ones, and are not adhering to their dosing regimens.  Although antibiotics are necessary in most cases, they are not necessary in farming and food production which is a leading cause for antibiotic resistant E. coli.  They are also not always necessary in many medical situations.  I think that sometimes they are just a quicker solution to feel better when bed rest can often do the same job in a longer amount of time; we have immune systems for a reason.  This is my opinion, however, and is not a fully educated statement. 

    I would also like to see more preventative care.  This is an area that deserves an infinite amount of resources; no other sector can survive without healthy individuals to run it.  Hypertension, diabetes (type 2), HIV, and STIs are by far the most common ailments in Extension 2 patients (and most likely all other clinics in Botswana).  Each of these could have been prevented with education and check-up appointments.  And not 5 minute check-ups where the doctor asks if you’re okay and you say you’re fine.  Patients should be able to form a comfortable relationship with the same doctor; what is the point of seeing a different doctor every time?  In the time that you could have spent explaining new issues and concerns, you’re instead talking about ones of the past in order to catch up.  With each checkup, doctors can see trends and connections in your health.  They can educate you on the direction you are going, what you can do to get well, and risk factors to look out for.  I think everyone has lied to a doctor at least once because of embarrassment; that should never be the case.  I think this is the biggest development for public health; countries are paying millions on these conditions, while the solution seems so straight forward.

    I find myself learning more and more each day about what goes in to public health and the progress that needs to be made.  I am forming new opinions while strengthening and building upon old ones.  I keep feeling more and more inclined to help others and seeing where I would like to be positioned in health care; on the forefront, dealing with patients one-on-one.  As for working abroad, it isn’t a question of “will I”, it’s “when can I start?”