Global Health Programs
Botswana Clinical Elective
Botswana-UPenn Partnership Mission
To help build capacity in:
Clinical Care
Education
Research
To offer opportunities in
global health for
Penn/CHOP trainees and
faculty
Botswana:
 Population 2 million
 Democratic
 Relatively Safe
 Upper middle-income
Batswana Life Expectancy
1966:
1990s (mid):
2005:
2009:
2012:
49
70
48
53
55
Botswana-UPenn Partnership History
► Penn
has been in Botswana since 2001.
► First invited by ACHAP (African Comprehensive
HIV/AIDS Partnerships) to have Penn physicians
assist in training local providers in the
management of HIV infected patients.
 ARVS had just been made available at lower cost in
Africa.
 Despite having national healthcare, Botswana did not
have enough qualified providers to implement
treatment.
Botswana-UPenn Partnership (BUP)
Building capacity and strengthening the existing healthcare system by
collaborating with the Ministry of Health and the University of Botswana
(UB)
1. Clinical care: General medicine for a population with high prevalence of
HIV and TB, and need for reproductive health services. Cervical cancer
screening program in HIV infected women, and a telemedicine program for
oral and skin diseases. ~ 170 fulltime BUP employees in Botswana
2. Education in collaboration with new UB School of Medicine: Bedside and
classroom teaching in Internal Medicine, Pediatrics and Family Medicine
3. Research
4. Global health opportunities for Penn trainees: 5-10 first year med students,
24 third/fourth year med students and ~ 25 residents/fellows annually
Botswana Clinical Elective
> 200 students have completed the elective to date
►
What is it?
 enriching experience providing exposure to multiple levels of healthcare in a lowresource setting (transformative, eye-opening)
 general medicine (not just ID)
 hard work
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What is it NOT?
 a vacation
 a license to experiment or behave in any way not permitted in UPHS/CHOP
environment
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Skills/knowledge/benefits you are likely to acquire/increase/experience
 Clinical confidence and competence
 Diagnosis and management skills in a resource-limited area, including end-of-life
care
 Impact of culture on patient presentation, doctor-patient and team relationships,
and the provision of medical care
 Exchange of knowledge with other students, health professionals, and trainees
 Spend time with dynamic, smart, resourceful Penn faculty committed to working in
resource-limited settings
Botswana Clinical Elective (cont’d)
►
~7 weeks typically including:
 Orientation / Didactics Week (Intro to Setswana/ HIV/ TB/
Opportunistic Infections/ basic medicine and pediatrics in Botswana
(~ 1 week)
 Supervised procedures, and inpatient medicine at Princess Marina
Hospital (PMH) in Gaborone (~2 weeks)
 Bamalete Lutheran Hospital in Ramotswa (~4 weeks)
►
Note: only 4 of the 7 weeks earn “away/other” credit
Botswana Elective:
Common Diagnoses
►
Tuberculosis
 Extrapulmonary
Cryptococcal meningitis
► Pyogenic meningitis
► Pneumonia/lung abscess
► Empyema
► Diarrhea
► Rheumatic heart disease
► Congestive heart failure
► Malignant hypertension
►
Diabetic ketoacidosis
► Renal failure
► Multiple malignancies
► Anemia
► Pulmonary disease
► Hepatitis & other hepatic
disorders
► Neurological disorders
► Dermatological disorders
► Seizures
►
Botswana Elective
Less Common Diagnoses
► Tetanus
► Pellagra
► Cobra
bite
► Scorpion sting
► Malaria
► Cysticercosis
► Cardiac tamponade
► Drug overdose
Botswana Elective Challenges
► Adjusting
to and respecting (avoid judging what
you cannot fully understand) a different healthcare
system which may at times appear inefficient and
unfair to you; e.g.
 Diagnoses often cannot be confirmed
 Patients die of things that they would not die of in the
US
► Being
part of a team that may require your
performing “lower-level” tasks
► Potential for things to go wrong in the workplace,
in everyday matters, and in travel plans
► Expectations vs. Reality (e.g. supervision)
Potential Exposures/Risk for Penn
Participants
HIV
TB
Crime
Accidents
Ebola
Contraindications for Botswana
Clinical Elective
►
►
Use of immunosuppressive drugs
Underlying immune deficiency or chronic disease,
including:



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HIV
history of a solid organ transplant
chronic kidney disease
diabetes mellitus
silicosis
Psychological condition which requires regular counseling
or which may be exacerbated by an unfamiliar
environment. Such conditions may include:
 addictions/substance abuse
 anxiety/phobias
 eating disorders
Botswana Elective: Living Conditions
► Housing
provided
 communal, comfortable & well-maintained
 walking distance to the hospital (NOTE –
students are prohibited from driving in
Botswana)
► Cost
of living is only slightly lower than in
Philadelphia
► Recreational activities available during nonwork hours
Pilane Courts Penn housing: laundry, bedroom, garden, kitchen
Botswana Elective: Finances
► Basics
 $1700 ($1200+$500) via Global Health Programs
 housing paid for by Global Health Programs
► Travel
advance + personal funds for:
►travel-related medications
►Airfare (Usage of air miles
and vaccines
to purchase is not
permitted by Penn Travel office)
►food
►recreational activities
►travelers insurance
Botswana: Prerequisites
►
Penn sub-internship in medicine,
pediatrics, emergency medicine, or family
medicine
►
ITD357 Simulated Procedures/ Reducing
Risk, Low Resource Setting
►
Supervised phlebotomies and IV
placements pre-departure and upon arrival
in Botswana
►
Student Health Services Pre-Travel Visit
►
Videos: Clinical Topics for Low Resource
Settings
SHS Visit:
High-Risk Clinical Experiences
Botswana Personal Commitment
Considerations
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Prerequisite: Medicine, Emergency Medicine, Pediatrics, or Family Medicine Sub-I
Residency Interviews: most occur from November to early February. Not all residency programs interview throughout this period. The
early match interviews (ophthalmology and urology) begin at the end of October and end in December. In specialties like medicine,
pediatrics, and ob/gyn, programs typically offer several interview dates. Competitive specialties like radiology, otolaryngology, and
dermatology typically offer fewer dates to choose from. Note that if you sign up for a slot that starts in January & ends in February, you will
have to complete all of your residency interviews in December. For more information, please contact Barbara Wagner
(wagnerb@mail.med.upenn.edu) or Helene Weinberg (hweinber@mail.med.upenn.edu).
Frontiers Courses: will be offered during the elective months of October and February, as well as the first two weeks of the March
rotation. Please be aware that you should take completion of Frontiers requirements into consideration when completing the Botswana
Clinical Experience registration form. Students exempt from Frontiers include: MD/PhD, MD/MPH, and MD/MTR. If you have questions
regarding Frontiers, please contact Helene Weinberg (hweinber@mail.med.upenn.edu) .
Match Day: If you sign up for a Botswana Clinical slot in March, you will miss Match Day
Graduation: If you sign up for a Botswana Clinical slot ending in May, you will be returning very close to graduation day (May 17, 2015)
Work Week – No Long Weekends: In Botswana, you are expected to work full days Monday thru Friday for the entire rotation period (see
dates below) – please do not request long weekends. Therefore, you are strongly encouraged to spend an extra week (before or after your 7week rotation) for travel and; if you need a few extra nights in a Penn house during this vacation week (and you check with Boipelo Dibotelo
before you finalize your travel plans and space is available) you will be welcome.
Challenges: This clinical experience has been challenging and potentially frustrating for Penn medical students. You will be exposed to
patients dying who would probably survive in the USA, unnecessary lack of supplies, the need to handle tasks that would be handled by other
team members in the USA, and the fact that ~80% of the patients you care for will be HIV+. You also face potential personal risks from
exposure to HIV, TB, crime, and accidents.
ITD 357 (Simulation Center) +: Please note that all students who are selected in the lottery must also commit to a single Saturday
morning (9am to 1:30 pm) ITD357 Risk Reduction course at the SOM Simulation Center, prior to departure, (typically offered in early March,
late April, early June, mid-August, mid-July, early October, mid-November, and early February), viewing 8-10 hours of video preparation and
providing documentation of this, attending an orientation, and reading the Botswana Handbook, before the start of travel.
Next Steps
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Review student reports
Lottery Registration by 12/16/2014
Offers by 12/19/14
Confirmation due by 1/2/2015
SHS Appointment
ITD 357 Scheduling
Videos
Handbook Review +++
Post-Botswana: submission of report, photos, & procedures
log; reconciliation of travel funds; TTBI 12 weeks after