So the meeting with the ministry personnel never actually came to fruition, we were unable to connect due to certain time constraints and obligations I was however able to meet directly with her nurse coordinator to share ideas. I got a sense from her that although cancer was had not been a major priority, the ministry of health is not recognizes how important and how significant of an impact it is having on the population.
We discussed the strategies to empower the local clinics and
health providers. The hierarchy of health care goes from health post, local
clinics, primary hospital, 2nd hospital, and tertiary
hospitals. So the plan is to map the
countries health clinic and posts, identify the numbers of health provides to
create an appropriate strategy to educate them. We discussed the most effect
mechanisms for educating health workers and her thoughts were that from the HIV
and TB initiatives, workshops had been very successful. I will have to continue to follow from afar.
I want to focus a little bit of my time in the different hospitals.
I spent majority of my 1st week in Bots at the oncology
department of the Gaborone private hospital (GPH). Here the government funded and
private patient receive radiation. So a
lot of patients I saw were government funded patients, whom I would have some
continuity with at the public hospital. I spent a lot of time assessing the
different areas of need. So I’ll start
with that. GPH is the only radiation
facility in the country. There is only one
linear accelerator and a handful (2-3) of radiation oncologists. Because of the
volume of patients, there is no room for specialization. They radiation
specialist saw patients with cancer of different primary sites, very unlike the
U.S, where you really focus on 2-3 disease sites. There were of course problems such that the
scanners were not always functional, which meant patient had to go the
radiology department to have their scans. The biggest problem I noted was the
lack of human resources, and human capacity. The issues of occasional machine
malfunctions were present, but the major issue was the lack of support. For
example, in the clinic, the patients generally come in and sit in a cue and
they are given a number and they are seen one after another without any form of
triage, they are no set appointments, so it is not uncommon for a patient to
come into the hospital and sit there for hours waiting for their appointment.
There are very few oncologists in Botswana; many of the ones here are
expatriates. (A lot of this has to do with the relatively nascent medical
school and a handful of residencies that are also relatively new). The
government sponsors training of their physicians abroad with the hopes that
they will return. However they are presented with better opportunities and
incentives and a good portion do not return (but this is an entirely different
topic for a different day). Given all the potential problems, there is a lot of
hope and room for improvement. Some physicians are choosing to come back and
work in their home country. For a low resources setting, the facility was functioning
adequately. Of course there were challenges, but there were a lot of positives.
There is a dosimetrist who assists with the radiation plans for patients. There
is also one physicist who assisted with QA. The software that was used for patients’
treatment with pretty updated and comparable to the software used at large
academic centers in the US.
The sign for oncology ward |
Cancer females are domestic goddesses who bond easily and separate with great difficulty. http://obatkankerserviks.info/
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