Teaching and Learning in Botswana

Jonathan Cunningham
Resident in Internal Medicine at Brigham and Women's Hospital
PGY 3

One of the most rewarding parts of my 4 weeks at Scottish Livingstone Hospital in Molepolole, Botswana was learning from and teaching the local medical team. My application for a limited medical license says I came for “capacity building,” but I had so much to learn as well. 

The skill set of the local team was dramatically different from my own. At first I felt useless. Many patients had medical issues I had never encountered in the United States. Extra-pulmonary tuberculosis and opportunistic infections such as cryptococcal meningitis and Kaposi’s sarcoma in AIDS patients are among the most common diagnoses. I was also unaccustomed to practicing with so little objective patient data. At Scottish Livingstone, labs come back the next day and must be drawn by the physician. Physical exam is more important. At home I often examine patients after imaging has made the diagnosis. In Botswana, CT scan is a scarce resource that requires transfer to the national tertiary care hospital. It was a privilege to learn from the skills of my local colleagues. 

"The multi-disciplinary team on the male medical ward”

I eventually found that I had something to contribute as well. In Botswana, medical school graduates receive only one year of post-graduate training before becoming independent doctors; only 3 months are devoted to internal medicine (the rest is pediatrics, surgery, and OB/GYN). On issues like asthma and congestive heart failure, which are prevalent in Boston, I was able to share the standard of care we provide in Boston. I led a teaching session on cardiac tamponade, an under-recognized issue in Botswana. We were also able to present difficult cases to specialists in Boston over the phone to bring their expertise to Botswana.

The two-way street of teaching between our Harvard team and local doctors fostered camaraderie and was great fun. I hope that I was able to build a small bit of capacity by sharing my excitement about internal medicine. Just as important, my time at Scottish Livingstone will change my practice in Boston by helping me to rely less on advanced testing. I’m grateful for the chance to work with these dedicated doctors in a very different setting.