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Botswana Health system: A cry for change

DR KARL BRIGHT
HEALTH PRACTITIONER


Botswana has over the years delighted itself in being ranked higher than most regional/sub Saharan countries in areas like peace, economy and freedom among others but not the least. At some point we were ranked number 1 for being the “most globalized nation” in Africa. A country dubbed as a middle-income country, with a population of 2 million and a life expectancy of just 54. Sadly enough, all these accolades do not reflect any good about our health care services in this nation and for that we are really concerned.


The health care system in Botswana is in big trouble and this does not reflect the pride we “always” have for our country, nor does it reflect the “good” praises we seldom get from other countries for our “good” governance. If this was a joke at some point, it is not now. Botswana needs to wake up to its dwindling health care services/system. What we see on paper should reflect what is on the ground. Sadly currently it is not.


To better understand this problem one needs to have seen better health care systems to be in a better platform to reflect on our own. All of our Drs have trained outside the country (except for the recent small group that graduated from UB School of Medicine) including the Australian health care system, European countries, Americas, Asia and other African countries. We have seen major differences but most of them are really basic that we as nation should put in place.


We are losing young lives in hospitals in Botswana comparatively, not because we don’t know what to do but because of the scarce simple basic medical supplies that a standard referral hospital should have at all times and the lack of medical Doctors. I know this is a hard pill to swallow, and most of those who claim to be concerned about this don’t talk about it, at least to a level where change would be certain.


We love our country and we will engage in all good manner of discussions with our government to see inevitable change. I recently visited home on a holiday during which my nephew aged 2, accidentally sustained a laceration on the forehead that needed suturing. To my shock or surprise, on arrival to Princess Marina, there was only 1 doctor and 2 nurses working in the emergency department of the biggest public referral hospital in Botswana.

I was told that there was no suturing material and no dressing materials and that it had been like that for weeks and that there was no one to help me as the DR was “busy” with the patients who came hours before we did. To make matters worse, there were many patients and no one to help me as the DR was “busy” with the patients who came hours before we did. To make matters worse, there were many patients in cubicles not attended to, some waiting in mattresses so sick on the waiting area, in wheel chairs, both old and young, some sleeping on benches not attended to. What a sad picture.


In addition, this was on a morning shift were on a normal basis you would expect many doctors to be on the shift. This made me sad and wondered why Botswana; a country with only a population of 2 million people would not have a very good health care system or at least a standard at par with other regional countries. Where is our health care system going? Things are getting worse rather than better.


Workers are frustrated and we are losing more doctors. The sad thig is we “always talk” about this and nothing improves. This is a time where we need to reflect on our own health care system and ask ourselves why we can’t compete with neighbouring countries like south Africa, Namibia, Zambia, Zimbabwe and other first world countries where our own Drs seem to be running to. What is causing our hospitals to be in a terrible situation like this? I recently asked some Drs in Marina and others who are in clinics around Gaborone where they themselves go for medical help when they are unwell or have an emergency.

The answer was surprising and just made me feel we are really far from getting it right. One of them said” we go to private hospitals”. I further asked… “Does that mean then you do not value your own services you provide and the hospitals you work in to help yourselves?? “What about the many who cannot afford private health care…?” …They answered, “Go thata monna….”. This is really sad and even the country’s top officials would agree that we are in trouble and need to fix our health system ASAP. We need to retain Drs in Botswana. Not only our own local citizen Drs but we need to have international well-accredited good doctors who will stay in Botswana and help this system to flourish.


Most of our problems I realize are not on the ground per se like most people think but a mixture of both management in our hospitals and ministry level flaws and lack of accountability in hospitals and local clinics. Botswana should retain majority of their Local Drs in major referral centres and reserve rural or district placements to outsiders as many of the first world countries do. But I do agree this is a complex task that would need proper execution to balance out things.


Perhaps those Drs sent to rural areas could receive more incentives to service these areas. You cannot run major hospitals with outsiders and send/transfer your own Drs who could be making a huge impact or difference in these Dr shortage places to rural areas. We need to wake up Batswana.

I want to go to a hospital and have the highest confidence that I would get the help I need and better off, take my children and relatives to our hospitals and know that they will come back well and alive. Unfortunately at the moment things are not encouraging. I am saying this with a sad heart because Botswana health care system is terrible comparatively but could be better.
I urge our leaders to take this seriously and work quicker lest we find ourselves with a “non-existent” health care system.

The time for talking is over and we need to seriously act now and put in place new policies that will see our health care system improve. There is no Motswana Dr who likes working oversees or wants to live overseas forever. They all want to work and live in Botswana-for home is where the heart is-and they want to help improve the health of Batswana.


Unfortunately many factors including political, financial and working conditions have forced them to be where they are today. Not because they are disloyal but because our own Botswana cannot provide a great platform for these Drs to practice their good quality medicine they have patiently studied for many years outside the country.

All of us Drs who received grants/loans for medical education are eternally grateful to the government and the public of Botswana for their monetary funds. To see Drs resigning and leaving the country is sad and a waste of millions of Pula’s and this should stop.“ This is like buying a Rolls Royce and not servicing it or not get concerned when someone steals it” one Dr Macheng at Princess Marina said.


And let us all be honest, most of these factors are the comparative low salaries, lack of specialists in Botswana or the enticement of and retaining these specialists from partner medical schools or other countries, the lack of medications and or the turn over time to stock other important supplies in our major hospitals. It’s a really saddening scenario. We have over the years been talking about these issues but its like talking to deaf ears.


Batswana need and demand to see a good health care system that would afford to treat even our president, ministers, ambassadors and other high officials etc. Not to fly them out of the country when trouble kicks in for “better health care”. That I do not take pride in and I call on our government to scrutinize this and for them to put new and life changing measures they have never engrossed before to change this saddening scenario. Better health should be for all i.e. for both the man and woman working or not, rich or poor, medical aid or no medical aid and it should all together be affordable.


I believe in Botswana and I believe we can improve things. I pray that my cry for the health care system of this country to improve would be heard. I call on the government and all Drs of this country, currently working in the public sector, private sector, retired, resigned, working in neighbouring countries or working overseas to go back to the drawing boards and work together to pen down new policies that would take this nation on a different yet better direction regarding our health care system.


I also call on the medical body of this country BMA-Botswana medical association (if existent at all) to wake up and represent the interests of Drs in this country and to seriously advocate, represent and fight the battles of Drs with utmost zeal and zest and with respect. They need to fervently liaise with the governing body to discuss issues and matters regarding health care in Botswana and to make sure that matters are resolved and changed within a timely manner for sole purpose of improving our people’s health.

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Opinions

Elected officials should guard against personal interest

23rd September 2020

Parliament was this week once again seized with matters that concern them and borders on conflict of interest and abuse of privilege.

The two matters are; review of MPs benefits as well as President Mokgweetsi Masisi’s participation in the bidding for Banyana Farms. For the latter, it should not come as a surprise that President Masisi succeeded in bid.

The President’s business interests have also been in the forefront. While President Masisi is entitled as a citizen to participate in a various businesses in the country or abroad, it is morally deficient for him to participate in a bidding process that is handled by the government he leads. By the virtue of his presidency, Masisi is the head of government and head of State.

Not long ago, former President Festus Mogae suggested that elected officials should consider using blind trust to manage their business interests once they are elected to public office. Though blind trusts are expensive, they are the best way of ensuring confidence in those that serve in public office.

A blind trust is a trust established by the owner (or trustor) giving another party (the trustee) full control of the trust. Blind trusts are often established in situations where individuals want to avoid conflicts of interest between their employment and investments.

The trustee has full discretion over the assets and investments while being charged with managing the assets and any income generated in the trust.

The trustor can terminate the trust, but otherwise exercises no control over the actions taken within the trust and receives no reports from the trustees while the blind trust is in force.

Botswana Democratic Party (BDP) Secretary General, Mpho Balopi, has defended President Masisi’s participation in business and in the Banyana Farms bidding. His contention is that, the practise even obtained during the administration of previous presidents.

The President is the most influential figure in the country. His role is representative and he enjoys a plethora of privileges. He is not an ordinary citizen. The President should therefore be mindful of this fact.

We should as a nation continue to thrive for improvement of our laws with the viewing of enhancing good governance. We should accept perpetuation of certain practices on the bases that they are a norm. MPs are custodians of good governance and they should measure up to the demands of their responsibility.

Parliament should not be spared for its role in countenancing these developments. Parliament is charged with the mandate of making laws and providing oversight, but for them to make laws that are meant solely for their benefits as MPs is unethical and from a governance point of view, wrong.

There have been debates in parliament, some dating from past years, about the benefits of MPs including pension benefits. It is of course self-serving for MPs to be deliberating on their compensation and other benefits.

In the past, we have also contended that MPs are not the right people to discuss their own compensation and there has to be Special Committee set for the purpose. This is a practice in advanced democracies.

By suggesting this, we are not suggesting that MP benefits are in anyway lucrative, but we are saying, an independent body may figure out the best way of handling such issues, and even offer MPs better benefits.

In the United Kingdom for example; since 2009 following a scandal relating to abuse of office, set-up Independent Parliamentary Standards Authority (IPSA)

IPSA is responsible for: setting the level of and paying MPs’ annual salaries; paying the salaries of MPs’ staff; drawing up, reviewing, and administering an MP’s allowance scheme; providing MPs with publicly available and information relating to taxation issues; and determining the procedures for investigations and complaints relating to MPs.

Owing to what has happened in the Parliament of Botswana recently, we now need to have a way of limiting what MPs can do especially when it comes to laws that concern them. We cannot be too trusting as a nation.

MPs can abuse office for their own agendas. There is need to act swiftly to deal with the inherent conflict of interest that arise as a result of our legislative setup. A voice of reason should emerge from Parliament to address this unpleasant situation. This cannot be business as usual.

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Opinions

The Corona Coronation (Part 10)

9th July 2020

Ever heard of a 666-type beast known as Fort Detrick?

Located in the US state of Maryland, about 80 km removed from Washington DC, Fort Detrick houses the US army’s top virus research laboratory. It has been identified as “home to the US Army Medical Research and Materiel Command, with its bio-defense agency, the US Army Medical Research Institute of Infectious Diseases, and  also hosts the National Cancer Institute-Frederick and the National Interagency Confederation for Biological Research and National Interagency Biodefense Campus”.

The 490-hectare campus researches the world’s deadliest pathogens, including Anthrax (in 1944, the Roosevelt administration ordered 1 million anthrax bombs from Fort Detrick), Ebola, smallpox, and … you guessed right: coronaviruses.  The facility, which carries out paid research projects for government agencies (including the CIA), universities and drug companies most of whom owned by the highly sinister military-industrial complex, employs 900 people.

Between 1945 and 1969, the sprawling complex (which has since become the US’s ”bio-defence centre” to put it mildly) was the hub of the US biological weapons programme. It was at Fort Detrick that Project MK Ultra, a top-secret CIA quest to subject   the human mind to routine robotic manipulation, a monstrosity the CIA openly owned up to in a congressional inquisition in 1975, was carried out.  In the consequent experiments, the guinea pigs comprised not only of people of the forgotten corner of America – inmates, prostitutes and the homeless but also prisoners of war and even regular US servicemen.

These unwitting participants underwent up to a 20-year-long ordeal of barbarous experiments involving psychoactive drugs (such as LSD), forced electroshocks, physical and sexual abuses, as well as a myriad of other torments. The experiments not only violated international law, but also the CIA’s own charter which forbids domestic activities. Over 180 doctors and researchers took part in these horrendous experiments and this in a country which touts itself as the most civilised on the globe!

Was the coronavirus actually manufactured at Fort Detrick (like HIV as I shall demonstrate at the appropriate time) and simply tactfully patented to other equally cacodemonic places such as the Wuhan Institute of Virology in China?

THE FORT DETRICK SCIENTISTS’ PROPHECY WAS WELL-INFORMED

 

About two years before the term novel coronavirus became a familiar feature in day-to-day banter, two scientist cryptically served advance warning of its imminence. They were Allison Totura and Sina Bavari, both researchers at Fort Detrick.

The two scientists talked of “novel highly pathogenic coronaviruses that may emerge from animal reservoir hosts”, adding, “These coronaviruses may have the potential to cause devastating pandemics due to unique features in virus biology including rapid viral replication, broad host range, cross-species transmission, person-to-person transmission, and lack of herd immunity in human populations  Associated with novel respiratory syndromes, they move from person-to-person via close contact and can result in high morbidity and mortality caused by the progression to acute respiratory distress syndrome (ARDS).”

All the above constitute some of the documented attributes and characteristics of the virus presently on the loose – the propagator of Covid-19. A recent clinical review of Covid-19 in The Economist seemed to bear out this prognostication when it said, “It is ARDS that sees people rushed to intensive-care units and put on ventilators”. As if sounding forth a veritable prophecy, the two scientists besought governments to start working on counter-measures there and then that could be “effective against such a virus”.

Well, it was not by sheer happenstance that Tortura and Bavari turned out to have been so incredibly and ominously prescient. They had it on good authority, having witnessed at ringside what the virus was capable of in the context of their own laboratory.  The gory scenario they painted for us came not from secondary sources but from the proverbial horse’s mouth folks.

CDC’S RECKLESS ADMISSION

In March this year, Robert Redfield, the US  Director for the Centre for Disease Control and Prevention (CDC),  told the House of Representatives’ Oversight Committee that it had transpired that some members of the American populace  who were certified as having died of influenza  turned out to have harboured the novel coronavirus per posthumous analysis of their tissue.

Redfield was not pressed to elaborate but the message was loud and clear – Covid-19 had been doing the rounds in the US much earlier than it was generally supposed and that the extent to which it was mistaken for flu was by far much more commonplace than was openly admitted. An outspoken Chinese diplomat, Zhao Lijian, seized on this rather casual revelation and insisted that the US disclose further information, exercise transparency on coronavirus cases and provide an explanation to the public.

But that was not all the beef Zhao had with the US. He further charged that the coronavirus was possibly transplanted to China by the US: whether inadvertently or by deliberate design he did not say.  Zhao pointed to the Military World Games of October 2019, in which US army representatives took part, as the context in which the coronavirus irrupted into China. Did the allegation ring hollow or there was a ring of truth to it?

THE BENASSIE FACTOR

The Military World Games, an Olympic-style spectrum of competitive action, are held every four years. The 2019 episode took place in Wuhan, China. The 7th such, the games ran from October 18 to October 27.  The US contingent comprised of 17 teams of over 280 athletes, plus an innumerable other staff members. Altogether, over 9000 athletes from 110 countries were on hand to showcase their athletic mettle in more than 27 sports. All NATO countries were present, with Africa on its part represented by 30 countries who included Botswana, Egypt, Kenya, Zambia, and Zimbabwe.

Besides the singular number of participants, the event notched up a whole array of firsts. One report spelt them out thus: “The first time the games were staged outside of military bases, the first time the games were all held in the same city, the first time an Athletes’ Village was constructed, the first time TV and VR systems were powered by 5G telecom technology, and the first use of all-round volunteer services for each delegation.”

Now, here is the clincher: the location of the guest house for the US team was located in the immediate neighbourhood of the Wuhan Seafood Market, the place the Chinese authorities to this day contend was the diffusion point of the coronavirus. But there is more: according to some reports, the person who allegedly but unwittingly transmitted the virus to the people milling about the market – Patient Zero of Covid-19 – was one Maatie Benassie.

Benassie, 52, is a security officer of Sergeant First Class rank at the Fort Belvoir military base in Virginia and took part in the 50-mile cycling road race in the same competitions. In the final lap, she was accidentally knocked down by a fellow contestant and sustained a fractured rib and a concussion though she soldiered on and completed the race with the agonising adversity.  Inevitably, she saw a bit of time in a local health facility.   According to information dug up by George Webb, an investigative journalist based in Washington DC,     Benassie would later test positive for Covid-19 at the Fort Belvoir Community Hospital.

Incidentally, Benassie apparently passed on the virus to other US soldiers at the games, who were hospitalised right there in China before they were airlifted back to the US. The US government straightaway prohibited the publicising of details on the matter under the time-honoured excuse of “national security interests”, which raised eyebrows as a matter-of-course. As if that was not fishy enough, the US out of the blue tightened Chinese visas to the US at the conclusion of the games.

The rest, as they say, is history: two months later, Covid-19 had taken hold on China territory.  “From that date onwards,” said one report, “one to five new cases were reported each day. By December 15, the total number of infections stood at 27 — the first double-digit daily rise was reported on December 17 — and by December 20, the total number of confirmed cases had reached 60.”

TWO CURIOUS RESEARCH HALTINGS

Is it a coincidence that all the US soldiers who fell ill at the Wuhan games did their preparatory training at the Fort Belvoir military base, only a 15-minutes’  drive from Fort Detrick?

That Fort Detrick is a plain-sight perpetrator of pathogenic evils is evidenced by a number of highly suspicious happenings concerning it. Remember the 2001 anthrax mailing attacks on government and media houses which killed five people right on US territory? The two principal suspects who puzzlingly were never charged, worked as microbiologists at Fort Detrick. Of the two, Bruce Ivins, who was the more culpable, died in 2008 of “suicide”. For “suicide”, read “elimination”, probably because he was in the process of spilling the beans and therefore cast the US government in a stigmatically diabolical light. Indeed, the following year, all research projects at Fort Detrick were suspended on grounds that the institute was “storing pathogens not listed   in its database”. The real truth was likely much more reprehensible.

In 2014, there was a mini local pandemic in the US which killed thousands of people and which the mainstream media were not gutsy enough to report. It arose following the weaponisation at Fort Detrick of the H7N9 virus, prompting the Obama administration to at once declare a moratorium on the research and withdraw funding.

The Trump administration, however, which has a pathological fixation on undoing practically all the good Obama did, reinstated the research under new rigorous guidelines in 2017. But since old habits die hard, the new guidelines were flouted at will, leading to another shutdown of the whole research gamut at the institute in August 2019.  This, nonetheless, was not wholesale as other areas of research, such as experiments to make bird flu more transmissible and which had begun in 2012, proceeded apace. As one commentator pointedly wondered aloud, was it really necessary to study how to make H5N1, which causes a type of bird flu with an eye-popping mortality rate, more transmissible?

Consistent with its character, the CDC was not prepared to furnish particulars upon issuing the cease and desist order, citing “national security reasons”. Could the real reason have been the manufacture of the novel coronavirus courtesy of a tip-off by the more scrupulous scientists?

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Opinions

Masisi faces ultimate test of his presidency

9th July 2020

President Mokgweetsi Masisi may have breathed a huge sigh of relief when he emerged victorious in last year’s 2019 general elections, but the ultimate test of his presidency has only just begun.

From COVID-19 pandemic effects; disenchanted unemployed youth, deteriorating diplomatic relations with neighbouring South Africa as well as emerging instability within the ruling party — Masisi has a lot to resolve in the next few years.

Last week we started an unwanted cold war with Botswana’s main trade partner, South Africa, in what we consider an ill-conceived move. Never, in the history of this country has Botswana shown South Africa a cold shoulder – particularly since the fall of the apartheid regime.

It is without a doubt that our country’s survival depends on having good relations with South Africa. As the Chairperson of African National Congress (ANC), Gwede Mantashe once said, a good relationship between Botswana and South Africa is not optional but necessary.

No matter how aggrieved we feel, we should never engage in a diplomatic war — with due respect to other neighbours— with South Africa. We will never gain anything from starting a diplomatic war with South Africa.

In fact, doing so will imperil our economy, given that majority of businesses in the retail sector and services sector are South African companies.

Former cabinet minister and Phakalane Estates proprietor, David Magang once opined that Botswana’s poor manufacturing sector and importation of more than 80 percent of the foodstuffs from South Africa, effectively renders Botswana a neo-colony of the former.

Magang’s statement may look demeaning, but that is the truth, and all sorts of examples can be produced to support that. Perhaps it is time to realise that as a nation, we are not independent enough to behave the way we do. And for God’s sake, we are a landlocked country!

Recently, the effects of COVID-19 have exposed the fragility of our economy; the devastating pleas of the unemployed and the uncertainty of the future. Botswana’s two mainstay source of income; diamonds and tourism have been hit hard. Going forward, there is a need to chart a new pathway, and surely it is not an easy task.

The ground is becoming fertile for uprisings that are not desirable in any country. That the government has not responded positively to the rising unemployment challenge is the truth, and very soon as a nation we will wake up to this reality.

The magnitude of the problem is so serious that citizens are running out of patience. The government on the other hand has not done much to instil confidence by assuring the populace that there is a plan.

The general feeling is that, not much will change, hence some sections of the society, will try to use other means to ensure that their demands are taken into consideration. Botswana might have enjoyed peace and stability in the past, but there is guarantee that, under the current circumstances, the status quo will be maintained.

It is evident that, increasingly, indigenous citizens are becoming resentful of naturalised and other foreign nationals. Many believe naturalised citizens, especially those of Indian origin, are the major beneficiaries in the economy, while the rest of the society is side-lined.

The resentfulness is likely to intensify going forward. We needed not to be heading in this direction. We needed not to be racist in our approach but when the pleas of the large section of the society are ignored, this is bound to happen.

It is should be the intention of every government that seeks to strive on non-racialism to ensure that there is shared prosperity. Share prosperity is the only way to make people of different races in one society to embrace each other, however, we have failed in this respect.

Masisi’s task goes beyond just delivering jobs and building a nation that we all desire, but he also has an immediate task of achieving stability within his own party. The matter is so serious that, there are threats of defection by a number of MPs, and if he does not arrest this, his government may collapse before completing the five year mandate.

The problems extend to the party itself, where Masisi found himself at war with his Secretary General, Mpho Balopi. The war is not just the fight for Central Committee position, but forms part of the succession plan.

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