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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

Internal party-democracy under pressure

21st June 2022

British novelist, W. Somerset Maugham once opined: “If a nation values anything more than freedom, it will lose its freedom; and the irony of it is that if it is comfort or money that it values more, it will lose that too.”

The truism in these words cannot be underestimated, especially when contextualizing against the political developments in Botswana. We have become a nation that does not value democracy, yet nothing represent freedom more than democracy. In fact, we desire, and value winning power or clinging to power more than anything else, even if it harms the democratic credentials of our political institutions. This is happening across political parties — ruling and opposition.

As far as democracy is concerned, we are regressing. We are becoming worse-off than we were in the past. If not arrested, Botswana will lose its status as among few democratic nations in the Africa. Ironically, Botswana was the first country in Africa to embrace democracy, and has held elections every five years without fail since independence.

We were once viewed as the shining example of Africa. Those accolades are not worth it any more. Young democracies such as South Africa, with strong institutions, deserves to be exalted. Botswana has lost faith in democracy, and we will pay a price for it. It is a slippery slope to dictatorship, which will bring among other excess, assault on civil liberties and human rights violations.

Former President, Festus Mogae once stated that Botswana’s democracy will only become authentic, when a different party, other than the Botswana Democratic Party (BDP) wins elections, and when the President of such party is not from Serowe.

Although many may not publicly care to admit, Mogae’s assertion is true. BDP has over the years projected itself as a dyed-in-the-wool proponent of democracy, but the moment its stay in power became threatened and uncertain, it started behaving in a manner that is at variance with democratic values.  This has been happening over the years now, and the situation is getting worse by the day.

Recently, the BDP party leadership has been preaching compromise and consensus candidates for 2024 general elections. Essentially, the leadership has lost faith in the Bulela Ditswe dispensation, which has been used to selected party candidates for council and parliament since 2003. The leadership is discouraging democracy because they believe primary elections threaten party unity. It is a strange assertion indeed.

Bulela Ditswe was an enrichment of internal party democracy in the sense that it replaced the previous method of selection of candidates known as Committee of 18, in which a branch committee made of 18 people endorsed the representatives. While it is true that political contest can divide, the ruling party should be investing in political education and strengthening in its primary elections processes. Democracy does not come cheap or easy, but it is valuable.

Any unity that we desire so much at the expense of democracy is not true unity. Like W. Somerset Maugham said, democracy would be lost in the process, and ultimately, even the unity that was desired would eventually be lost too. Any solution that sacrifice democracy would not bring any results in the long run, except misery.

We have seen that also in opposition ranks. The Umbrella for Democratic Change (UDC) recently indicated that its incumbent Members of Parliament (MPs) should not be challenged for their seats. While BDP is sacrificing democracy to stay in power, UDC is sacrificing democracy to win power. It is a scary reality given the fact that both parties – ruling and opposition — have embraced this position and believe democracy is the hindrance to their political ambitions.

These current reality points to one thing; our political parties have lost faith in democracy. They desire power more than, the purpose of power itself. It is also a crisis of leadership across the political divide, where we have seen dissenting views being met with persecution. We have seen perverting of political process endorsed by those in echelons of power to manipulate political outcomes in their favour.

Democracy should not be optional, it should be mandatory. Any leader proposing curtailing of democracy should be viewed with suspicion, and his adventures should be rejected before it is too late. Members of political parties, as subscribers of democracy, should collectively rise to the occasion to save their democracy from self-interest that is becoming prevalent among Botswana political parties.

The so-called compromise candidates, only benefits the leadership because it creates comforts for them. But for members, and for the nation, it is causing damage by reversing the gains that have been made over the years. We should reject leaders who only preach democracy in word, but are hesitant to practice it.

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Opinions

The Big Deal About Piracy

21st June 2022
piracy

Piracy of all kinds continues to have a massive impact on the global creative industry and the economies of the countries where it thrives.

One of the biggest misconceptions around piracy is that an individual consumer’s piracy activities, especially in a market the size of Botswana’s, is only a drop in the pool of potential losses to the different sectors of the economy piracy affects.

When someone sitting in Gaborone, Botswana logs onto an illegal site to download King Richard online, they don’t imagine that their one download will do anything to the production house’s pocket or make a dent in the actors’ net worth. At best, the sensitivity towards this illegal pirating activity likely only exists when contemplating going about pirating a local musician’s music or a short film produced locally.

The ripple effects of piracy at whatever scale reach far beyond what the average consumer could ever imagine. Figures released by software security and media technology company, Irdeto, show that users in five major African territories made approximately 17,4 million total visits to the top 10 identified piracy sites on the internet.

The economic impact of this on the creative industry alone soars to between 40 and 97.1 billion dollars, according a 2022 Dataprot study. In addition, they estimate that “illegally streamed copyrighted content consumes 24% of global bandwidth”.

As Botswana’s creative industry remains relatively slight on the scale of comparison to industries such as Nollywood and Nilewood where the creative industry contributes a huge proportion to West and East Africa’s respective GDPs, that does not imply that piracy activities in Botswana do not have a similar impact on our economy and the ability of our creative industry to grow.

When individuals make decisions to illegally consume content via internet streaming sites they believe they are saving money for themselves in the name of enjoying content they desire to consume. Although this is a personal choice that remains the prerogative of the consumer, looking beyond the fact that streaming on illegal content sites is piracy, the ripple effect of this decision also has an endless trail of impact where funds which could be used to grow the local creative industry through increased consumption, and revenue which would otherwise be fed back into Botswana’s economy are being diverted.

“Why can’t our local creative industry grow?” “Why don’t we see more home-grown films and shows in Botswana?” are questions constantly posed by those who consume television content in Botswana. The answer to this lies largely in the fact that Botswana’s local content needs an audience in order for it to grow. It needs support from government and entities which are in a position to fund and help the industry scale greater heights.

Any organisational body willing to support and grow the local creative industry needs to exist and operate in an economy which can support its mandates. Content piracy is a cycle that can only be alleviated when consumers make wiser decisions around what they consume and how.

This goes beyond eradicating piracy activities in so far as television content is concerned. This extends to the importation and trade in counterfeit goods, resale of goods and services not intended for resale across the border, outside its jurisdiction, and more. All of these activities stunt the growth of an economy and make it nearly impossible for industries and sectors to propel themselves to places where they can positively impact society and reinvest into the country’s economy.

So what can be done to turn the tide here in Botswana in order to see our local production houses gain the momentum required to produce more, license more and expand their horizons? While those who enforce the law continue to work towards minimizing piracy activities, it’s imperative that as consumers we work to make their efforts easier by being mindful of how our individual actions play a role in preventing the success of our local creative networks and our economy’s growth.

Whether you are pirating a Hollywood Blockbuster, illegally streaming a popular Motswana artist’s music, or smuggling in an illegal decoder to view content restricted to South Africa only, your actions have an impact on how we as a nation will make our mark on the global landscape with local creative productions. Thembi Legwaila is Corporate Affairs Manager, MultiChoice Botswana

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Opinions

Our Strength is our Unity

18th March 2022
Craig-Cloud

Putin Chose War.  We Remain United with Ukraine.

U.S. Ambassador Craig L. Cloud

This is a dangerous moment for Europe and for freedom-loving people around the world.  By launching his brutal assault on the people of Ukraine, Vladimir Putin has also committed an assault on the principles that uphold global peace and democracy.  But the people of Ukraine are resilient.

They’ve had a democracy for decades, and their bravery is inspiring the world.  The United States, together with our Allies and partners across the globe, will continue to support the Ukrainian people as they defend their country.  By choosing to pay for a war instead of investing in the needs of Russians, Putin’s invasion of Ukraine will be a strategic failure for the Kremlin and ravage the future of the Russian people.

When the history of this era is written, it will show that Putin’s choice to launch an unprovoked, unjust, and premeditated attack left the West more unified and Russia exponentially weaker.

United in Our Response

This will not end well for Vladimir Putin.  Together, the United States and our Allies and partners are taking action to hold Russia accountable.  As a result of unprecedented global sanctions coordination, the United States, the United Kingdom, the European Union, Japan, and Canada have removed selected Russian banks from the SWIFT messaging system and imposed restrictive measures on the Russian Central Bank.

President Biden announced sweeping financial sanctions and stringent export controls that will damage Russia’s economy, financial system, and access to cutting-edge technology.  After Putin began his invasion, the ruble hit its weakest point in history, and the Russian stock market plunged.

Along with the United Kingdom and European Union, the United States imposed sanctions on the architects of this war, including Putin himself.

By moving in close coordination with a powerful coalition of Allies and partners representing more than half of the global economy, we have magnified the impact of our actions to impose maximum costs on Putin and his regime.  In response to Putin’s war of choice, we will limit Russia’s ability to do business in U.S. dollars.

We will stunt Russia’s ability to finance and grow its military.  We will impair Russia’s ability to compete in the global economy.  And we are prepared to do more.

In addition to economic penalties, this week President Biden authorized an additional $1 billion over the $350 million of security assistance he recently approved, and a $650 million in 2021, to immediately help Ukraine defend itself, bringing America’s total security assistance to Ukraine over the past year to $2 billion.

We also stand ready to defend our NATO Allies.  President Biden has coordinated with Allied governments to position thousands of additional forces in Germany and Poland as part of our commitment to NATO’s collective defense.

He authorized the deployment of ground and air forces already stationed in Europe to NATO’s eastern and southeastern flanks:  Estonia, Latvia, Lithuania, Poland, and Romania.  Our Allies have also added their own forces and capabilities to ensure our collective defense.  There should be no doubt about the readiness of the greatest military Alliance in the history of the world:  NATO is more united than ever.

The United States has also coordinated with major oil-producing and consuming countries to underscore our common interest in securing global energy supplies.  We are working with energy companies to surge their capacity to supply energy to the market, particularly as prices increase.

Putin’s Unprovoked and Premeditated War

This was an attack that Vladimir Putin has planned for a long time.  He methodically moved more than 150,000 troops and military equipment to Ukraine’s border.  He moved blood supplies into position and built field hospitals, demonstrating his intentions all along.

He rejected every good-faith effort by the United States and our Allies and partners to address his fabricated security concerns and to avoid needless conflict and human suffering by engaging in diplomacy and dialogue.

Putin executed his playbook exactly as we had warned he would do.  We saw Russia’s proxies increase their shelling in the Donbas.  We saw the Russian government launch cyber-operations against Ukraine.  We saw staged political theater in Moscow and heard outlandish and baseless claims made about Ukraine in an attempt to justify Russia’s aggression.

Russia continues to justify its military aggression by falsely claiming the need to stop “genocide” in Ukraine – despite there being no evidence that genocide was occurring there.  We saw Russia use these tactics before when they invaded Ukraine in 2014 and Georgia in 2008.

And then, at almost the very same moment the United Nations Security Council was meeting to stand up for Ukraine’s sovereignty and forestall disaster, Putin launched his invasion in violation of international law.  Missiles began to rain down, striking historic cities across Ukraine.  Then came air raids, columns of tanks, and battalions of troops, all riding a renewed wave of disinformation and outright lies.

We have been transparent with the world.  We declassified our intelligence about Russia’s plans so there could be no confusion and no cover up.  Putin is the aggressor.  Putin chose this war.  And now his people will bear the consequences of his decision to invest in war rather than in them.

Transatlantic Unity and Resolve Stronger Than Ever

Putin’s goal of dividing the West has failed.  In the face of one of the most significant challenges to European security and democratic ideals since World War II, the United States and our Allies and partners have joined together in solidarity.  We have united, coordinating intensively to engage as one with Russia and Ukraine, provided assistance to Ukraine, developed a broad response, and reaffirmed our commitment to NATO.

Putin has failed to divide us.  Putin has failed to undermine our shared belief in the fundamental right of sovereign nations to choose their destiny and their allies.  And Putin will fail to erase the proud nation of Ukraine.

The next few days, weeks, and months will be incredibly difficult for the people of Ukraine.  Putin has unleashed great suffering on them.  But the Ukrainian people have known 30 years of independence, and they have repeatedly shown they will not tolerate anyone who tries to take their country backwards.

The world is watching this conflict closely, and if Russian forces commit atrocities, we will explore all international mechanisms that could be used to bring those responsible – whether members of the military or their civilian leadership – to account.

Putin’s aggression against Ukraine will cost Russia profoundly, both economically and strategically.  The Russian people deserve better from their government than the immense cost to their future that this invasion has precipitated.

Liberty, democracy, and human dignity are forces far more powerful than fear and oppression.  In the contest between democracy and autocracy, between sovereignty and subjugation, make no mistake:  Freedom will prevail.

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