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Botswana public health care system in crisis

Kesitegile Gobotswang

“THINGS FALL APART”. These prophetic words of Chinua Achebe the Nigerian celebrated novelist and poet are fitting to describe the health care system in Botswana today. To describe the health care systems as a sector in a state of chaos is obviously a serious underestimation.

Let us acknowledge from the onset that while in other African countries diamonds were used to fight endless wars in Botswana money from the diamonds were mainly used in the development of the health, social and physical infrastructure.

Morden and state of the art hospitals were constructed in towns and major villages. Primary health facilities were established in villages across the length and breadth of the country. However, an omission of monumental proportions was in factoring in the maintenance cost of the infrastructure.

Consequently most health facilities are in a terrible state. The quality of health care has deteriorated to the extent that Ministers, senior public servants and their close relatives shun it in favour of South African ones. For the majority of Batswana they have no choice but to face appalling conditions and a staff whose morale is at its all-time low due to neglected working conditions. 

In many hospitals the emergency services have virtually collapsed as patients die after spending hours waiting for medical attention. The waiting time at public health facilities is unbearable. On average one has to budget eight (8) hours to get medical attention – a situation that affects productivity at the work place.

Over crowing is prevalent in the majority of public hospitals in Botswana. One of the local medical doctors recently revealed that with a bed capacity of 567 Princess Marina Hospital admits 750 patients. Patients sleeping on floors are not uncommon at public hospitals due to overcrowding.

This has the potential to increase preventable mortality at public health facilities. The situation at some primary hospitals is so bad that mixed sex medical wards have been reported. Under such circumstances sexual abuses or even rape cases cannot be ruled out.

Patients are not safe at public health facilities. The less we talk about the poor quality of meals at the hospitals the better. The basic rule is that if the Minister cannot enjoy it, it is not good for the patients.

In the rural areas the situation is worsened by the botched reversal of decentralization of the health care system as clinics are without ambulances and drivers spend most of the time playing cards under trees, idling.

The poverty stricken local Councillors are frequently forced to use their private open vans to transport the critically sick and pregnant women to health facilities. Yet government so it fit to increase salaries of Members of Parliament, the President and his Cabinet Ministers at the exclusion of Councillors who carry the burden of a collapsed health care system. 

X-ray and laundry machines are dysfunctional in most Hospitals. Where equipment is operational it is often not calibrated and tested resulting in misdiagnosis and possible loss of life. In this regard information collected from health facilities is highly questionable.

It is not surprising that in respect to nutrition information government reports single digits levels of under-nutrition (about 5%) while representative community-based surveys and United Nations agencies record double digits rates (about 13%) of poor nutrition among under-fives. Simple put it means 8% of children classified as normal are in fact undernourished.

Of late the biggest scaring development of the public health care system is the frequent reports of blood contamination. In March 2016 there was a health scare when the Ministry of Health confirmed that blood with bacteria that causes syphilis was detected. It was further revealed that the contaminated blood had already been used on some unsuspecting patients at Scottish Livingstone and Princess Marina Hospitals.

At the time of the reports system failure (whatever that is) was blamed for the problem. A service that deals with issues of life and death cannot afford to experience system failures. Recently yet another health scare was reported.

As it was the case in the previous report bacteria that causes syphilis was detected in the blood that was delivered at PMH and Scottish Livingstone. These incidents were widely reported in the regional and international press with the potential to tarnish the already worsening image of the country.

This time around the Ministry of Health blames human error for the disaster. Subsequently three clinical officers from the National Blood Transfusion Service (NBTS) were suspended to safe the face of the person who must account – the Minister of Health. It is unclear why these two hospitals and why syphilis.

The Ministry has a lot to explain to calm the worried general public. This is because if a referral hospital like PMH and a state of the art hospital like Scottish Livingstone can experience such incidents district as well as primary hospitals might be at greater risks across the country. The blood contamination crisis is a tip of the ice bag. It is just a reflection of a health system in an intensive care unit (ICU).

The poor state of the health care system in Botswana is well documented in the regular assessment reports conducted by the Council for Health Service Accreditation of Southern Africa (COHSASA).

According to the latest report all public health facilities except Scottish Livingstone, Mahalapye Hospital, Airstrip Clinic (Mahalapye), Xhosa Clinic (Mahalapye), and Phuthadikobo Clinic (Molepolole) failed to the accreditation exercise because of poor quality of service. Among the private hospitals only Orapa and Jwaneng Hospitals are accredited.

Most of the problems facing the country today can be attributable to three things only – corruption, corruption, and officially sanctioned corruption. Tenders and public procurements are corruptly awarded to briefcase companies owned by individuals with close connections to the powers that be through special awards procedures.

As a result shoddy maintenance work is carried out on the infrastructure and sensitive medical equipment. There is no indication that the corrupt ridden Economic Stimulus Program (ESP) will address problems of infrastructural decay at health facilities.  

In addressing corruption the Botswana Congress Party (BCP) advocates for the enactment of a laws on Declaration of Assets and Liabilities, Freedom of Information, Prohibition of Insider Trading, and the amendment of the recently passed law on the Protection of Whistle Blowers to be aligned to international best practice. The amended law should allow Members of Parliament and the media to receive such reports.

Concerning the maintenance of the physical infrastructure, BCP advocates for the introduction of massive public works program similar but not identical to post World War Marshall Plan. The envisaged program will replace the wasteful Ipelegeng program. It will also succeed in engaging Batswana in gainful employment as well as imparting basic maintenance skills.

Crowded hospitals are also a reflection of the failure of the preventive measures espoused by the well-acclaimed primary health care (PHC). Hence the BCP advocates for a robust reinvigoration of the PHC to address lifestyle diseases caused by poor diets, lack of physical exercise, smoking, alcohol and drug abuse.

Kesitegile Gobotswang (PhD) is the Deputy Leader, BCP

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Export Processing Zones: How to Get SEZA to Sizzle

23rd September 2020
Export Processing Zone (EPZ) factory in Kenya

In 2005, the Business & Economic Advisory Council (BEAC) pitched the idea of the establishment of Special Economic Zones (SEZs) to the Mogae Administration.

It took five years before the SEZ policy was formulated, another five years before the relevant law was enacted, and a full three years before the Special Economic Zones Authority (SEZA) became operational.

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Egypt Bagged Again

23rd September 2020

… courtesy of infiltration stratagem by Jehovah-Enlil’s clan

With the passing of Joshua’s generation, General Atiku, the promised peace and prosperity of a land flowing with milk and honey disappeared, giving way to chaos and confusion.

Maybe Joshua himself was to blame for this shambolic state of affairs. He had failed to mentor a successor in the manner Moses had mentored him. He had left the nation without a central government or a human head of state but as a confederacy of twelve independent tribes without any unifying force except their Anunnaki gods.

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23rd September 2020

If I say the word ‘robot’ to you,  I can guess what would immediately spring to mind –  a cute little Android or animal-like creature with human or pet animal characteristics and a ‘heart’, that is to say to say a battery, of gold, the sort we’ve all seen in various movies and  tv shows.  Think R2D2 or 3CPO in Star Wars, Wall-E in the movie of the same name,  Sonny in I Robot, loveable rogue Bender in Futurama,  Johnny 5 in Short Circuit…

Of course there are the evil ones too, the sort that want to rise up and eliminate us  inferior humans – Roy Batty in Blade Runner, Schwarzenegger’s T-800 in The Terminator,  Box in Logan’s Run,  Police robots in Elysium and  Otomo in Robocop.

And that’s to name but a few.  As a general rule of thumb, the closer the robot is to human form, the more dangerous it is and of course the ultimate threat in any Sci-Fi movie is that the robots will turn the tables and become the masters, not the mechanical slaves.  And whilst we are in reality a long way from robotic domination, there are an increasing number of examples of  robotics in the workplace.

ROBOT BLOODHOUNDS Sometimes by the time that one of us smells something the damage has already begun – the smell of burning rubber or even worse, the smell of deadly gas. Thank goodness for a robot capable of quickly detecting and analyzing a smell from our very own footprint.

A*Library Bot The A*Star (Singapore) developed library bot which when books are equipped with RFID location chips, can scan shelves quickly seeking out-of-place titles.  It manoeuvres with ease around corners, enhances the sorting and searching of books, and can self-navigate the library facility during non-open hours.

DRUG-COMPOUNDING ROBOT Automated medicine distribution system, connected to the hospital prescription system. It’s goal? To manipulate a large variety of objects (i.e.: drug vials, syringes, and IV bags) normally used in the manual process of drugs compounding to facilitate stronger standardisation, create higher levels of patient safety, and lower the risk of hospital staff exposed to toxic substances.

AUTOMOTIVE INDUSTRY ROBOTS Applications include screw-driving, assembling, painting, trimming/cutting, pouring hazardous substances, labelling, welding, handling, quality control applications as well as tasks that require extreme precision,

AGRICULTURAL ROBOTS Ecrobotix, a Swiss technology firm has a solar-controlled ‘bot that not only can identify weeds but thereafter can treat them. Naio Technologies based in southwestern France has developed a robot with the ability to weed, hoe, and assist during harvesting. Energid Technologies has developed a citrus picking system that retrieves one piece of fruit every 2-3 seconds and Spain-based Agrobot has taken the treachery out of strawberry picking. Meanwhile, Blue River Technology has developed the LettuceBot2 that attaches itself to a tractor to thin out lettuce fields as well as prevent herbicide-resistant weeds. And that’s only scratching the finely-tilled soil.

INDUSTRIAL FLOOR SCRUBBERS The Global Automatic Floor Scrubber Machine boasts a 1.6HP motor that offers 113″ water lift, 180 RPM and a coverage rate of 17,000 sq. ft. per hour

These examples all come from the aptly-named site    because while these functions are labour-saving and ripe for automation, the increasing use of artificial intelligence in the workplace will undoubtedly lead to increasing reliance on machines and a resulting swathe of human redundancies in a broad spectrum of industries and services.

This process has been greatly boosted by the global pandemic due to a combination of a workforce on furlough, whether by decree or by choice, and the obvious advantages of using virus-free machines – I don’t think computer viruses count!  For example, it was suggested recently that their use might have a beneficial effect in care homes for the elderly, solving short staffing issues and cheering up the old folks with the novelty of having their tea, coffee and medicines delivered by glorified model cars.  It’s a theory, at any rate.

Already, customers at the South-Korean  fast-food chain No Brand Burger can avoid any interaction with a human server during the pandemic.  The chain is using robots to take orders, prepare food and bring meals out to diners.  Customers order and pay via touchscreen, then their request is sent to the kitchen where a cooking machine heats up the buns and patties. When it’s ready, a robot ‘waiter’ brings out their takeout bag.   

‘This is the first time I’ve actually seen such robots, so they are really amazing and fun,’ Shin Hyun Soo, an office worker at No Brand in Seoul for the first time, told the AP. 

Human workers add toppings to the burgers and wrap them up in takeout bags before passing them over to yellow-and-black serving robots, which have been compared to Minions. 

Also in Korea, the Italian restaurant chain Mad for Garlic is using serving robots even for sit-down customers. Using 3D space mapping and other technology, the electronic ‘waiter,’ known as Aglio Kim, navigates between tables with up to five orders.  Mad for Garlic manager Lee Young-ho said kids especially like the robots, which can carry up to 66lbs in their trays.

These catering robots look nothing like their human counterparts – in fact they are nothing more than glorified food trolleys so using our thumb rule from the movies, mankind is safe from imminent takeover but clearly  Korean hospitality sector workers’ jobs are not.

And right there is the dichotomy – replacement by stealth.  Remote-controlled robotic waiters and waitresses don’t need to be paid, they don’t go on strike and they don’t spread disease so it’s a sure bet their army is already on the march.

But there may be more redundancies on the way as well.  Have you noticed how AI designers have an inability to use words of more than one syllable?  So ‘robot’ has become ‘bot’ and ‘android’ simply ‘droid?  Well, guys, if you continue to build machines ultimately smarter than yourselves you ‘rons  may find yourself surplus to requirements too – that’s ‘moron’ to us polysyllabic humans”!

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