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It’s not yet Uhuru, but Botswana has done well in fighting COVID-19!

Though the fight has not yet been won, it is worth noting that Botswana has, so far, done well in its fight against COVID-19.

According to Government of Botswana’s website, as at 14th May 2020, 11495 tests had been performed and resulted from which 11471 tested negative; 24 were confirmed cases; there was 1 death; there was no new confirmed case and there were 17 recoveries.

This, in my view, is an epic achievement if regard is had to several factors which we discuss herein. But before that, we give a brief timeline of COVID-19 to put the matter in its proper perspective.

On 31st December 2019, Wuhan Municipal Health Commission, reported a cluster of cases of Pneumonia in Wuhan, Hubei Province, in China. On 4th January 2020, WHO reported, through social media, that there was a cluster of Pneumonia cases – with no deaths – in Wuhan, Hubei province.

On 12th January 2020, China publicly shared the genetic sequence of COVID-19. The following day, on 13th January 2020, a case of COVID-19 was confirmed in Thailand, the first recorded case outside of China.

On 30th January 2020, WHO declared the novel coronavirus outbreak (2019-nCoV) a Public Health Emergency of International Concern (PHEIC). On 11th March 2020, WHO made the assessment that COVID-19 can be characterized as a pandemic.

On 13th March 2020, the COVID-19 Solidarity Response Fund was launched to receive donations from private individuals, corporations and institutions.

Africa’s first COVID-19 case was recorded in Egypt on 14th February 2020. On 21st March 2020, the Government of Botswana declared COVID-19 a public health emergency and introduced a number of precautionary measures in response to the pandemic.

On 30th March 2020, the Minister of Health and Wellness, Dr. Lemogang Kwape, announced Botswana’s first three cases of COVID-19. According to Dr. Kwape, the three had travelled to Britain and Thailand.

The following day, on 31st March 2020, His Excellency the President, Dr. Mokgweetsi Eric Keabetswe Masisi, declared a State of Public Emergency (SoPE) to deal with (COVID-19) in terms of section 17 of the Constitution of Botswana.

On 2nd April 2020 at midnight, Botswana entered into a lockdown, which is still on, and will, hopefully, end on 20th May 2020. Firstly, Dr. Masisi has to be commended for timeously declaring COVID-19 a public health emergency, something which resulted in the introduction of precautionary measures in response to the pandemic as recommended by WHO.

Of course, one may question why he only made such declaration on 21st March 2020 when WHO had declared it as such as far back as 30th January 2020. In my view, the fact that Africa only recorded its first case, in Egypt, on 14th February 2020, as well as the fact that there was no confirmed case locally warranted the wait and see approach.

In my view, had the declaration been made too early, the lockdown would have been longer something which would have been detrimental because anecdotal evidence suggests that countries which enter into a lockdown to early run the risk of having to lift it at a time that can put the lives of its citizens at risk.

Dr. Masisi must also be commended for not using the SoPE to contravene the Rule of Law and violate human rights as some had feared. For instance, the Legislature and the Judiciary remained functional during the SoPE. Martial law was never applied; those who were charged of offences were taken to the courts, which continued operational.

There have been few reported cases of brutality by members of the armed forces who enforced the lockdown, and when such allegations arose the President spoke strongly against them.

Parliament too remained functional. In fact, all the Emergency Powers Regulations which the President issued were passed by Parliament after intense debates which were televised for all to see. Secondly, Botswana must be commended for containing the virus and saving lives. You will be aware that since the first three cases were confirmed in Botswana on 30th March 2020, we have since had an addition of only 21 cases.

This, in my view, is an epic achievement considering the fact that we share a border with South Africa which is a COVID-19 epicentre in Africa. Not only that, we also share a porous border with Zimbabwe, a country with a multifunctional health system.

Further, since the first confirmed cases, we have had only 1 death and 17 recoveries. Of course, loss of life, even for one person, is regrettable, but the fact that out of 24 confirmed cases, only 1 person has died is quite commendable. This can only be because our screening, testing, quarantining and management system was effective.

Also commendable is the fact that, with the meagre resources at our disposal, we have been able to test 11495 people. Thirdly, government’s messaging with respect to social distancing and hygiene protocols was clear and well-articulated from the beginning.

Commendably, the messages were communicated in various indigenous languages through Botswana Television and Radio Botswana. Not only that. Sign language interpretation was also used to cater for those with hearing disabilities. Hopefully, in future a Braille will be considered for those with both hearing and visual impairments.

Fourth, government established a COVID-19 Relief Fund and put up an investment of Two Billion Pula as seed capital, something which saw foreign governments, banks, companies, parastatals and individuals making donations and contributions to help alleviate the effects of COVID-19 on our people.

To allay the fears that the money in the Fund may be misappropriated, government has made an undertaking that it shall ensure that at the end of the COVID-19 pandemic the Fund will be audited by Independent Auditors.

Fifth, food relief. Government assessed Batswana to identify those who are in distress after which those in need would be given food hampers. It ought to be stated that there have been several complaints that in some instances it took too long to conduct assessments and to distribute the food hampers.

There have also been complaints that even when the hampers were delivered, they were short and had some rotten items. There is no doubt that some of these problems were occasioned by the fact that we do not have enough Social Welfare Officers. Shortage of transport also contributed. That notwithstanding, anecdotal evidence suggests that majority of our people received and continue to receive food hampers.

Sixth, employee protection. When the SoPE and lockdown were announced, there were fears that many employees would lose their jobs through unlawful retrenchments and dismissals.

Government must be commended because it avoided, or at least deferred, this by promulgating Regulations that prohibited the retrenchment and dismissal of employees during the SoPE. It, however, ought to be stated that some employees were retrenched and/or dismissed because it took some time before the Regulations were amended to that effect.

To cater for the companies that could not be able to continue operating because of the financial constraints occasioned by the lockdown, the Regulations permit company closure during the SoPE.

In my view, the Regulations should have also addressed such issues as forced paid leave; forced unpaid leave; reduction of salaries, etc. because they remain a source of conflict between employers and employees and will, no doubt, burden the courts in due course.

Seventh, assistance for businesses. Realising that businesses’ cashflow will be affected by the lockdown, government introduced a wage subsidy to subsidise eligible business in the payment of wages. Also, in an effort to give businesses some cash-flow relief, Government guaranteed loans by commercial banks to businesses affected by COVID-19.

Government also gave eligible businesses affected by COVID-19 access to credit to support ongoing operations in conditions where credit became more difficult to obtain. Government also gave tax concessions to businesses in eligible sectors.

Government also made an undertaking that institutions will pay Government Purchase Orders (GPOs) within five (5) days and parastatals will pay within 24 hours. Government also made an undertaking that it will pay all outstanding arrears for invoices within two (2) weeks and extended the validity period for GPOs. It also undertook to expedite VAT refunds to businesses to assist with cash flow.

The private sector also came to the party. In the financial services industry, Banks agreed to offer restructuring of loan facilities, including owner-occupied residential property mortgages and motor vehicle loans. Commercial banks offered a payment holiday for three (3) months with the option to extend to six (6) months to the affected sectors.

Banks also restructured and rescheduled regular payment obligations including life insurance premium payment, retirement fund contributions and loan instalments for at least three months. Most importantly, Batswana have to be commended for respecting the lockdown and adhering to the social distancing and hygiene protocols for if they had not done so we would have had more infections and deaths.

Our Nurses, Doctors, Social Welfare Officers, the Police and soldiers who were at the forefront of the battle deserve special commendation. Of course, we could have done better in such areas as assessments and delivery of food hampers; expeditious allocation of travel permits and establishment of a rent subsidy, but, on the whole, we did well, especially considering the size of our economy and the fact that we have never faced such a devastating pandemic.

But, the war is not over. As we move towards the lifting of the lockdown on 21st May 2020 as planned, two issues remain of concern to me. The first is the issuance of green permits which will be required for travel across zones from the 21st May 2020.

In my view, the Regulations must be amended to include, among essential travel, travel for medical reasons, travel to be with family and any other travel which the Issuing Officer may, in his or her own discretion, deem fit.

The second is the development of a COVID-19 Economic Stimulus Programme (ESP). My prayer is that when the COVID-19 ESP is developed, priority should be given to sustainable programmes as opposed to short term projects designed to gain quick political expediency as was the case in 2016.

*Ndulamo Anthony Morima, LLM(NWU); LLB(UNISA); DSE(UB); CoP (BAC); CoP (IISA) is the proprietor of Morima Attorneys. He can be contacted at 71410352 or anmorima@gmail.com

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Appendicitis: Recognising the Signs

29th March 2022

Many a times I get clients casually walking into my room and requesting to be checked for “appendix”.  Few questions down the line, it is clear they are unaware of where the appendix is or what to expect when one does have it (appendicitis). Jokingly (or maybe not) I would tell them they would possibly not be having appendicitis and laughing as hard as they are doing. On the other hand, I would be impressed that at least they know and acknowledge that appendicitis is a serious thing that they should be worried about.

So, what is Appendicitis?

Appendicitis is an inflammation of the appendix; a thin, finger-like pouch attached to the large intestine on the lower right side of the abdomen. Often the inflammation can be as a result of blockage either by the faecal matter, a foreign body, infection, trauma or a tumour. Appendicitis is generally acute, with symptoms coming on over the course of a day and becoming severe rapidly. Chronic appendicitis can also occur, though rarely. In chronic cases, symptoms are less severe and can last for days, weeks, or even months. 

Acute appendicitis is a medical emergency that almost always ends up in the operating theatre. Though the appendix is locally referred to as “lela la sukiri”, no one knows its exact role and it definitely does not have anything to do with sugar metabolism. Appendicitis can strike at any age, but it is mostly common from the teen years to the 30s.

Signs to look out for

If you have any of the following symptoms, go and see a Doctor immediately! Timely diagnosis and treatment are vital in acute appendicitis;

Sudden pain that starts around the navel and shifts to the lower right abdomen within hours

The pain becomes constant and increases in severity (or comes back despite painkillers)

The pain worsens on coughing, sneezing, laughing, walking or deep breaths

Loss of appetite

Nausea and vomiting

Fever

Constipation or diarrhoea

Abdominal bloating/fullness

Diagnosis

The doctor often asks questions regarding the symptoms and the patient’s medical history. This will be followed up by a physical examination in which the Doctor presses on the abdomen to check for any tenderness, and the location of the pain. With acute appendicitis, pressing on and letting go of the right lower abdomen usually elicits an excruciatingly unbearable pain. Several tests may be ordered to determine especially the severity of the illness and to rule out other causes of abdominal pain. The tests may conditions include: blood tests, a pregnancy test, urinalysis, abdominal  “How do ultrasound scans work?” ultrasound (scan), CT scan or MRI Scan.

Treatment

The gold standard treatment of acute appendicitis is surgical removal of the appendix known as appendectomy. Luckily, a person can live just fine without an appendix! Surgical options include laparoscopy or open surgery and the type will be decided on by the Surgeon after assessing the patient’s condition. Painkillers and antibiotics are also given intravenously usually before, during and after the surgery.

Complications

Appendicitis can cause serious complications such as;

Appendicular mass/abscessIf the appendix is inflamed or bursts, one may develop a pocket of pus around it known as an abscess. In most cases, the abscess will be treated with antibiotics and drained first by placing a tube through one’s abdominal wall into the abscess. The tube may be left in place for a few hours or days while the infection is clearing up but ultimately one would still have surgery to remove the appendix.

Peritonitis – without treatment, the appendix can rupture/burst. The risk of this rises 48–72 hours after symptoms start. A ruptured appendix spreads the infection throughout the abdomen (peritonitis). This is life threatening and requires immediate surgery to remove the appendix and clean the abdominal cavity.

Death – The complications of appendicitis (and appendectomy) can be life threatening, only if the diagnosis has been missed and no proper treatment has been given on time. This is rare though with the evolved medical care.

If you need further advice or treatment please call 4924730, email  HYPERLINK “mailto:info@themedicscentre.co.bw” info@themedicscentre.co.bw or visit www.themedisccentre.co.bw

Antoinette Boima, MBBS, BMedSci, PgDip HIV/AIDS, Cert Aesth Med is the Managing Director of The Medics Centre in Palapye.

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A degree of common sense

7th February 2022

Here’s a news item from last month you may have missed. In December 2021 the University of Staffordshire announced it would be offered a degree course in pantomime! Yes, that’s right, a degree in popular festive entertainment, the Christmas panto.

We used to have one here, put on by the Capitol Players, though it seems to have fallen away in recent times, but the spectacle is still alive and well in the UK, both in local ad-dram (amateur dramatic ) societies and on the London stage and most of the major cities, these latter productions usually featuring at least one big-draw name from the world of show business with ticket prices commensurate with the star’s salary.

In case you’re unfamiliar with the pantomime format, it consists of a raucous mixture of songs and comedy all based around a well-known fairy or folk tale. Aladdin and His Magic Lamp, Cinderella, Jack & The Beanstalk & Dick Whittington are perennial favourites but any well-known tall tale goes. There is no set script, unlike a play, and storyline is just a peg to hang a coat of contemporary, often bawdy, gags on, in what should be a rollicking production of cross dressing – there has to be at least one pantomime dame, played by a man and always a figure of fun, and a Principal Boy, ostensibly the male lead, yet played by an attractive young woman.

As an art form it can trace its roots back to 16th century Italy and the Commedia Del’Arte which used a mélange of music, dance, acrobatics along with a cast of comic stock characters so it has a long and proud theatrical tradition but you have to wonder, does that really qualify it as a suitable subject for a university? Further, what use might any degree be that can be acquired in a single year? And last but not least, how much standing does any degree have which comes from a jumped-up polytechnic, granted university status along with many of its ilk back in 1992, for reasons best known to the government of the time? Even more worrying are the stated aims of the course.

Staffordshire University claims it is a world first and the masters course is aimed at people working inside as well as outside the industry. Students on the course, due to start in September 2022, will get practical training in the art form as well as research the discipline.

“We want to see how far we can take this,” Associate Professor of Acting and Directing Robert Marsden said. The role of pantomime in the 21st Century was also going to be examined, he said, “particularly post Me Too and Black Lives Matter”. Questions including “how do we address the gender issues, how do we tell the story of Aladdin in 2021, how do we get that balance of male/female roles?” will be asked, Prof Marsden added.

Eek! Sounds like Prof. Marsden wants to rob it of both its history and its comedic aspects – well, good luck with that! Of course that isn’t the only bizarre, obscure and frankly time and money-wasting degree course available. Staying with the performing arts there’s Contemporary Circus and Physical Performance at Bath Spa University. Sounds like fun but why on earth would a circus performer need a university degree?

Or how about a Surf Science and Technology degree at Cornwall College (part of the University of Plymouth). Where the one thing you don’t learn is….how to surf!

Then there is a  degree in Floral Design at University Centre Myerscough. No, I hadn’t heard of it either – turns out it’s a college of further education in Preston, a town that in my experience fits the old joke of ‘I went there once…..It was closed’ to a ‘T’!

Another handy (pun intended) art is that of Hand Embroidery BA (Hons), offered at the University for the Creative Arts. Or you could waste away sorry, while away, your time on a course in Animal Behaviour and Psychology. This degree at the University of Chester teaches you about the way animals think and feel. Cockroaches have personalities according to the subject specs– you couldn’t make it up.

Happily all these educational institutes may have to look to their laurels and try to justify their very existence in the near future. In plans announced this week, universities could face fines of up to £500,000 (P750m), be stripped of their right to take student loans or effectively shut down if they cannot get 60 per cent of students into a professional job under a crackdown on ‘Mickey Mouse’ courses. Further, at least 80 per cent of students should not drop out after the first year, and 75 per cent should graduate.

The rules, published by the Office for Students (OfS), aim to eliminate ‘low-quality’ courses by setting new standards & requiring courses to improve their rating in the TEF, the official universities ratings system. Universities not meeting the new standards will not be able to charge full annual fees of £9,250. Unconventional courses that could fall victim to the new rules could include the University of Sunderland’s BA in Fashion Journalism, where students learn essential’ skills such as catwalk reporting and the history of Chanel.  They have only a 40 per cent chance of entering highly skilled work 15 months after leaving.

At University College Birmingham, BSC Bakery and Patisserie Technology students – who learn how to ‘make artisan bread’ – have a 15 per cent chance of a professional job within 15 months. Universities minister Michelle Donelan welcomed the move, saying ‘When students go to university, they do so in the pursuit of a life-changing education, one which helps pave their path towards a highly skilled career. Any university that fails to match this ambition must be held to account.’

OfS found that at 25 universities, fewer than half of students find professional work within 15 months.  Business and management courses at the University of Bedfordshire (14.8 per cent) were among the least likely to lead to graduate-level jobs.  Asked to comment, the University of Sunderland said it always looked ‘to find ways to improve outcomes’; University College Birmingham said data on graduates and definition of ‘professional work’ was limited. I’ll bet it is! As the saying goes, ’what the eye doesn’t see, the heart doesn’t grieve over’. What a pantomime!

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Why regular health checks are important!

7th February 2022

With the world still reeling from the negative impact of the Coronavirus disease-19 (COVID-19), and the latest Omicron variant (which is responsible for the ongoing global forth wave) on everyone’s lips, we should not forget and neglect other aspects of our health.

While anyone can get infected with corona virus and become seriously ill or die at any age, studies continue to show that people aged 60 years and above, and those with underlying medical conditions like hypertension, heart and lung problems, diabetes, obesity, cancers, or mental illness are at a higher risk of developing serious illness or dying from covid-19.

It is a good habit to visit a doctor regularly, even if you feel healthy. Regular health checks can help identify any early signs of health issues or assess your risk of future illness hence prompting one to take charge and maintain a healthy lifestyle. Heart disease, diabetes, some cancers and other non-communicable diseases (even communicable) can often be picked up in their early stages, when chances for effective treatment are high.

During a health check, your doctor will take a thorough history from you regarding your medical history, your family’s history of disease, your social life and habits, including your diet, physical activity, alcohol use, smoking and drug intake. S/he will examine you including measuring your weight, blood pressure, feeling your body organs and listening to your heart and lungs amongst the rest. Depending on the assessment, your doctor will notify you how often you need to have a health check. If you have a high risk of a particular health condition, your doctor may recommend more frequent health checks from an early age.

Diet – a healthy diet improves one’s general health and wellbeing. It is recommended that we have at least two serves of fruit and five serves of vegetables daily. Physical activity – regular physical activity has significant health benefits on one’s body, mind & soul. It contributes to preventing and managing non-communicable diseases such as cardiovascular diseases, cancers and diabetes, reduce symptoms of depression and anxiety, enhances thinking, learning, and judgment skills and improves overall well-being. According to the world health organisation (WHO), people who are insufficiently active have a 20% to 30% increased risk of death compared to people who are sufficiently active. Aim for 30 minutes to an hour of moderate physical activity at least four days in a week. Examples of moderate physical activity include brisk walking, gentle swimming and social tennis.

Weight – maintaining a healthy weight range helps in preventing long-term complications like cardiovascular disease, diabetes and arthritis. It is also vital for one’s mental wellbeing and keeping up with normal activities of daily living. Ask your doctor to check your body mass index (BMI) and waist circumference annually. If you are at a higher risk, you should have your weight checked more frequently and a stern management plan in place.

Alcohol – as per WHO reports, alcohol consumption contributes to 3 million deaths each year globally as well as to the disabilities and poor health of millions of people. Healthy drinking entails taking no more than two standard drinks per drinking day with at least two alcohol-free days in a week.

Smoking –Nicotine contained in tobacco is highly addictive and tobacco use is a major risk factor for cardiovascular and respiratory diseases, many different types of cancer, and many other debilitating health conditions. Every year, at least a whopping 8 million people succumb from tobacco use worldwide. Tobacco can also be deadly for non-smokers through second-hand smoke exposure. It is not ‘fashionable’ if it is going to cost you and your loved ones lives! If you are currently smoking, talk to your doctor and get help in quitting as soon as possible to reduce the harm.

Blood pressure: Hypertension is a serious medical condition and can increase the risk of heart, brain, kidney and other diseases. It is a major cause of premature death worldwide, with upwards of 1 in 4 men and 1 in 5 women – over a billion people – having the condition. Have your blood pressure checked annually if it is normal, you are aged under 40 and there is no family history of hypertension. You might need to have it checked more frequently if you are over 40, your blood pressure is on the high side, or you have a personal or family history of high blood pressure, stroke or heart attack. Your doctor will be there to guide you.

Dental care – eating a low-sugar diet and cleaning and flossing the teeth regularly can reduce one’s risk of tooth decay, gum disease and tooth loss. Visit a dentist every six months for a dental examination and professional cleaning, or more frequently as per your dentist’s advice.
Blood tests – annual to five-yearly blood tests may be done to further assess or confirm risk of disease. These may include blood sugar levels, cholesterol levels, kidney function, liver function, tumour markers, among other things. They may be done frequently if there is already an existing medical condition.

Cancer screening – various screening techniques can be done to detect different cancers in their early or pre-cancer stages. These include; skin inspections for any suspicious moles/spots, two-yearly mammograms for those at risk of developing breast cancer, Pap smear or the new Cervical Screening Test (CST) every five years, stool tests and colonoscopy (every five years) for those at most risk of bowel cancer, prostate cancer screening for those at risk (over 45 years of age, family history of cancers etc.). Discuss appropriate tests with your doctor.

Vaccinations – You should discuss with your doctor about the necessary routine immunisation, in particular; the Covid-19 vaccines, an annual flu shot, a five-yearly pneumococcal vaccine if you have never had one or you are immunocompromised and any other boosters that you might need.

If you need further advice or treatment please call 4924730, email HYPERLINK “mailto:info@themedicscentre.co.bw” info@themedicscentre.co.bw or visit www.themedisccentre.co.bw

Antoinette Boima, MBBS, BMedSci, PgDip HIV/AIDS, Cert Aesth Med is the Managing Director of The Medics Centre in Palapye.

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