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School re-opening during COVID-19-the health, educational and logistical dilemma (Part II)

As you are aware, on 27th July, the Greater Gaborone COVID-19 zone was put under lock down after a reported spike in new COVID-19 cases. In essence, we have suffered the much dreaded second spike.

Worth mentioning is the fact that new COVID-19 cases were also identified in some schools in Gaborone and Mogoditshane, with one private school recording an estimated 30% infection rate. In view of this, Botswana Sectors of Educators Trade Union (BOSETU) has called for the closure of schools up to next year, arguing that no effective learning can occur under the circumstances.

BOSETU’s calls notwithstanding, the only commitment that government has made is that pre-schools will not re-open when schools re-open. The question is: is government right not to accede to calls to leave all schools closed when the Greater Gaborone lockdown is lifted, possibly in a week’s time? To answer this question, a detailed background is required.

In May, when government announced its intention to open schools on 2nd June and 16th June for completing classes and all other classes respectively, debate ensued as to whether it would be safe in view of the COVID-19 pandemic.

At the time, trade unions, especially BOSETU and Botswana Teachers Union(BTU) argued that the shortage of classrooms, laboratories, toilets, washing basins, etc will make the observance of social distancing and hygiene impossible, risking an uncontrollable spread of COVID-19 when schools re-open.

Government, on the other hand, argued that the aforesaid constraints notwithstanding, opening schools is important lest our children lag behind to an extent which will be difficult of remediation in future. Government further argued that schools have been assigned funds to address the infrastructural concerns raised by the trade unions.

At the time, I argued that because government had, for years, failed to build more classrooms, laboratories and toilets, such backlog could not be addressed in the two months that schools were closed during the national lockdown. I also argued that the high teacher-student ratio caused by limited teachers, classrooms and laboratories would also take years to address.

I, however, argued that be that as it may, schools must open at one point or another. To me, the question then was: when would it be appropriate for schools to re-open, and in what manner?
In attempting to answer the question, I considered what other countries had done. At the time, France, which had recorded 70 new cases of COVID-19 in schools, had allowed schools to reopen, with classes capped at 10 students for preschools and 15 students for other age groups.

In the United Kingdom, there were plans to re-open schools from 1st June though trade unions were opposed to the decision. Some local Councils were threatening to defy the national government and not re-open as planned, arguing that opening so early poses a risk of a second COVID-19 spike.

In South Africa, government also intended to re-open schools in June, but trade unions, especially the South African Democratic Teachers Union (SADTU), were threatening to advice teachers not to go back to work until it is safe to do so. South Africa’s Minister of Basic Education, Angie Motshekga, defended government’s decision to re-open, arguing that it would be unfair for those who do not want to re-open to disadvantage those who want to re-open.

As you may be aware, the South African government later decided to close schools when, as trade unions had warned, the country suffered a second COVID-19 spike.  From the above, it is clear that the trend was to re-open schools in June. The Botswana government was, therefore, not alone in that regard. However, I argued then, as I do now, that this is not a case of the majority; It is a question of life and death where rationale, not numbers, must prevail.

I also wish to add that the determining factor here should be the circumstances of each country, taking into account such factors as the health system’ s readiness to cope should the number of those who require hospitalisation rise exponentially. The question I posed then was whether opening in June would not pose the risk of a second COVID-19 spike as had happened in France?

According to the guidelines given by the Ministry of Health & Wellness, all institutions, including schools, must practice social distancing, where people must be about two meters apart. I argued then that if we still have classes of more than forty students, some of whom share chairs, desks, textbooks and laboratory equipment, social distancing is not feasible in schools.

I also argued that the requirement for combis to keep registers, take body temperatures, and to keep record of such in respect of all passengers, including students, was a near impossibility. To illustrate my point, I gave an example of urban schools, where students would have to be waiting for combis from as early as 5:30 am, in the cold of winter.

As you are aware, that early in the morning combis are in a rush and students struggle for combis with those going to work. Is it realistic that combi operators would keep registers; take temperatures and record such in such circumstances?  I also argued that the fact that this routine must also be done at schools compounds the problem. I gave an example of a senior secondary school with, say, 2000 students, arguing that taking body temperatures is a near impossibility considering that some schools would have only two thermometers, for instance?

I opined that even if the students arrive at school as early as 6:00 am, it is near impossible for them to complete all the said protocols in time to start their lessons at, say, 7:45 am? As you may have observed, an attempt to adhere to the above protocols has resulted in students overcrowding, for instance, in queues at the school gate, something which increases the risk of infection.

Then there is the requirement to wash hands regularly. I questioned whether our schools would have enough washing basins and soap or sanitizers for such? Even if we had enough, how many students would wash their hands, especially in the cold of winter?

Then there is the requirement to wear face masks. I had a suspicion that it will be difficult for students, especially at lower primary school to wear face masks at all, or to wear them properly. Then there are boarding schools whose hostels are, as of necessity, congested, with bunker beds and shared showers. In some schools, about 98% of students are boarders. I wondered how social distancing and hygiene would be ensured in such an environment?

Then there is mealtime where students queue for meals; seat in groups when they eat; and gather at the tap for washing their hands and utensils after meals. Then there are primary school students, especially at lower levels, who, even if they may have been told that COVID-19 is a deadly virus, may not have the cognitive and affectionate ability to comply with the social distancing and hygiene protocols.

I concluded that if strict regard is had to the aforegoing, schools would not re-open in June, even in January 2021. I, however, opined that that would have devastating consequences in the long term, contending that we must make do with what we have and re-open schools as soon as it is safe to do so for the sake of our children’s future.

For me, the question was: when and how, then, should we re-open schools? I gave three alternatives in order of priority. The first alternative was for schools to re-open in July. This view was informed by the fact that June is the coldest month of the year, during which many people contact the influenza virus and suffer bouts of flue.

It was my view that if schools opened in June, we may face a double jeopardy of flue and COVID-19 in schools. I contended that because when somebody has flue, they have a temperature rise, this will pose a challenge considering the requirement to take temperatures for COVID-19.

I argued that, as per the COVID-19 protocols, we could end up having to refer many students whose temperatures are more than 37.4 Degrees Celsius not because of COVID-19, but because of a common cold, something which would, no doubt, overwhelm our system.

As you are aware, we have students with such underlying illnesses as Asthma. Ordinarily, such conditions worsen in winter. Some may be triggered by allergies, and some students may be allergic to the sanitizers that will be used. The second alternative was for only completing classes (i.e. Standard 7, Form 3 and Form 5) to re-open in June, and the rest to re-open in January 2021.

In my view, this would free up classrooms; laboratories; hostels and dining halls, making compliance with the COVID-19 social distancing and hygiene protocols feasible. The third alternative was for only Form 5s to re-open in June and the rest, including Standard 7s and Form 3s, to re-open in January 2021.

As you are aware, we have automatic progression from Standard 7 to Form 1. We also have near automatic progression from Form 3 to Form 4. In my view, there would, therefore, be limited impact on Standard 7s and Form 3s since their examinations are, for all intents and purposes, more formative than summative.

I opined that to cater for the subject matter the students would have lost, a bridging course and/or remedial lessons could be developed for January 2021. Also, the Form 1s and Form 4s could open early and have reduced school vacations to cover up for lost time. I argued that, in any event, students taking such practical subjects as Agriculture, Home Economics and Design & Technology have already lost a lot of time in preparing for their practical examinations.

At the time, government had hinted at the possibility of using the double shift system in terms of which a class would be split into two, with each sub-class coming to school at different times. You may be aware that this system has been used before and it was stopped because of the numerous problems it presented. Besides overworking teachers, something which affected their delivery and led to poor results among students, some students were attacked and raped by criminals because they had to knock off late from school.

I argued that in the COVID-19 era, this would be problematic because students, especially in urban areas, would be put at the risk of boarding combis which have not been sanitized and without the requisite social distancing since such protocols are unlikely to be observed when it is dark, especially in winter.

From the new infections recorded in the one school in Gaborone and another in Mogoditshane, it is clear that if the COVID-19 virus finds its way into a school, many students may be infected.
Therefore, in view of my argument that it is difficult for students to comply with COVID-19 protocols, it may be in the children’s best interest that school re-opening be delayed until it is safe for them to return.

In my view, considering that August is said to be the peak month for many countries, including our neighbour, South Africa, it may be advisable to re-open schools in January 2021 because after August/September very little will be left of third term. Logically, the January 2021 argument should only be applicable for the schools in the Greater Gaborone zone, but if the Greater Gaborone zone schools are to remain closed, so too should schools in the rest of the country because students sit for the same national examinations.

*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 HYPERLINK “mailto:anmorima@gmail.com” 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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