The Associate Project Director of the Botswana Medical Education Partnerships Initiative (BOMEPI), Dr Oatlhokwa Nkomazana, says the time has come for Botswana government to make available, attractive systems which may in a way reduce or stop completely the mass exodus of Batswana doctors who leave this country in large numbers to go and seek greener pastures elsewhere.
Over the years, she says this country had lost many medical doctors, most of whom would, upon completion of their studies, either prefer to remain and work overseas, or would come back home for a short stint before they head back to where they feel the packages are attractive, even though it is government’s wish that they work locally to provide health care to fellow countrymen and help grow the country’s health sector.
“We have had a retention forum in the past, and although our curricular is very much supportive of retention, at the moment there is nothing binding our medical graduates to stay,” said Nkomazana. “All that needs to be done is for our country to improve for it to convince them to consider staying because as it stands now, the country has become too dependent on expatriate doctors while we have locals trained in the same disciplines.”
Nkomazana said this in Maun during a site visit of the Letsholathebe II Memorial Hospital by a delegation from the University Of Botswana School Of Medicine (UBSom) whose aim was to highlight achievements made by the school to put in place programs and infrastructure for both teaching and learning.
Letsholathebe is a referral district hospital, which was selected alongside Princess Marina Hospital, Mahalapye District Hospital and S’brana Mental Hospital in Lobatse to undertake the training of locally relevant doctors who currently rotate between these hospitals doing their clinical training.
Community sites have also been set up in Gaborone, Molepolole and Serowe where UBSom students will be distributed for training. In Maun they will be deployed at Maun General Hospital 24 hour clinic, Sedie, Boseja and Moeti clinics as part of their project.
Responding to a question posed by Sunday Standard as to whether they are wholly convinced as project facilitators that the local training will bear fruit, considering the already minute number of training personnel, particularly in Maun where there are only three, Nkomazana said apart from the three lecturers, they also rely on assistance from specialist doctors based at training centers, including Letsholathebe, who, despite lecturing, also avails time to see patients, citing herself as one such example.
She said the university has no recruiting powers as the bulk of teaching is done by people from the Ministry of Health. After training, she said the students do two years internship, and can work independently as registered doctors after completion.
According to Ray Mangope, the Deputy Director of Public Affairs at UB, UBSoM has since its establishment in 2009 been working hard to set up its programs and the necessary infrastructure to support teaching and learning, which include the outfitting of the clinical teaching sites where trainee doctors spend the last three years of their training.
However, he said two rural clinical sites have been strategically chosen to expose the learners to rural medical practice in areas similar to those where they will be needed most as practitioners, which is part of the long term strategy to encourage the retention of doctors in rural settings.
The UBSoM is said to have admitted the first group of thirty six medical students to its five-year programme in August 2009, and now has 229 medical students distributed over the five years, while the first batch of 36 are expected to complete their course of studies and graduate in medicine and surgery in the second quarter of 2014.
A press statement from UBSoM states that the school successfully competed for a US$10 million grant by the President’s Emergency Plan for Aids (PEPFAR) through Health Resources and Services (HRSA) to support the training of doctors in Botswana as well as their retention in places where they are most needed, such as in the districts, and also to build locally and regionally relevant research infrastructure. In partnership with the University of Pennsylvania and the Harvard School of medicine, BOMEPI has also invested significantly in curriculum and faculty development, as well in the creation of a positive teaching and learning environment in the four clinical sites being Maun, Gaborone, Lobatse and Mahalapye.
Letsholathebe II Memorial Hospital Superintendent, Dr Maxwell Mungisi, said although a new thing, stumbling blocks will always be noticed from time to time even though that should not discourage any development as their goal should always remain.
“We will always have to achieve, no matter what surfaces along the way. We still do not have enough lectures, and I believe that will determine the kind of product we are going to produce at the end of the day, and I do not know if the government and UBSoM can come up with solutions to mitigate this. As a teaching site, we need more specialist doctors, because the more we have, the more they will impart knowledge on our students. On the other hand also, I believe that the daily availability of doctors here is a blessing to our communities since they will also improve the quality of service we offer as they add up to the number of doctors we already have, meaning they spend more time with patients other than just treating to clear because of the work load.”
However, he said they are challenged on the part of accommodation as their students have to stay in the village and travel long kilometers on a daily basis, thus disrupting the normal flow of events. He said their desire is for the issue of accommodation to be addressed so as to allow them to stay within the hospital vicinity as they have to be within reach most of their time to better carry out their day to day tasks.