Thursday, December 3, 2020

School of Medicine comedy of errors

Had the government developed enabling legislation more than four years ago, the School of Medicine (SoM) students at the University of Botswana would now be able to use cadavers for their practicals, Sunday Standard has learnt.

Part of the planning around SoM was to put together what is known as the High Ranking Committee, which was made up of permanent secretaries from the ministries of Finance and Development Planning, Local Government, Health and Education and Study Skills with the latter sitting at the head of the table. Membership of the Local Government PS ceased when Health took over clinics. The HRC was explicitly tasked with ensuring the promulgation of enabling legislation, which task entails the amendment of the Public Health Act.

In terms of the plan to establish SoM, one of the key functions of the HRC is to ensure “the promulgation of enabling legislation (amended Public Health Act) for medical education and training in Botswana, embracing procurement and use of cadavers and organ transplants.”

One of the things that the HRC was assigned to do in June/July 2007, was to decide on the role of project players, among them the Ministry of Health (MoH). Between September and October of that year, the HRC was to propose any amendments to legislation while MoH was to report on the status of amendments to the Public Health. Consultation between the two parties was to yield an amended Public Health Act in November/December of the same year. Alongside that, UB was to contract a consultant to provide a bibliography of laws pertaining to the practice of medicine from which determination was to be made as regards those that needed to be knocked into shape in readiness for SoM. UB decided it had adequate personnel and the task was handled by its law department.

Although the process was initiated, it was never seen through to the end. A draft amendment to the Public Health Act was passed around, sent back to its originators, got stuck somewhere and never went back into circulation.

At around this time, the health minister was Professor Sheila Tlou. Now working in South Africa as Director of the UNAIDS Regional Support Team for East and Southern Africa, Tlou says that during her term in office, the process to amend ‘all’ relevant pieces was well in train. She took the Human Tissues and Organs Bill to cabinet which tweaked the language and scope of the bill.

Subsequently, it was decided that all relevant additions would be incorporated into the Public Health Act. Throughout the process, Tlou says she impressed upon her cabinet colleagues the need to have legislation ready in time for the opening of SoM. Thereafter, she says the proposed law “was pushed to the Attorney General and I don’t know what happened afterwards because I left cabinet.” She did so on April 1, 2008 by reason of not being reappointed by President Ian Khama when he took over from Festus Mogae.

“As far as I am concerned, legislation – including one that allowed the use of cadavers – should have been long in place when the school started enrolling students. I don’t know what happened afterwards but I expected future ministers to pick up where I left off,” Tlou says.

She was succeeded by Lesego Motsumi who stated publicly that she would have no qualms donating her body for medical education and research. However, even as she was saying this, there was and there still is no legally sanctioned donation of human cadavers for medical training.

According to the spokesperson of the Ministry of Education and Study Skills, Oarabile Phefo, the process of amending the Public Health Act is “at an advanced stage.” Sunday Standard sought to find out how far that process was but at press time and more than a week after written questions were submitted, the Attorney General Chambers still had not shed light on the matter.

Whatever the reasons for the delay, the result has been that students at SoM are unable to learn anatomy by cadaveric dissection because currently there is no legislation that permits the donation of dead bodies. The practice in medical schools is that before medical students lay their hands on the living, they learn anatomy from the dead – their first patients as it were. Through this first experience, students learn the structural organisation of the body in a three-dimensional way, acquire manual dexterity, useful communication skills as well as bond by team work.

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The Telegraph December 2

Digital edition of The Telegraph, December 2, 2020.