The BIDMC-Botswana Program is based at Scottish Livingstone Hospital (SLH), a large district hospital in Botswana located an hour from the capital city" of Gaborone. Boston-based physicians affiliated with the Botswana-Harvard Partnership have been doing research on HIV and providing clinical care at SLH for years. BIDMC is proud to have a full-time clinical preceptor, Dr. Tomer Barak, at the site. Recent visitors to SLH include the Chair of the Department of Medicine, Dr. Mark Zeidel, residents and attendings from Medicine and other BIDMC departments, and residents from other medical centers.
The Resident Experience
Visiting residents from BIDMC and other institutions work at SLH for four to six weeks. They primarily deliver inpatient care on a general medical service. Although many inpatients have HIV-related disorders, residents are exposed to a wide range of inpatient conditions. Residents round with SLH medical officers, nurses, and Dr. Barak, the BIDMC-affiliated on-site internist. Residents also participate in outpatient HIV care delivery in a clinic that is part of the National Antiretroviral Treatment Program. In addition, they prepare teaching sessions for and participate in learning sessions from SLH medical staff of all levels. Residents are expected to work with local hospital staff on quality improvement programs to benefit SLH. Read more about this clinical elective and about residents' experiences in the BIDMC-Botswana Program.
Scottish Livingstone Hospital
SLH is located in Molepolole, a large traditional village 60 km from the capital city of Botswana, Gaborone. Molepolole has a population of approximately 70,000 inhabitants within the Kweneng East district (190,000 inhabitants), which has an age-adjusted HIV prevalence of 32.1%. SLH is a 350-bed hospital offering inpatient and outpatient medicine and pediatric services, full obstetrics/gynecology care, surgical services, and an emergency department. It is staffed by generalist physicians.
SLH is a site for the National Antiretroviral Treatment Program. In this program, persons eligible for HAART include adults with an active or recent AIDS-defining illness (including tuberculosis) and / or CD4 cell count < 250 cells/mm3. The first-line and second-line government approved HAART regimens are similar to those used in the United States, and newer agents have recently been added as options for salvage therapy. CD4 cell counts, plasma HIV-1 viral loads, routine chemistries, and hematology are available through the program for monitoring patients and making treatment decisions. Viral genotyping is available for clinical decision-making purposes at the time of second treatment regimen failure.
A Little History
The relationship between Harvard and Botswana is longstanding. In 1996, Max Essex, DVM, PhD, of the Harvard School of Public Health, started working in that country to try to understand the extraordinarily high rates of HIV that were threatening the nation (for a time, the highest rates of HIV in the world). The Botswana-Harvard AIDS Institute Partnership (BHP) was formed as a collaborative research and training initiative in that year and has grown into a fully-operational research laboratory and training center in Gaborone, Botswana, with ongoing research and training initiatives occurring throughout Botswana. Many seminal clinical and laboratory studies have been conducted on topics such as mother-to-child transmission (PMTCT) of HIV, design of an HIV-1C vaccine, and studies on HIV drug resistance at BHP.
Roger Shapiro, MD, of the Division of Infectious Diseases at the BIDMC, was one of the first researchers to begin working at BHP and has been a leader on studies from southern Africa related to infant outcomes and peripartum PMTCT strategies since 1999. With funding assistance from the Harvard Initiative for Global Health, Dr. Shapiro established a Clinical Care and Research Fellowship at the Scottish Livingstone Hospital in Molepolole, Botswana, to support fellows and junior faculty starting careers in international HIV work. This fellowship has greatly benefited the BIDMC and the Harvard community at large, as residents from across Harvard have rotated through Scottish Livingstone Hospital under the tutelage of the fellows to learn about providing HIV care in a resource-limited setting.
Harvard's relationship with Scottish Livingstone Hospital and the national medical school of Botswana is growing with the full-time appointment of a BIDMC internal medicine attending on site as of August 2011.
Botswana is a politically stable country in southeastern Africa. Its population is approximately 1.8 million people, and it is the size of France. Most of the populace lives on the outskirts of the great Kalahari Desert. The government has received widespread recognition for a progressive and laudable response to the HIV epidemic. Botswana was the first African nation to introduce a national program to prevent mother to child transmission (PMTCT) of HIV. Botswana opened its first medical school in 2009, and national residents and medical students will also be rotating at SLH.
Administrative support, Housing and Transportation
Residents live in Gabarone, the capital of Botswana, about 60 km from the hospital (45 minutes away). Most reside in an apartment complex maintained by the University of Pennsylvania, side-by-side with other expatriates. Gabarone is a modern and sophisticated city, and it is relatively easy to navigate. Weekly medical teaching conferences are available at Princess Marina Hospital, the principal teaching site of the University of Pennsylvania, close to the residence. Residents generally travel to and from SLH by car with Dr. Coppock or Dr. Powis. Administrative support for residents (e.g., medical licensure, visas, transport) is provided by staff of the BIDMC-Bostwana Program.
BIDMC-Botswana Program Contacts: John Crocker, Tomer Barak and Dagan Coppock.
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