Botswana Elective for Residents and Fellows

Anesthesia/Critical Care Global Health Program in Botswana

This is a 4-week (or longer) elective in Botswana under the supervision of BIDMC faculty anesthesiologist, Dr. Catriona Stewart. Dr. Stewart is a practicing anesthesiologist, working under the auspices of the Botswana Harvard Partnership. She has an adjunct faculty position at the University of Botswana and also practices clinically at Princess Marina Hospital (PMH) and Sir Ketumile Masire Teaching Hospital (SKMT) in Gaborone. She serves as the Program Director for the international Anesthesia and Critical Care resident and fellowship rotations in Gaborone. By participating in this rotation, trainees will have the opportunity to learn, practice and teach at any one of these medical centers, depending on interest and caseloads.

Senior residents in their CA-3/PGY-4 year and anesthesia fellows are welcome to apply to this elective rotation in Gaborone. The specialties provided by PMH are emergency, pediatric, orthopedic, urological, vascular, ENT, dental, plastics, general, obstetric and gynecological surgeries. PMH is the government tertiary referral hospital.

Elective surgeries are currently being carried out at SKMT, emergency and obstetric and gynecological surgery at PMH

The department consists of consultants, anesthetic trainees year 1 and 2, medical officers, anesthetic nurses and they are split across the two sites. The operating theatres are busy and in January 2024 in 2 theaters we performed 400 operations (due to the others being closed).

The experience of practicing medicine in a resource-challenged country is invaluable and often life-changing. Residents and fellows will have the opportunity to use their skills as educators and clinicians to augment the field of anesthesia and critical care in Botswana and residents will experience bidirectional learning with the clinician on the ground in Botswana. Resident must be prepared for a dynamic experience. The resource limitations not only include medications but can encompass all aspects of medical care from supply chain to electricity to staffing. Emphasis is placed on teaching, developing clinical skills and utilizing valuable resources and troubleshooting in a resource limited setting.

Trainees will learn about perioperative patient care and the management of general anesthesia, regional anesthesia and sedation in a setting that is quite different from their

usual workplaces. Participants will often be caring for patients who present with advanced pathology of diseases not often seen in their home training institutions, both in the ICU as well as in the operating theatres.

This experience can serve as an opportunity for participants at the end of their training to realize the knowledge and capabilities they’ve developed over many years. Rotators gain confidence in their teaching skills and decision-making abilities in an environment where clinical assessment, flexibility, communication and teamwork are crucial to success.

How To Apply

Interested residents and fellows should email Dr. Catriona Stewart at cstewar8@bidmc.harvard.edu and include your CV, and letter of interest.

Learning Objectives

To develop an understanding of the role of anesthesia, critical care and surgery in global public health.
To appreciate the burden of surgical disease in a middle-income country including the absence of essential infrastructure for the provision of safe anesthesia.
To refine the clinical skills required for providing anesthesia and critical care in austere and remote settings where technology and other resources are limited.
To provide patient care that is compassionate, ethical, appropriate and effective for low- and middle-income countries.
To make a lasting contribution to anesthesia care and knowledge in one of three ways: Undertake a QI project to help remedy any one of the myriad barriers to care in which patients in Botswana experience; to contribute to the international literature through a mentored research project pertaining to the global burden of surgical disease and/or the global anesthesia crisis; or to expand knowledge of established and evolving biomedical, clinical, epidemiological and social-behavioral sciences, as well as the application of this knowledge to the safe practice of anesthesia in austere and remote settings.

What To Expect