Pamela Jackson-Malik: Africa trip reveals AIDS crisis, human spirit

Ever hear of the "Penn Firm" located in Botswana in southern Africa? Until recently, I hadn't either. In early May of this year, the Penn School of Nursing sent out an announcement about an opportunity for an international student summer experience in Botswana, Africa. This observational experience would be the first of its kind and we would be the first nursing group to travel to the city of Gaborone (pronounced "Hah bah row nay"). This would be a chance to get a first hand look at how Botswana is addressing their HIV /AIDS epidemic.

The Joint United Nations Program on HIV/AIDS estimates that over the past two decades approximately 40 million people worldwide have become infected and over 12 million people have died. According the Center of Disease Control (CDC), Southern Africa has the highest prevalence of HIV infected individuals in the world. Moreover, Botswana has one of the highest prevalence of HIV infection in the world and almost 40 percent of all adults in this population of 1.7 million are infected. The average life expectancy in Botswana is about 45 years and given the current progression of HIV/AIDS life expectancy is projected to drop as low as 35. AIDS is the number one cause of deaths in Botswana.

Several public and private organizations have joined the battle to fight AIDS such as the University of Pennsylvania, Baylor University, Harvard University, the United Nations, and the CDC, just to name a few. The aim is to encourage HIV testing, provide treatment, administer antiretroviral (ARV) therapy, monitor adherence, and implement prevention programs throughout Botswana. But Penn has also gone one step further. Penn's medical school runs a medical inpatient service program called the "Penn Firm" in the Princess Marina Hospital, a 550-plus bed regional referral hospital located in the city of Gaborone.

After first hearing of the program, I met with Dr. Rob Roy McGregor and Dr. Steven Gluckman, two physicians instrumental in establishing the Botswana Penn Firm. They told me about HIV, ARV therapy, the country, culture, and people of Botswana. But when it came to tell me about the purpose of the Penn Firm, both men excitedly and passionately explained what Penn physicians, residents, and medical students were doing for the citizens' Botswana. I was well acquainted with HIV/AIDS treatment and prevention programs in the United States, but I've never seen medical staff so passionate about a cause. I prepared for my trip to southern Africa.

We arrived in Botswana and spent the first day meeting and greeting faculty and getting oriented to the University of Botswana campus. We met with officials in the American Embassy, Ministry of Health, Ministry of Local Government and Nurses Association, to name a few. And yes, we did gain insight into how well the National Health Care Plan provided coverage to its citizens and how the HIV/AIDS epidemic challenges the system.

But nothing prepared us for what we would encounter in the clinical setting. For our first observational experience we were scheduled to spend the day at the Princess Marina Hospital, touring the hospital's inpatient units and outpatient ambulatory care clinics. The outpatient waiting room was literally over flowing with people waiting to be seen. The ambulatory-primary care nurse manager gave us a tour through various clinical areas and told us she expected more patients throughout the day.

I went on to the Penn inpatient service male and female medical units. What I saw was overwhelming. There were patients everywhere. These 35 to 40 bed inpatient units had over 50 to 60 admitted patients. Not only were the beds occupied, there were patients on mattresses on the floors and in the hallways. Strikingly, a majority of the patients were very young and looked sick. The nurse manager of the Penn unit told us that most patients were suffering from AIDS. Staff was extended and needed additional help.

Nursing staff and physicians were constantly moving throughout the units and the nurse manager graciously took time to meet and greet us and told us about the condition and answered our questions. My immediate internal response was "How can I help?" As a nurse, I wanted to pitch-in and do something. I had to remember that this was an observational experience and we were not allowed to provide patient care.

For me, though, the most disturbing time was when the Penn nursing group visited the pediatric unit. Once again this unit was also filled over capacity. Mothers had mattresses on the floors next to their children's beds and staff was engaged in patient care. To see so many small infants lying there almost lifeless was heart wrenching. The heavy workload is overwhelming compared to American standards, yet despite the conditions you got the sense that staff had adjusted to the situation and focused on providing patient care. How they managed to keep a clean and orderly unit while providing care was beyond me. By the end of the day I had a profound respect for the doctors and nurses.

The following days we travel to remote community based clinics, out-posts, remote hospitals, hospice, birthing centers, and rehabilitation facilities in located villages outside of the city of Gaborone. We where pleased to see that these programs were managed and operated by nurses, several of whom came out of retirement because of the need for staffing and to prevent and treat HIV/AIDS.

Almost two weeks later, the nursing group returned to the Princess Mariana Hospital and met with Dr. Jason Kessler, a Penn full-time attending physician. Dr. Kessler explained that he and one or two Penn Internal Medicine Residents and several medical students provide medical coverage for the inpatient unit, in collaboration with Botswana physicians and nurses. It was customary for a physician to treat at least 200 patients each 12-14 hour day in the inpatient area and in the clinics.

One of us asked him why he stays in Botswana working under such demanding conditions. He simply replied, "I stay because the work is so full-filling and I get a true sense of accomplishment. I can't explain it, but I feel like I'm serving a greater purpose. I can't find this kind of experience in the United States."

At that moment I understood MacGregor's and Gluckman's enthusiasm. It's not about the money or the prestige to say I worked in Africa. These Penn physicians are there for the higher purpose, the cause. They are there to save as many lives as possible no matter what the conditions and to fight HIV/AIDS.

Pamela Jackson-Malik is a Ph.D. candidate, health policy and policy research major from Boston, Mass., and editorial page cartoonist for The Summer Pennsylvanian.

Please note All comments are eligible for publication in The Daily Pennsylvanian.