Perspective | When fighting AIDS trains doctors, too

Six years ago, Harvey Friedman received a call that would alter his entire medical career.

The Merck and Gates foundations had partnered with the government of Botswana to make HIV medications available, and they needed his help to distribute and train people to administer anti-retroviral drugs.

"They chose us," said Friedman, the chief of Infectious Diseases at the Hospital of the University of Pennsylvania.

Originally, Penn had only one full-time doctor in the country, whose HIV infection rate nears 40 percent.

Today, Penn has eight full-time doctors, an intern-training program and will help open the country's first medical school - but Penn is not just working to improve the country's HIV treatment and quality of life.

This past summer, undergraduates and Veterinary School students made their way to Botswana, opening these students' eyes to a country much unlike their own.

The medical side

Friedman and Stephen Gluckman, HUP's clinical director of Infectious Diseases, initially hoped to design and implement an HIV-treatment program in 2001, Gluckman said.

Since then, it has become a "model program for the world," he added.

When Penn began its involvement in Botswana, there was no medical school or graduate medical program for training medical interns, residents and fellows. Batswana - the people of Botswana - had to go abroad for such training.

Only 12 percent of them returned after finish their studies.

There "has been a serious brain drain," Gluckman said.

In response, Penn helped begin an intern training program last January; a medical school and a residency-training program will start in about a year.

"I hope these will grow into being the future of medicine in Botswana," Gluckman said.

University President Amy Gutmann, who traveled to Botswana this past summer, said the highlight of her trip was seeing Friedman, Gluckman and the other medical staff at the AIDS clinic at the Princess Marina hospital.

"That's an existing proof of what we can do . to make a difference in this world," she said.

Penn has expanded from the initial Princess Marina hospital to a hospital in Francistown and nine of the district hospitals in the country, Friedman said.

He added that Penn helped begin a women's program this year with a cervical cancer screening program in HIV patients and a joint treatment program for HIV and tuberculosis infected patients.

Still, it's not just Penn doctors who are trying to improve medical care in the region.

Penn medical students and residents can complete elective credit in Botswana: About 72 medical students apply for 32 spots, and the students are chosen by lottery.

Going to Botswana "gives [students] a chance to really be doctors and practice medicine with a stethoscope rather than by merely ordering tests," Gluckman said.

Penn medical fellow Jennifer Cohn worked in the country for six weeks as an infectious-disease resident. On the female medical ward, she cared for 30 to 40 patients every day and encountered many patients with HIV complications.

She said the "sheer volume of patients was overwhelming."

"Botswana has one of the highest HIV infection rates of any country," Cohn said. "It was really overwhelming that pretty much half of the population in the capital Gaborone was infected."

On the bandwagon

Two summers ago, University Provost Ron Daniels decided to see Botswana for himself.

It was during this visit that the provost began to see Botswana as "one of our critical international priorities," he added.

Since the medical school already had a strong presence there, it made sense to him to deepen the University's involvement there rather than spread it more thinly.

"HIV/AIDS . had such a devastating impact on the country," Daniels said. "It's not just an issue that raises concerns about the nature of medical intervention, but it raises all sorts of issues" like education, social policy and other areas of governance.

Soon, the Wharton School, the School of Social Policy and Practice and the Nursing School also entered the sub-Saharan African country.

Communications professor John Jemmott is working with Loretta Sweet Jemmott of the Nursing School as well as the University of Botswana to develop an HIV/AIDS protection program for adolescents, Daniels added.

"The idea is . to really see this as a cluster of activity that would enlist the involvement of people throughout the University," Daniels added.

For example, Wharton professor Ian MacMillan is working with students from the Engineering, Wharton and Medical schools to develop software that will help monitor administration of medicine to patients.

"Botswana stands out as one of the great success stories in Sub-Saharan Africa," Daniels said.

The summer program

Penn started offering the opportunity for undergraduates and Veterinary students to go to Botswana for 10 weeks last summer.

College senior Rachel Han, who volunteered at the Princess Marina hospital, implemented patient surveys and helped make a hospital brochure.

"I hope that in that summer, the hospital learned the importance of getting information from their patients and . improving the general conditions of the hospital," Han said.

College junior Rachel Shah, a Daily Pennsylvanian photographer, worked in the eye ward, where she helped set up a database to monitor the outcome of cataract surgery.

"One of the biggest problems in Botswana is the lack of human resources," she said.

Third-year Vet student Emily Howe said she was "pleasantly surprised" by how developed the city was.

At one point, she was mugged, and Howe said people came out of their houses to chase the two culprits.

"I saw the best of humanity and the worst of humanity," she said of the incident.

Howe and fellow Vet student Florence McAvoy spent the majority of their time working at an animal-veterinary practice.

McAvoy said working there was different from working in the United States because doctors often lacked the resources that are taken for granted in the United States.

We "couldn't perform all of the diagnostics that we were used to performing at Penn," Howe said.

And for some students, Botswana offered experiences that could never occur in the United States.

Third-year Vet student Janna Kerins recalled having to help pull a rhinoceros out of the mud, which took more than nine hours.

The experience "was completely new to me," she added. You "can't really get that here."

Back to Philadelphia

Though the groundwork is taking place in Sub-Saharan Africa, a lot of the preparation takes place here in West Philadelphia.

John and Loretta Jemmott conduct a great deal of the research on sexually transmitted diseases they use in Botswana in West Philadelphia, Daniels said.

"Our global engagement in Botswana and our local engagement in Philadelphia are two sides of the same coin," Gutmann said.

Daniels said Penn will continue to send Penn students to Botswana.

Sometimes, though, Penn doesn't need to send its students in order to have them make an impact in the Sub-Saharan country.

Gutmann said one highlight of her trip was meeting with the president of Botswana and discovering that his chief of staff was a Penn graduate -sporting a Penn tie.

Botswana "is a model . for how we should engage globally," she said.

Each week, The Daily Pennsylvanian takes an in-depth look at an issue affecting the community. See Perspective every Tuesday.

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