Monday, December 1, 2008

Healthcare Across Cultures

Below are two versions of the same story. One audio/visual and one textual. Digest however you please...

(Special thanks to Margarett Davis, Paul Richards and Lindsey Stull for their help with this report.)



Scottish Bagpipes are not a cultural phenomenon usually associated with Sub-Saharan Africa.

However, on November 1st, five men wearing kilts brought the sounds of the highlands to a new parking lot in Molepolole, the largest urban village in Botswana. The parking lot, empty of cars, was instead filled with politicians, foreign dignitaries and several hundred residents of Molepolole, many of whom commute to the nearby capital city of Gaborone for employment and healthcare. The crowd gathered in the heat of the nearby-Kalahari Desert to celebrate the re-opening of Scottish Livingstone Hospital. The hospital’s origins stretch back nearly a century to when Scottish missionaries brought Western medicine and healthcare to Botswana.

In recent years, as Molepolole underwent a dramatic population surge, the government-run hospital became too small to adequately serve the needs of the 250,000-person community. After a massive reconstruction, which cost nearly 350 million Pula (around $50 million USD), the hospital reopened with a grand spectacle of speakers and performances.

Scottish Livingston Hospital is named in honor of Dr. David Livingstone, the famous Scottish missionary and explorer who trekked across much of central and southern Africa in the mid 1800s. Credited as the first practitioner of modern medicine in Botswana, Livingstone's personal motto was, "Christianity, Commerce and Civilization."

In 1947, another Scottish missionary and physician by the name of Dr. Alfred Merriweather followed in Livingstone's footsteps. He came to Molepolole to run the Livingstone Hospital, and continued to work there until 1980, even after its transition to a state-run health facility.

Merriweather was a beloved figure in his lifetime. He became fluent in the regional Setswana dialect, adopted a Motswana daughter, and worked to establish effective healthcare facilities around the nation. Likewise, his novel approach to missionary work was based on a tolerance for local culture and traditions.

Scottish Livingstone Hospital used to be little more than a large clinic. However, after the remodeling, the hospital is now an expansive complex of buildings, connected by passages and courtyards. The Minister of Health, Lesego Motsumi, announced that the new space will house 350 beds for inpatient care, an emergency and accident center, updated equipment, and a host of specialist services. Partnering with German doctors, the hospital will soon be opening a cardiology unit that, according to Motsumi, will be the first of its kind in Botswana and one of few in all of Africa.

The Minister explained the economic implications of the Hospital’s construction.

"Annually we spend about P70 million on referrals to South Africa. With facilities such as this one, we’ll be in a position to reduce costs to the nation,” she said.

According to various official sources, somewhere between 25% and 33% of the adult population in Botswana is HIV positive. And though this marks a dramatic decrease over the past five years, Botswana still ranks as having one of the highest infection rates in the world. But with partnerships and donations coming from a wide range of sources like the Centers for Disease Control, The Gates Foundation, the U.S. President's Emergency Plan for AIDS Relief, also known as PEPFAR, Botswana is working to address this problem. The Scottish Livingstone Hospital represents one of the many projects that the government hopes will provide more effective treatment and preventative care for HIV/AIDS patients.

Later in the ceremony, Dikgaka, a traditional performance group, took to a small stage in the parking lot. Several dozen men and women clad in animal skins and strings of bead-filled moth cocoons danced, sang and stomped their feet. Meanwhile, guests in suits, ties, and high heels, watched with amusement and appreciation.

In many ways, the contrast between the audience and performers represents the community's integration of new living standards and cultures. As the Molepolole Representative in Parliament, Daniel Kwelagobe, explained in the regional dialect of Setswana, this large, sleek building may represent change, but it is change uniquely fitted to the needs of the community.