Care Scotland…Africa?

Margaret Graham reflects on an educational trip to Botswana…

As the plane came in to land in Botswana I was struck by two things: the vast emptiness stretching out beneath and the richness of it all. The bright red earth, the green of the vegetation, a land which, on first site, is ripe for development and yet one where there are few houses and nothing you could call a city. There is a sense of ‘the land that time forgot’ and I couldn’t help wondering how long it could stay that way.

Anyone who has read the No 1 Ladies Detective Agency (those who have not yet discovered it should do so now) will identify with my excitement as we headed for Molepolole Road and my hotel which was to be home for the next two weeks.

This, in itself, was an interesting journey. It is 4 kilometres from the airport to the hotel, but there is one drawback – there are no signposts and few street names, so unless you know where you are going and how to get there, you face a challenge. However, one hour after leaving the airport we finally found The Grand Palm Resort, which is neither all that grand nor a resort, but it has potential. The tourist industry is expanding and the Alexander McCall Smith books are putting Botswana on the map for tourists from all over the world.

My driver, and instant friend, is Brigitte – she is from Frankfurt and is in Botswana for 2 years to develop a series of courses in Health and Social Care which will be taught in the Technical Colleges. I am here as her consultant and in two weeks need to decide with her where to start and what should be on offer to meet the care provision needs the country is beginning to identify.

As I unpacked my suddenly inadequate selection of clothes into the equally inadequate wardrobe provided, I switched on the television and was caught almost immediately by the programme that came on. Young people were discussing what they should be told about HIV/AIDS by their parents and teachers. They were clear, articulate and angry. The adult presenter was patronising and dismissive. Suddenly the enormity of the job they have in store here seemed almost overwhelming. {mospagebreak}

The statistics are frightening, one in three of the population is HIV positive and the latest figures estimate that 80% of the university students have already contracted the disease. The strain of the virus is different from those in other parts of the world and people can become infected with more than one strain which makes it even more difficult to slow down the progression of full-blown Aids with the use of anti-retroviral therapy. Diagnosis is slow, due in the main to a reluctance to be tested, so often by the time people are diagnosed as HIV positive they are already very sick and have only a short time to live.

There is some home-based care available but this is carried out by volunteers with little training and certainly no training in interpersonal skills. The suicide rate is high and those who do not choose this way out often suffer from depression, which largely goes untreated. Training the home based care workers will make a difference to the quality of life Aids sufferers have left, but it will take a long time as the college is not even built yet and the most basic training will take a year.

What becomes clear almost immediately is that HIV/AIDS is a social problem rooted in the culture and customs of the country. While this is something I knew at one level, the reality is very complex indeed.
The search for the legislation which would tell me the legal age of consent to sexual activity was a long and arduous one, however, once found, it seemed that the law was, to say the least, vague, giving three different ages in different sections ranging from 12-18. Girls and women have not yet been empowered to say no, even if they want to and the superstition that if a man has Aids he can be cured by sleeping with a virgin remains a real belief in some areas. All of this means that although a legal definition of child molestation exists (vaguely), as does a legal definition of rape, the cultural norms within the family do not protect children and therefore even the basic building blocks of equality and rights are missing.

I was told that in the rural areas where traditional doctors continue to practice, the traditional form of curing infection is blood letting – the problem being that the same blade, un-sterilised, is used on everyone. {mospagebreak}

At the end of my two weeks we have designed outline programmes for Foundation, Certificate, Advanced Certificate and Diploma courses; written three units as examples to give the Social Workers and Health Professionals an idea of the level and content to expect from the training programmes; and outlined possible job descriptions for workers at each of the levels.

Perhaps even more importantly we have designed a unit on HIV/Aids that will be taught to every student in Further Education in all colleges from the end of this year, with the aim of starting to help the young people understand what has happened and how it can change if they change. Now this may not sound a lot but the structure of the day tends to conspire against one, as does the bureaucracy – work commences at 7.30a.m. and ends at 4.30p.m., with lunch from 1p.m.-2p.m., so really any meaningful work needs to be done in the morning, which is OK so long as the technology holds together.

This is not a poor country – the diamonds discovered following independence in 1966 ensured this. It is developing rapidly and new industry, housing, shopping malls, and all that goes along with these things are more and more in evidence. Despite all this, Botswana remains highly dependent on neighbouring South Africa for most things, including foodstuffs. There is little large-scale farming here, although cattle are revered (an individual’s wealth is still measured by the cattle he owns) and meat is plentiful and very cheap. They grow little in the way of fruit or vegetables and while beef production is large scale and commercialised in the south of the country, it has not expanded out of this area.

And so my time here is drawing to a close, and I can honestly say I am in love with Botswana – the climate is wonderful the people are happy and friendly, the ex-pat community have made me welcome and entertained me well. I have seen animals in their natural habitat: the giraffe were awesome, the Impala and the Kudi were graceful, the Zebra, Warthogs, Wilderbeast, Ostrich and all the others have given me wonderful memories of my safari.

I simply can’t wait for my next trip.