Bryony Freeman The youth vote

Published: 15/01/2004, Volume II4, No. 5888 Page 29

My elective trip to Botswana as part of the NHS management trainee scheme has ended. As my placement drew to a close it was a chance to begin preparation for my second training scheme placement at the Commission for Healthcare Improvement and to contemplate necessary readjustments to life back in London.

The main elements of my elective were to learn how to work independently and to adapt to a new healthcare environment, in this case dominated by the treatment of HIV/AIDS. The UK is experiencing a rise in HIV-2 (African strain) and so to understand the differences in cultural presentation is crucial. For example, while HIV/AIDS in the UK undoubtedly has some stigma attached, HIV/AIDS in Botswana has difference stigmatic issues. For example, public faith in traditional healers can be a huge barrier to treatment as a number of patients will either combine anti-retroviral drugs with traditional medicine or will avoid ARVs altogether. There are other issues too.

Girls aged around 12 often have 'sugar daddies'who provide them with expensive gifts that would normally be out of their reach. In return these girls will have sex with these older men, although they still have boyfriends their own age in order to fit in socially.

One girl I met told me that when she was at school, she had a boyfriend in her class but had regular sex with a man in his 40s who had given her many presents. She finds herself, now age 17, pregnant and HIV positive.

In a society built on community and family support, those infected are often embarrassed to tell their family and therefore deny themselves this support network.Women who have given birth are afraid to bottlefeed their babies as they see this as an advertisement to the world that they have HIV. So instead of protecting their babies, they take the risk of infecting their child in order to protect their reputation.

Working in a different healthcare environment has given me the opportunity to work independently and actively seek input and feedback to ensure continuous improvements. But I have found it taxing to assess my work constantly and to increase efficacy. In addition, some of the cultural aspects of working in Botswana have taken a few weeks to become accustomed to.

For example, to be polite, people will often agree with you and say they will do something - but do not.

One rather cynical nurse I met told me about a meeting for Vision 2016, a Botswana government initiative. The seven 'pillars' of this vision detail Botswana's aims for life in 2016, with emphasis on environment, health and community life. At the meeting, teams would take the stage in turn and reveal ideas for their assigned pillar.

When the pillar representing prosperity, productivity and innovation was shown, its team leader admitted: 'I am sorry Mr Chairperson, we couldn't think what to do.'

For some, this sums up much of what is happening in Botswana.

Bryony Freeman is an NHS management trainee