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Our dependency on South African hospitals: An enduring affirmation of Botswana as a South African Province

SHARE   |   Tuesday, 20 November 2018   |   By Dr Letshwiti B. Tutwane
Chris Hani Baragwanatha Academy Hospital in South Africa Chris Hani Baragwanatha Academy Hospital in South Africa

As an undergraduate many years ago, I had the opportunity to learn that independence of a country does not mean attainment of a national flag or creation of a national anthem. It means full autonomy; the journey towards self-sufficiency in many sectors. I acknowledge that this self-sufficiency cannot be achieved over night but it is a priority for most serious countries and many of them have achieved that, whether it is about food production, education or health care. I also learned over the years that national security does not only concern itself with protection of territorial integrity but also includes amongst others food security and sound medical care. Depending on other countries for food and health care is viewed as serious security threats by serious countries but not this country. Leaders of these serious countries have pride and a sense of national identity. In our country our leaders have no shame or pride to protect. That is why it does not bother them for foreigners to be rich whilst their own people are poor. That is why they can give millions or billions of pula worth of contracts to foreigners and not be bothered about their people. Of course as a scholar I am quite sensible and know that there are exceptions where we need to treat every situation with its merits. In this case I am talking about a national disease that has plaques us for years: I am talking about the attitude of our leaders.

Two news reports this past week made me to reflect on his problem that has bothered me for many years.  The first was a story in the local media that South African hospitals are turning away our people because our government is not able to pay these hospitals. They are owed millions of rands. The second one was from the South African media who reported that Health Minister Dr Aaron Motsoaledi was complaining that foreigners were a burden the South African health system. This is what he actually said:  “The weight that foreign nationals are bringing to the country has got nothing to do with xenophobia… it’s a reality. Our hospitals are full, we can’t control them. When a woman is pregnant and about to deliver a baby you can’t turn her away from the hospital and say you are a foreign national… you can’t. And when they deliver a premature baby, you have got to keep them in hospital. When more and more come, you can’t say the hospital is full now go away… they have to be admitted, we have got no option – and when they get admitted in large numbers, they cause overcrowding, infection control starts failing’.


Although this was a very unpopular statement for which he has been criticised, I agree with him. It is like Trump complaining about a caravan of migrants trying to reach the US. On that one I agree with him. Every leader has a responsibility to provide good governance for his people and should not make his citizens a burden of another country.  It breaks my heart to watch television every day and see hundreds of Africans drowning in the sea whilst trying to make it to Europe to search for a better life. And this is a result of poor leadership by African leaders and nobody seems to be bothered. I guess the more die the better for these leaders.

In our case the issue of relying on South Africa for medical care is astounding. From my childhood I have always known this to be the case and it appears it will not end during my lifetime. When we got the two major private hospitals of Gaborone Private Hospital and Bokamoso I naively got excited and thought our woes were over. Alas, we still send many patients to South Africa.  


Over the years I have been talking to doctors to understand the course of this. Even as I prepared for this problem I did talk to some medical doctors.  Like I have said above it’s a question of leadership. Medical care is expensive.  Doctors don’t come cheap, especially those who specialise. The problem is that the government of Botswana is not willing to pay these specialists. Rather, the government is willing to train doctors and let them fly off to other countries to reside there permanently. Dozens (hundreds by other accounts) of Batswana doctors have remained overseas after their training because the government salary structure here is very unattractive. In addition, those working for government are not allowed to engage in private practice at the same time. One doctor told me that this was one thing that could help increase their poor remuneration and it’s the practice in a lot of countries.  Another doctor shocked me with the revelation that all the new doctors trained locally head to the US for better opportunities after graduation. Does this bother government? Not yet. The other thing that bothers me is the government willingness to spend billions of our money on South African based doctors. I was informed by those in the know that the irony of this is that some of our hospitals have state of the art equipment but lack the necessary equipment. The new Sir Ketumile Masire Teaching Hospital at the University of Botswana is also one of those that boast of this kind of equipment. ‘The only question is whether we will get the personnel to operate it. We can do cardiac surgeries here’, the doctor informed me. So the government will prefer not to take specialists from outside, or attract Batswana from outside to work here and give them mouth-watering offers.  We need a comprehensive reward system for medical professionals. I suspect hundreds of our people, the very people who put the government into power die every year due to poor medical care. It is normal for people to be on the queue for doctor’s appointment for 2 years. And when these people die nobody is bothered because we do not see human life as precious. In the medical field it is just statistics. Hospital superintendents are so much used to people dying around them that they can’t be bothered. Why should they, when they are not rulers of the country?

I wonder how we can address the issue of specialist medical personnel when we can’t address primary health care issues. Primary health care is a major problem in Botswana. Shortage of doctors is a serious problem.  Right in the city of Gaborone patients struggle to see doctors at our clinics. So you can imagine what happens in places far flung from the city. We don’t regard medical care as a human right in this country but rather seeing a doctor is a luxury enjoyed by upper echelons of the working class who are on medical aid or the middle class who can afford a doctor’s fee unaided. President Masisi needs to think seriously about this issue and come up with a solution. Some things we need to accept. Just like lawyers, doctors are expensive. Government must be prepared to accept this and deal with it. The other issue is the supply chain management system of our drugs. That medication, especially tablets is not available at a clinic has become normal. The irony of it is that we have these professionals and political leaders who have trained in prestigious Western universities but still display the all too familiar African attitude: they can’t be bothered.  Who has bewitched our leaders?


If we are seriously an independent country we need to wean ourselves off South Africa. We already depend on this country for almost everything else. Crazy as he is, President Trump is troubled by the huge trade deficit with China. I may not approve his method of addressing it but at least he is worried. In our country we are not bothered. We are happy to remain the 10th province of South Africa. How do we expect this country to respect us? Already we spent millions training our people in their universities. And they are not grateful for our generosity. We have serious trade wars with them, including the one involving Hyundai. They just know that we are a bewitched nation.  We need a sense of national pride and shame. Although he was not talking about us specifically, Motsoaledi was right. We are a burden.

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