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Stanford University School of Medicine

A small African country with a powerful voice

The recent film "A United Kingdom" tells the story of Botswana’s maverick first president who defied convention and caused an international scandal by marrying a British woman he met as a law student at Oxford. Seretse Khama, who went on to become a revered figure, set the tone for the country’s progressive policies, which I glimpsed while on a recent visit to the small southern African nation.

Botswana first captured my attention through my work in covering the AIDS epidemic. In 2008, I attended the International AIDS Conference in Mexico City, where one of the headline speakers was Festus Mogae, who had recently retired as Botswana’s president. It was striking to me that a head of state of an African nation would make the effort to appear at the conference, but it was emblematic of Botswana’s leadership in the AIDS crisis – and in African politics generally, where the country has stood up for human rights and ethical leadership.

Botswana has suffered greatly as a result of HIV/AIDS, and few families remain untouched by the disease. The country has one of the highest rates of infection, with some 22 percent of adults living with HIV in 2015, according to the latest figures from the United Nations Joint Programme on HIV/AIDS. Though the country was criticized by some for its late response to the crisis, the government ultimately took a strong stand, using its ample resources to support free antiretroviral care for all and encouraging other countries to follow its lead. That stands in sharp contrast to its neighbor, South Africa, whose president denied the existence of HIV for years, condemning millions to die until the nation’s health minister announced at the 2010 AIDS conference that the government was making a substantial investment in treatment and prevention.

"They (Botswana's leaders) absolutely were and are still leading the fight against HIV," Piya Sorcar, PhD, a Stanford lecturer and TeachAIDS founder, told me. She began working in Botswana in 2010 after being contacted by the Ministry of Education there who was looking for new ways to reinforce sound educational messages about how to prevent HIV.  TeachAIDS, a nonprofit spun out of Stanford, makes culturally appropriate tools to educate people about AIDS prevention. Her team ultimately developed a version in both English and Setswana, the country's two official languages, that was distributed across Botswana and celebrated in a national TeachAIDS Day, she said.

"I was inspired by how thoughtful and proactive leaders across Botswana were in identifying innovative models. They were constantly searching for new and better methods to expand education and their approaches to more effective prevention education," she told me. She also met with former President Mogae, who invited her and a group of exuberant school children to his home, where he delivered a message of hope that is included in every educational module.

"He was the most trusted name in HIV work," Sorcar told me. "Everyone knew him as a leader in the field and trusted him. There are few leaders that can command that kind of respect and attention across generations, and he was certainly one of them."

During my trip to Botswana, we had the opportunity to visit a rural clinic in the eastern Kalahari region. A health educator gave us a brief tour of the tidy little facility, where nurses provide primary care to nearby villagers for common conditions such as malaria and tuberculosis. AIDS still remains high on the list of medical problems treated there, with patients coming monthly for their supply of anti-AIDS medication, the educator told us. A box of condoms, overtly displayed on a counter in the clinic, provided testimony to ongoing efforts to prevent transmission of the virus.

The wide availability of drug treatment has kept AIDS death rates relatively low; some 3,200 people died of AIDS-related complications in 2015, out of a total of 350,000 infected individuals, according to UNAIDS. The government provides universal health care in Botswana, regardless of the condition, so that care is free or comes at a nominal charge. The same is true of public education, making it one of the more literate countries in Africa, with 87 percent of children attending school and 85 percent of all adults able to read, according to UNICEF figures.

Botswana’s progressive leadership extends beyond the health world and was on full display in its national parks. More than 40 percent of the country is set aside as park reserve, and a 2014 law prohibits hunting of any game there. So while elephant herds have been decimated in some areas of east and southern Africa in pursuit of the ivory trade, these gentle giants freely roam the landscape of Botswana in great abundance. And there is a fierce respect for the environment. During a visit to one reserve, known as the Moremi Game Reserve, our local guide stopped the vehicle to get out and retrieve a single plastic bottle that had been discarded in the dirt by the roadside. He chided the park’s employees for not catching this slight on the Earth sooner.

Photo, of health care workers in a village clinic, by Ruthann Richter

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