The Largest HIV Clinic in the World

Many of us started our time here by working with nurses at the IDCC (Immunodeficiency Care Center), which is located at Princess Marina Hospital. With over 19,000 patients, it is the largest HIV clinic in the world! It was truly amazing to see the operation there and the way that they have worked to take hold of this particular crisis.

Patients in Botswana receive free ARV treatment, but  they must come to the clinic once a month usually to refill medications and have a follow-up with a nurse or a doctor. To explain the process, I will walk you through a regular visit that a patient would have and the role that the Penn Nursing students took. Patients all arrive for 7:30 a.m. appointments and are seen on a first come first served basis. Thus, some who arrive at 7:30 end up waiting until lunch time to be seen. In the morning, the nurses pull all the charts of the patients they are expecting. Then, when patients arrive, they are first registered on paper at the front desk. From there, they came to the Penn Nursing students for vital signs and some attempts at Setswana conversation. Next, they are sent to the computer to be registered there and for their information to be updated, which was also done by our group. Finally, they proceeded down the hall to see a nurse or doctor.

For those patients who are doing well with medication adherence and who are generally healthy and have no complaints, a nurse sees them and follows up. However, for those who come in not doing well and who have particular health concerns, they are seen by a doctor who can help work with any opportunistic infections or other problems. It was really interesting to see how these nurses had truly specialized in HIV and were able to do very specific medication and health management.

Additionally, there was counseling available for patients, and I had the chance to sit in on a few sessions with a nurse. Patients are referred to this specific type of counseling session when they have defaulted on HIV treatments. This session gives the nurse a chance to talk with the patient and try to understand the barriers the patient may be facing in trying to remain healthy. They also tried to pair patients with a close friend or family member to be their "buddy" to help them stay on track and actively managing their health. In some cases, the nurse even sent a patient home to get a buddy before they would counsel them. It seemed like an approach that was working for some patients, but others continued to struggle -- especially when support at home was lacking.

Another great part of the day was having a chance to sit with all the nurses during the tea break (which is compulsory, it seems). We were able to discuss Botswana, politics, history, and compare nursing structure to the United States. We learned that, in Botswana, nurses simply go into an allocation pool and are sent to work in any government clinic or hospital. Thus, it seemed like nurses did not really have a choice about what area they were hired for or what specialties they may like. It made me wonder about dedication and devotion to a particular position or patient population if there was no choice involved. However, many of the nurses did seem satisfied with where they were and liked having the chance to switch around every few years within the system. If nothing else, the job security is a positive factor for them.

After wrapping up by helping to put the charts away, we all headed home. Ready for tomorrow!