A Year In Review - Volunteering in Botswana
by Dr. Michael Pretorius, Clinic Supervisor, Mahalapye, Botswana
Dr. Michael Pretorius, Clinic Supervisor, and Onkabetse, health assistant, stand outside of the Mahalapye District Hospital, the location of one of World Spine Care's clinics in Botswana.
At the start of 2023, I left my life in Johannesburg, South Africa as a chiropractor in private practice, moved to Botswana, and started working as a clinic supervisor and clinician in the World Spine Care clinic at the Mahalapye District Hospital.
Lower back pain is the leading cause of disability worldwide. When you are in an underserved community with crippling back or neck pain, the effect spills over to your family and community. There are many socioeconomic factors involved. Chiropractic care, for the most part, in many developing countries, is unfortunately a very privileged type of healthcare, exclusive to those who can afford it or have medical insurance. There is a huge lack of public health facilities/clinics for any musculoskeletal conditions.
I applied to work for World Spine Care (WSC), a non-profit organization that sets up spinal health clinics and research programs in underdeveloped countries. Pre-COVID, WSC had clinics in the Mahalapye District hospital with a satellite clinic in the Shoshong village (80 km north). Unfortunately, they have been closed for the last 2 years due to the pandemic and lack of volunteers.
Working in public health offers an opportunity to be part of the greater medical team, to help those regardless of their economic situation, and maybe the people that need care the most. Here you work in the public sector, in the hospitals, receiving referrals from orthopedic surgeons, neurologists, and family physicians. You are next door to the Physiotherapy and Occupational Therapy departments, two halls away from the X-ray and CT department.
So I packed my bags and whatever else could fit into my little car and moved to Gaborone. That same day I arrived, I submitted all the necessary paperwork to BHPC (Botswana Health Professions Council) to register as a chiropractor. I spent a week observing one of the clinics in Gaborone and familiarizing myself with all the paperwork and databases that we complete for every patient, and just how different it all is in public health.
Finally, after a month in Botswana, I moved out of a guest house in Gaborone and into the new house in Mahalapye. It took several days to just get the house clean and unpack all of the stuff that had just been left behind in boxes by different volunteers over the last 10 years.
Dr. Pretorius gives Onkabetse and Joan Haldeman a tour of the World Spine Care residence in Mahalapye during the Haldeman's visit to Botswana last year.
The next task was getting the clinic room ready. I went and introduced myself to the superintendent at the hospital, and at the morning meeting, he introduced me to all the hospital staff. We work with Medical Auxiliaries as assistants, similarly trained to nurses, but adapted to working and helping out in any department in the hospital. They are also vital for translation and assisting with the patients and paperwork.
It didn’t take long for the doctors in orthopedics and casualties to hear that we had opened, and before long, the referrals came flooding in. I do enjoy how the consult is set up, how the paperwork is laid out, and the whole flow of the history, assessment, and treatment. We use the Global Spine Care Initiative classification system. Every patient gets a diagnosis, as well as a GSCI classification. Every patient is also part of a greater research program where we map out the prevalence of each of the GSCI Classes in different countries around the world and look for correlations, similarities, differences, etc.
World Spine Care Clinic Supervisor, Michael Pretorius, provides manual therapy to a patient in the Mahalapye District Hospital in Botswana.
The reality of how busy the clinic schedules are just highlights the faults of many healthcare systems. The WSC clinics are fully booked for the next 2-3 months and, on top of that, often have waiting lists for new patients. In Africa, very few manual therapists are booked that far in advance with such a huge list of patients just waiting for an appointment date. And that’s not because there isn’t a need—there definitely is—but because there is no affordable option. As a result, people live with chronic pain.
The top things I've learned from my time in the clinic
Patient rehabilitation is crucial for managing chronic musculoskeletal conditions. Our role as healthcare providers involves diagnosing the condition and empowering patients to take charge of their daily management. This includes educating them about their condition, offering advice on posture and biomechanics, and prescribing exercises tailored to their needs. Emphasizing lifestyle changes, such as modifying daily habits, is essential for long-term pain relief and improved function. By implementing a combination of group and personal rehabilitation programs alongside manual therapy, patients can make significant progress, but commitment is key to achieving positive outcomes.
It's essential to take the time to educate patients about basic biomechanics, their diagnosis, and prognosis. Many patients come to us after seeing multiple healthcare providers without fully understanding their condition or treatment plan. By providing clear explanations and realistic expectations, we can empower patients to actively participate in their recovery journey.
Rather than focusing solely on degenerative diagnoses, such as degenerative joint disease (DJD), it's important to present these conditions as manageable processes. Arthritis and degeneration are natural aspects of aging, requiring a holistic approach to treatment, including lifestyle modifications and regular exercise. By reframing the narrative and emphasizing the need for ongoing management, patients can better cope with their conditions and maintain a good quality of life.
The need for musculoskeletal healthcare is underestimated, often overshadowed by the focus on communicable diseases like HIV, tuberculosis, and COVID-19. However, musculoskeletal conditions, while less fatal, have a significant impact on global health, particularly in developing countries where labor-intensive work is common. Initiatives like the WHO Rehabilitation 2030 and global clinic guidelines for managing chronic low back pain signal a promising shift towards prioritizing musculoskeletal health worldwide. It's a step towards ensuring that everyone, regardless of socioeconomic status, has access to quality care for chronic musculoskeletal conditions.
This article originally appeared in the April 2024 issue of the World Federation of Chiropractic Quarterly World Report.
