Botswana’s public health system coped effectively with most of the basic health needs of the nation until the HIV/AIDS epidemic hit the country about a decade ago. Specialist oncology treatments, including radiotherapy and chemotherapy were introduced by the private sector as late as 1999. Two years later (2001), the first oncology ward was opened at Princess Marina Hospital. There are no official cancer statistics but experienced health professionals estimate the most common cancers to be Kaposi’s sarcoma and cancers of the cervix, prostate, lung, breast and head and neck. ¹⁰, ¹¹

Despite Botswana’s dynamic and aggressive approach to treating AIDS, there are gaps in the field of palliative care provision for patients living with other terminal conditions. The Ministry of Health does not provide palliative care support for people dying from cancers, AIDS and other illnesses, although there are signs of increasing interest in this field. Whilst effective pain control with the use of morphine was introduced into the adult oncology ward in 2001, pain control in the health system is limited.

Ideas of witchcraft are common and are generally directed at women – who are often blamed for the death of a husband or relative. Cultural understandings identify an external cause of an illness. For example: cancer of the oesophagus is attributed to eating something that has caused choking. Use of both traditional and allopathic care is common.

Holy Cross Hospice. In 1994, concerned members of the community, the Anglican Church and Dr Moffat (Superintendent of Princess Marina Hospital and an Anglican priest) drafted a constitution to establish an organisation which was hoped would address the growing threat of AIDS in Gaborone. In October 1995 the registered Holy Cross Hospice established itself on donated land. An Australian nurse, sponsored by the Episcopalian Church in the USA and linked to the Anglican Church in Botswana, was the first nurse at the Hospice. She networked with the clinics and the Princess Marina Hospital - and accompanied doctors on their rounds in the community. Terminally ill patients were referred to the centre. NORAD donated a vehicle to enable home-based care to be delivered. Language was a barrier, however, and soon afterwards a Botswana nurse was employed. Gradually, more staff were employed and local volunteers began to help in the kitchen and by sewing and craft-making. At that time about 10 patients were registered, mainly suffering from symptomatic HIV. Volunteers from the Anglican Church in the UK also offered practical help.

Funding has been a constant problem and several nurses have resigned due to poor salaries. ‘Nurses were paid less than government hospitals, and as it’s a stressful job anyway there was little incentive to stay’¹². The service now sustains a drop-in centre, day care centre and home based care. It continues to look after children orphaned by the deaths of either or both parent(s) who were registered hospice patients.

Light and Courage Centre. 1n 1998, in response to the ever-increasing number of infected individuals in Francistown, the Light and Courage Centre was established by the Francistown Multisectoral AIDS Committee (DMSAC) as a day centre to provide support and information to community members infected and affected by HIV/AIDS. The roots of the present Centre lie with the appointment of Ms Angelina Magaga as Acting Coordinator in March 2000 and the arrival in July 2000 of Mrs Olwen Donald as Nurse/Development Worker.

In May 2001 the facilities were handed over to the Light and Courage Centre Trust, a community based organization managed by a Board of Trustees drawn from both the business sector and the wider community of Francistown (Deed of Trust No. 482 /2000 dated 30 November 2000). DMSAC, however, is still responsible for the co-ordination of all HIV/AIDS activities and is therefore still involved with, and supportive of, the Centre.¹³

The Centre is mindful of the increasing number of persons who could benefit from its services - and that it is the only one of its kind in Francistown. The organisation, therefore, is in the process of acquiring more land and extending its facilities to expand its programme.

Ramotswa Hospice at Home . Christa Kiebelstein, a nurse who worked with the Bamalete Lutheran Hospital and Dr. Ian Kennedy, shared a vision of establishing a hospice at the hospital. The latter was the medical superintendent at the hospital and according to Kiebelstein ‘has been shaping the medical landscape in Botwana during his 30 years service as MO.’¹⁴

The Matron of the hospital at that time was Mrs Johanna Kalake. ‘She played a very important part as Matron of the BLH. at Ramotswa in getting the hospice on the way. She has retired as Matron, but lives in Ramotswa just near the Bamalete Lutheran Hospital. She is now 64 years old, but still working at a clinic of the District Council.’¹⁴

This hospice started by caring for the elderly and chronically ill but was rapidly adapted to providing care for HIV positive patients as well. Cancer patients comprise a significant proportion of the registered patients. The hospital provides the referral system for the hospice. Patients who have incurable cancer or who have been diagnosed HIV positive are advised to go to the hospice, situated in the grounds of the hospital. The main focus is on home care although those who require facilities and care unavailable at home are brought daily for respite care. Baths, medical care, occupational interests and re-hydration are available.