Changing the face of Medical Education in Africa

BCM's Major Bradshaw, M.D., helps usher in a new era in medical education in Africa by serving as Interim Founding Dean of the University of Botswana Medical School.

Throughout his career, Major Bradshaw, M.D., said he has made a habit of learning on the job. And perhaps nowhere has he had more of a learning curve than in his latest role: Interim Founding Dean of the University of Botswana Medical School.

Not only has Bradshaw had to make the adjustment to living and working in a vastly different culture, but he also has the daunting task of developing a medical school from the ground up in a nation that has been depleted of medical leadership.

Bradshaw, who served as Dean of Medical Education at Baylor College of Medicine for 10 years, arrived in Botswana in July 2006 for a one-year stint. But the Texas native quickly learned that life moves at a slower pace in southern Africa,
so he will remain until December 2008.

Still, he and his colleagues from the University of Botswana, the University of Pennsylvania, local government and other institutions have made major strides over the last year, including placing 12 natives of Botswana in internships at a national hospital and developing a plan for both undergraduate and graduate medical education.

Bradshaw was familiar with Botswana before arriving as Interim Dean. He and his wife visited in 1996, and they had fond memories, especially of the people.

Social interaction is important to the very friendly people of Botswana, Bradshaw explained, and so is making sure everyone is included in the decision-making process. This is called Khotla, a tribal tradition that gives everyone the chance to speak at village meetings. These traits, while endearing, are part of what had made the process of launching the medical school more like a lazy river than a roaring rapid.

"Life goes with the cycle of days and seasons," Bradshaw said. "In Africa in general and Botswana in particular, mañana is warp speed. Professionally, you have to adjust to a lack of the concept of time being important."

But that doesn't indicate a lack of commitment to a medical school, Bradshaw cautioned. The process got under way more than 10 years ago, when a feasibility study was conducted and found that a medical school was viable. A presidential directive to start phased development of the school followed in 1999, and premed curriculum for undergraduate students was developed. Another important milestone was establishing a partnership with medical schools in South Africa and Australia. Through this agreement, select premed students complete a year and a half at the University of Botswana and then go on to one of the partner schools for their medical education.

"It's a really exciting time for the University of Botswana to be on the cusp of having a medical school and to have residents for the first time. I can already see the excitement they bring."
Mark Kline, M.D., BCM Professor of Pediatrics–Retrovirology;
Founder, Baylor International Pediatric AIDS Initiative

BCM entered its partnership with the University of Botswana in 2005, after already establishing an important presence in Africa through the Baylor International Pediatric AIDS Initiative, founded by Mark Kline, M.D., BCM Professor of Pediatrics-Retrovirology.

There is clearly a need for a medical school in Botswana, Bradshaw pointed out. Like other African nations, Botswana is a country that has been hit hard by the HIV/AIDS epidemic. Around 30 percent of the total population is HIV positive, and among women of child-bearing age, about 45 percent are HIV positive, he said.

At the same time, the country suffers from a brain drain of medical professionals. Young people who want to pursue a medical career go abroad for their education and most don't return, Kline said. "It will be key to keep some of these good students at home for their medical education, because then they'll feel a real connection to the medical community here and in other south Africa countries," Kline said.

Dr. Bradshaw with a student and a patient

On the Front Lines: Dr. Bradshaw plays an active part in the education process in Botswana and regularly shares his expertise in activities such as hospital rounds.

Bradshaw estimates that there are only a handful of Botswana doctors in the government health care system, which includes a network of facilities ranging from mobile care in rural areas to two 500-bed national referral hospitals. There are a number of factors that contribute to the lack of native doctors, including the low pay scale and lack of equipment and specialists, like pathologists and radiologists.

"Medical students and interns want to come back to Botswana for training and to practice medicine," he said. "The family ties are incredibly tight in Botswana, and the loyalty to the country is strong. It's a matter of establishing a system so they can come back."

Bradshaw has placed his focus on improving the residency program and developing the undergraduate medical curriculum.

The first class of medical students will be drawn from the group of premed students who enroll in August 2007. They will start their two-year basic science curriculum in August 2008 and then complete two years of clinical work, graduating from medical school in 2012. Other students in that class will continue to attend the partner schools for their medical education.

Bradshaw draws on his years of experience at Baylor College of Medicine in developing the medical curriculum. He served as Dean of Medical Education at BCM for a decade before leaving for Botswana, and he was in charge of the Office of Student Affairs for 20 years as Associate Dean.

Kline called Bradshaw a blessing to the University of Botswana. "There's no one that knows more about how a medical school functions and the essential elements of medical education," he said. "There are some really talented people in Botswana who he's been working with, but I think they needed a catalyst, and he has provided that."

"Some aspects of medical education are the same no matter where you are," Bradshaw said. But at the same time, he said the particular needs of Botswana need to be addressed in the curriculum, so there will be an emphasis on HIV/AIDS treatment, for example.

Meanwhile, graduate education will see major improve-ments over the next three years. Twelve interns who completed their education at the University of Botswana partner schools have returned to their native country for their residency training at the national referral hospitals in Gaborone and Francistown. They are joined by 16 government-sponsored interns, and in January 2008, the total number of interns will rise to about 60 and will continue to grow, Bradshaw said.

"The need for well-trained doctors here is a great one. The presence of the medical school should help to reverse the brain drain and also promises to elevate the overall level of medical care available to the people of Botswana."
Liz Lowenthal, a BCM graduate who is Associate Director of the Botswana Baylor Children's Center of Excellence

Those Batswanas who have returned home in recent years for internships were thrown into the system, but now a plan has been developed to give them specialty training.

In January 2008, training in internal medicine and pediatrics will be launched at Princess Marina Hospital in Gaborone, followed the next year by training in obstetrics and gynecology, family medicine, emergency medicine and general surgery. Training in those specialties will take place at Nyangabgwe Referral Hospital in Francistown by 2010 and some training will also get under way at smaller district hospitals.

The need for attending physicians is great, Bradshaw said. He had hoped to hire faculty to fill this need by now, but that's one goal he hasn't been able to achieve. Instead, he has turned to Baylor College of Medicine alumni for help. He sent a letter to BCM alumni seeking help in the training of these interns, and he said the response has been very positive. Other important achievements in the development of the medical school include beginning construction of the basic sciences building, which will house laboratories and teaching facilities. Plans are also being drawn up for a 400-bed academic teaching hospital, which is scheduled to open in 2013.

Bradshaw also said university officials are moving toward hiring the real founding dean, which will be a five-year appointment. That person is expected to be in place within the next 12 months. "I think it's important that the founding dean is involved in hiring faculty and the final design of the curriculum," Bradshaw said.

"I don't have a dog in this fight," Bradshaw chuckled. "My ego is not tied up in this." Even so, it's clear that Bradshaw has an affection for Botswana and its people, and he's pleased to have an important role in an effort that could improve countless lives.

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Volume 3, Issue 2, Summer 2007


	Changing the face of Medical Education in Africa by Dana Benson BCM's Major Bradshaw, M.D., helps usher in a new era in medical education in Africa by serving as Interim Founding Dean of the University of Botswana Medical School. Throughout his career, Major Bradshaw, M.D., said he has made a habit of learning on the job. And perhaps nowhere has he had more of a learning curve than in his latest role: Interim Founding Dean of the University of Botswana Medical School. Not only has Bradshaw had to make the adjustment to living and working in a vastly different culture, but he also has the daunting task of developing a medical school from the ground up in a nation that has been depleted of medical leadership. Bradshaw, who served as Dean of Medical Education at Baylor College of Medicine for 10 years, arrived in Botswana in July 2006 for a one-year stint. But the Texas native quickly learned that life moves at a slower pace in southern Africa, so he will remain until December 2008. Still, he and his colleagues from the University of Botswana, the University of Pennsylvania, local government and other institutions have made major strides over the last year, including placing 12 natives of Botswana in internships at a national hospital and developing a plan for both undergraduate and graduate medical education. Bradshaw was familiar with Botswana before arriving as Interim Dean. He and his wife visited in 1996, and they had fond memories, especially of the people. Social interaction is important to the very friendly people of Botswana, Bradshaw explained, and so is making sure everyone is included in the decision-making process. This is called Khotla, a tribal tradition that gives everyone the chance to speak at village meetings. These traits, while endearing, are part of what had made the process of launching the medical school more like a lazy river than a roaring rapid. "Life goes with the cycle of days and seasons," Bradshaw said. "In Africa in general and Botswana in particular, mañana is warp speed. Professionally, you have to adjust to a lack of the concept of time being important." But that doesn't indicate a lack of commitment to a medical school, Bradshaw cautioned. The process got under way more than 10 years ago, when a feasibility study was conducted and found that a medical school was viable. A presidential directive to start phased development of the school followed in 1999, and premed curriculum for undergraduate students was developed. Another important milestone was establishing a partnership with medical schools in South Africa and Australia. Through this agreement, select premed students complete a year and a half at the University of Botswana and then go on to one of the partner schools for their medical education. "It's a really exciting time for the University of Botswana to be on the cusp of having a medical school and to have residents for the first time. I can already see the excitement they bring." Mark Kline, M.D., BCM Professor of Pediatrics–Retrovirology; Founder, Baylor International Pediatric AIDS Initiative BCM entered its partnership with the University of Botswana in 2005, after already establishing an important presence in Africa through the Baylor International Pediatric AIDS Initiative, founded by Mark Kline, M.D., BCM Professor of Pediatrics-Retrovirology. There is clearly a need for a medical school in Botswana, Bradshaw pointed out. Like other African nations, Botswana is a country that has been hit hard by the HIV/AIDS epidemic. Around 30 percent of the total population is HIV positive, and among women of child-bearing age, about 45 percent are HIV positive, he said. At the same time, the country suffers from a brain drain of medical professionals. Young people who want to pursue a medical career go abroad for their education and most don't return, Kline said. "It will be key to keep some of these good students at home for their medical education, because then they'll feel a real connection to the medical community here and in other south Africa countries," Kline said. On the Front Lines: Dr. Bradshaw plays an active part in the education process in Botswana and regularly shares his expertise in activities such as hospital rounds. Bradshaw estimates that there are only a handful of Botswana doctors in the government health care system, which includes a network of facilities ranging from mobile care in rural areas to two 500-bed national referral hospitals. There are a number of factors that contribute to the lack of native doctors, including the low pay scale and lack of equipment and specialists, like pathologists and radiologists. "Medical students and interns want to come back to Botswana for training and to practice medicine," he said. "The family ties are incredibly tight in Botswana, and the loyalty to the country is strong. It's a matter of establishing a system so they can come back." Bradshaw has placed his focus on improving the residency program and developing the undergraduate medical curriculum. The first class of medical students will be drawn from the group of premed students who enroll in August 2007. They will start their two-year basic science curriculum in August 2008 and then complete two years of clinical work, graduating from medical school in 2012. Other students in that class will continue to attend the partner schools for their medical education. Bradshaw draws on his years of experience at Baylor College of Medicine in developing the medical curriculum. He served as Dean of Medical Education at BCM for a decade before leaving for Botswana, and he was in charge of the Office of Student Affairs for 20 years as Associate Dean. Kline called Bradshaw a blessing to the University of Botswana. "There's no one that knows more about how a medical school functions and the essential elements of medical education," he said. "There are some really talented people in Botswana who he's been working with, but I think they needed a catalyst, and he has provided that." "Some aspects of medical education are the same no matter where you are," Bradshaw said. But at the same time, he said the particular needs of Botswana need to be addressed in the curriculum, so there will be an emphasis on HIV/AIDS treatment, for example. Meanwhile, graduate education will see major improve-ments over the next three years. Twelve interns who completed their education at the University of Botswana partner schools have returned to their native country for their residency training at the national referral hospitals in Gaborone and Francistown. They are joined by 16 government-sponsored interns, and in January 2008, the total number of interns will rise to about 60 and will continue to grow, Bradshaw said. "The need for well-trained doctors here is a great one. The presence of the medical school should help to reverse the brain drain and also promises to elevate the overall level of medical care available to the people of Botswana." Liz Lowenthal, a BCM graduate who is Associate Director of the Botswana Baylor Children's Center of Excellence Those Batswanas who have returned home in recent years for internships were thrown into the system, but now a plan has been developed to give them specialty training. In January 2008, training in internal medicine and pediatrics will be launched at Princess Marina Hospital in Gaborone, followed the next year by training in obstetrics and gynecology, family medicine, emergency medicine and general surgery. Training in those specialties will take place at Nyangabgwe Referral Hospital in Francistown by 2010 and some training will also get under way at smaller district hospitals. The need for attending physicians is great, Bradshaw said. He had hoped to hire faculty to fill this need by now, but that's one goal he hasn't been able to achieve. Instead, he has turned to Baylor College of Medicine alumni for help. He sent a letter to BCM alumni seeking help in the training of these interns, and he said the response has been very positive. Other important achievements in the development of the medical school include beginning construction of the basic sciences building, which will house laboratories and teaching facilities. Plans are also being drawn up for a 400-bed academic teaching hospital, which is scheduled to open in 2013. Bradshaw also said university officials are moving toward hiring the real founding dean, which will be a five-year appointment. That person is expected to be in place within the next 12 months. "I think it's important that the founding dean is involved in hiring faculty and the final design of the curriculum," Bradshaw said. "I don't have a dog in this fight," Bradshaw chuckled. "My ego is not tied up in this." Even so, it's clear that Bradshaw has an affection for Botswana and its people, and he's pleased to have an important role in an effort that could improve countless lives.		Search all issues: Features Saving Twins Before Birth Blessing to Botswana Preserving Brains Cocaine Vaccine Shows Promise News Building, Bucks & BBQ DNA Discoverer Gets His Own BCM Cancer Center One of Select Few Spotlight Bert O'Malley: A Pioneer in Molecular Endocrinology Making Sense of the Sense of Touch Tissue Samples Go Digital Severe Skin Conditions Take a Back Seat at Camp Dermadillo Health Economist Must Put Price Tag on the Priceless Doctor Creates Cartoon that "Bugs" Kids About the Risks of Tobacco Briefs Living Longer is Smelly Business Clinical Trials for Cancer Southward Bound Green Tea Component Blocks HIV Cell Entry Genetics Technique Takes Bite out of Research Barriers Sports Legends Lend Helping Hands, Arms to College Development & Alumni News Mitchell Gift Furthers Brain Research Lambert Receives Lifetime Achievement Award Kleberg Foundation Gift Establishes RNAi Screening Core Facility Alumnus Named White House Fellow New Trustees Announced Tailoring Technology to Benefit You, the Patient

	Volume 3, Issue 2, Summer 2007



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