U.S. Medics Support Botswana HIV Prevention Efforts

By Donna Miles

American Forces Press Service

THEBEPHATSHWA AIR BASE, Botswana, Aug. 14, 2012 – A U.S. military medical team here for the Southern Accord 12 exercise is helping the Botswana Defense Force confront its country’s most pressing health crisis one circumcision surgery at a time.

The U.S. team is working side by side with its military hosts to promote Botswana’s national program of education, HIV screening and male circumcision surgeries to stem what’s become a national epidemic, explained Army Col. (Dr.) Michael Kelly, an Army Reserve surgeon deployed here from the Army Reserve Medical Command in Washington.

The Botswana Ministry of Health’s goal, Kelly said, is to bring the number of new HIV diagnoses to zero by 2016. That’s an ambitious plan, in light of an HIV rate that has skyrocketed since the first case of AIDS was diagnosed in Botswana in 1985.

Today, 17.6 percent of the general population is infected with HIV, and the rate continues to climb by 2.2 percent per year, Maj. Mooketsi Ditsela, the Botswana Defense Force’s HIV coordinator, told American Forces Press Service. Men ages 30 to 45 suffer the highest infection rates, topping 40 percent, according to Health Ministry statistics.

As the Botswana government adopted an aggressive national prevention strategy, it teamed the Health Ministry with the Botswana Defense Force, which was showing signs of progress in reducing infections within its ranks.

In addition to education about the risks of unprotected sex and multiple partners and the importance of proper condom use, the national program includes a “safe male circumcision” strategy, Ditsela said. Unlike in the United States, circumcision is not a cultural norm in Botswana, Kelly explained. Yet research shows that the simple procedure can reduce HIV infections among males by as much as 60 percent.

So in meetings to plan humanitarian civic assistance projects for Southern Accord 12, Air Force Capt. Francis Obuseh wasn’t completely surprised by the Botswanans’ request for help in conducting male circumcisions.

Working with a partner-nation military to conduct male circumcisions during those clinics would be a first for the U.S. military, Obuseh said. Few U.S. medical doctors are experienced in the procedure. Kelly, for example, said he hadn’t performed one in about 30 years, when he was undergoing his surgery residency.

But as an epidemiologist who grew up in Nigeria and has studied HIV around the African continent, Obuseh welcomed the opportunity to teach U.S. medics new skills, strengthen the partnership between the two militaries’ medical teams and to make a valuable contribution to the Botswanan people.

“This is excellent way for them to partner together in an area of great importance that can make a lasting difference,” he said.

Obuseh emphasized that the circumcisions were just one part of a comprehensive HIV program for the local villagers, funded in part by the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, program.

Members of the Botswana Defense Force provide HIV counseling, screening and education about the safe male circumcision procedure. Meanwhile, the U.S. medical personnel are working side by side with them, performing the surgeries. To prepare the U.S. surgeons, nurses and surgical technicians who arrived here earlier this month for Southern Accord 12, Botswana Defense Force medical personnel conducted two days of classes to teach them the techniques.

They put them to practice yesterday for the third medical clinic since they arrived, performing circumcisions on 28 men ranging in age from 14 to 49 not far from the base in the tiny village of Monwane.

Army Spc. Chris Kepler, a medic with the 396th Combat Support Hospital, said he “begged and pleaded” for the chance to serve as circulating nurse for the clinic. He scurried among five operating areas sectioned off within a generator-powered tent, preparing rooms, drawing medications and applying dressings once the surgeries were completed.

“This is a lot of work, but it’s exciting to be a part of a humanitarian mission like this,” Kepler said. “I feel that we are serving a bigger purpose and getting a chance to give back. … I wouldn’t trade this experience for the world.”

Army Spc. Christina Shoemaker, a 396th CSH surgical technician, acknowledged the challenges of working in an austere environment with limited instruments and a steady flow of patients. But just as she knows she is helping to change their lives, she said, her experience here is changing her own.

“This has been a really big influence on me that I will take home,” she said, expressing interest in working with HIV-positive patients at a local veterans hospital as a volunteer. “It’s a great feeling knowing that we have helped these people,” she said.

Army Capt. Julie Karpinski, a registered nurse with the 396th CSH, said she enjoyed learning a new skill while making a contribution she knows will benefit the people of Botswana long after Southern Accord 12 ends.

“If you can’t change the fact that HIV is here, at least this procedure is minimizing the transmission rate. And that is huge,” she said. “Being a part of it is wonderful.”

Southern Accord is a joint, combined training exercise led by U.S. Army Africa to expand capabilities between the U.S. military and Botswana Defense Force and enhance their interoperability. In addition to training activities relevant to peace support operations, it includes engineering projects and four medical and dental clinics in local communities.