I guess we have to treat them, but...: health care provider perspectives on management of women presenting with unsafe abortion in Botswana

Maternal mortality due to unsafe abortion and its complications stands among the three leading causes of maternal death in Botswana. Health care providers (HCPs) including doctors and nurses are at the frontline of providing care to women who have had an unsafe abortion. This qualitative study explored the knowledge, attitudes and perceptions of HCPs towards unsafe abortion in Botswana. We purposively sampled 18 HCPs and used a semi-structured topic guide to engage them in in-depth interviews, which were audio-recorded. These interviews were transcribed and analysed to identify emerging themes. We found that HCPs were knowledgeable about unsafe abortion, local inducers, and its management. However, their religious and moral biases as well as concern for the safety of women biased their view on the subject-matter and of the women themselves. These biases also affected their willingness to provide care, including provision of analgesics. Notwithstanding these biases and the reported lack of clarity on their legal role in managing unsafe abortion, many HCPs recognised their duty-of-care to patients. The continued strengthening of post-abortion services should be implemented in conjunction with engagements with providers to clarify their values and the roles they would be willing to play in abortion and post-abortion care services

'I guess we have to treat them, but … ': health care provider perspectives on management of women presenting with unsafe abortion in Botswana

Maternal mortality due to unsafe abortion and its complications stands among the three leading causes of maternal death in Botswana. Health care providers (HCPs) including doctors and nurses are at the frontline of providing care to women who have had an unsafe abortion. This qualitative study explored the knowledge, attitudes and perceptions of HCPs towards unsafe abortion in Botswana. We purposively sampled 18 HCPs and used a semi-structured topic guide to engage them in in-depth interviews, which were audio-recorded. These interviews were transcribed and analysed to identify emerging themes. We found that HCPs were knowledgeable about unsafe abortion, local inducers, and its management. However, their religious and moral biases as well as concern for the safety of women biased their view on the subject-matter and of the women themselves. These biases also affected their willingness to provide care, including provision of analgesics. Notwithstanding these biases and the reported lack of clarity on their legal role in managing unsafe abortion, many HCPs recognised their duty-of-care to patients. The continued strengthening of post-abortion services should be implemented in conjunction with engagements with providers to clarify their values and the roles they would be willing to play in abortion and post-abortion care services

Anaesthetic management of a patient with morbid obesity: case report

The purpose of this case report is to describe our experience of the anaesthetic management of a patient with morbid obesity  undergoing general surgery. The obese patient is at great risk of problems with endotracheal intubation and developing peri-operative respiratory and cardiovascular complications. The difficulties in moving and positioning the patient and gaining venous access add to the problems. Anaesthesia and surgery on an obese patient should not be undertaken lightly without a full understanding of the potential problems. Keywords: obesity; morbid obesity; body mass index (BMI); ideal body weight (IBW); peri-operative management; Botswana

Assessment of surgical care capacity at non-tertiary hospitals in Botswana

Background: Most low- and middle-income communities (LMICs) live in rural areas and are served mainly by primary and district hospitals. This study seeks to geographically map these hospitals and measure their surgical care capacity in Botswana. Methods: This 3-month cross-sectional observational study was conducted at the Department of Surgery, University of Botswana. Google Map was used to map hospitals geographically. The PIPES (personnel, infrastructure, procedures, equipment, and supplies) tool was used to assess the surgical care capacity of hospitals. This tool was developed by Surgeons Overseas to quantify surgical capacity in low-resource settings. Consent was obtained. Results: Nine districts and ten primary hospitals were assessed. The distance from settlements to the nearest healthcare facility in sparsely populated areas was relatively larger, making timely healthcare access potentially problematic. Intensive care services were unavailable except at three hospitals. None of the hospitals had full blood bank services. X-ray and ultrasound machines and basic supplies were available at over 90% of the hospitals. Conclusion: There was a general lack of surgical care specialists. Hospitals with a full complement of surgical care specialists had relatively higher PIPES indices. We recommend investing in deploying specialized surgical care providers to primary and district hospitals