Botswana: Background, HIV, and Nutrition
Botswana covers a large area with a relatively small population of less than two million people. Most of the land is scrub and of course the Kalahari Desert, which itself covers four-fifths of the entire country. It certainly is dry here – red earth and brown clumps of once-was-green grass. 
The rains are due soon – the lady who just brought me some Rooibos tea tells me they will arrive on the 29th of September. But this is now the third drought year, and all around is dry and rocky. Very little in the way of agriculture, then, apart from huge numbers of cattle, and pesky goats that like to take Kamikaze routes across the main highways, just as a huge truck is thundering towards them at 120 kmh.
The people here are mostly Tswana, speaking the Setswana language which will be familiar to those who have read the Number One Ladies Detective Agency books (Dumela Mma Ramotswe). However there are also people from other tribes and countries, including an increasing number of refugees from Zimbabwe.
I remember from my stamp collecting days a page of faded stamps from Bechuanaland Protectorate – well, that’s where I’m writing from now. In 1885, Rhodes asked the British to form the Protectorate to ward off the expanding Boer republic, and in 1895 the Tswana kings persuaded the British to “protect” them from absorption into Rhodesia. However it wasn’t until 1966 that Botswana gained its independence from the British.
Botswana is one of the wealthier African countries. A year after independence, diamonds were discovered, and the country changed from being poverty-stricken to relatively well-to-do. A drive round the centre of Gaborone reveals some astonishingly modern and obviously astronomically expensive Government buildings, and even Old Naledi, Gaborone’s township looks comfortable compared to the Cape Flats. 
Life expectancy here was one of the highest in Africa, until it dramatically declined as HIV took its toll.
HIV in Botswana
Botswana may have the worst HIV prevalence in the world. There is some confusion however over just how bad things are. The WHO collects HIV surveillance data by analysing anonymous blood samples collected from antenatal clinics. This data suggests that almost 40% of people are HIV positive. The Botswana Dept of Health disputes these figures, saying that its own data shows less than 20% of the population is positive. The argument is that pregnant women are more likely to be HIV positive as they are a group obviously having unprotected sex. Either way HIV rates are high.
The country is proud of its success with the roll-out of antiretrovirals. In the last few years ARV clinics have opened up in most areas, and those with a CD4 less than 200 are commenced on treatment. My view is that they indeed should be proud, and now they have two more challenges: finding a way to reach those who need treatment but have not yet started; and maintaining adherence and good health in those already commenced on ARVs. More about facing these challenges in later posts.
Nutrition in Botswana
This is a traditional day’s diet here:
Breakfast
Soft Porridge, made from Sorghum and water. High fibre and filling.
Lunch
Large portion of Mabele (Sorghum meal), Pap (soft maize meal), Rice or Brown wheat flour steamed dumpling, served with chunks of dark beef (Seswaa) and a vegetable such as spinach cooked with onions. A piece of fruit is sometimes eaten for dessert.
Evening Meal
Same as lunch, occasionally an alternative to beef such as chicken, goat or donkey.
Meat, especially beef, is a central part of the meal. Botswana is a major producer of free-range beef, exporting to other African countries and indeed worldwide. The starchy part of the meal is hefty; I was surprised by how many obese people can be seen here, and how many inpatients at the hospitals are admitted with newly diagnosed diabetes.
Fruits and vegetables are more difficult to find unless you have money. Botswana imports almost all of its fruit and veg. For people ill with HIV with little money to spend on food, where fruit and vegetables are vital for proper immune function, finding cheap sources can be impossible. I discussed this with Kgmotoso Vasco, dietitian working in Gaborone. She grew up in Molepolole, a village an hour’s drive away.
She said people were reluctant to grow their own produce when she had recommended this. They said that the soil was too dry and rocky. To my eye they seemed to have a valid point. However Kgmotoso had created her own vegetable garden in Molepolole after working hard to remove rocks and stones from the soil. Regular watering during the dry season was necessary, but good quality produce was the result. Kgmotoso also suggested that the Batswanan people had forgotten many traditional skills such as vegetable growing. Zimbabweans settling in Botswana were successfully growing crops however, and even selling them to their Tswana neighbours. Kgmotoso was hopeful that the Molepolole villagers will follow their Zimbabwean neighbours’ example.
The rains are due soon – the lady who just brought me some Rooibos tea tells me they will arrive on the 29th of September. But this is now the third drought year, and all around is dry and rocky. Very little in the way of agriculture, then, apart from huge numbers of cattle, and pesky goats that like to take Kamikaze routes across the main highways, just as a huge truck is thundering towards them at 120 kmh.The people here are mostly Tswana, speaking the Setswana language which will be familiar to those who have read the Number One Ladies Detective Agency books (Dumela Mma Ramotswe). However there are also people from other tribes and countries, including an increasing number of refugees from Zimbabwe.
I remember from my stamp collecting days a page of faded stamps from Bechuanaland Protectorate – well, that’s where I’m writing from now. In 1885, Rhodes asked the British to form the Protectorate to ward off the expanding Boer republic, and in 1895 the Tswana kings persuaded the British to “protect” them from absorption into Rhodesia. However it wasn’t until 1966 that Botswana gained its independence from the British.
Botswana is one of the wealthier African countries. A year after independence, diamonds were discovered, and the country changed from being poverty-stricken to relatively well-to-do. A drive round the centre of Gaborone reveals some astonishingly modern and obviously astronomically expensive Government buildings, and even Old Naledi, Gaborone’s township looks comfortable compared to the Cape Flats. 
Life expectancy here was one of the highest in Africa, until it dramatically declined as HIV took its toll.HIV in Botswana
Botswana may have the worst HIV prevalence in the world. There is some confusion however over just how bad things are. The WHO collects HIV surveillance data by analysing anonymous blood samples collected from antenatal clinics. This data suggests that almost 40% of people are HIV positive. The Botswana Dept of Health disputes these figures, saying that its own data shows less than 20% of the population is positive. The argument is that pregnant women are more likely to be HIV positive as they are a group obviously having unprotected sex. Either way HIV rates are high.
The country is proud of its success with the roll-out of antiretrovirals. In the last few years ARV clinics have opened up in most areas, and those with a CD4 less than 200 are commenced on treatment. My view is that they indeed should be proud, and now they have two more challenges: finding a way to reach those who need treatment but have not yet started; and maintaining adherence and good health in those already commenced on ARVs. More about facing these challenges in later posts.
Nutrition in Botswana
This is a traditional day’s diet here:
Breakfast
Soft Porridge, made from Sorghum and water. High fibre and filling.
Lunch
Large portion of Mabele (Sorghum meal), Pap (soft maize meal), Rice or Brown wheat flour steamed dumpling, served with chunks of dark beef (Seswaa) and a vegetable such as spinach cooked with onions. A piece of fruit is sometimes eaten for dessert.
Evening Meal
Same as lunch, occasionally an alternative to beef such as chicken, goat or donkey.
Meat, especially beef, is a central part of the meal. Botswana is a major producer of free-range beef, exporting to other African countries and indeed worldwide. The starchy part of the meal is hefty; I was surprised by how many obese people can be seen here, and how many inpatients at the hospitals are admitted with newly diagnosed diabetes.
Fruits and vegetables are more difficult to find unless you have money. Botswana imports almost all of its fruit and veg. For people ill with HIV with little money to spend on food, where fruit and vegetables are vital for proper immune function, finding cheap sources can be impossible. I discussed this with Kgmotoso Vasco, dietitian working in Gaborone. She grew up in Molepolole, a village an hour’s drive away.
She said people were reluctant to grow their own produce when she had recommended this. They said that the soil was too dry and rocky. To my eye they seemed to have a valid point. However Kgmotoso had created her own vegetable garden in Molepolole after working hard to remove rocks and stones from the soil. Regular watering during the dry season was necessary, but good quality produce was the result. Kgmotoso also suggested that the Batswanan people had forgotten many traditional skills such as vegetable growing. Zimbabweans settling in Botswana were successfully growing crops however, and even selling them to their Tswana neighbours. Kgmotoso was hopeful that the Molepolole villagers will follow their Zimbabwean neighbours’ example.
posted by Alastair at
Tuesday, September 18, 2007
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