This past fall semester, I have been partaking in a community public health study abroad program in Gaborone, Botswana. Through the program, I visited local clinics and health posts once a week to observe the functioning of health systems in Botswana, and I enrolled in coursework at the University of Botswana studying public health topics in the context of Botswana and Sub-Saharan Africa (SSA). I also had the opportunity to travel to other countries in Africa and learn about their various histories, health and education systems, and unique values.
While in Botswana, I also worked in collaboration with the Botswana Sexual and Reproductive Health Initiative (BSRHI) on a research study entitled PREPARE (PRomoting Equity for Pregnant Adolescents in REsearch). Adolescent girls in Sub-Saharan Africa bear a profoundly inequitable burden of the HIV epidemic as well as the highest adolescent pregnancy rates globally due to issues such as child marriages and low educational statuses of many adolescents. Yet, this study has shown me that there are immense gaps in knowledge of how to treat/work with pregnant adolescents in medical settings. These gaps are due to both persisting ethical complexities and no culturally sensitive formal guidelines on issues like who provides consent for treatment, if consultations with parents/father of the baby are necessary, and whether medical information should be disclosed to either party. It baffles me that while there continues to be such a large number of pregnant adolescents each year in Sub-Saharan Africa, their HIV and other comorbidities are often unable to be treated, and they are constantly left out of receiving the benefits of new medications and therapies simply due to a lack of established protocols for their inclusion. I plan to continue working on The PREPARE study until its completion, in order to be a partner in providing empirically informed guidance for conducting ethically responsible HIV/co-infections research with pregnant adolescents.
I am deeply grateful for my research project, as it has given me the opportunity to hear the feelings and opinions of marginalized groups and community health workers in Botswana. It has taught me the unique challenges and barriers they face while attempting to access or provide proper care. As a personal project inspired by these unique voices, I was moved to conduct a comprehensive community needs assessment of a rural village in Botswana over five months. I worked alongside the village health worker to bring HIV self-testing to each home, after community members expressed their need for this service due to immense stigma and shame surrounding being tested at the health post. Partnering with a local NGO, Tebelopele Voluntary Counseling and Testing Centre, we coordinated a full mobile clinic visit to Kgope Village in which self test kits were dropped off at all homes, and all residents were able to access free HIV self testing kits, education, counseling, PrEP/PEP medication.
I acknowledge that I have not lived in Sub-Saharan Africa all my life and cannot begin to make an impact without understanding the different customs, generational values and practices of the region. I will be attending both the Africa CDC Youth Pre-Conference and the CPHIA conference series in Lusaka, Zambia this November to do exactly this. I hope to learn further from public health professionals in Africa and discuss barriers/strategies for improving maternal and child health outcomes in SSA. As I continue my global health career, I want to ensure that I am constantly prioritizing learning from and listening to the communities I am working with. They will always be my leaders, and they will always be my collaborators, as I aim to simply be a vehicle for these communities to achieve their public health goals and targets.
Berkeley Public Health and the LEAP program have equipped me with the necessary skills to excel in the duties of my internship, and to be a culturally responsive and ethical worker in the field of public health. Through this hands-on experience abroad, I have learned that establishing a relationship with health workers and residents of the communities you are working with is vital to ensuring an effective collaboration for inciting positive change. I have learned much about adverse maternal and child health outcomes within Sub-Saharan Africa during my time abroad, and have been able to connect with many public health professionals in the region to hear about some of the unique challenges faced within health in Botswana and SSA. As I wrap up my time in Botswana, I am certain that I hope to pursue work in the global health sector, and continue learning about the ways of life and health challenges of communities around the globe.
This semester has been incredibly enriching, and I would highly recommend it to anyone interested in pursuing a career in global health of any kind. Beyond all, I am grateful for the opportunity I have had this semester to travel around Sub-Saharan Africa and interact with people from different cultures and backgrounds. By the end of the program, I will have visited 7 countries (Botswana, South Africa, Zimbabwe, Zambia, Namibia, Tanzania, and Mozambique), and have been able to learn so much about their histories, cultures, and frustrations.
If any students are interested in partaking in the same study abroad program, or hearing more about my experience abroad, feel free to connect with me on LinkedIn https://www.linkedin.com/in/raksha-rajeshmohan-b54a7a201
Raksha Rajeshmohan is part of the Advanced LEAP Scholar cohort, Class of 2024.
First photo: Raksha (right) and nurse at mobile clinic in Kgope Village. Second photo: Raksha (second to the left front row) with BSRHI staff team.
For undergraduate students who are interested in joining future Advanced LEAP Scholar cohorts and in studying abroad, we encourage you to speak to with an academic advisor and plan to go before formally starting the Advanced LEAP Scholar curriculum.