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In 2002, facing the prospect of his nation’s extinction, Botswana’s president Festus Mogae announced a sweeping resolution to make AIDS prevention and care a top priority, marshalling resources in a coordinated effort to stop the scourge in its tracks. In the aftermath of the resolution, Mogae managed to transform Botswana’s public health system into one of the most progressive systems in the world. Soon afterwards, he found an eager cash purse in the Bill and Melinda Gates Foundation and the Merck Corporation, both of which agreed to pool resources and provide free anti-retroviral drugs (ARVs) to all Batswana suffering from AIDS. This revolutionary program, known in Botswana as Masa, the Setswana word for “New Dawn”, was a glimmer of hope in the middle of an otherwise gloomy forecast. Never before had a country with such a high percentage of HIV positive individuals offered its citizens free medications for life. The program put Botswana at the vanguard for AIDS care, and the country was immediately hailed around the world as a model for international public health.

But what is the reality of AIDS care in Botswana? I had the opportunity to visit Gaborone, Botswana two years later, in 2004, as part of a research project I was conducting for the University of Pennsylvania School of Medicine. The University of Pennsylvania, along with Harvard and Baylor Universities, has established programs in the country to help provide care for the tens of thousands of infected. On the way to the main public hospital, Princess Marina Hospital, one passes a set of white trailers stacked in a parking lot behind the hospital entrance. This is the reality of AIDS care in Botswana.

Humble and humbling, these trailers makeup the Infectious Disease Care Clinic (IDCC), the main site of ARV distribution for Botswana, and the greatest hope the world has right now against AIDS. Outside, hawkers sell foods and phone-cards to those visiting the IDCC as part of their new monthly routine. The space inside is crammed with people sitting in chairs or standing in the hallways, waiting in the heat for a nurse to call their name. Despite the government’s openness with the disease, stigma persists among the people and many people travel to the IDCC in early morning hours so as not to be seen procuring medications.

Still more ignore the disease altogether until it is too late to save them. The male medical ward of the next-door Princess Marina Hospital is brimming with patients. Makeshift mattresses flood the floors and patients are jammed tightly into dirty, stuffy corridors. Still, these are the lucky ones, the ones who seek medical care at all. Some come too late. An entire wing of the medical ward is reserved for patients with little chance of survival. Here, many patients lie motionless on a ventilator, their faces wrenched into the pose they were in when cryptococcal meningitis stiffened their joints and crushed their brain. Nearby, a man comes in complaining of a rash. As policy, the medical team orders an HIV test on him. Positive.

Another man enters wearing a string tied around his torso, a good-luck charm made by a Shaman. The doctors painstakingly try to give him care without cutting the charm. In the flurry of activity, other patients go unnoticed. They develop huge pressure ulcers on their back and buttocks from nurses who have been too busy caring for others to turn them on their side. And the nurses and doctors should not be faulted either. Each day is a melee of activity that challenges the will and energy of each doctor or nurse on the wards to persevere. The Penn doctors work from 9 am to 9 pm every day, returning exhausted and upset over the portion of their patients that will probably not make it through the night. Just another day in Botswana.