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Yet despite the grim situation in the wards, the situation still represents a step forward from the pre-Masa era. Early reports have told of public health successes in both prevention and care, and the percentage infected has slowed its gradual rise. The real question, however, is whether or not it is sustainable for Botswana to keep nearly 40% of the population on chronic care with regular checkups every 6 months. At the moment, the program’s prospects are dim. Botswana does not have its own a medical school. What few doctors Botswana has at its disposal are trained either in South Africa or abroad. With long hours for the medical staff, it has been difficult to recruit and keep good international doctors. Some international doctors, particularly the Cubans, are appointed by their governments to be stationed in Botswana, but while they have the skill, they lack the incentive to work the long hours that AIDS care requires. The Botswanan government is working on establishing a medical school, but this isn’t likely to affect the health care situation until a number of years have already passed. And even when the school is finished, it will be a challenge to prevent newly-trained doctors from emigrating to the First World and its promise of high incomes. As it stands, Botswanan AIDS patients must wait as long as one or two weeks to receive care and new medications from the IDCC. Some don’t have the time to wait that long and so choose to pay out of pocket at a private clinic for the medications rather than die. Poorer patients, of course, don’t have this luxury.

The international community has responded to the crisis by establishing the Knowledge and Innovation Shall Overcome (KITSO) AIDS program, a joint endeavor of the Botswana-Harvard program, the African Comprehensive AIDS Partnership (ACHAP), and the University of Pennsylvania. This short course teaches the fundamentals of AIDS education to health care professionals and licenses them to practice AIDS care in Botswana without an MD. While this program is an excellent start, a broader effort to teach a longer and more substantive AIDS-training course to a wider group of individuals is needed. A full medical degree is not necessary in this resource-scarce situation to provide basic AIDS care to a majority of the population. Even in the U.S., such care is often provided by nurse practitioners. If routine AIDS care were handled by these so-called AIDS specialists, physicians could then focus on providing care for more complex cases, as well as for those procedures that go beyond the scope of the AIDS epidemic. AIDS-specialists could establish clinics in their areas and broaden the scope of AIDS care in the country. Moreover, since their training would not qualify as a full degree in the developed world, AIDS-practitioners would be less likely to leave their struggling countries behind. The training could be done cheaply, effectively, and portably through a series of videos and standardized tests. Such a training program would put the care for the future of Botswana into the hands of those who most deeply care for it, the Batswana themselves. Nor should this type of specialty- education be limited to Botswana alone or even to just AIDS care. Nutrition specialists or malaria specialists would be great assets to the healthcare of developing countries across the world.

While prospects for AIDS care in Botswana might seem initially unsustainable, a training program could pave the way and become a model for a new international health effort to equip AIDS-afflicted countries with the manpower to combat the scourge. Botswana, the “Gem of Africa,” could become a shining beacon of healthcare and set the standard for AIDS care around the world.