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Dr Moeti: First woman WHO Regional Director for Africa

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Give us some background on you and WHO.
I joined WHO’s Africa regional office in 1999 and served as deputy regional director, assistant regional director, director of non-communicable diseases, WHO representative for Malawi, and co-ordinator of the Inter-Country Support Team for South and East African countries. Before joining the WHO, I worked with UNAids as Team Leader of the Africa and Middle East Desk in Geneva (1997-1999). I also served as Unicef’s regional health advisor for East and Southern Africa; and with Botswana’s Ministry of Health as a clinician and public health specialist.

You have been vocal about the shrinking donor funding. How can African countries fill in the gaps and sustain progress in healthcare?
It was inevitable that we would get here. Countries are developing, their economies are growing. This means that as countries graduate into middle-income states, they need to smartly invest more of their resources in health. If donor funding is reducing, African countries need to be working on ways to improve their own revenue. While they are trying to seal the gap, they need to work better on areas that need emphasis. It is not as if the money is not there, it may not be getting into the public purse. Therefore, we need to talk about flight of capital and address cases of some international donors not paying taxes to the degree that they should.
At the same time, instead of lamenting and worrying about the flight of donor money, countries need to invest much more effort in getting their own revenue from areas like taxation. I should say, Botswana has done well over the years, government expenditure on health has increased substantially. It is one of the few African countries to have reached the Abuja Target, with 15% of total government expenditure allocated to healthcare.

With a continent that is heavily populated with young people, what is the involvement of youth in an agenda like Universal Health Coverage?
We need to deal with the awkwardness of having old and young people in the room to talk about health or at least engage young people where they are and bring their views and voice into decision-making. At the WHO, we are learning to do this. Our adolescent health programme has not been among the best funded or our strongest and we are deciding that it deserves this added emphasis because it deals with the biggest demographic in the region.
We are therefore recruiting young people to change how we are working and asking our adolescent health programme to work with all the other programmes, so that those working on HIV/Aids, sexual and reproductive health, non-communicable diseases, and health systems development take on board the needs of young people.

Talk about WHO’s renewed approach to dealing with health emergencies and outbreaks.
Lessons from the Ebola outbreak in West Africa revealed critical gaps in WHO’s emergency preparedness. We are therefore adjusting our programmes to have a smart technical focus in line with the region’s priorities, basing interventions on evidence and lessons learned from experience. We have now reformed our Health Emergencies Programme and are part of a global WHO approach of one emergency programme, one workforce, one budget and one line of accountability.
That means, for example, that my director, who is the team leader in Africa, does not need to get permission from me for everything he has to do. One of the big changes we have put in place is that this director can work directly with the executive director in Geneva and the WHO country representative to make decisions.
This is the approach we used to address recent disease outbreaks in Africa such as the yellow fever outbreak in Angola. We are also working with other partners in a structured way and co-ordinating the work that needs to be done between the three levels to provide better support.

How prepared are African countries to deal with emerging issues like antimicrobial resistance and disease outbreaks?
I genuinely think African countries (maybe not all of them) are better prepared on the whole than they were pre-Ebola outbreak.
But I also think we are not quite there yet. Health systems are still very weak. If you look at an objective tool like the International Health Regulations, there are very many gaps in African countries.
With data collected from about 12 of the 47 countries, we have more evidence-based information about the existing gaps and what needs to be done.
Countries have also begun putting together co-ordination mechanisms on the so called emergency operation centres, where you can deal with one of the key problems when something arises:
“How do I have an effective co-ordination nod which directs the actions from investigations, confirmation, response, surveillance and monitoring to see that an outbreak is being brought under control?”
That is one more step to being better prepared. We have also seen improvement in the laboratory capacity to quickly diagnose some of the organisms causing outbreaks. At the end of the day, what needs to happen is that if an outbreak is starting somewhere and the infected person goes to a clinic anywhere in a country, you need to have in the health worker diagnostic capacity to pick up that something unusual is happening, report that and trigger investigations that will conclude what is going on.

Research has not been explored especially when you focus on Africa’s role. How can we see more research by ‘Africa for Africa’?
Africa has paradoxically been quite involved in global health research but much of this has been invested in by outside entities and the agenda of this research has been determined by the funders of the research.
We need our own domestic investment in research which will enable the countries to define their own research priorities and, most importantly, to work with the outcomes of those researches to inform policy and service delivery.
I have seen the private sector becoming more and more engaged in playing its role in healthcare.
And we must admit that there are a lot of opportunities to harness the resources, skills and experiences of private sector. However, I think it needs to be done within a framework of clear alignment with national priorities and for us, because this is the Sustainable Development Goals era, clear alignment with the idea of driving towards equity, better quality services access but also emphasising affordability.

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‘Cancer took away my boobs, not my life’

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Sun Health: What events led up to your diagnosis, or, how did you discover that you were suffering from cancer?

Mpho Kgaodi:My journey with Breast cancer started in 2012. Around April I felt a lump on my right breast. It was not painful at all, just slightly itchy. It was on the upper part of my breast. I ignored it for about three days but it kept nagging me and then I decided to go see my doctor. He also confirmed that there was a lump on my breast He sent me for mammogram that confirmed an abnormality on the structure of my right breast. I then went to see him with the results and he informed me that there are two ways to test that lump – Biopsy, which meant that he will be taking a piece of that lump to send it to the laboratory for examination and the other option was to totally remove the lump, Lumpectomy. I decided that he removes the whole lump, because I really didn’t want that Lump on my breast.

SH: We know that about 10% of all breast cancers are hereditary. Are there other women affected in your family?
MK: I don’t know of any other woman or even man in my family who has had cancer, though it is hereditary.

SH: What were your first thoughts when you received the diagnosis?
MK: I cried for a brief moment. I was overwhelmed with emotions, fear of death. I quickly recovered from that dreadful thought and remembered that I have a great husband and three boys. I felt that I had so much to live for.The doctor informed me about the options I had regarding treatment and he gave me time to think about it. I drove back home to Lobatse and by the time I arrived at my house, I had already made up my mind that I am going for total removal of the breast. I broke the news to my family and they were just as shocked as I was when the doctor broke the news to me. I explained to them my decision to go for surgery and they were very supportive. Few weeks later, I went for a mystectomy.

SH: How long were you in treatment

MK: The surgery was followed by Chemotherapy. The first time I walked into the oncology centre, I found so many people there already. I then realised that I am not the only person with cancer, it is so many of us. It gave me strength and courage. I had heard that the side effects of chemo are brutal, seeing those people made me realise that if others can do it so can I. I decided to go for it as I had so much will and spirit to stay alive and raise my kids. After the second session of chemo, I started losing my hair, nail beds turned black. I was never discouraged though, despite my aching body and the constant nausea after chemo. I had six cycles of it. In 2013 around April again, I experienced severe pain on my left breast, but with no Lump. My doctor again recommended I go for a mammogram. It confirmed cancer which was still at stage 1. I then insisted that they remove the breast. I would lose both my breasts but I knew staying alive for my boys was more important. Other people thought the pain was psychological, and I knew what I felt and my mind was made up. I had the second mastectomy and had to go through another cycle of chemo which I completed. I am now on oral medication. I take my tablet daily. It is recommended that I take it for ten years. I have just started on my year 6 on the tablet. I do go for regular check ups, to establish if the cancer is not back.

SH: What helped keep your spirits up and gave you support during this period?

MK: A good friend of mine and colleague told me about Journey of Hope Botswana. He introduced me to them, and I had tremendous support from them. I also went to Cancer Association Botswana to introduce myself. My family has also been my backbone, supporting me through it all. I am so greatful. On days that my spirits are low, I always take my mind to positive thoughts. I try to remind myself of the good times, sometimes I even find myself laughing out loud.

SH: How has this affected you at a psychological level?

MK: My life has not really changed for the worst. Like the saying “when life gives you lemons, make lemon aid out of them”. I lost my job after the second diagnosis of cancer. While this affected my family financially I never got discouraged, as this gave me time to take care of my family. I am a full time stay home mom. I walk this journey with my family. My boys understand that I had Cancer but now I am okay. They sometimes check if I have taken my medication, and they would even ask about my next appointment. I am blessed to have them.

SH: Facing the diagnosis of breast cancer is one of the most feared experiences in our society. What has been your experience as you worked with communities through Cancer Association of Botswana (CAB)?

MK: Working with CAB has been eye opening. Through motivational talks and other actives like the annual stiletto walk, the message has been positively received. There is still a lot to be done though, especially to make people understand that breast cancer is NOT a death sentence. So many lives can be saved.

SH: Amongst raising awareness, cancer awareness month is about celebrating individuals like yourself and their triumphs over cancer. Is there anything you would like to say to the community of cancer survivors and women in general?

MK: I have learnt so much from being diagnosed with cancer. I appreciate life more. I never used go and see a doctor without any pains or any thing “wrong” with my body. Now I do it regularly and so far I always get a clean bill of health. I encourage everybody to do regular self -breast examination. It is easy, convenient, cost-effective and can really help with early detection. I believe there is a lot to be done as far as breast cancer awareness. Remember men can also have breast cancer.

To all those who are going through cancer at the moment, remember you are not alone. Let’s walk this journey together. Let’s walk with Hope, Courage and Strength. There is life after cancer. Cancer took away my boobs it did not take my life. As October is breast cancer awareness, let’s support those affected, honour the survivors and remember the fallen.
PINK RIBBON ALWAYS

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Caroline Gartland speaks on Children and Mental Health

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Tell us about yourself and your background
I’m originally from the UK but have been in Botswana for eight years so this is now home! I have a Combined Honours degree in Psychology an MSc in Mental Health and have had a pretty varied career.
I started off working with offenders doing rehabilitation programmes; went on to support the victims of domestic violence then ended up working in Child and Adolescent Mental Health Services for the National Health Service.
I’ve done a lot of work, mainly voluntary, in different fields since being in Botswana but my passion is now Early Childhood Mental Health.

What does your work entail?
Early childhood mental health is mainly working with parents, caregivers and teachers to help them understand how children develop and the best ways to support their mental health and brain development as they grow. It’s about providing training and opportunities for families to bond with their children and introducing new ways of playing and interacting.

What sparked your interest in early childhood mental health?
Quite simply, having my own children! My daughter was born five years ago and I was fascinated watching her develop and grow. It occurred to me that the younger you begin to consider mental health and provide tools for resilience against life’s adversities, the better outcomes you are likely to have.
I began reading everything I could get my hands on, and completed a diploma in Infant Mental Health. I’ve worked down the lifespan but I feel I’m now where I belong, working with babies and young children.

What mental health issues have you observed in children in Botswana?
Mental Health is still stigmatised around the world and Botswana is no exception. Most people immediately think of mental illness, but mental health is about so much more; we all have mental health and some days we are fine and able to deal with life’s challenges and some days we need more support and tools under our belt to help us cope.

Young children can experience mental health problems. Anxiety is a common one, but we are more likely to focus on the behaviour we see rather than how the child is feeling. An anxious child who refuses to go to school may be labelled as ‘difficult’ or ‘naughty’ but what they are expressing is a painful emotion that they need help dealing with.

Describe one thing you find fulfilling and challenging about working in this industry.
Working with children and families is a pleasure and a privilege. To make life a little bit easier for someone is all that matters, you don’t have to be out there saving the world to make a difference.
My major challenge is time. I would love to do more, I’d love to do an MSc in play therapy and a couple of other therapeutic techniques I’ve come across in Europe but that gets put on hold as I focus on my own family and business.

Can you share an anecdote about how mental health consultation works?
I think that education, understanding and connection are the three keys to giving a child the best start in life. Led by that, SensoBaby provides classes in the community for parents and caregivers to connect with their infants.

We offer workshops on parenting and play to foster understanding of child development and wellbeing and we are available to troubleshoot specific problems an individual or agency has with the young children in their care or the systems they have in place. When it comes to individual parents, mostly what they need is to feel heard, supported and guided in their parenting choices.
You can read all the baby books in the world but they won’t give you the answers you need for your child, through responsive parenting and connection, you’ll find you have the solutions you need.

What advice do you have for child-care providers or early childhood teachers who are at their wits’ end over a child’s challenging behaviour but don’t have access to a consultant?
Empathy is an important and undervalued skill – the ability to consider another’s viewpoint. What is that child feeling? Their behaviour might be challenging and hard to deal with but often the root cause is an unmet need. There’s a famous quote from an American Clinical Psychologist, “The children who need love the most, will ask for it in the most unloving ways.”

Does a mother’s mental health affect her foetus? How important would you say is paying attention to women’s well being during pregnancy as with their physical well being?
100% yes. It is so important to support a woman’s wellbeing during pregnancy. As an example, if the mother experiences significant stress and rising levels of cortisol (the stress hormone) during pregnancy, the foetus will be affected and in some cases will be more sensitive to stress in childhood or later in life.

Pregnant women and new families (Dads as well!) deserve nurturing care themselves and shouldn’t be afraid to ask for support. SensoBaby run FREE monthly coffee mornings to support pregnant and new mothers because we understand the importance of maternal wellbeing.

Do smart phones and television make our children mentally ill as is often purported?
I don’t think technology is always the villain it’s made out to be. The key is in the relationship with that technology. Moderate use of TV’s and smart phones are fine, as long as they aren’t a substitute for outdoor play, imaginative play and meaningful interactions. If a child is crying or upset and we hand them a device to keep them quiet then we have missed an important opportunity for connection, helping them process what is going on and supporting them to calm down and settle themselves.

Now, I know you are involved in an exciting programme that helps caregivers and children to bond and get the children off to the best start in life through play. Can you say a little bit about that work and just how you are seeing it play out?
SensoBaby is our baby; a project born from passion and a desire to support families in Botswana. We offer play-based classes for children and their caregivers that are underpinned by the principles of child wellness as well as early foundations for learning.

When you provide developmentally appropriate opportunities to play, you learn so much about your child. That understanding and observation builds strong connections, which will form the basis of that child’s future relationships and self esteem. Play is so much more than ‘a fun activity.’

We offer a number of trainings and workshops for parents, nannies and community stakeholders and hope to increase our offerings this year. Our community partnerships and voluntary programmes have been successful so far and we hope to see more impact in 2018.

We currently serve the Gaborone community but would like to expand throughout Botswana as opportunities arise. The response to SensoBaby has been fantastic so far and we can’t wait to see how far we can go with the concept!

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