Working towards sustainable care in Botswana

Angela Forsyth with physical therapist Okwadilwe Motswakae from Princess Marina Hospital

A WFH visit in 2003 to Botswana changed the life and work of Angela Forsyth, physical therapist at the Penn Comprehensive Hemophilia Treatment Center in Philadelphia.

“The trip really opened my eyes,” she says. “It’s so unfair that with our wealth of knowledge of hemophilia and advanced factor treatment, there are still places where care is not adequate. While we were visiting the Princess Marina Hospital in Gabarone, we heard of a young man with hemophilia who died from an uncontrolled nosebleed.”

Ironically, the hospital had factor concentrates sitting unused on its pharmacy shelves. For Angela and her team, this confirmed the importance of information and medical training. “The hospital didn’t know how to diagnose hemophilia or treat patients, so we focused on education for the whole medical team. My role focused on musculoskeletal complications. We looked at the damage bleeding causes joints and the importance of physical therapy management at all stages of hemophilia treatment.”

Since her initial visit to Botswana, she’s worked as a volunteer in the WFH Twinning Program, which partners her center and Princess Marina Hospital. The program has also been extended to include training at regional hospitals and local clinics.

“Our main aim is to help establish long-term hemophilia care that sustains itself,” says Angela. “They have an enthusiastic medical team over there that trains others and passes on vital information. As a PT, I demonstrate the benefits of prescribed exercises and physical activity. Many patients aren’t aware that keeping muscles strong protects joints and may decrease dependence on factor concentrates.”

Angela says Botswana’s high HIV infection rate severely overshadows most other diseases, making it difficult to focus resources on a rare disorder such as hemophilia. Nevertheless, she has seen significant progress since 2003 in the small, southern African republic. “Patients in Botswana are fortunate as they have access to factor products and the government is committed to public health care. Twinning has helped raise awareness of hemophilia, increased diagnosis, and improved patient treatment. WFH global data has also helped health authorities to predict how many hemophilia patients to expect and what resources will be needed to treat them.”

She adds, “the knowledge gained from my experiences in Botswana and attending WFH world congresses have definitely affected my clinic practice in the US. I know that my own patients have benefited from what I have learned.

“I strongly believe the benefits of treatment should be available to everyone with hemophilia so they have the same opportunities to lead the best life possible. I think the WFH motto of Treatment for All really says it all and I want to continue playing my part.”

Country Profile: Botswana

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