Magdeline Kamuru

Magdeline Kamuru is used to receiving six-month refills of anti-retrovirals (ARVs) at her clinic on the outskirts of Botswana’s capital, Gaborone. She was disturbed, then, to be given only one week’s supply when she visited in October.

This was just days after Botswana’s Minister of Health and Wellness Stephen Modise called an end to the country’s public health emergency he had declared in August. The initial declaration had been prompted by shortages of medicines at health facilities across the country. And not just ARVs, but even basics like paracetamol.

The shortages appear to be the result of a faltering economy. Botswana has long been dependent on sales from its diamond mines, but the global market for the gems is way down and with it the country’s revenues. As a result, the country was having trouble staying on top of its medicine procurement.

But the problems created by the funding shortfall had been compounded by the Trump administration’s actions. First, the January order to pause all U.S. aid and then the subsequent cuts to the systems that monitor drug supplies and help ferry stocks to health facilities around Botswana.

This had fueled the emergency that, no matter what Modise claimed, certainly hadn’t subsided at Kamuru’s clinic. When she pleaded for a larger refill, a nurse told her there simply weren’t enough ARVs on hand to give her more.

It is the first time. Everything has been flexible until the stop order.

When she returned the following week, Kamuru waited more than nine hours only to be given a two-weeks’ supply. On her third visit in a month’s time, she was given a refill for one month, but only after complaining that she could not afford the cost of coming to the clinic so often.

It was terrorizing. We may be no longer having some medication as it is happening now.

Kamuru is also a community health worker for a local HIV organization. She said many of her clients have experienced similar shortages, but if she is struggling, it is almost certainly worse for them.

Other people, they can’t talk on their own behalf. They will just be forced to take one week or two days. Even if they can’t afford the transport, it’s going to be difficult for them to speak for themselves. Some don’t even come at all.

We don’t know what is tomorrow. It’s mentally devastating seeing the client you’ve known has been consistent in taking the medicine, and then you see that she turns into a defaulter due to the fact that she cannot afford transport expenses.