"The BLH is running in emergency mode"

Theology student Annika Weise completed an internship at Bamalete Lutheran Hospital (Botswana) in 2024. She returned to BLH in August 2025 and reports on the difficult situation there:

In August 2024, I was able to do a church internship as a theology student in Botswana through the Ev.-luth Mission in Lower Saxony (ELM). During my internship, I accompanied Pastor Thabiso Segatlhe. He works full-time at Bamalete Lutheran Hospital (BLH) as a hospital chaplain. He is also a pastor in the Evangelical Lutheran Church in Botswana (ELCB). I was able to accompany him and his colleagues in both places.

Bamalete Lutheran Hospital is a Christian health centre. The hospital provides public care and has a total of 134 beds in various departments. The BLH consists of many small yellow buildings, some new brick buildings, a small chapel and a large yellow church. The hospital was founded in 1934 by German Lutheran missionaries and was originally financed, but more recently by the Botswana government. Since 2013, there has been a hospice in the hospital, which is mainly run by the nursing staff.

BLH also includes the Lutheran School of Nursing, which is located right next door and was founded in 1934 by Sister Emma Pfitzinger from Germany on behalf of the Lutheran mission. In February 2022, the hospital was handed over in its entirety by the Ev.-luth. Mission in Lower Saxony (ELM) to various churches and the Botswana government.

The healthcare system is free of charge for the people of Botswana. According to UNICEF, the nearest health post is less than five kilometres away for 84 percent of the population - an enormous achievement for a country that is roughly the size of France and has fewer inhabitants than Berlin. The high number of HIV infections is a major problem. At least one in five people are said to be affected. Botswana was well on the way to curbing the epidemic: with free condoms or contraceptives, education in schools and programmes specifically for the vulnerable group of adolescent girls. However, many of these specially supported programmes had to be stopped due to the lack of payments from the USA.

I flew to Botswana again in mid-August 2025. A friend accompanied me this time. We organised it privately to do internships at BLH and ELCB for five weeks. Lena Feist is a 4th year medical student and accompanied the doctors at BLH. I was able to go with Thabiso Segatlhe again.

Shortly before our trip, a national health emergency was declared in Botswana - due to the tense economic situation and the lack of payments from USAID (United States Agency for International Development). Normally, the state provides all medicines and materials to the hospitals, but this is no longer possible due to the poor economic situation. Many medicines would still be available on a private bill, but many people here cannot afford this. Simple tests such as blood glucose measurements can no longer be offered, which has already led to deaths among people with diabetes.

The BLH is currently operating in a kind of emergency mode. No more planned operations are being carried out, only critical emergencies. Patients are sent to the capital Gaborone to the Marina Hospital for examinations as there is no medical equipment available. Only women with complications during pregnancy are still in the maternity ward. The emergency room is often yawningly empty.

There are currently 200 women on the waiting list for elective gynaecological operations because there is no equipment available for these procedures. Instead of around 60 operations per month, there are currently only around 15 operations per month. The nurses are constantly off duty because they have to accompany patients when they are transferred to Marina Hospital. There are no state ambulance crews, so the nursing staff have to do this work with drivers.

Many medications are not available, so poorer alternatives are used. Medication and care for chronically ill patients can hardly take place. Epilepsy medication, for example, has to be bought privately because it is no longer available in the state system. On some days, there were only two bags of infusions left in the hospital, which are reserved for extreme emergencies.

This week, a van was attacked in South Africa on its way to Botswana. The Botswana government had bought a large lorry full of medicines in South Africa for distribution in the country. The attack has further delayed the arrival of important medicines in Botswana.

Compared to last year, it is clearly noticeable that there are fewer patients in hospital. The waiting area, where morning prayers are also held, was normally super full in the morning. At the moment, there are often only around 20 patients waiting in the morning. Thabiso's work has also changed. He is currently attending a lot of meetings as a mentor and manager. He and other BLH employees are trying to raise donations to ensure the hospital's survival, so to speak. Various church congregations from Ramotswa and the surrounding area are now bringing food to the hospital. As a pastor, Thabiso is trying to support the hospital staff during this difficult time. His pastoral work is on a completely different level at the moment.

Many employees seem exhausted and tense in these uncertain times, as some of their salaries
cannot be paid. In addition to the lack of medication, the medical equipment is also very critical at the moment. Since the ELM withdrew from the BLH, the BLH can no longer afford to service and insure the medical equipment, as the prices for service and insurance have suddenly increased fivefold since the ELM's long-term contract expired. The BLH cannot afford the high prices. The BLH would like support from ELM to take out new insurance and the service it includes, which they want to pay for themselves. Without the service, the medical devices pose a very high risk when working, as they are very old and do not work reliably.

In the current local situation, the BLH is at a disadvantage in terms of money allocation due to the fact that it is partly state and partly church-run. The government is currently only supporting state hospitals, but is now clearly reaching its limits. The BLH is of great importance to the people of Ramotswa and the surrounding area. Patients appreciate the Christian hospital and the expertise on site and therefore come there specifically.

One positive aspect is that the hospitals are moving closer together. Since the crisis, the hospitals in Ramotswa and the surrounding area have been working much more closely together, exchanging more information and trying to share materials with each other. Another positive development is that the hospital has established itself as a referral hospital for outpatients. Appointments for specialists can only be obtained with a referral from the local district clinics, thus making better use of resources.

We hope that the BLH will survive the crisis and, with support and donations, will be able to flourish again and continue to provide people with good medical care.