Protocol For External Visitors

As an external visitor (an individual who is not a student or fellow at Penn, or is not directly employed by Penn or CHOP), we want to ensure that you understand what steps you need to take before you arrive in Botswana and the services that BUP may provide to you with their associated fees.

This form is only for those external visitors who have already made arrangements to work with BUP. BUP does not facilitate global health experiences for external visitors. You must make those arrangements directly with BUP faculty.

Please complete the following form at least 30 days prior your arrival. It is best to submit this form as early as possible.

Your signature will be required as proof of your acknowledgement and acceptance of the terms and conditions of BUP described here. You will be notified once the completed form and supporting documents have been reviewed and accepted.

I. Visitor Information
Name Name First Last
Email
Occupation
Home Instiution
Primary Contact at Home Institution
Dates of visit to Botswana

dd/MMM/yy to dd/MMM/yy
Reason for visit to Botswana/ BUP. Please be specific, include the name and title of who invited you to Botswana and the activities you plan to conduct while in Botswana such as research, clinical work, etc and who will be supervising you.
Primary Contact in Botswana/ BUP
II. Emergency Contact and Phone Numbers
Name of Emergency Contact Name of Emergency Contact First Last
Phone #1

include the country code
Phone #2

include country code
Email
III. Pre-Departure Responsibilities

Prior to arrival in Botswana, all external visitors are responsible for obtaining/ completing the following:
1. Travel Health Insurance – external visitors working with BUP must provide proof of travel health insurance for the duration of the individual’s stay in Botswana. Proof of coverage must be submitted with this form. Upload your proof below.
Upload a proof of travel health insurance here:

Attach Files
2. Travel Med Visit – external visitors must consult with a healthcare provider to obtain any recommended prescriptions. These medications should be filled and brought with you to Botswana.

The following (#3 -5) is ONLY for those who are planning to practice medicine in Botswana.

3. If you will be performing any clinical activities in Botswana, you must register with the Botswana Health Professions Council (BHPC). You must prepare your application prior to your arrival in Botswana. See the next section if you would like assistance with this application.

4. Post-Exposure Prophylaxis (PEP) – external visitors working in a clinical setting have an increased risk of exposing themselves to HIV and Hepatitis B and C. External visitors are responsible for consulting with a healthcare provider to obtain a prescription for Post-Exposure Prophylaxis (PEP). This PEP prescription should be filled and brought to Botswana to be taken in the event of an exposure. As an external visitor, you will need to establish an action plan with your healthcare provider in the event that you are exposed to these infectious diseases, especially regarding access to testing, counseling, and follow up treatment as needed.

5. Medical Professional Liability Insurance – Penn medical professional liability insurance is limited to Penn employees, faculty, and students. It is important that any external clinicians who work with BUP and practice medicine in Botswana are aware that they are not covered by Penn’s medical professional liability insurance and are at risk for any legal implications that may arise as a result of your clinical practice. In Botswana, it is not required by law to have medical professional liability insurance to practice medicine in the public sector. However, Penn/ BUP strongly recommends that you consult with your home institution or clinical practice regarding its coverage and/or advice for its clinicians practicing medicine in other countries. If your home institution or clinical practice provides medical professional liability insurance while you are practicing in Botswana, please bring any documentation of this coverage with you.
IV. BUP Services and Associated Costs
Please check all the services that you are requesting. Hold your mouse over the service to see the cost and more information appear to the right:

Please check all the services that you are requesting. Hold your mouse over the service to see the cost and more information appear to the right: BHPC Application Assistance

The cost of this service is $100 and is due within 30 days of the invoice date.

BUP can provide administrative support to register external visitors with the Botswana Health Professions Council (BHPC), which is required for all physicians practicing medicine in Botswana. BUP will explain the necessary documentation needed to complete the BHPC application and assist with its submission.
Visa and Permit Assistance

The government of Botswana has specific requirements for visitors who carry out work in country. These requirements apply to most external visitors. BUP can guide you through the requirements to enter and work in Botswana. Please check this service if you would like BUP's assistance in obtaining a visa or a work permit while you are in Botswana. If you are unsure about what may be required of you, please check this box and we will provide guidance. (Visas = $150; Short-term Exemption Permit = $100; Long-term Exemption Permit = $450; Work & Residence = $500, Dependents = $250/person)
Airport Transfer

One roundtrip airport transfer is $30 and is due within 30 days of the invoice date.

BUP can provide airport pick up and drop off services to/from the Sir Seretse Khama International Airport in Gaborone. This service is reserved for BUP work-related travel to/from the airport (i.e. your initial arrival and final departure). It is not intended for any personal travel to/from the airport during your time in Botswana. If you are requesting an airport pick up and drop off, please submit your flight itinerary with this form.

BUP does NOT provide visitor car or driving services. If you need a car or a driver while in Botswana, BUP can provide car rental and driver service recommendations upon request.
If you are requesting an airport pick up and drop off, you must submit your flight itinerary with this form. Upload a File.

Attach Files
Accommodations at Village View

The nightly rate is $70 for external visitors (this rate is subject to change in the new fiscal year, starting July 1).

Space permitting, BUP can also provide shared accommodations for your stay in Botswana at Village View, residential flats leased by the University of Pennsylvania. A deposit will be required to confirm this reservation. The balance is due within 30 days of the invoice date.
If you would like to request a reservation at Village View, please provide the dates you are requesting accommodations (use this date format, ie 06/JUN/18 to 30/AUG/18)

dd/MMM/yy to dd/MMM/yy
If you check any of the services above, please tell us how will you be paying (credit card or check)?

If you check any of the services above, please tell us how will you be paying (credit card or check)? Credit Card Check
V. Acknowledgement of Risks and Release from Liability

In consideration for being allowed to participate in the Botswana UPenn Partnership (BUP), I acknowledge and agree as follows:

Although the BUP has taken reasonable steps to provide appropriate resources and guidance so that external visitors may participate in activities for which they may be skilled, I acknowledge and appreciate that such foreign service projects are not without risk. I understand that the BUP is not in a position to guarantee my personal health or safety during my participation in this project. Notwithstanding, the BUP thinks it is important for each trainee to be informed of the inherent risks.

External visitors will travel to and from work and live in Gaborone, Botswana where they may be subject to numerous risks, environmental and otherwise. Specific hazards include the risk of crime, exposure to communicable diseases including, but not limited to, Tuberculosis, Hepatitis, Tetanus and HIV, as well as the hazards of travel to, from and around Botswana, inadequate medical care and remote access to medical treatment. Knowing these risks, I am aware that I must have travel health insurance for the entire duration of my time in Botswana and it is not provided for me by BUP.

I am aware that the participation in foreign service project activities entails risks. I understand that the description of these risks is not complete and that other unknown or unanticipated risks may result in injury, illness or economic loss. I am participating in these activities on a purely voluntary basis.

I assume full responsibility for all risks associated with my participation in this project and I agree to hold harmless, release and forever discharge the Trustees of the University of Pennsylvania, the School of Medicine of the University of Pennsylvania, the Department of Medicine of the Clinical Practices of the University of Pennsylvania, the University of Pennsylvania Health System, the Botswana UPenn Partnership, and their respective trustees, officers, directors, employees, agents, faculty and students from and against any and all claims, demands and causes of action of whatever kind that I may have including but, not limited to, illness, bodily injury, imprisonment, death, and loss of personal property, or the consequences thereof, resulting from or in any way connected with my participation in the BUP.
VI. Visitor Signature and Acceptance of Risks and Terms
My signature below indicates my acceptance of my responsibilities outlined above. I assume full responsibility for all risks associated with my travel to Botswana and with my work with BUP.

My signature below also indicates my acceptance of the terms and costs of the services that BUP offers as outlined above.

Draw your signature into the box below.

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.

Protocol For External Visitors

Protocol For External Visitors

I. Visitor Information

II. Emergency Contact and Phone Numbers

III. Pre-Departure Responsibilities

IV. BUP Services and Associated Costs

V. Acknowledgement of Risks and Release from Liability

VI. Visitor Signature and Acceptance of Risks and Terms