Dr. Chiapo Lesetedi is the only Hepatopancreaticobilliary Surgeon in the country. In simple terms, he is a Hepatobilliary Surgeon and Specialist General Surgeon.

But some locals who do fully understand his field, refer to him as ‘Ngaka ya Gala’, which is further from what he does. Batswana in their usual comical way of sharing news, will happily tell their friends how ‘Ngaka ya gala’ has given them their life back.

And this is something that Dr. Lesetedi wishes to demystify and simplify his profession. Botswana Guardian recently sat down for an eye-opening conversation with Dr. Lesetedi.

He started off by explaining that Hepa refers to the liver, and pancreati refers to the pancreas ‘Lenyeme in Setswana’. Billiary, refers to gall bladder and tubes that transports bile from the liver to the intestine.

Since 2016, when he returned to Botswana, he has been the only Hepatobilliary Surgeon in the country. This means that his workload is not your average one, as he attends to clients from all over the country. Some come on referral from Government facilities. His sub speciality focuses on the liver, pancreas, and the gall bladder.

His work entails performing what is known as Endoscopic Retrograde Cholangio-Pancreatography or (ERCP). This is a procedure to diagnose and treat problems found in the liver, gall bladder, bile ducts as well as the pancreas.

The Endoscopy that he does is diagnostic and intervention, where he treats patients. For example, a patient might come in vomiting blood, and he then has to diagnose and treat that.

His work sounds very complicated, but for him, it is just another day in the office. Amazingly, even organs that might seem untouchable to the layman such as pancreas and liver, can be operated on.

Showing a picture of an opened pancreas, he explains the types of surgeries he performs vary. Starting off with the liver, he explains that a patient will come in with Jaundice eyes (where the skin or the whites of the eyes turn yellow). This might be a sign that there is something wrong, and could be obstructive jaundice or could be a sign of Hepatitis.

“It could be a sign that there is a blockage on the bile duct, which prevents the normal drainage of bile,” he explains noting that this will mean that bile is not going into the intestines, and will cause jaundice. Other symptoms of this might be a dark urine. The condition is very common.

They also check whether this is cancerous or not cancerous. When there is no cancer, this might be caused by gallstones, or in extreme cases it might be one of two cancers namely liver, pancreas cancer or even bile ducts cancer. “What we have observed is that these cancers, are very aggressive,” he points out.

A patient will be diagnosed with Pancreatic Cancer, which usually presents very late. Going back to the blockage, he says that it might be liver cancer that causes that blockage. This is where ERCP comes in. A tube will be inserted to unblock, and bile will be able to flow freely.

In an advanced cancer, they will unblock, and a piece will be taken to the Laboratory, and the patient will be put on Chemo. “Or this might be through surgery. If it is in the liver, a piece of the liver will be removed, and the liver will regrow, or the gall bladder will be removed. A part of the pancreas can be removed, depending on where the cancer is such as the tail of the pancreas,” he shares.

He explains that the liver can regrow very fast. In fact, it can be back to normal size in close to two weeks. But even with what appears to be a simple procedure, some Batswana fear a procedure of this nature. He says that some people still get shocked that a piece of the liver can be cut. “The liver can regenerate,” he points out.

Once he has explained in detail to a patient especially where there is a cancer, the patient will be at ease. The cancer of the liver and pancreas is very common. And every week, he has a patient of one of the two referred to him.

In instances, where it is very late for the organ to be removed, the patient is made to feel comfortable and their quality of life improved (palliation). Other cancers will include the colon cancer, which is very common on the left side.

The Cancers are very common in Botswana, and they usually affect patients who are in their forties upwards, and will present late. Painting a picture of cancer stages, he says that at Stage 1, 2, the cancer is still localised, but at stage 3, it now affects surrounding organs and that Stage 4, it is very advanced, and has spread to distant organs such as the liver. At Stage 1, 2 an operation can be done, but stage 4 is palliation.

In the last two/three months, he has seen younger patients in their twenties who are diagnosed with advanced liver cancer, and pancreatic cancer.

“I have seen patients in their 30/40’s with oesophagus cancer,” explains Dr. Lesetedi. Generally, he says that there are risk factors associated with cancer, such as smoking and alcohol consumption. Most cancers are sporadic where there is no family history. “We encourage Batswana to see doctors as early as possible,” he says.

They also deal with ulcers and heart burn. He will do an Endoscopy for diagnosis and treatment. “Or patient who will come in vomiting blood, we will use the endoscopy to stop the bleeding,” says Dr. Lesetedi.

He explains that a patient who might possibly come in vomiting blood might have ulcers or varices (where veins are enlarged or swollen) in the oesophagus. “When the veins burst, a patient will vomit blood,” he notes.

Other procedures include the removal of gall bladder, which stores bile. When we eat, especially fatty foods, is secreted into the intestines from the gall bladder. And when one has symptomatic gallstones, the gall bladder can be removed.

“This is a common operation, and I am not the only who can do it. Other Surgeons also do it,” he explains noting that usually a patient can live a normal life even without the gall bladder.

Prior to training as a specialist in this field, he said that what happened was that patients were referred to South Africa, which was costly. Today, the whole country refers patients to him. On average, he points out that he sees many patients as inpatients and outpatients.

In the meantime, he says that patients can access his services on Medical Aids portals or hear about his work through word of mouth.

Dr. Lesetedi completed his Primary Degree at Dublin, Ireland, followed by his General Surgery again at Ireland. He then came to work at Princess Marina in 2003 until 2011, when he left to continue his General Surgery

studies with a sub speciality on Hepatobilliary and Surgery.

He returned to Marina in 2016. In 2017, he left Marina to venture into private practice starting with Bokamoso, and opening another office at Sidilega. He was inspired to venture into this field, during his time at Princess Marina where he used to see a lot of patients with conditions of the liver and pancreas, who were usually referred outside the country. “I developed an interest to study this sub speciality as a way to help Batswana, as I saw a gap.

Even today, there are still gaps in sub specialities. You can see that even after 6 years, there is only one person who is dealing with this big volume,” he points out. His highlight is the satisfaction that he gets when he assists a patient. He is also involved in Surgery in General, and is the President of the Botswana Surgical Society.

He is also involved in other organisations and societies such as the South African Gastroenterology Society, and is an Executive Member of the Hepatobilliary Association of Southern Africa (HPBASA).