By Sarah Woodrow, MD
Cooper Neurological Institute
This is part one in a series of updates from Dr. Woodrow’s mission to Ethiopia. View additional posts from her on the Inside Cooper blog by clicking here to view all posts tagged “Ethiopia.”
We all enter medicine to make a difference, to help people when they cannot help themselves. It is easy during medical training to lose sight of this. It is not surprising, really. It is not that you stop wanting to help people or do the right thing, it is just that during residency you spend whatever spare energy and time you have focusing on yourself. Between the sleepless nights and countless pages, there often is little time for anything else. You forget the big picture. And then one day, something happens to change your perspective, to make you take a step back and realize what is really important to you.
For me, that moment came in the fall of 2006 when I had the privilege of working as a Foundation for International Education in Neurological Surgery (FIENS) volunteer in Addis Ababa, Ethiopia.
Ethiopia is a landlocked country located in the northeast corner of Africa with a population of over 75 million people. Addis Ababa is the country’s capital and its largest city – with over two million inhabitants. Geographically, Ethiopia is an amazingly diverse country with large mountain ranges separated by the semi-dry plateaus of the rift valley and a tropical forest in the east. Its people are just as amazing and equally as diverse with over 80 distinct cultural groups, each with its own associated language. Despite this cultural wealth, Ethiopia remains economically one of the poorest countries in the world with most of the population surviving on subsistence farming and more than 50 percent living below the poverty line.
Healthcare in Ethiopia is largely privatized. There are a few government-funded hospitals, mostly located in larger cities. The Black Lion Hospital, where I worked, is one of them. It is one of the two public hospitals in the country (both in Addis) that offer neurosurgical services. For the majority of the population, their poverty level means they cannot access adequate healthcare – let alone afford the often two or three day journey into a larger city for care. Most, I expect, did not make it that far.
Twenty million to one. That, roughly, is the neurosurgeon to patient population currently in Ethiopia with only four neurosurgeons (three local and one Norwegian) currently in practice, all in Addis Ababa. Twenty million to one. Although some might argue that the current North American benchmarks may be exceedingly generous, there can be no doubt this ratio is exceedingly low.
There is hope in Ethiopia, however. And, at present, that hope comes in the form of young doctors taking a path that hopefully many will follow as fully trained general surgeons who are currently re-training in Addis to become neurosurgeons. Experience from other fields in medicine has repeatedly demonstrated that the key to effectively training and retaining healthcare workers in developing world countries is to train them in their own environments.
Foreign-based training simply results in too high a “brain drain.” Such experience has led the Department of Surgery at the Addis Ababa University to initiate a four-year neurosurgical subspecialty training program. Developed in association with FIENS, the curriculum is approved and monitored by the College of Surgeons of East, Central, and Southern Africa (COSECSA). Knowing this, I have traveled to Ethiopia and am returning less to provide a set of hands for the operating room and more to help develop the knowledge and skills of the new recruits.