By Sarah Woodrow, MD
Cooper Neurological Institute
This is part two 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.”
It is the rainy reason here. I forgot that. We are not talking about a little spring shower, either. It pours. For hours. It’s cleaner than I remember ‘tho and that may be a good thing because with all the rubbish that usually fills the corners of the streets, the drains get blocked and when the rain comes the streets of Addis become one large swimming pool. Fortunately, I think I have arrived at the end of the rainy season so I may not have to face too many mini floods. The upside is that the rainy season brings with it the warmer weather – I would take warm and wet over cold and dry any day!
I arrived late last night. After almost 2 hours waiting in line for my visa I was greeted by some warm friendly faces. Dr. Abat and his wife Betty. They were some of the first people I came to know when I started making these trips here four years ago. He was a first year resident in neurosurgery then. He is now an attending neurosurgeon at the Black Lion Hospital, the hospital I will be working at while here in Ethiopia. It is an 800 bed hospital and the largest teaching hospital associated with the University of Addis Ababa. I feel like a proud parent having contributed a little bit to his training over the last few years. And his success represents so much more than just a personal one.
You see, Ethiopia is a country of 75 million people. The vast majority of the population are subsistence farmers – supporting themselves and their families with whatever crops and herds they can raise. It is amongst the poorest countries in the world. Last I checked, on the WHO scale it ranked in the bottom 10 countries in the world in terms of it socioeconomic status. The average family income is just over $100/ year.
Not surprisingly, the practice of medicine is very different here. As most of the population lives in isolated small villages – often separated by amazing scenery – it would take many hours, on foot or donkey to access the closest medical clinic – usually staffed by either a nurse or a first year intern. As a result, many villages have their own witch doctor or shaman who provide the first level of care to the local population. If things are serious, and a family can afford both the time and money involved, they then get referred to one of the local cities where small hospitals and some basic specialties are offered – internal medicine, infectious diseases and general surgery.
Even today, the only place to access neurosurgical services is in Addis Ababa, the nation’s capitol. For many villagers this means a trip of 2 or 3 days or more – partly by foot, the rest by bus. Many I suspect don’t make it this far –the financial burden of either the trip itself or the loss of a healthy member of the family to accompany the sick patient is just too much. In 2006 there were only 3 Ethiopian neurosurgeons and a handful of mostly temporary foreign-trained ones who worked in a variety of state-run and charity care hospitals in the capitol. By the end of this year that number will have double to 6 with currently 8 more in training. And it all started with Abat. He, and his classmate Mersha, were the first two neurosurgeons to be trained within this country.
As part of a growing movement to develop the practice of medicine in Ethiopia the University of Addis Ababa, partnering with several other institutions from around the world, has begun training a variety of medical and surgical subspecialties, neurosurgery among them. It is a plan that makes sense given the “brain drain” that has historically afflicted many developing world countries in numerous professions, including medicine. So far it looks like it may be working.
This is my third trip to Addis – all under the auspices of FIENS – the Foundation for International Education of Neurological Surgeons – a group of volunteer neurosugeons who travel to developing world countries to help advance the education of surgeons there. I don’t know who get more out of these trips – me or my hosts. I just know that every time I make one of these trips I returned humbled by the experience and ever more grateful for that which I do have. I look forward to sharing with you my story.