The Anglo-Ethiopian Society
Health Care in Ethiopia
Author - Paul Buxton
Visitors to Ethiopia are soon aware of how modern technology has developed in the context of an ancient civilisation. Rural life, virtually unchanged for millennia, continues alongside modern airports and thriving business enterprises. This contrast exists in the provision of health care as well.
The challenge is, on the one hand, for Ethiopian hospitals and university departments to continue developing medical research, training and treatment to the highest standard. On the other hand there is the need for health care for the majority of the population who live in scattered rural communities. For them access may be difficult and often impracticable. Only 60% of the population is within walking distance of health facilities.
The government is providing increasing resources for training rural health workers who form an essential front line in both the prevention and treatment of disease. At the same time there is a need for training facilities for doctors who wish to become specialists. Dermatologists are needed because many infectious diseases, such as leprosy and leishmaniasis, present with changes in the skin. The lecture on Mossy Foot given to the Society by Dr Claire Fuller on 18 June highlights the kind of disabling conditions that are endemic in parts of Ethiopia. It is also an example of how specialist knowledge and experience can be used to solve significant medical problems in the community.
In the past doctors who wished to specialise in Dermatology have had to find the necessary training overseas. This is a very expensive exercise and a drain on the resources of the country. It also means that the doctors experience the diagnosis and treatment of a rather different spectrum of diseases than they see in Ethiopia. They also use sophisticated equipment and drugs that are not relevant in Ethiopia.
At the same time the experience and knowledge of specialists in the UK and other countries is a largely untapped resource that can be used for training overseas specialists in their own countries. So it makes sense for specialists from here to go to Ethiopia as visiting lecturers. One teacher can teach 12 trainee residents whereas they can only go abroad one or two at a time. This means that the specialists are trained in their own country in their own institutions.
The initiative for implementing this idea came from a small group of the existing consultants in Ethiopia - principally Dr Dagnachew, in Addis Ababa. He contacted a number of specialists in Europe and as a result Professor Aldo Morrone and myself attended a planning meeting in June 2005 at the invitation of Dr Dagnachew and Dr Zufan Lakew, the University Medical School Dean of Medicine, University of Addis Ababa. This was attended by 18 dermatologists, mostly from Addis and one from Jimma as well.
A curriculum that would provide training to an internationally recognised standard was proposed. Although a 4-year programme was proposed initially it was agreed that this would be reduced to 3 years in keeping with other specialties. The training itself would be provided by consultants from the UK going as visiting lecturers to Addis, generally in pairs. In November 2006 I visited Addis Ababa with Professor Peter Friedman in order to assess how consultants from the UK could best contribute to the residents training programme. Professor Friedman gave a number of well presented lectures that widened the horizons of the resident doctors scientifically, medically and culturally as well as giving them a sound foundation for their specialist training.
|The first group of postgraduate residents at the Black Lion Hospital, with Dr Dagnachew (top right), Professor Peter Friedman and
Dr Paul Buxton
Photo © Paul Buxton
As a result a curriculum was worked out and arrangements made for dermatologists to go to Addis as visiting lecturers. For the last three years Professor Friedman has arranged for two specialists at a time to travel to Addis and provide training over a two week period. This has been limited to the autumn months to avoid the wet season.
Overall a total of 8 consultants have been involved - some making more than one visit. There have of course been problems along the way but in January 2008 the first 6 specialists graduated to be followed by a further group each year.
When travelling in Ethiopia you are soon aware of the need to improve health in the community. Crippled beggars sit by the roadside and blind elderly people, often led by a child, implore you for small change when you stop at traffic lights. The problem is less apparent in the villages where the children thronging the roads are not obviously ill but 39,000 children died of measles in 2002 while the maternal mortality rate is 850 per 100,000 births.
|Health worker examining a patient in rural health centre
Photo Courtesy of Tropical Health and Education Trust
The government is providing increased resources for training rural health workers who form an essential front line in both the prevention and treatment of disease. They carry out immunisation programmes, detect problems in pregnancy and childbirth and deal with the majority of everyday illnesses. As well as being able to treat common ailments, using a limited range of available medications, it is important that they are able to recognise more serious conditions. The early stages of some forms of leprosy for example can look very similar to patches of superficial dermatitis or fungal infection.
|Dabat Health Centre
Photo © Paul Buxton
In order to provide them with up to date information and on how to recognize and manage common conditions with limited resources the Community Dermatology Journal was started in 2005. There are now 5000 issues going to 700 countries free of charge twice each year. Although originally written by specialists from Europe, increasingly contributions are coming from the developing world. Distribution to rural health centres is a challenge but larger medical centres are taking on responsibility for getting copies to the health centres in their area.
The journal is now published under the aegis of the International Foundation for Dermatology, a registered charity. Details of how you can support the charity can be found on their website.
Copies of the Community Dermatology Journal can be read online.