Emergency Medicine: Ethiopia Update & Call for Applicants

Jan 25, 2018
James Maskalyk

The holidays come upon us, and are too soon gone. With them, though, is a chance to reflect on the year that passed and what matters most. We are particularly grateful to the large and growing number of people who, through trips to Addis or by giving from Toronto, have expanded their circle of care all the way to Ethiopia, and with that, contributed to making many people well.

It has been almost ten years since the U of T’s eyes blinked open in Black Lion hospital in Addis. Since then, we have sent almost 30 faculty delegates (many returning multiple times), 24 senior residents, taught over 400 hours of lectures, stood at the bedside for thousands more until our feet were sore, delivered certifying exams, published dozens of papers and one book, conducted two leadership conferences, and eaten approximately fourteen tons of injera.

Most importantly, we have graduated twenty-one EM physicians who otherwise wouldn't be there. Many of them, despite their youth, are already ED chiefs and CEOs of busy hospitals. Others have started a new residency program of their own, with almost 40 trainees, with another 44 to follow at Black Lion, where we continue to teach. This past September, we hosted our first Ethiopian fellow. She studied at the Poison Centre, and became the first ERP certified in ACLS. She returned to Addis and is teaching nurses, medics, and residents the best of what she has learned.

The contributions are not just from the traveling delegates, but from many of you who have taken time in Toronto to develop resource-appropriate exam questions, commented on research and QI design, and mentored new faculty who otherwise would have no guidance about how to make a career. Though still fragile, the EM community is nearing the point where it might perpetuate itself. It still needs support as it tries, particularly as stretches itself towards the 100 million people in Ethiopia it has yet to contact, but it is moving in that direction, stronger every day.

As far as we know, this is one of the first attempts to ameliorate extreme poverty in such a low-resource setting by supporting the growth of a community to address diseases and injuries that keep people poor. While we are continuing as we have, increasing the number of graduates and ensuring the quality of their training, we are contemplating a serious shift in focus. It is our hope that by 2020 we will move away from the usual postgraduate teaching of the past decade, towards a model that provides support to the graduated EM physician. We will continue to engage at the postgraduate level (exams, certification), but also support professional exchanges, telemedicine opportunities, research partnerships, and subspecialty development. We believe this shift, combined with a well trained cohort of clinicians, will allow Ethiopia to grow in its own unique direction and take on the difficult task of spreading it to its neighbouring countries. ethiopia medicine.jpg

This endeavour is not as much about extending a body of knowledge to a distant place as it is proving that even people far from us matter, deserve the best care the environment can afford no matter who they are. This includes the man in downtown Addis Ababa, sleeping on the street, and the young woman gasping from her rheumatic heart a hundred miles from the nearest town. Thanks to all of you who, by believing this to be true, have moved them closer .
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I am attaching three photos. One is of the drug cupboard taken on the first trip Nazanin and I took to Addis in 2008, the second from last month. Over the interceding decade, we never took a single drug, only talked about which ones we missed the most. The third is from this year’s leadership conference. It was your attention that helped fill them both.
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Deep gratitude for it, and to all of you who choose the difficult but worthwhile life in the ER.

Those of you interested in traveling to Addis to teach, please contact Elayna Fremes (efremes@ghem.ca) for available dates (one spot in May 2018, plus dates in 2019), so too those of you interested in giving in other ways (peer reviewing exam questions, hosting visiting fellows). As our plans for Ethiopia 2020 evolve, we will also be looking for more capable hands and ideas.


TAAAC-EM Executive

Megan Landes
Lisa Puchalski Ritchie
Margaret Salmon
Eileen Chung
Jennifer Bryan

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