tin roof.

i flew into ethiopia 2 weeks ago to better understand the state of emergency medicine in addis, particularly at the postgraduate teaching hospital of Addis Ababa University, the “black lion”.  though it might be better to draw out the suspense, i’ll cut it:  there is none.

nor did i expect to find any.  there are no emergency medicine providers here, and no training program in the country.  there have been several stunted attempts to start it over the past fifteen years, none of them successful.  this time, however, AAU is confident.  not only do they have interested partners (u of t, wisconsin), and a curriculum set to begin in sept 2009 (i have seen an early draft), but there is a tremendous amount of political will.  a young doctor who works in what stands for an emergency department now says that when he runs into administrative problems, he SMS’s a health minister.

the system itself is an interesting combination of few public resources, a capable private system out of reach of the average Ethiopian, and no middle ground.
a patient I saw the other day arrived with a cat scan obtained from an outside lab that showed a subarachnoid hemorrhage (a brain bleed)  and marked swelling of the cerebrum.   the treatment?  a drug to prevent vessel spasm, marginally effective, which the patient’s family would have to buy at the hospital pharmacy.  i suggested elevating the head of the bed to decrease the pressure in the brain. the end.

there is one neurosurgeon at a private hospital, but the family had no money for the transfer and surgery to clip the bleeding vessel.  the next patient I saw was having a heart attack.  aspirin.  no cardiologists at the hospital, no surgeons in the country.  the end.

the medical knowledge of the trainees i have worked with at all levels is quite sophisticated, as impressive as anywhere in canada and in some instances, moreso because the solution is not as close as the nearest phone.  however, the chance for intervention is small.  part of the reason, of course, is the average Ethiopians proximity to the poverty line.  another, though, is the large ethiopian diaspora.  over the past several years, thousands of qualified postgraduates have left to train outside of the country. i’ve been told that only dozens have come back.  it is tough to imagine a strong community of advocates for health problems in addis, or the country, when those with the most qualified voice, those most apt to find creative solutions, have left their country to seek a better life for their children.

one of my greatest pleasures in the past two weeks, though, has been meeting with physicians who are committed to staying, despite the adversity.  they work in the public system, giving care for almost no recompense, and to pay their rent and their children’s tuition, work evenings and weekends in private clinics.   “when do you see your wife?” i asked one of the surgeons who was taking me on a tour of the addis’ public hospitals,  “when i can….when i can…” he answered.

it is the hope of aau, and the university of toronto’s academic collaboration  with ethiopia (TAAAC), that by training doctor’s in the country, they will be invigorated, inspired to stay.  more than that, by learning to care for individuals in their unique context, unique solutions will be found, not just for ethiopians, but for millions of other people in the world who have emergencies in places where help isn’t as close as a telephone.

this afternoon, i walked back from addis’ national museum.  i’d been there before, to visit lucy.  as you might know, a much older relative of ours has the dust swept off of her, not so far from here.  she’s *****million years old, and challenges the notion of when hominids diverged.  so much has happened since then.

i was walking down the road from there, on my way to find (internet) connection, and i stopped to take a picture of acres of angled tin roofs, children running on the stone strewn paths between.  i know exactly where i stood, and i took the photograph in the hopes that i could take another in twenty years, from the same precise place, and show people how much it has changed.