By Fasika Jembere
During the months of May and June this year, I had the unique opportunity to shadow and learn alongside pediatricians, residents, interns and medical undergraduate students here in Addis Ababa. This two-month-long internship allowed me to experience all levels of Ethiopian healthcare and I was able to procure over 200 hours of learning and working with the doctors and nurses. I worked in the pediatric ward and emergency of St. Paul Hospital and Black Lion Hospital, which are two of Ethiopia’s leading primary health facilities that are funded by the government. As well, I shadowed pediatricians with extensive years of experience in Brook Internal Medicine and Pediatric Clinic, a private medical center that serves Ethiopia’s wealthier citizens. In addition, I spent some time at the Woreda 14 Health Center’s Emergency and Outpatient Department (OPD) which serves as a secondary health facility for day to day health concerns and emergencies.
This was truly a one of a kind experience and was an opportunity to have hands on practice in the world of healthcare in Ethiopia. During these two months I saw a range of illnesses spanning from the most complicated cases of meningitis and congenital heart diseases to everyday illnesses such as the common cold and ear infections. It was fascinating to see how Ethiopian healthcare professionals deal with the varying cases of illnesses and diseases that impact the patients on a day to day basis. Throughout this time, I was able to immerse myself in the hospital environment and witness how the physicians diagnose and treat the patients, ranging from the most dire and imminent patients that can be found in Black Lion and St. Paul hospitals to general check-ups and follow up procedures in the smaller clinics and institutions. It is clear that the sheer number of patients and sick people clearly outweigh the number of doctors that are available to treat and medicate the patients; however, the determination and knowledge of the physicians is truly remarkable.
In Black Lion Hospital, I learned alongside third year undergraduate medical students. Although these students were still in the preliminary stages of their education (medicine takes six years to complete in Ethiopia), they were constantly interacting with patients and transferring their classroom learning to bedside experience. This transfer of knowledge was something I was able to be a part of by participating in educational seminars and practicing simulations on mannequins for basic procedures such as IM injections and IV-line insertions. As well, I had the opportunity to interact on a one-to-one basis with the patients and their families, as I learned with the C-1 students how to clerk a patient and take a detailed history and complete a physical examination.
In St. Paul Hospital, my experience was a little different since I spent my time shadowing interns who were nearly finished with their medical degree and residents who were working towards their specialization. During this time, I had the opportunity to regularly participate in rounds around the pediatric ward. At this time, we would circle through each patient and discuss their diagnosis, history and current management. This experience helped me familiarize myself with many complex and unique medical cases and get situated in the ward. This difference in atmosphere helped me see how the doctors work together using the symptoms and evidence presented to find a diagnosis and course of treatment for the patients. Working with experienced physicians and nurses gave me an insight into the sacrifice and dedication it takes to be constantly aware of your patients’ status and ensure you are giving them the highest quality of care.
Additionally, one thing that truly immersed me in the health system of Ethiopia was working in the Woreda 14 Health Center. These facilities are fully government funded and provide the general population with a first-stop location for a variety of services from general check-ups to higher level referrals to primary hospitals for more serious and life-threatening sicknesses. My time there was instrumental to see how the people of Ethiopia receive health care. It was truly astounding to see the sheer number of patients that needed medical attention on a day to day basis. The cases ranged from on the job accidents such as a nail stuck in a persons’ hand to seizing children and adults. The health centers are readily available throughout Addis Ababa and are where many people receive the medical attention they need.
Working and learning in all these medical institutions was truly an invaluable experience and gave me insight into how the hospitals and clinics in Ethiopia are run and the daily routines that are involved. As I do have experience volunteering in hospitals in Canada, there was a stark contrast between medical practices seen in the two different countries. The greatest challenge for many of the physicians seems to be a lack of resources and the incredibly low ratio of doctors to patients.
As well, there are immensely long lines for many of the medical imaging machines since there are not that many in the country. Moreover, these long lines are further impacted when there are frequent malfunctions of the CT Scan and MRI. Furthermore, when a problem occurs, it makes it increasingly difficult for the patients to obtain timely results and they are unable to receive the necessary health care they need. This backlog in the system ultimately makes it very difficult to diagnose the patients and properly medicate and treat them.
In addition, there are a variety of setbacks when it comes to the availability of medications. Considering only a limited number of pharmaceuticals are imported into the country, it becomes difficult to write a prescription for a medicine that is both necessary and readily available in the country. As well, the limited supply makes many of the products extremely expensive and many Ethiopian citizens are unable to afford the proper medication or treatment to help cure their illness. The lack of money and medical resources ultimately makes it very difficult for the system to work for the people who are in dire need of the medication the most.
Nevertheless, the hospitals and the Ethiopian healthcare are still on the path of modernization. While there may still be many challenges and hardships, hopefully many of them will be solved through time and more resources being available to the physicians and medical staff to adequately diagnose and treat their patients.
This internship was not only a way to understand the day to day schedules of a hospital, it also allowed me to broaden my perspectives and understand the hardship that occurs when there is health inequality present in the medical system. Primarily, it impacts the patients since they are unable to receive the highest quality of care due to many basic necessities being unavailable, such as imaging and medication. Secondly, the physicians and nurses are also gravely affected since they are unable to fulfill their roles to the highest extent due to the limitations that are present. My time working in these hospitals and medical facilities was undoubtedly an eye-opening opportunity and it allowed me to have first-hand experience in the Ethiopian healthcare system.
This opportunity could not have been possible without all the help from my grandfather who helped me get in contact with many of the physicians. As well a great thanks for the guidance and support I received from all the doctors, students and nurses that taught me and directed me throughout my time in Ethiopia.
Ed.’s Note: Fasika Jembere is visiting from Toronto, Canada and is a student at the University of Toronto. The views expressed in this article do not necessarily reflect the views of The Reporter.