The pain of medical internship
This week, at Arsi University, within the town of Assela, which is about 200 kilometers outside of the capital, medical interns on the verge of graduating from medical school made a rare protest. They wanted to highlight the shortcomings of their livelihoods, the long hours they are forced to endure, low and mostly of no financial benefits for services rendered, lack of security from patients and a call for better infrastructure for their learning experience.
They were following a protest that happened at Jimma University’s medical school over similar issues earlier in the week.
Instead, the students’ protest was met with forceful dispersion and some even sustained injuries after being confronted by the local police force. This has brought many including former medical students to open up about their internship experiences, in order to help address the lingering issues of how Ethiopia treats its aspiring medical professionals, that are for the most part changing its narrative of better health for Ethiopia’s fast-growing populations and its future guardians.
In a social media protest, that has become the norm of a new generation of professionals, activists, the voice of one young doctor in particular, Gelila Sintayehu (MD), who graduated from Addis Ababa University School of Medicine in 2016 and currently lectures at the Debre Birhan University, seems to have resonated with many, including aspiring and professional doctors, pushing them to share their own experiences openly.
“Where ever we are in the world, going through medical school and becoming a practicing physician is no mediocre task,” she told The Reporter. “What makes it more challenging for students in developing nations like ours is the substandard learning facilities and inadequate tools for proper patient management.”
On a series of tweets, now shared and liked by hundreds, Gelila, a frequent twitter on her own right with far influence than her 1700 Twitter followers suggest, shared her own about the long hours of work, dedication in an ever changing yet under-resourced health care system that is in need of repair to help accommodate a growing population that heavenly replies on publicly funded health care system.
Her experience seemed to be uniform-like, to a number of interns whom The Reporter was able to speak to, earlier this week, at some of the government run hospitals.
I was lucky to have found internship and to able to become the first medical doctor in my family,” one intern told The Reporter. “But the long hours, the little pay I receive have made my experience unfortunate and added much pressure on me financially. I hold a powerful title, but I perform my duties on an empty stomach,” he added.
“The whole experience of medical intern is embracing a lifestyle of poverty. We work hard, we pay a price for what we hope to become, yet, we are likely to be unemployed once we graduate and become a medical doctor,” another voiced.
“I want to be able to move to a western country and be trained more and have a good life as a doctor. In Ethiopia, doctors lack good facilities and fair salary. Even then, I should not be worried about job prospects, in a nation that is in need of doctors, but treats us second class citizens”, another echoed the same sentiment.
In an Ethiopian society, which has sent more medical doctors to western nations than those staying put in the country, as noted by its one-time Ethiopian Minister of Health and now at the helm of the World Health Organization in 2013, Tedros Adhanom (PhD), much strides have been made to accommodate the challenges of accommodating a fast-growing population of almost 110 million people, with a doctor per patient ratio has gone down from 100,000 to a doctor to 15,000. The country has opened up dozens of universities, even those with specialized teachings such as medicine, with little regards to quality of education and creating job opportunities at the end.
“When I was an intern, I remember limping on my way home because I had just spent close to 36 hours on my feet. My friends and I skipped so many meals, lost weight. We were barely paid. We had to endure constant verbal abuse from our superiors. We weren't just doctors,” she said on twitter, tagging the nations activist young Health Minister, Amir Aman (MD). “We were also porters, attendants, and our patients’ keepers. I personally don't remember spending any time at my family's dinner table because I was too tired. Whenever we questioned why things are the way they are, everyone tells us to “push through, this is internship.”
Even then, internship opportunities have become elusive for many. There are many who have been waiting for it for long. Gelila was lucky to have one, but she became a witness to its shortcomings, on how the deterioration of efficacy that comes with working long hours thus damaging not only the physician’s ability but the experiences of patients.
“It was the toughest year of my life so far. I'm sure a lot of doctors would share this sentiment. The only thing that keeps an intern going is the prospect of starting a job and advancing his/her career. Now imagine slaving away in medical school for seven years and being told that there's no job for you. To add insult to injury, you're not allowed to have your degree certificate because the government that refuses to give you a job also somehow believes that you're indispensable.”
There are many western nations who have been forced to tweak their laws governing internship, while in Ethiopia there are no plans to do so. Ethiopian interns are forced to work long hours, with little or no pay, while putting undue pressures on the intern.
In Canada, there was a rush to bring in legislation, to help protect young people, after a series of deaths, linked to long hours and exhaustion. In British Columbia, a 22-year-old crushed his car, according to his family, after working 16 hours straight in a 24-hour period and instantly died. In Ethiopia, there are no plans to do so. There are many profitable companies and government agencies, recruiting interns with little financial gain, and long hours.
For Gelila, it’s important the voices of the future medical professionals of Ethiopia are heard and their issues addressed.
“Interns deserve to be heard. They deserve to be treated with respect. They deserve to have humane working hours. Most of all, they deserve to have a job. Our country doesn't have nearly enough doctors to turn them down. Reevaluate your system! Clean it up! Stop messing with people's lives! Work on creating more health institutions! Do better,” she advised.