A working group

Ethiopia - Working Group

A working group at the EM-PACE Symposium on Jan. 26-28 in Addis Ababa.  Participants discussed their shared research interests and ways that they could collaborate within the EM-PACE framework to address health needs, specifically surrounding interdisciplinary work between U-M faculty and Ethiopian partners.

From left to right Jody Lori (wearing the white sweater), Michelle Munro, and Sue Anne Bell, all of the U-M School of Nursing. Continuing clockwise around is Addis Argo, professor of law at University of Gondar; Harvey Leo, associate professor of Public Health at U-M, Bridgette Carr, director of the U-M Law School Human Trafficking Clinic and her research fellow Eva Foti- Pagan. Off camera is Tim Johnson, chair of obstetrics and gynecology at U-M.


Coffee break

Ethiopian woman brews coffee at EM-PACE symposium.

Ethiopians know how to make a great cup of coffee, and they should because the country is known as the birthplace of the beverage. This woman was providing a traditional Ethiopian coffee service during a symposium for the Ethiopia-Michigan Platform for Advancing Collaborative Engagement in Addis Ababa. The beans are roasted and brewed right before your eyes.  (Photo by Amy Conger, assistant vice provost for global and engaged education at U-M.)

A traditional Ethiopian coffee service at the EM-PACE symposium.

Ethiopia’s foreign minister praises U-M’s Ghana experience

Dr. Tedros Adhanom Ghebreyesus

Dr. Tedros Adhanom Ghebreyesus

We had the great honor to meet with Dr. Tedros Adhanom Ghebreyesus, Ethiopia’s former health minister who now serves as the country’s foreign minister. Dr. Tedros was one of the prime movers in establishing the partnership between the University of Michigan and St. Paul’s Hospital Millennium Medical College. He visited U-M three years ago and met with Joe Kolars, Tim Johnson and Senait Fisseha to discuss possible partnerships. He said U-M was an attractive partner because of the Johnson-led collaboration with colleagues in Ghana that has been working to improve health care in the West African nation for three decades.

Tedros and Fisseha

Tedros and Fisseha

“What Michigan did in Ghana could be easily applied here,” the foreign minister said. “You cannot implement U.S. standards here, but a U.S. institution with experience in Africa really has more to deliver in Africa. Some of the things they did in Ghana can be replicated in Ethiopia. They know what they are doing. They don’t come with some illusion about the situation and what can be done. They have the experience, so they will come will come with the right understanding and come with something that is tailor made for you.”



A new emergency room

Dr. Zerihoun in his new, smaller office at St. Paul’s Hospital.

Zerihun Abebe’s new office looked like a construction zone, with chunks of brick and plaster piled on the floor. Workers recently knocked a big hole in his wall, creating an entryway to his assistant’s office. The renovation is just one part of a much bigger expansion plan led by Abebe, the provost of St. Paul’s Hospital and Millennium Medical College – the University of Michigan’s biggest partner in Ethiopia.

His spacious old office has been converted to an emergency room that’s better able to handle the growing number of patients in the booming capital of Addis Ababa.

“Addis is suddenly full of traffic accidents, and we only have 12 to 14 beds. It’s crazy,” he said. “Everyday, there are 45 to 50 cases showing up that deserve admission, and for most of them we don’t have beds for them. Now, we will have 35 more beds – 50 beds in total.”



New hope for childless couples

Dr. Jenberu Meskelu in the Andrology Clinic

Dr. Jenberu Meskelu in the Andrology Clinic

The inability to have a child is an extremely serious problem in Ethiopian culture, says Jenberu Meskelu, a physician at St. Paul’s Hospital Millennium Medical College in Addis Ababa.

“If you are a married person, you are expected to have a child,” Meskelu said.

Many couples who have trouble conceiving have to rely on traditional medicine, holy water or other remedies that waste their time and money. But now, patients are getting help at St. Paul’s, which last month opened the first andrology laboratory in a public hospital in Ethiopia.

About two months ago, Meskelu went to the University of Michigan to receive training in andrology, which focuses on male impotence and infertility. The training was part of a rapidly expanding collaboration between U-M and St. Paul’s.

“Before going to Michigan, I had only read about andrology,” Meskelu said. “I didn’t know how it was really done.”

After returning to Ethiopia, he wasted no time practicing what he learned. Two weeks ago, he performed his first intrauterine insemination, which involves taking a semen sample, separating the fast-moving sperm from the slower ones and placing them into the woman’s womb. He plans to do another IUI next week.

It’s too early to tell whether the procedure was successful, but Meskelu is hopeful.

His lab is basic, with a couple microscopes, a centrifuge and supplies that he rations because they can be scarce in Ethiopia.

“It’s a small lab,” he said, “but it will get bigger and bigger.”




An exciting time for doctors

Malede Birara

Malede Birara

His parents, brother and even his wife think he’s foolish for not practicing medicine at a private clinic, where he could be making six to seven times more money. But Malede Birara has no plans to leave his job as a physician in the OB-GYN department at St. Paul’s Hospital Millennium Medical College in Addis Ababa.

He’s staying because he wants to continue doing research. “There are few private hospitals that give you the opportunity to grow in your academic area, “ he said.

St. Paul’s provides him housing. He owns a car. And he can easily pay all his bills.

Still, Birara’s choice to remain in Ethiopia is unusual among his peers. Brain drain has been a serious problem in the region. Many doctors have left the countries to work in major U.S. cities, like Atlanta and Washington, D.C.

Birara doesn’t believe money was the primary factor motivating doctors to leave Ethiopia. He thinks the most important thing for doctors is having a satisfying work environment – a place with good resources, equipment, training and opportunities to develop.

Ethiopia’s government is beginning to understand that now. “I see a bright future, “ Birara said.

During the past 20 years or so, the government’s top priority was the prevention of diseases such as malaria, tuberculosis and HIV, he said. Most resources went to lower-level medical staff.

But in the past two years, the priorities have shifted to developing hospitals and expanding specialty training, Birara said.

“In our OB-GYN department two years ago, we had three people,” he said. “Now we have nine.”

It’s an exciting and hopeful time for Birara. “We expect more and more.”

Feeling safe

Sarah Bell and Sunasia Echols in the hospital.

Sarah Bell (left) and Sunasia Echols in St. Paul’s Hospital.

Sarah Bell isn’t new to Africa. Before beginning medical school at the University of Michigan last year, she spent a year in South Africa doing grassroots HIV education. Then she traveled to South Sudan for another year with a child-survival program.

This summer, Bell is working on a research project in women’s health at St. Paul’s Hospital Millennium Medical College in the Ethiopian capital, Addis Ababa. Her experience in Ethiopia is vastly different from her previous experience in South Africa and South Sudan. Ethiopia, she has found, is “far friendlier.” 

For example, while living in South Africa’s beautiful Cape Town, Bell never felt completely safe.

“My boss got stabbed five times,” she said. “My roommates got held up at knifepoint. I’d get my butt slapped if I walked alone on the streets during the day. Here in Ethiopia, people will say things, but it’s all very friendly. In South Africa, it was all pretty aggressive. I couldn’t go anywhere alone at night.”

In South Sudan, crime and harassment were less of a problem, but violence was a constant threat. “I was more concerned about land mines and rocket-propelled grenade launchers or the start of another war,” Bell said.

In Ethiopia, she’s found that people “kind of look out for you.”

“Today, my bag broke, and I was carrying bananas,” she said. “Some guy came up and gave me another bag. He didn’t want anything. I offered him a banana, and he said, ‘No, no, no.’ I never get ripped off by the banana seller. They treat you fairly. I’ve been so impressed with the people, both inside and outside the hospital.”


Surgery with condoms

A condom is inserted into a patient’s abdomen during surgery.

Ethiopian doctors have much to teach their counterparts in the West about being resourceful and efficient. They often don’t have the fancy, high-tech equipment common in the U.S., so they improvise, using everyday items like condoms in the operating room.

A good example of this is how they perform laparoscopy. It’s a common procedure in which the surgeon makes a small incision to remove some type of mass – such as a cyst, tumor or tissue – from a patient’s body.

In the U.S., physicians use a relatively expensive device designed for the procedure. The surgeon makes a small incision and pushes a plastic tube called a “port” through the opening. A hollow rod is inserted through the tube and into the body. Inside the rod is a bag that can be deployed inside the patient. Using grasping instruments, the surgeon can maneuver the mass into the bag, which eventually gets pulled out of the body. If the mass ruptures during the procedure, the bag contains any fluid (or other nasty stuff) and keeps it from spreading in the body. After the surgery, the instrument gets tossed in the trash.

In Ethiopia, doctors also insert the tube or port into the patient’s body. But they don’t use the fancy hollow rod with the bag inside. Instead, they use a stick along with a condom – or a surgical glove for a large mass – which is pushed through the port and used to round up the offending object. The condom costs just pennies, and the rod and tube are sterilized and reused.

Beth Skinner, who specializes in minimally invasive gynecologic surgery at the University of Michigan, has spent the week operating with Ethiopian colleagues at St. Paul’s Hospital Millennium College. This is her third trip to the country. Each visit motivates her to rethink her own views and processes.

“They do a lot of resourceful things here,” she said. “In the U.S., we can be very wasteful, using so much equipment.”

The U-M physician also has been impressed with the efficiency of Ethiopian surgeons. “They are very expeditious in the operating room,” she said. “They are very ‘start, stop, done.’”

The Ethiopians have to work this way because of their huge caseload. It’s also costly to keep people under anesthesia for hours.

To be sure, the U.S. has higher standards of sterilization and multiple safety checks in the operating room. This can slow things down and increase costs.

Still, Skinner said, “We have a lot to learn from each other in Ethiopia.”





Partners as colleagues and friends


What makes a good partner? The question came up in a discussion I had today with Lia Tadesse, a key figure in the University of Michigan’s rapidly expanding collaboration with St. Paul’s Hospital Millennium College in Addis Ababa. Tadesse is an OB-GYN physician and vice provost for academics and research at St. Paul’s.

The ideal partners are willing to listen and  focus on St. Paul’s needs, she said. “We have seen in some cases previously that some partners would come with their own perceived idea about what we need, and it doesn’t fit,” Tadesse noted. “So partners who are open to give what is needed, based on the needs of the institution or country, is one priority.”

Forming solid relationships is also important. “We don’t see our partnerships just as partnerships,” Tadesse said.

She noted that when Senait Fisseha, an associate professor in OB-GYN at U-M, began working with St. Paul’s to set up the collaboration,  she established ties across hospital departments and at every level, not only with top management.

“The huge strength of this collaboration is that there are quite a lot of strong relationships,” Tadesse said. “It’s just not as partners working together but as colleagues and good friends. So it gives us the openness to discuss everything.”





Bold travelers

Sunasia, Sarah, Emilia and Ninette with their lab techs.

Sunasia, Sarah, Emilia and Ninette with their lab techs.

Overwhelmed with homesickness, Sunasia Echols laid awake until 5 a.m. on her first night in Ethiopia.

“I was just like: ‘Oh, I just want to go home. I can’t believe I’m here,’” said the University of Michigan senior majoring in psychology. “But at the same time, I was like: ‘I can’t believe I’m here! I’ve always wanted to go to Africa. It was one of my biggest dreams.’ “

Sunasia Echols

Sunasia Echols

Before coming to Ethiopia, Echols had never been abroad. Many students pick a more traditional route,  studying in places like Rome, London and Madrid. So by choosing Ethiopia, Echols was making a bold move.

Her family was happy to hear she was going to Ethiopia to spend the summer with two other U-M undergraduates and a second-year medical student working on a research project about women’s health. The students are part of the Minority Health and Health Disparities International Research Training Program.

“My dad said, ‘I don’t want you to go, but I really want you to go.’ They were scared of me going away so far,” she said. “My mom was really excited. She never had the opportunity to do it, so she said, ‘Yeah, you should go for it. I really want you to go.’”

While Echols is mostly over her homesickness, she said it still flares up during important family events she’s missing, such as her father’s recent birthday.

Ninette Musili

Ninette Musili

She has had to experience some other hardships, including sporadic Internet access and limited water supply in her dorm. And a pickpocket stole her iPhone. But she’s still having a great time.

“Going to the cultural restaurants and seeing Ethiopia’s history is just amazing,” she said. “I’m not a history-type person, but going there and learning about it is great.”

One of Echols’ research partners, Ninette Musili, was born in Kenya and moved to the U.S. when she was 9 years old. Although she loves hot weather and wishes Ethiopia’s often chilly rainy season would be warmer, she’s enjoying her time in the nation’s capital, Addis Ababa.

“The city is still developing and the country is on a rapid development program. It’s a little bit like Nairobi was when they decided to redo the city and there was construction everywhere. It’s a little bit familiar but at the same time it’s very different because the culture is different,” said Musili, a junior majoring in biomolecular science.

Sarah Bell

Sarah Bell

She added, “I appreciate the fact that Ethiopia is a lot safer in some ways than Kenya is. In general, people are more willing to help. If you’re out late at night, it feels safer because people don’t bother you as much than if you were out late in Kenya.”

The medical student in the group, Sarah Bell, added that Addis Ababa is regarded to be one of the safest cities in Africa.

Emilia Iglesias

Emilia Iglesias

The third undergraduate in the group is Emilia Iglesias, who was born in Guatemala and moved to the U.S. when she was 9 months old. Since then, she had never gone overseas – not even to Canada, even though she grew up in Michigan.

“I’ve always dreamt of going abroad,” said the junior majoring in neuroscience. “It didn’t really matter where I went. I just wanted to go somewhere, but I’m glad I came here because everyone is so friendly, just amazing. I’m going to be very sad to leave. I’d love to come back, but I really want to go to other countries.”