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.”



A booming economy


7/13/14 Construction under way in downtown Addis Ababa, Ethiopia.

Another high-rise building goes up in Ethiopia’s capital.

By William Foreman

During his many trips to Ethiopia, Prashant Yadav used to be surrounded by aid workers on flights to the country. But lately, he’s noticed that his fellow passengers are working for large financial firms in London that are investing in the East African country.



“Ethiopia is the second most populous country on the African continent after Nigeria,” said Yadav, a senior research fellow at the William Davidson Institute at the University of Michigan.

“Gradually, what we are starting to see is that a lot of companies are thinking about the potential demand for consumer products, electronics, infrastructure and other things. That is what is driving huge growth, at least in Addis Ababa,” said Yadav, who also holds faculty appointments at U-M’s Ross School of Business and the School of Public Health.

Ethiopia’s economy has been growing between 8 percent and 10 percent in recent years. Giant billboards around Addis Ababa advertise chilled bottles of Heineken beer or the latest Samsung smart phones. Cranes are busy constructing high-rise buildings, and a mass-transit tram system is being built on elevated tracks.

Yadav is researching Ethiopia’s  health-care system and will soon return to the country this summer. He’s particularly interested in how private hospitals, which traditionally cater to the wealthy, can expand their customer base to include patients who aren’t among the super rich. I’ll write more about that in a later post.