No amount of doctors training can change the equation but a just system that motivates and continues to inspire the educated to serve and, serve again!

Ibrahim Elemo, M.D., M.P.H | January 30, 2014

The Difficult road in a place called Abba Roba, before crossing Segen River to reach Konso District

The following piece is in response to an article published on ayyaantuu.com about the brain drain of physicians and other skilled professionals from Ethiopia and other parts of Africa to Canada and other western countries. This is not a new story to many people. What is rather new to some of us is the Ethiopian government’s strategy to deal with this tragedy by massively producing physicians. I read this story a day after I called a 36 year school director who ended in a hospital, one hundred KM away from his home town only because he had a headache and found to have hypertension and given some medicine to control his blood pressure; where he came from there is actually a district level hospital. I spoke with the same person 2 days before, and to my best knowledge he was in good state of health.  I called him and his phone was answered by his wife, who told me that he receiving urgent care in a hospital. I asked to speak with him; asked him how he feels and what medicine he was given. His blood pressure at the time I spoke to him was not elevated.  I realized that the poor teacher was suffering not from hypertensive emergency but the side effects of the wrong blood pressure medication about which neither the patient nor the health professional had any idea that it could be causing his symptoms.  His wife initially told me that they are planning to take him to a higher level immediately if he does not feel better. He is given two medicine, a rapid release Nifedipine and Furosemide. He continues to use it thinking that his BP is getting out of control and causing profound dizziness. You can imagine the financial impact of the poor quality of care. It could have costed the poor teacher thousands of Birr until he gets to a tertiary care level or a dedicated physician who reviews his medication, listens to his story well and tells him to stop taking the wrong medicine he was put on. This is the story of thousands of people if not every day, every week in a country where the government’s policy is to deal with the massive exodus of Physicians by overproducing physicians and saturating the domestic market.  They have no strategy of retaining the best of the best but have strategy to use the worst of the worst among communities of people to rule over them indefinitely.  To get back to the main reason why I decided to write this short piece; is reflecting on my own trajectory from “a committed subject”  willing to serve his country to someone soon to be a professional selling his service for a fee in a western country.

Locating a village in Waata Wondo, a remote hard to reach area of Taltalle District in South Oromiya, Year 2000 National Polio Immunization campaign.

“According to Canada-based CUSO International, between 1990 and 2006, Ethiopia trained 3,700 doctors. Only 700 of them stayed to work there. Africa’s health-care system isn’t the only sector hemorrhaging skilled workers — there are more African-born engineers and scientists living in Canada and the U.S. than in all of Africa.”http://ayyaantuu.com/horn-of-africa-news/global-voices-stemming-the-african-brain-drain-out-of-3700-medical-doctors-on-700-stay/. Reading this story on Ayyaantuu.com made me think about my own decision to leave my country. Fresh out of medical school, I want to Oromiya Health Bureau and asked the Head to assign me to Borana zone, which was back one of the few zones physicians avoid going to at any cost. There was a tremendous violence even against physicians, economic deprivation of the local communities was unparalleled anywhere in Ethiopia except Ogaden and parts of Hararge.  Borana was occupied by thousands of TPLF soldiers stationed in almost all towns and major check points and camps…Nobody wants to go to Borana unless you have no option, that was the situation 13 years ago. Per my request, I was assigned to Borana and went there with a letter and asked the Head of the zonal Health Department, Dr. Assefa Sime, to assign me to the most disadvantaged Health Center so that I can serve the poorest of the poor and the most marginalized communities and difficult to reach populations of the zone. Some of you who know me personally may think, in fact the difficult to reach in Borana is Taltalle and that is where you are from and where you wanted to go. But, that was not the case, I was ready to go anywhere in Oromiya as far as Begi in West Wallaga. Here are some of the facts, Borana was the most liked place by Physicians at the end of the fall of Derg regime (because of lucrative contraband business and good financial status of the Borana and a grateful community) and the most unpopular few years later after the coming to power of the current regime. A few years before I came to Borana, there were 13 physicians in Nagelle Borana Hospital, and 2-3 physicians in all Health centers. By the time I came, there were only 3 GPs and I Surgeon. They all left in a matter of few years. There was a similar trend in almost all zones of Oromiya. There were more doctors in AA/FF, than in the rest of the country. Oromiya’s health facilities were to be a “ghost place”.

The zonal health administration told me that they can’t assign a doctor to HC when the zonal hospitals are almost empty. There were only 3 physicians in the Brand new Bule Hora Hospital. Each of these Hospitals were serving more than 1.5 Million population at the time.  As a result, I was assigned to work in Nagelle Borana Hospital,   A few months later, I had to go to Taltalle district to supervise the National Polio eradication campaign. Taltalle is 10,000 Square KM wide district bigger than North Shawa zone of Oromiya. We had only one car to do supervision of the campaign which lasts only for few days; in this big district, which is bigger than Kosovo, now a country in Europe. El-Dima, a military post at the Ethio-Kenya border during Haile Selassie regime, is 105 KM from Millami- the main town.  I went to El-Dima from Millami, on foot back and forth fresh out of high school, that how teachers and health care workers used to reach several communities in Taltalle district.  It was a difficult campaign to supervise. Nowadays, I think Taltalle could be better administered as 2 or 3 separate districts than 1.  Anyways, I decided to go to Waata Wondo, a place no Physician has ever set his/her feet on. It is only 60 KMs from Millami. However, because of lack of road infrastructure, we had to take the longest route, through Birindar. Konso, across Weyto River and the desert to reach WW from the back. We had to take a better route, better is a relative term.  Look at the picture below if you want to know how good that road was. It was like a spiritual journey. I lack words to express the feeling. The pride of being there, taking all the risks and personal hardships. It is after all, a service to my country and my people. Being there for my people, against all the odds and challenges! That is what I ask all Physicians in training back home to consider. Graduate, be bold, and go to even the most disadvantaged area, serve!  You will be proud of your service to your country at the prime of your life. Always think about staying and working, and of course cooperating with others in changing the political system to a system which is based on the best interest of all its peoples. That is probably the panacea. No amount of doctors training can change the equation but a just system that motivates and continues to inspire the educated to serve and, serve again!

Kaayo Qabna!

Dr. Ibrahim Elemo