School of Medicine and Public Health Builds on Ethiopia Partnership

What seems unthinkable in American health care is commonplace in Ethiopia.

Taxicabs are often used to transport critical patients to the hospital. Ambulances are available, but generally don't come equipped with life-saving equipment. Even if they did, the driver may not have any medical training.

Life expectancy is about 53 years in Ethiopia; it's 78 in the U.S.

And there is fewer than one physician for every 39,000 people in Ethiopia.

This is the status quo in Ethiopia, a country where the development of emergency medical resources and expertise is still in its infancy. But UW Health physicians and health professionals are working to help change that.

Addressing a Critical Need

The University of Wisconsin School of Medicine and Public Health is a partner in a National Institutes of Health-funded initiative to improve medical education while building the health care workforce in Ethiopia.

Four Ethiopian health professionals from Black Lion Hospital in Addis Ababa - physicians Muluwork Tefera and Tigist Bacha, and nurses Tibebe Aweke and Bayush Teka - visited Madison this fall for a six-week fellowship, where they observed and learned about emergency medical services at UW Hospital and Clinics.

The NIH initiative builds on the School of Medicine and Public Health's existing twinning partnership to build emergency services in Ethiopia.

Video: Learn About the Twinning Partnership

"The first efforts were - and still are - in trying to prevent diseases that we just don't see much in the U.S.," said Dr. Scott Hagen, an assistant professor of pediatrics who has made two trips to Ethiopia to provide education and patient care. "I think as they get a better handle on doing that, then the next step is providing care for patients who get sick despite those efforts, which is where we are in the western world."

Ethiopia, a country of 88 million in eastern Africa, has a high infant mortality rate - about 80 per 1,000 live births vs. about six per 1,000 in the United States. AIDS and other major infectious diseases, including malaria, typhoid and hepatitis, are public health crises that have resulted in part from vaccine shortages and environmental factors such as a lack of clean drinking water.

These issues are compounded by the fact that there the number of physicians is so low relative to the population.

One of the important goals of the partnership is to build the health care workforce. Black Lion is one of only two teaching hospitals in Ethiopia and the largest in the country, and the skills the Ethiopian fellows learned here will be taught to medical students, physicians and other health professionals.

"We are producing a lot of medical doctors and specialists, so this training for residents and interns will be helpful," Tefera said.

Strategies for Quality Improvement

Though their stay was short, the Ethiopians were exposed to the full spectrum of emergency services - from how our 911 system operates to pediatric advanced life support and pain management.

They participated in hands-on learning activities, including pediatric advanced airway management simulations and ambulance ride-alongs with the Madison Fire Department.

The Ethiopians also developed quality improvement projects in order to strengthen hand hygiene, improve the patient registration process, reduce the length of emergency department stays and improve the quality of triage.

Video: Learn About the Ethiopians' Quality Improvement Projects

Bacha said emergency departments in Ethiopia function more like casualty wards. She pointed to one study that showed the average stay in the ED was five days, and the maximum was 33 days.

Her project will include developing guidelines for emergency treatment of common diseases so that doctors can quickly decide when to refer a patient to a specialist and when a patient can be treated and discharged as soon as possible.

"Even with our limited resources, there are a lot of things we can do," Bacha said.

Benefits are Mutual

The Ethiopian partnership isn't beneficial only to the visiting fellows. Hagen, who specializes in pediatric critical care, said caring for patients abroad and teaching visiting doctors and nurses has been very satisfying because it reminds him why he became a physician.

He added that the School of Medicine and Public Health also benefits because an increasing number of students are interested in providing health care internationally. The medical school offers a variety of global health experiences, which can be attractive to prospective students.

"This is one of the things that medical students really key in on now," Hagen said.