The Alumni Voice

THE ALUMNI VOICE The Alumni Voice A Special Publication of The Alumni of University of Gondar Special Publication of on the Occasion of The 60th Year Diamond Jubilee Celebration July 4-7, 2014 The Alumni of University of Gondar on the Occasion of The 60th Year Diamond Jubilee Celebrations July 5-7, 2014

27-30 2006

CONGRATULATIONS

UNIVERSITY OF GONDAR ON YOUR

TH 60 DIAMOND JUBILEE ANNIVERSARY

Admiration and appreciation of University of Gondar staff for their

continuing efforts to educate the next generation of Ethiopian professionals and congratulations on sixty years of excellence!

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THE ALUMNI VOICE a special Publication of the alumni of university of Gondar on the occasion of the 60th year diamond Jubilee Celebration July 4-7, 2014

The Alumni Voice Special Publication of The Alumni of University of Gondar on the Occasion of The 60th Year Diamond Jubilee Celebrations July 5-7, 2014

27-30 2006

Table of Contents Members of the University of Gondar Alumni Steering Committee in the United States...... 5

Acknowledgements...... 7

A Message from the University of Gondar Alumni Steering Committee in the United States...... 9 Anteneh Habte, MD 1984 Elias Said Siraj, MD 1988 Mulugeta Z. Fissha MD 1998 Nuru Abseno Robi, MD 1988 Yared Aytaged Gebreyesus, MD 1988 Yared Wondimkun Endailalu, MD, PhD 1986

REPORT OF THE HISTORIC GONDAR COLLEGE OF MEDICAL SCIENCES ALUMNI REUNION IN THE USA IN SEPTEMBER 2012...... 11

THE INITIAL YEARS OF GONDAR COLLEGE OF MEDICAL SCIENCES...... 15 Professor Mallede Maru Founding Dean of Gondar College of Medical Sciences

UNIQUE? HIGHLY INNOVATIVE? : REFLECTIONS ON THE HAILE SELASSIE I PUBLIC HEALTH COLLEGE AND TRAINING CENTER, GONDAR ETHIOPIA...... 19 Dennis G. Carlson, M.D., D.T.M.&H., M.P.H., M.A. Former Dean and Professor, 1964-67 Haile Selassie l Public Health College and Training Centre Haile Selassie l University, Gondar, Ethiopia

Reflections on the Contributions of Gondar Public Health College & Training Center to the University of Gondar...... 23 Gebreselassie Okubagzhi, B.Sc, MPH, Dr.med in Epidemiology 1966 Alumnus, Health Officer

SIXTY YEARS OF PUBLIC HEALTH AND MEDICAL EDUCATION: A SHINING LEGACY IN THE HISTORY OF ETHIOPA The Mission and Vision of Higher Public Health Education in Ethiopia...... 26 Ahmed A. Moen, D.Ph., MPH, MHA

A unique Health Training Foundation that evolved into a University...... 29 Kinfe Gebeyehu MD, MPH, FAAP

Salvaging MARAKI: The untold story...... 33 Tesfaye Tessema, MD. Dean of GCMS 1998 -2002

The Journey of Nursing at University of Gondar: personal reflections on the training for the noble profession...... 35 Tigist Alemu Kassa

University of Gondar: The pioneer in Physical Therapy Education in Ethiopia...... 38 Elleni Estifanos

Training of medical doctors in Gondar, Ethiopia: the Gondar-Leipzig Link...... 40 Dieter Reissig, Prof.Dr. Med.

Physiotherapy: Member of the Gondar Team for ten years...... 43 Pauline Henderson Marieke Boersma

The Process of Affirmation of the Gondar College of Medical Sciences (GCMS) as a Second Medical School in Ethiopia...... 45 Dr. Mohammed Kedir 1984 Alumnus in Medicine, first batch of GCMS

Volunteerism and Public Service: A Moral Imperative for the Diaspora...... 48 Anteneh Habte, MD

Continued Table of Contents Continued THE ROLE OF THE DIASPORA IN EXPANDING MEDICAL SPECIALTY TRAINING IN ETHIOPIA: GENERAL OBSERVATIONS & PERSONAL REFLECTIONS...... 50 Elias Said Siraj, MD, FACP, FACE 1988 alumnus of GCMS

Reminiscing Gondar College of Medical Sciences...... 55 Yared Aytaged Gebreyesus

The life of an international medical graduate...... 59 Mulugeta Z Fissha, MD, FACC

On the Path to Excellence, Perspectives of an Alumnus...... 61 Yared Wondmikun Endailalu, MD, PhD, FIME

MEMORIES FROM GONDAR IN THE 1960s...... 67 Louis Molineaux, M.D., Ph.D.

Being an even number...... 72 Sirak Petros, MD 1984 Alumnus, Medicine

We have come so far...... 74 Dr. Selamawit Tessema Alumnus, Class of 1988

SIXTY YEARS OF PUBLIC HEALTH AND MEDICAL EDUCATION: A SHINING LEGACY IN THE HISTORY OF ETHIOPA A Reflection on Bedside Teaching...... 75

Dr. Hiberet Tessema Belay GCMS graduate Year 2001 Dr. Workineh Getaneh Tadesse GCMS graduate Year 2000

Serving Our Continent The Pastoral Sector- The Lost Opportunity in Regional Integration and Development...... 78 Zelalem Attlee, MD, MHCM, DRPH(c)

DOCTOR: WHO SHALL BE NAMED?...... 81 Yared Wondimkun Endailalu Nuru Abseno Robi

Values and Beliefs of Abyssinians: An Expatriate Experience...... 84 Dr. Hardeep Rai Sharma Served as an Expatriate in University of Gondar, Ethiopia during October 2004-March 2012

Sasakawa Health Prize Winner Gondar College of Medical Sciences May 1998...... 87 Tesfaye Tessema. MD Dean of GCMS 1998-2002

Gondar-Leicester (UK)Link: a fruitful long-term partnership...... 88 Professor Mike Silverman, Emeritus Professor of Child Health, University of Leicester (UK) and former Chair of the Link Executive Committee Dr Heather Dipple, Consultant Psychiatrist, Leicester UK and Current Chair of the Link Executive Committee

In Memory of Dr Teshale Seboxa...... 93 Ermias Diro, MD Elias Said Siraj, MD Makeda Semret, MD Wondwossen Amogne MD Yewondwossen Tadesse, MD Members of the Gondar Alumni Steering Committee in the USA:

Anteneh Habte, MD Elias Said Siraj, MD Mulugeta Z. Fissha MD 1984 1988 1998

Nuru Abseno Robi, MD Yared Aytaged Gebreyesus, MD Yared Wondimkun 1988 1988 Endailalu, MD, PhD 1986

Ethiopian Diaspora Volunteer Program

Volunteer Opportunity:

The Volunteer Healthcare Corps (VHC) is recruiting MEDICAL INSTRUCTORS for ETHIOPIA as part of the country’s Medical Education Initiative.

We seek qualified individuals, such as GONDAR COLLEGE OF MEDICAL SCIENCES ALUMNI, to help equip students at the 13 new Ethiopian Medical Schools with the essential knowledge and skills they need to more effectively address healthcare challenges in Ethiopia!

THE OPPORTUNITY: THE BENEFITS:  Teach basic science courses; The VHC provides each volunteer with  Serve as faculty & student mentor;  Round-trip airfare;  Develop teaching & learning materials  Housing stipend & living allowance;  Provide clinical training;  In-country support;  Advise Medical Education  Expenses for vaccinations, visas, Initiative leadership and work permits

Contact [email protected] for more information.

To apply, visit www.TwinningAgainstAIDS.org/volunteers.html and submit an online application. Send CV & cover letter to: [email protected].

The Ethiopian Diaspora Volunteer Program was launched by the Volunteer Healthcare Corps in 2006 and has placed more than 60 Diaspora volunteers to date. This HIV/AIDS Twinning Center project supports Ethiopia’s Medical Education Initiative in close collaboration with the Federal Ministry of Health and Ministry of Education. It is funded by the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Centers for Disease Control and Prevention (CDC) in Ethiopia.. Acknowledgements The University of Gondar Alumni Steering Committee in the USA

When we, the Steering Committee of University of Gondar Alumni in the USA, decided to work on the publication of an alumni magazine on this historic occasion, we were not sure how it will be received by the stakeholders. As we reached out to alumni, faculty and friends of University of Gondar to share their memories and reflections on the occasion of the Diamond Jubilee, the response was immediate and heartwarmingly enthusiastic. True to the good old Ethiopian culture, they all embraced the idea of sharing their scholarly ideas, fascinating stories and historical pictures. The magazine then took a life of its own with our role as editors becoming one of primarily shepherding the process and coordinating the effort. Our mission would have not been accomplished if it were not for our esteemed contributors who collectively highlighted milestones of our alma mater through its 60 year journey. Our appreciation to each and every one of them is boundless.

We would like to express our deepest appreciation to Professor Mengesha Admassu, President of Gondar University, and the rest of his leadership team for their unwavering support and encouragement throughout the project.

We are also grateful to Dr. Enawgaw Mehari, President of People to People, for his invaluable advise, technical and administrative support. Our special thanks goes to also to Mr. Matthew Watts, St. Claire Regional Medical Center at Morehead, Kentucky, who spent many volunteer hours in designing the layout and graphics of the magazine. His professional assistance helped us achieve the high standard we had aspired for from the outset.

We will be remiss if we do not recognize Ato Shambel Eniew who was our contact person in Addis Ababa and facilitated the publication of the magazine.

We gratefully acknowledge the following organizations not only for their sponsorship which helped offset some of the cost of the publication of the commemorative magazine, but also for their active role in supporting health care in Ethio- pia:

• Blue Nile Medical Center

• Comprehensive Health Solution

• Ethiopian Airlines

• Ethiopian American Doctors Group

• Jimma University Alumni

• Mayo Clinic

• People to People (P2P)

• Twinning Center of the American International Health Alliance (AIHA)

Finally, our heartfelt thanks to all of you, our supporters, who shared, liked, tagged and commented on social media to help us feel the pulse of our readership.

A Message from the College of Medical Sciences, was the recipient of the alumni recognition University of Gondar award. Our committee also nominated and successfully lobbied for Dr. Alumni Steering Committee Mallede to receive People to People’s (P2P) lifetime achievement award. We in the United States facilitated the signing of a Memoran- dum of Understanding between P2P On behalf of the alumni of Univer- ments in their alma mater and chan- and the medical school in Gondar and sity of Gondar in the United States, nel their efforts to share their skills, invited and sponsored a Gondar med- we would like to extend our heartfelt knowledge and monetary resources in ical school faculty for the annual P2P congratulations on the occasion of its a streamlined fashion which is respon- global health conference in Washing- Diamond Jubilee. This is a momentous sive to the needs of the institution. We ton DC. Our colleagues in Ethiopia milestone by all accounts and places are grateful for the enthusiastic and are also working in forming a sister the University firmly in the ranks sustained support of the University organization and it is our belief and of the leading institutions of higher leadership under its President Profes- hope that we will have coordination of learning in the continent. sor Mengesha Admassu, who allowed efforts going forward. us unfettered access and proceeded to The idea of forming an ad hoc com- establish an alumni office within the Over the last year, our committee mittee to jumpstart an alumni net- University and designated a contact has been working diligently to make work for graduates and friends of person. meaningful contributions towards the University of Gondar took root in successful celebration of the Diamond early 2011 when the three founding We started out by creating a database Jubilee. We mobilized our colleagues in members (Anteneh, Elias & Mu- of Gondar alumni in the USA which the Diaspora to be actively involved in lugeta) visited the school on separate are estimated to number in the hun- the celebration and participate in per- missions. We all came back awestruck dreds. A yahoo mail group forum was son whenever possible. We are pleased by the transformation of a college of a established for ease of communication to see that this group is well repre- few hundred students to a sprawling and the University has since added an sented during this festive occasion. We three campus facility with over 20,000 alumni page on its website. Three more also undertook the task of publishing a enrollees. This was also a stark remind- of our colleagues joined us and the special alumni magazine by compiling er of the disconnect between alumni steering committee was expanded to the thoughts and reflections of histor- in the Diaspora and their alma mater. six. Our focus in these formative years ic figures who have left their indelible We were all aware of the integral role has been to create awareness, build marks and accomplished professionals alumni societies played in US institu- our database and increase the number whose career path was shaped by Uni- tions of higher learning and agreed of subscribers to our forum, encour- versity of Gondar and/or its predeces- that establishing an alumni network age dialogue among the University sor institutions. We organized a clinical was a cause worth pursuing for our leadership, faculty and students and symposium for faculty and students in alma mater. As we started our proj- alumni in the USA and provide the concert with the University, whereby ect, we were keenly aware of similar opportunity for interested individuals alumni experts from the US, Europe attempts in the past, both inside and and group to foster partnership with and Ethiopia will speak on relevant outside Ethiopia, which fizzled out af- Gondar University. medical topics. Our overall effort is a ter a short period. From the outset, we fitting tribute to an institution whose agreed that the network we form has to Our activities over the last several proud but humble beginnings belie be loose by design and primarily serve years include meetings with the Uni- its current position as a hub of higher as the liaison between alumni and the versity leadership in various venues learning in the country. University leadership. The objective and the first ever alumni reunion in was to form a network through which the United States where Dr. Mallede It is our sincere hope that an increas- alumni can keep abreast with develop- Maru, founding Dean of the Gondar ing number of Gondar alumni will play 9 an active role in supporting their alma leader among institutions of higher part of Gondar’s legacy and wish the mater going forward. We also hope learning in Ethiopia when it comes students, faculty and leadership a hap- that Gondar University will emulate to fostering alumni associations. The py anniversary and many more years of successful models of alumni partner- future of University of Gondar looks growth, innovation and excellence. ship from around the globe and be a very promising. We are proud to be

10 REPORT OF THE HISTORIC GONDAR award on behalf of his father. The interesting thing that day was that an- COLLEGE OF MEDICAL SCIENCES other son of Gondar, Professor Haile Gerima, the internationally renowned ALUMNI REUNION IN THE USA IN film maker and artist was awarded the P2P “Public Service Award”. After SEPTEMBER 2012 observing this coincidence, Professor Haile Gerima joked about a possible This historic reunion was organized by cal education in Ethiopia. There were “Gondar conspiracy” within P2P. the GCMS Alumni Steering Com- more than 10 guests from Ethiopia The next day, the GCMS alumni re- mittee in USA. The date, Sunday Sep- including H.E. Dr. Tedros Adhanom, union took place also in Washington tember 23rd, 2012 was chosen to coin- the then Minister of Health, as well as DC. It was a very joyous and at times cide with the annual Global Ethiopian representatives of 5 medical schools emotional event as people who have Diaspora Conference on Healthcare from Ethiopia. University of Gondar not met each other for decades were and Medical Education which was was represented by Dr. Yonas Yilma, able to meet for the first time! Alumni sponsored by People to People (P2P) Clinical Director of Gondar Universi- starting from the first batch of 1985 and conducted on Saturday September ty Hospital. During this event, Profes- 22nd, 2012. That way the potential for sor Mallede Maru, the founding Dean graduates to the most recent ones were bringing as many as possible alumni to of GCMS was recognized by P2P and represented. In addition to Dr. Yonas the event was maximized. awarded the ‘Life Time Achievement Yilma, who officially represented Uni- Award”. Even though initially, Profes- versity of Gondar, we also had the plea- Before describing the Alumni Event, sor Mallede was scheduled to come sure of having Dr. Kassahun Desalegn, we would like to say few words about in person and receive his award, that a Dermatologist from Gondar who the P2P event which brought together was not possible due to last minute happens to be in the USA for training. more than 200 health care professionals unexpected circumstances. His son, Other alumni guests from Ethiopia together (mostly Ethiopian Diaspora Dr. Mehrette Mallede Maru, who has included Dr. Tequam Debebe, Chair- physicians) to discuss and debate issues become a Cardiologist in the USA on man of Radiology at AAU and Dr. related to the health care and medi- the footsteps of his dad, received the

Alumni Reunion 11 Muluken Bekele, ENT specialist from something off the ground and made for decades, the news of University of Hawassa University. this reunion possible. Those founding Gondar expanding so much and hav- members were Dr. Anteneh Habte, ing more than 20,000 students was In addition to informal chats, jokes Dr. Elias Said Siraj and Dr. Mulugeta simply exciting and unimaginable. Dr. and laughs, there were also formal Z. Fissha. The committee highlighted Yonas also briefed the alumni about discussions organized by the Steer- the fact that their membership in the the preparations the University is un- ing Committee. The committee made steering committee is not forever and dertaking to celebrate the 60th an- brief presentations regarding what has encouraged new volunteers to join the niversary of the establishment of the been done to jumpstart the GCMS committee so that responsibilities can Public Health College in Gondar (to Alumni Network from scratch, the be shared and gradually transitioned be celebrated in Summer of 2014) and steps taken to create effective channels to a newer generation. After the dis- encouraged of communication with Gondar Uni- cussions, Dr. Nuru Abseno Robi, Dr. versity and summarized the various Yared Aytaged Gebreyesus and later the alumni to come and participate in activities undertaken. Slide shows of Dr. Yared Wondimkun Endailalu, who the celebrations in Gondar. Both the pictures from Gondar University from have been very helpful to the steering steering committee and the alumni at recent trips of the steering committee committee in organizing this event, large promised to explore possibilities members were also presented. Sub- have agreed to join and expand the of attending the event once the details sequently a vigorous discussion was steering committee to 6 members. of the event are made public. undertaken regarding the successes and the challenges of the alumni ac- Subsequently, Dr. Yonas Yilma, updat- After that, the steering committee, on tivities and suggestions for future died the attendees regarding the current behalf of all the GCMS alumni, pre- rections were gathered. The attendees status of the University of Gondar sented a recognition plaque to Profes- commended the initiatives and activi- in general and the Medical School/ sor Mallede Maru for his role in estab- ties of the Steering Committee who Hospital in particular. For some of the lishing GCMS and making it through over a period of 1 year have started alumni, who have not been to Gondar the difficult early years of the college.

Alumni Award to Dr. Mallede 12 His son, Dr. Mehrette Mallede Maru received the award on behalf of his father. Following the award ceremony, a video recording of Professor Mallede was shown, where he thanked the alumni for the recognition bestowed on him. He also explained the history of the establishment of GCMS and the difficulties encountered at the beginning in a very humorous and en- tertaining way. The alumni were very moved to hear directly from Professor Mallede.

After the conclusion of the formal session, the ceremony was continued with dinner, and informal chats and discussions. As they say, all good things fi- P2P Award to Dr. Mallede nally do come to an end… and we finally had to say good bye and travel to our respective states scattered through The reunion finally was concluded came from various states of USA as out the USA. with the hope that this was the first of well as from Ethiopia and contributed several reunions to come in the future. Over all the first reunion was a great to the success of the event. success. For a first event in the USA, On behalf of the steering committee, Reported by the GCMS Alumni this was a great start. It did create the we would like to use this opportunity Steering Committee impression that with some effort and to thank all the alumni and guests who dedication people can come together and work for a good cause of supporting their Alma Matter and at the same time remember the old good days.

THE INITIAL YEARS OF GONDAR In December 1961 the College became part of the Addis Ababa Uni- COLLEGE OF MEDICAL SCIENCES versity (AAU). The Health Officer’s curriculum was upgraded to a degree Professor Mallede Maru program and that of the Community Founding Dean of Gondar College of Medical Sciences Nurse’s and Sanitarian’s were upgraded to diploma levels.

In 1971, I came to the College from Princess Tsehai Hospital in Addis Ababa. Gondar at that time was a vi- brant city. The economy was good due to the large Sesame commercial farms in Setit Humera and Metema. I came to Gondar because I was interested in teaching and was also very much dissatisfied with my salary in Ad- dis. I learnt that the Dean, Dr Birru Mengesha was looking for a GP and was ready to pay a monthly salary of 1200 Birr and fully furnished house. That was very attractive for me who The establishment of the Public 2. To establish a center in Gondar was getting a mere gross salary of 750 Health College and Training Center to train auxiliary health personnel Birr in Addis. Within a few months, I (PHC) in Gondar in 1954 was dic- including health officers, commu- became the Hospital Director. Every tated by the pressing health problems nity nurses and sanitarians Friday we used to go in teams to the that were present at that time. There five outreach Health Centers to super- was a malaria epidemic in Dembia 3. To conduct epidemiological inves- vise the weekly student activity reports Wereda that killed more than 30,000 tigations and surveys to determine and conferences. That was a tradi- people. The tragedy was known locally local patterns of diseases in order tion established by the PHC which is and internationally. Dejazmach Asrate to provide firm rational basis to still continued by the Medical Col- Kassa, the Provincial Governor at that train students. lege. In 1982 the name of the PHC time, requested for an immediate so- was changed to Gondar College of lution for the problem. After a period 4. To promote extension of health Medical Sciences because the medical of planning by experts from USAID services throughout the country. students did not want Public Health and the Ethiopian Government, co- College and Training Center to be on 5. Eventually to expand teaching fa- operation agreements were signed be- their Diploma. tween the Ethiopian Government and cilities at Gondar to train staff of USAID on April 29, 1953 and the full professional grade. In July 1972, I left for the USA for Ethiopian Government and WHO postgraduate studies. I returned in From 1954-1961 the College trained on September 3, 1954. The agreement July 1976 as Internist and Cardiolo- the Health Officer at the Diploma signed contained the following objec- gist. When I returned, the conditions level and Community Nurse and the tives: in Gondar where frightening. Guns Sanitarian at Certificate level. The cur- shots were heard every night. People ricula was designed to train them to 1. To develop a model provincial and were dying left and right. The students work in rural setting as a team. The municipal health service for the were frightened. The safety of our staff training at Gondar was unique and Province of Begemidir & Semien and students was precarious. In April was copied by other countries with and the town of Gondar. 1979 Dean Birru left for postgradu- some variations. 15 ate studies. I was appointed Dean and must be met as soon as possible. The visited KMU in Leipzig. At the end Zein Ahmed became the Assistant requirements were new buildings for of the visit a cooperation protocol Dean. preclinical and clinical departments, was signed between Professor Fritz dormitories, apartment for teach- Muller and Dr Mallede Maru. Karl The year 1974, along with the dramat- ing staff a new library and remodel- Marx University agreed to provide the ic socio-political upheaval, brought a ing the Hospital building to increase Gondar Medical Faculty all the neces- number of changes in the curricula of the number of beds from 220 to 350 sary academic staff, teaching materials the health professionals in Ethiopia. and increase the number of operation and laboratory supplies Due to the critical shortage of trained health professionals, the curriculum for medical doctors was reduced by two years and that of the Health Offi- cer, Nurse and Sanitarian by 6 months. In December 1976, the training of the Health Officer and the Community Nurse was discontinued without any evaluation of the contribution of the program to the nation’s health. The graduates of the PHC were in fact the founders of public health service all over Ethiopia. From the Health Centers established all over the country they were the sole health care and Dr Duri, Dr Mallede with Prof. Rhatmann at KMU preventive health providers. In order to control epidemics and treat the sick, rooms. They recommended additional The first batch of 107 medical stu- they went to the remotest places on foot staff for the clinical departments 16, dents arrived in Gondar in September and when possible on horseback. They the preclinical departments 17, GPs 1978 and joined the Basic Sciences treated the sick, controlled epidemics 30, nurses 40, Midwives 6 and Health Department which was fully staffed by and promoted disease prevention. On Assistants 40.The Committee recom- graduate assistants recruited from the the occasion of the 60th anniversary mended a capital budget of 4,756,400 Faculties of Science and Social Sci- of the founding of the Gondar Uni- Birr for construction and 1,850,650 ence. The Basic Science courses were versity, we salute those dedicate and Birr for equipment and supplies. completed without any problem. courageous pioneer Health Officers, Community Nurses and Sanitarians. In July 1977, the AAU and the Karl During the last week of August 1979 Marks University (KMU) signed an the five professors for Anatomy, Phys- On December 1976, the Provisional agreement on Scientific and Cul- iology and Biochemistry arrived at Military Administrative Council gave tural Cooperation. In February 1978, Addis Ababa by plane with the nec- a directive to the AAU and the Minis- a delegation lead by professor D. Sc. essary equipments and teaching ma- try of Health to start training medical L. Rhatmann visited the College. The terials. I received them in Addis and doctors in Gondar in place of Health idea of establishing the Medical Col- sent them to Gondar by a new Toyota Officers. An expert Committee was lege was discussed. It was agreed to car. However our teaching program established from the Ministry of meet in Leipzig in May 1979 to dis- was seriously threatened by a car ac- Health and AAU in 1977. The Com- cuss the details of the program. From cident that happened during the trip mittee recommended that the training May 29 to June 2, 1978, a delegation of the professors from Addis Ababa to of medical doctors in Gondar can be consisting of Ato Bililigne Mandefro, Gondar. Fortunately only one assistant started immediately with the avail- Academic Vice President, W/ro Mis- professor of Physiology had fracture able classrooms and dormitories but rake Elias, External Relations Offi- of his right humerus, with only minor the following additional requirements cer and Dr Mallede Maru, the Dean injuries of the other four professors. 16 The assistant Professor was advised to The second Presidential Steering was not in use. In our desperation, return home but refused. Such was the Committee led by Dr Duri Moham- we went to Major Melaku Tefera, the enthusiasm and commitment of our med visited the College from April then Governer of Gondar province to German colleagues who came to teach 13 -16, 1981. The visit was in keeping ask him to give us the tanker for the and give medical services at the Col- with the University policy to estab- College which he did without hesita- lege. lish and maintain identical standards tion. We brought it to Science Amba, at the two Medical Faculties and also where it is still giving service to the The teaching program started on to see the progress of the implementa- present time. September 13, 1979. The work of the tion of the recommendations of first three Departments was coordinated Presidential Committee. The second major phase in the devel- by Docent Dieter Reissig who was a opment of the Medical Faculty was the good organizer. The laboratory work The Committee after evaluation of the establishment of the four major Clini- for the Departments was started in preclinical teaching activities conclud- cal Departments and the takeover of January 1980 due to lack of laboratory ed that the standard at Gondar was the Hospital Services by the German materials. The major problem was lack lower than Addis Ababa. In order to Professors. of cadavers for Anatomical dissection. have identical standards between the The problem of cadaver was solved by two Faculties the Committee recom- The Committee recommended to raise a donation of two new and one dis- mended that: the Hospital bed number from 220 to sected cadaver from the Department 350 by modifying the existing wards of of Anatomy of AAMF. 1. The admitting criteria should be the Hospital, changing the dormitories identical. After that students were inside the Hospital to wards and by The preparations for the opening of assigned by lot. building additional rooms in the exist- the Departments of Pathology, Phar- ing wards. The recommendations were macology, Microbiology and Parasi- 2. The course content and curricu- fulfilled during the 1980-81 academic tology were completed well ahead of lum should be similar. year. In August 1981, Prof. Schle- time. The equipments, chemicals, sup- gel Head of Gyn & Obs, Docent Dr plies and teaching materials that were 3. The teaching facilities should be Raue, Head of Pediatrics, Docent Dr ordered arrived from abroad. The prob- similar. Duck, Head of Internal Medicine and lem of cadavers was solved by sending Docent Dr Bellmann, Head Surgery 4. The evaluation for both Medical Prof. Reissig and the anatomy tech- arrived in Gondar to organize their Faculties should be identical. nician to the Anatomy Department respective departments. There were 4 of Addis AAMF with the necessary internists, 4 surgeons, one anesthetist, The attainment of the above objective chemicals to prepare new cadavers. 3 Pediatricians and 3 Obstetrician and can only be accomlished by having a They were able to prepare three cadav- Gynecologists. When all the Depart- close link between the two Institu- ers which were brought to Gondar in ments became fully functional the to- tions. The link was not strong and the especially made coffins by the untiring tal number of the staff from KMU was above recommendations were only carpenters of the College Carpenter 28. From 1979 to 1991 a total of 107 partially fulfilled. Shop, who made all those laboratory KMU Professors came to the Col- benches and stools. We were well pre- lege. Their enthusiasm, dedication and The Committee also looked in to the pared for the next academic year. commitment were second to none. We crowded condition of the dormitories are grateful for their contribution to and the unsatisfactory living quarters During the last week of August two the development of the College and of the staff. The need for new dormi- Microbiologists, two Physiologists, the nation at large. tories and apartments was acute. There one Biochemist, one Anatomist and was water shortage for the students, one Pharmacologist arrived in Gond- There were doubts by the students that staff and for Science Amba laborato- ar and the 1980-81 academic program the medical education in Gondar was ries. The College was trying all means was started as scheduled. The academic below standard because of the Presi- to make water available. We found a year was successfully completed with- dential Committee comment and the large tanker near Terara Hotel which out problem. rumors going around. In order to as- 17 sure our students that the standard at Gondar was good, we brought Interns from AAMF at great cost. That ru- mor evaporated within the first week of the arrival of Addis Ababa Interns. After working for a few weeks with them the confidence of our students in themselves was considerable. We sent in exchange 20 Gondar Interns for a 6 months rotation to AAMF. The staff in Addis Ababa was highly satisfied with their performance. The exchange of interns was stopped after four years.

All the buildings and all the staff that With president Mengesha and his Officers were promised for the new Medical stopped, we did not know what to do all the people involved in establishing College never materialized. We con- with the huge donated land. Outside a university second to none. tinued to teach for years under the of our expertise, we tried to cultivate most difficult conditions. In spite of crops and started a research program Professor Mallede Maru, MD is the found- that we were able to produce physi- ing Dean of Gondar College of Medical Sci- in collaboration with Almaya Agricul- cians of the highest standard. ences. Dr. Mallede was born and grew up in tural College on cross breeding cows the Gondar region. He did his undergraduate From July 28 to August 3, 1983, stu- from Fogera and Bale with Holstein degree at Addis Ababa University followed dents from year I - IV were assessed bulls until 1991. by medical school education at American by external examiners from Khartoum University of Beirut. He then returned to At present time, that humble begin- Ethiopia where he served as a general prac- and Addis Ababa Universities. The re- ning of the PHC has expanded to titioner at Princess Tsehai Hospital in Addis. sults of the examination were laudable. the huge University of Gondar at the In 1969, he joined the Public Health Col- The graduation ceremony of the first lege and Training Centre in Gondar where original site in Chechela and on the medical doctors in 1984 was memo- he started his long and successful career. In land donated for the University by rable. the 1970’s he went to the USA and finished those far sighted peasant farmers some Internal Medicine and Cardiology train- In closing, I would like to see few 40 years ago. ing. Despite the violent and turbulent years words about initial plans to establish of the 1970s in Ethiopia and the temptation Twenty years after I left GCMS,I was to stay in the USA, in 1976 he decided to a University in Gondar. The Univer- invited by President Professor Mag- come back to the Public Health College and sity was planned to be built by the nesia to participate in the University Training Centre in Gondar out of his desire people of Gondar 40 years ago and to serve his country. He then played a lead- of Gondar Millennium Graduation the foundation stone was laid by Em- ing role in the establishment of the Gondar Ceremony as a guest of honor. During peror Haile Selassie. The site plan for College of Medical Sciences where he became the Ceremony, when I saw such a huge the different faculties was prepared the founding Dean. Since 1992, he continued number of graduates parading in front and the collection of donations for the to serve his country at Addis Ababa Univer- of the podium at the donated site, I sity (AAU) where at various times became University building was started. How- thought this was a dream come true, Professor of Medicine and Chairman of the ever the Emperor was not happy of the for me and for the people of Gondar. Department of Internal Medicine. Since his peoples’ initiative and he stopped the retirement from AAU, he has been working collection saying that ‘’the time is not at the International Cardiovascular Hospi- On the occasion of the 60th Anniver- now’’. We took possession of the land tal as Consultant Cardiologist and Medical sary of the founding of the Gondar claiming to build the University. Af- Director. Dr. Mallede is married to Mebrat University, I would like to congratulate ter the building of the University was Beyene and has 5 children.

18 UNIQUE? HIGHLY INNOVATIVE? : As the Ethiopian Ministry of Pub- lic Health was gaining momentum, it requested the WHO to provide REFLECTIONS ON THE HAILE consultation and other resources to SELASSIE I PUBLIC HEALTH COLLEGE launch a program that would address the crucial health needs of the popula- AND TRAINING CENTER, tion. The responses from international agencies were supportive and rapid. GONDAR ETHIOPIA Highly qualified and experienced experts came from all over the globe for Dennis G. Carlson, M.D., D.T.M.&H., M.P.H., M.A. Former Dean and Professor, 1964-67 consultations, surveys, and planning Haile Selassie l Public Health College and Training Centre sessions, beginning in 1951. Based on Haile Selassie l University, their findings and recommendations, a Gondar, Ethiopia second agreement was signed in 1953 to create a practical comprehensive Gondar drew so much attention. Are plan to be implemented. Such na- there lessons we can learn that would tional/international collaboration was be useful today? unique in such a “clean slate” environment. Sixty years ago the situation of Ethio- pia was quite unique in modern history. The plan that evolved was based on The disease environment was almost the specific current health problems untouched by modern health services. facing Ethiopia and considered what There were no Ethiopian physicians, a local resources were available. Another few Ethiopian nurses, and a very few unique dimension was that WHO was modern hospitals and clinics that were founded on a combination of premises primarily dependent on international seldom, if ever, articulated before; par- support. ticularly that preventive health actions are as important as clinical curative The Haile Selassie I Public Health The times were receptive for bold new care; that promotion of healthy condi- College and Training Centre in Gond- efforts to be launched; the Ministry tions for the individual, the family and ar was one of the most widely known of Public Health had just been estab- the community are essential for long and discussed education and training lished in 1948; WHO and UNICEF term well-being of a society, and that institutions for health professions in were emerging as global organiza- these functions needed to be integrat- the middle of the 20th Century. Many tions designed to pioneer and assist ed with curative services on a coordi- international health experts came to international development; Emperor nated and simultaneous basis. visit. More World Health Organiza- Haile Selassie was recognized as a tion (WHO) experts visited the Public powerful force because of his role in The basic model that emerged was Health College than any other train- establishing the United Nations; bi- that a team of health practitioners was ing institution that the WHO was lateral agencies such as “Point Four” essential; all these tasks could not be connected with. Many who came said of the United States, (now USAID), managed by relying on one kind of that it was “truly unique” and “highly were ready to help with funding and practitioner, such as a physician. Even innovative.” What caused these re- personnel. There were practically no if competent and willing, physicians sponses? On what did they base their “Ethiopian vested interests,” such as a would not be able perform curative, judgments? Now, as we celebrate sixty medical association, who would natu- preventive and promotional services years since its establishment, it is valu- rally be threatened by non-traditional simultaneously and to the extent nec- able to try to understand why the approaches to providing health care to essary. The planners also realized that “grand-parent” of the University of large populations. these functions are difficult to imple-

19 ment by hospitals and clinics focused cases and a basic medical laboratory. community nurses, protecting food on curative services, where the urgency The health center would also be the establishments and water supplies by of medical intervention is paramount. administrative base for home visiting, environmental health technicians, and There were other reasons; the eco- home deliveries, environmental health medical laboratory tests by labora- nomic costs argued against trying to activities, school and prison services tory technicians. Moreover, the gradu- provide sufficient numbers of physi- and immunization programs. ates of the Public Health College and cians for the 15 to 20 million Ethio- Training Centre needed to be able to pians living at that time. Even more, Sometimes it is easy to forget that the perform their roles competently and the reluctance of most physicians to mission of the “Gondar Project” was safely in countryside settings where work and live in rural settings was also not only about training health per- they would have little support or su- an important reality. New and differ- sonnel; equally as important was that pervision. ent health personnel were needed who it was designed as a “regional model” would be able to function as inter-de- that could be expanded to serve the Basic principles of learning included: pendent teams in rural and small town entire nation. Regional health services integration of theory and practice conditions. were designed to serve the two million throughout training because of the people in the Beghemeder and Simien short length of training: four years for The teams would consist of health of- Province, analogous to the present health officers; three years for sanitar- ficers, community health nurses, and Amhara Region. It would create a ians and community health nurses and sanitarians (or environmental health “provincial health department” staffed two years for laboratory technicians. technicians). Soon after the College by college staff and students that would Each type of team member needed to opened it became obvious that labo- manage epidemic outbreaks, whether gain practical experience working with ratory technicians were also needed malaria, meningitis or other infectious the other categories; since all graduates on the core staff. The Health Officer diseases as well as strengthen general had to be safely competent at the time would carry out clinical tasks as well health services. Health centers would of graduation, students needed to have as be the team leader and administra- serve sub-divisions, approximately increasingly more practical experience tive head for the health center and its equivalent to “weredas” in current as they moved toward graduation. outreach services. The Community practice. Likewise the Project staff Nurse would perform clinical func- and students would develop a munici- All students participated in “core tions in the health center as well as do pal health department for the historic courses” from their first years in the home visiting, health education and city of Gondar. The Gondar Hospital, college that presented the major health home deliveries. Sanitarians would be originally built to serve Italian military problems they would face in future concerned with environmental health personnel, would become a regional, service. During the 1960s these core problems such as safe water supply and teaching hospital. courses were combined together into waste disposal. Laboratory technicians one weekly two-hour session for all would assist in making clinical diag- Monumental challenges were faced categories of students. At these con- noses. All members needed to know in building an effective learning en- ferences there were case presentations what roles their teammates would be vironment suitable for training these of patients and families with a preva- performing and how they would func- four kinds of personnel, who needed lent health problem. Following this a tion together. to function interdependently in the panel of teaching staff would discuss same environment. Clearly there was a the case. After the initial presentation The College graduates would work core of community health knowledge and panel discussion, all students par- in service health centers all over the and skills that all team members must ticipated in small groups where each country, particularly in rural and re- know and be able to practice such as category of students was represented. mote locations. The health center health education and immunizations. In the small group discussions teach- would provide clinical, curative, outpa- At the same time each category had ing staff helped students learn not only tient care, along with obstetric deliv- separate sets of skills that were practi- what tasks they themselves would per- ery services, emergency surgery, have cally exclusive, e.g. clinical diagnoses form, but also what they could expect a few inpatient beds for emergency for health officers, home delivery by other team members would be doing.

20 Without question the most important The requirement for “Ethiopian Stud- know. However it seems it would have phase of learning for all categories ies” was seen as an opportunity for been quite possible to do so in other were the six to nine months spent liv- students to understand the history and parts of Ethiopia. ing and working in the four training culture of their own country as well as health centers where students were su- an ideal opportunity to learn first hand The concept and practice of educating pervised by College teaching staff on about historical development in the and training mid-level health practi- a weekly basis. The remaining months northern parts of Ethiopia. Students tioners, such as the health officer, was were spent on campus working in the and teaching staff were able to visit clearly shown to be feasible and de- hospital and clinics and going off cam- such places as Axum, Adwa, Debra sirable. Similar programs of training pus to control epidemics and do stud- Damo, Asmara and Massawa. Schol- mid-level primary care practitioners ies. Health officers in their final year ars from the university faculties in have been established in many parts were also required to complete applied Addis Ababa, such as Professors Sven of the world. In the last fifteen years research projects that often resulted in Rubenson, Getachew Haile, and KC Ethiopia has renewed such training useful original findings. Such practical Joseph, gave fascinating lectures about and expanded the roles of health of- training for teams of health students various streams of Ethiopian history ficers. Over 5,000 health officers have still is rare anywhere in the world. and society that enabled students and been prepared for primary care service teachers to prepare to contribute to in over 3,000 health centers. It was highly unusual, if not unique, Ethiopia’s modern development more On the international scene the author that the senior teaching staff originat- effectively. was involved in the development of a ed from so many different countries; “Health Associate” program that was expatriate teachers came from ten to Was the Public Health College and very similar to the Health Officer of fifteen countries around the world Training Centre a unique place? There Ethiopia while teaching at Johns Hop- through the 1950s and 1960s. At is no question that it was a unique and kins University in Baltimore, Maryland, various times they included staff from bold educational and service institu- in the United States. The training and China, Taiwan, India, Syria, Israel, tion that proved to be highly success- utilization of “physician assistants” is now Yugoslavia, Greece, France, Germany, ful in ushering modern health care well established throughout the United Belgium, Holland, Australia, Ireland, into most areas of Ethiopia. Experts States. Physician assistants are not only France, Great Britain, Canada and from all over the world exclaimed that key members of primary care teams, but the United States. The sum impact of they had never seen any learning insti- often play essential roles in secondary this mixture of teachers from so many tution even closely similar to it. Was and tertiary medical care teams. cultures was that no single foreign cul- it significantly innovative? Absolutely. ture could dominate the thinking and The Gondar Public Health College The Gondar Public Health College practice of the entire learning environ- and Training Centre taught many new and Training Centre was certainly a ment. Thus the evolving goals, values concepts and practices that were devel- unique enterprise. Without doubt it and objectives reflected the original oping at the frontiers of public health was also a highly innovative institu- vision of the initial planners and ad- and was on the “cutting edge” of global tion whose influence spread not only ministrators. professional education and training. throughout Ethiopia, but also to many Were there gaps and weaknesses? Of parts of the world. Most importantly, Other remarkable changes took place course! One critical weakness was that the graduates of this prestigious learn- when the Public Health College and responsible authorities did not prepare ing center in Gondar have been suc- Training Centre became part of Haile comprehensive plans to guide future cessful in improving the health of the Selassie I University in 1961-1962. An decision makers on how to expand the people of Ethiopia. Hearty congratu- “academic environment” was super- training and educational processes, so lations to the “Grand-parent” institu- imposed on what was generally seen graduates could effectively serve the tion of health professional education as a training program. Several basic whole growing population. Would it in Ethiopia! courses were added in the physical and have been possible to replicate the en- social sciences for health officers who tire process in other locations and so- Dennis Carlson is a former Dean and Di- would receive baccalaureate degrees. cieties? It is impossible in retrospect to rector of the Haile Selassie I Public Health 21 College and Training Center in Gondar, as a general physician and surgeon in Ambo, the Kossoye Development Program in Gond- Ethiopia in its early days. He did his under- Ethiopia; Associate Professor at Johns Hop- ar. He also worked as an international public graduate medical education at the University kins University in Baltimore, Maryland; health consultant in Sub-Saharan Africa, the of Washington and post-graduate training Professor of Community Health at Addis Middle East, and the Caribbean. He co- au- in surgery, tropical medicine and hygiene, Ababa University. He also served as Senior thored a book with his son, Andrew Carlson, public health and behavioral sciences and Health Advisor for Save the Children Feder- entitled “Health, Wealth and Family in Ru- medical history, respectively, at the Univer- ation in Yifat Ena Timuga, Ethiopia; Senior ral Ethiopia: Kossoye, North Gondar, 1967- sity of Washington, University of London, Consultant for the Ethiopia Public Health 2007”, Addis Ababa University Press, 2008. University of California at Berkeley, and Training Initiative under the Carter Center He lives with his wife, Beulah Downing, on Johns Hopkins University. He also worked and continues to serve as Associate Director of Bainbridge Island near Seattle, Washington.

22 Reflections on the realities of the respective countries. Some African countries adapted the Contributions Medical Assistants’ training program to respond to the crisis and medical of Gondar Public Health assistants render valuable services to College & Training Center to the health system even today. Ethiopia opted to establish the Public the University of Gondar Health College and Training Center Gebreselassie Okubagzhi, B.Sc, MPH, Dr.med in Epidemiology to respond to the human resource cri- 1966 Alumnus, Health Officer sis after careful analysis of the prevailing situation based on the findings of international consultants.

The Establishment of the college

The Public Health College and Train- ing Center was the first mid-level health professional training institution in Ethiopia, established in 1954 in the historic city of Gondar to train mainly health officers, community nurses and Sanitarians to work as a team in providing integrated health services to the Introduction reduce the suffering of the population rural populations who had no access to in genera, and rural population in par- modern health services. This paper is a reflection of the writer’s ticular. International level discussions personal experience as a student and were held and consensus was reached The health officer training was initially instructor of the Public Health Col- to address the health crisis by training a diploma program but in 1962 it was lege and training center (PHC&TC) appropriate health workers. upgraded to B.sc. degree in Public . The paper attempts to bring to the Health when the college became part attention of the reader what the Uni- The contentious question was what of the then Haile Selassie I University. versity of Gondar could possibly in- type of training institutions should The first degree holders graduated in herit from its predecessor, the Public these countries establish? And should June 1966 and the writer was a mem- Health College. all countries adapt similar train- ber of this first group of graduates. ing schemes? Some suggested to Factors Leading to the establishment train conventional medical doctors Student Recruitment of PHC&TC and nurses because other approaches meant resorting to training second Recruitment of Health Officers, Com- In the late 1940s and early 1950s, it was rate health professionals. Since it was munity Nurses and Sanitarians was clear that health services in developing difficult to reach a consensus on the conducted by the college in close col- countries were limited and the situa- type and structure of the training in- laboration with the Ministry of Public tion was worst in rural areas where ex- stitutions and programs, understand- Health until the college became part cessive morbidity and mortality caused ing was reached that each country be of Haile Selassie I University which by epidemics of communicable dis- left to decide on the type and num- was later re-named Addis Ababa Uni- eases was rampant. Conscious of the ber of health workforce to be trained versity. Recruitment was conducted grave situation, the global community and the type of training institution to by the college staff visiting secondary was urged to take remedial actions to be established based on the objective schools in the country where the can-

23 didates were interviewed and selected. of classroom teaching and practical training methodology. This gave the This gave better opportunity for the sessions carried out within and out- PHC&TC its unique contribution college to select the best candidates side the college compound under the to the development of a pioneering with proper gender, language and geo- close supervision of the teaching staff. teaching methodology and has earned graphic mix and for the candidates, to Other than the classroom demon- it recognition by global organizations know the institution they were going strations, there were two regular field such as WHO as an important con- to join. The recruitment process might practices namely the Ambagiorgis Fri- tribution of the college to human re- have contributed, among other things, day program and the Training Health source development in health. to the high motivation and dedication Center assignment. The field work on observed among the graduates of the Fridays was to introduce students to The Internship Period college team work and to help them appreciate, for the first time, the role of each The fourth year for health officers, The Teaching Staff team member in the operation of the the third year for community nurses health system. and sanitarians was designated as an The initial teaching staff was com- internship year. A part of the intern- posed of high caliber expatriates During the field practice, the com- ship period for the health officers for with much international experience munity nurses conducted home visits, example, was spent in the college, ro- in tropical diseases and came mainly provided MCH services and home tating among various experience ar- from England, USA, Germany, New deliveries; the health officers and com- eas including Epidemic Control and guinea, China, Ireland, Yugoslavia and munity nurses gave health education, the rest in the training health centers Italy. This unique mix of staff mighy outpatient care, and treatment at the which were initially located in Ko- have contributed to the innovation field clinic , the sanitarians helped in laduba, Dabat and Gorgora and later observed in the design and structure of sanitation and hygiene activities in the expanded to Gondar and Addis Ze- the training program and competence community including providing sup- men. of the graduates to deliver rural health port to construction of latrines, pro- services successfully. To continuously tection of safe water and school and During the internship, the interns ensure the availability of competent prison health services. traveled to the villages extending staff, the college strictly implemented health center services to surrounding a staff development plan and in a rela- The hospital was used for training villages using horses or mules, that tively short time succeeded in train- health officers and nurses in patient were available at the training health ing its Ethiopian staff many of whom management under the close supervi- center compound, as a means of trans- were its own graduates. The classroom sion of physicians and senior nurses portation. All interns were required to teaching, the field supervision, man- and midwives. ride these animals as part of the health agement and leadership was provided center practice and that is why adapt- by trained national staff. The Gondar Team and its commu- ing to local transport means is not a nity based training challenge to PHC college graduates. When the college started functioning, the infrastructure was limited and the The basic principle of PHC&TC was The internship period is an important teaching facilities were poor. However, to train middle level health workers as opportunity for health officers, com- staff creativity in handling the defi- a team using communities for teaching munity nurses and sanitarians to learn ciencies and student resilience to learn the health cadres. This is a significant to work together as a team. The health under difficult circumstances has con- development from pedagogic perspec- officer is the team leader and admin- tributed to the successes registered by tive. The college was a pioneer in in- istrator of the training health center. the college. troducing The Gondar Team approach At the end of the day, the teams assess and enhancing the Community based the activities of the day and take joint The Training Program training concept which today is emu- decisions to resolve issues and plan for lated by many training institutions the next day. This is one of the many The training program was composed at home and abroad as an essential opportunities for team discussion and

24 participation in the joint decision any kind working in remote rural areas of rendering the appropriate ser- making process at the time. vices.

All interns lived in the health center The strength of the college program 6. The Gondar health Team has been compound and were responsible for can be traced to i) the analysis of the exemplary in showing multidis- managing the preparation of their prevailing situation preceding the ciplinary approach in handling food by forming a food committee training program design, ii) proper health problems and should be composed of the three team members. staffing with experienced high caliber maintained and strengthened. Social evenings were occasionally or- international staff and well planned ganized to enjoy their stay together national staff development, iii) well 7. The training health centers were and improve their interactions. designed theoretical and practical appropriate instruments to create training programs, and iv) regular field teamwork spirit and ensure in- There were weekly supportive supervi- supervision of the health team by ex- volvement in participatory decision visits by the college staff to the perienced staff at all critical phases of sion making and hence should be training health centers to monitor the the training. maintained and strengthened. activities of interns in training health centers and to guide them on how to Summary of major lessons that could 8. The community based training handle specific issues and solve prob- be transferred to the University of which was initiated at the incep- lems encountered by interns in the Gondar include: tion of the college was an impor- provision of health services, in addi- tant approach to be enhanced and tion to helping health officers with 1. The design and structure of any further developed by the Univer- their senior health project research. training institution should be pre- sity of Gondar. Furthermore, evening discussions were ceded by proper analysis of the Dr. Gebreselassie Okubagzhi is one of the held with the supervisors on technical prevailing situation. first Health Officer graduates of Gondar and management issues and this has Public Health College in 1966. He later got 2. Recruitment of appropriate expe- created an additional opportunity for his Masters degree in Public Health Admin- rienced staff is critical to ensure further learning. istration from the University of Michigan, the creation of a strong training Ann Arbor, USA in 1971 and Dr. med in At the completion of the internship, institution and training of compe- Epidemiology from Karl Marx University, the prospective graduates were as- tent graduates. in Leipzig, Germany in 1982. He was one sessed for their theoretical and practi- of the few figures of who played a significant and leading role in the various stages of the cal knowledge and skills and degrees 3. A national staff development plan history of the University of Gondar in par- and diplomas were awarded to the should be drawn and implement- ticular in the area of Public Health. He has ed to timely replace the expatriate successful ones. Furthermore, each also served as a World Bank senior specialist. candidate had to pass through rigor- staff and achieve self sufficiency by ous supervised field practices to ensure developing the core national staff. that the graduate is equipped with the necessary skills to function as a suc- 4. Recruitment of dedicated and cessful practitioner in the field of his/ willing candidates to serve under her assignment. difficult circumstances requires proper assessment of candidate at The graduates were assigned as a team entry through rigorous interviews. to remote rural health centers where they provided preventive and cura- 5. Proper mix of theoretical and tive services and their services were practical sessions with regular su- highly appreciated and earned them pervision by competent staff will community admiration and respect. It ensure the production of appro- should be noted that the Health Of- priate health professionals capable ficers were the first degree holders of 25 SIXTY YEARS OF PUBLIC HEALTH graduates of allied health professions has always been “people’s health come AND MEDICAL EDUCATION: A first” and “do no harm first” a twin ful- filment of the WHO 1946 definition SHINING LEGACY IN THE HISTORY of health as “ the complete state of physical, mental and social well-being OF ETHIOPA and not merely the absence of disease or infirmity.” The Mission and Vision The fact that I attended Menelik II of Higher Public Health School, the first elementary school that laid the foundation of modern educa- Education in Ethiopia tion in 1908, and became the Director Ahmed A. Moen, D.Ph., MPH, MHA of Medical Services in the Ministry to oversee its contemporary sister insti- The disparity in access to health care tution named as Menelik II Hospital for the population within the coun- in 1909, connects my generation with try and the available resources in the the glorious idea of nation and institu- urban curative hospitals and the rural tion building in Ethiopia. Those were community health centers in Ethiopia the ideas and legacies of our forefa- were seemingly insurmountable. thers that never died and were realized in the early twentieth century. The Health Officer emerged as a lead- They were reborn with the establish- er of a dream team inflamed by the ment of the first College of Public human passion and a laudable mission Health in Gondar in 1954, hundreds of providing access to health care for of miles away from Menelik II Hospi- all regardless of where they resided. tal, the first modern Hospital in Addis The idea of training and employing Ababa. The college effectively shifted primary health care providers to prac- the focus of public health and medi- As the University of Gondar cele- tice where the majority of the people cine from urban based hospital cen- brates its 60th anniversary, its shining lived and worked emanated from the ters to integrated community-based legacy and place in history as home of Ethiopian experience that preceded ambulatory services. These were true the first Public Health College and the Alma Ata Declaration of Primary interdisciplinary teams comprising of Training Centre (PHC & TC) will Care and Health For All in 1978. No a health officer, a community nurse/ be forever seared in our thoughts and one in my generation of health care midwife, a sanitarian and a laboratory memory. After being founded in 1954, professionals could have ever imag- technician providing care in medically the college quickly evolved into a com- ined that in July 2014 we would be underserved areas where the majority prehensive and seamlessly integrated celebrating the re-birth of the Gondar of Ethiopians and the poorest of the public health and medical institution College of Public Health that evolved poor live and work. of higher learning for the twenty-first into a world class University of service, century. The idea and ideal of Gondar education and research. The University The Paradigm Shift of Public Health Public Health College brought primary has accomplished all this while staying and Medical Profession in Ethiopia: health care to the forefront of national true to its vision and mission and core and international policy, heralding the values of integrating public health and This unique initiative through the beginning of a multi-disciplinary and medical health care delivery service in technical assistance and support of comprehensive approach to tackle the contemporary Ethiopia. In effect, what USAID served as a precedent setting critical health needs of medically un- the University of Gondar nurtured prototype of a successful partnership derserved and technologically under- and inculcated in its students and resourced countries such as Ethiopia. between the Ministry of Health and 26 an institution of higher education until to a medical school may have been offering undergraduate and graduate its ownership was transferred to Addis misplaced. My new status as a public degrees in multiple disciplines. Today, Ababa University in 1961. Thus, the health manager in the malaria eradica- the University celebrates its success college started conferring baccalau- tion effort led me to my maiden con- after graduating 1357 medical doc- reate degrees to its graduates instead tact with the Gondar School of Public tors, 1627 health officers, and 7068 of diplomas and certificates signaling Health. The Ministry of Health and allied health professionals including a momentous transition that eventu- the Malaria Control Project agreed to nurses, midwives, laboratory techni- ally led to the establishment of Addis base their offices in Azezo and partner cians, pharmacists, sanitarians and Ababa Medical School in 1964. The with the training and demonstration social workers. It also offers a PhD in connection between the old and new health centers operated by the College public health in collaboration with the paradigm of public health and medi- of Public Health. The malaria control Addis Continental Institute of Pub- cine was further consolidated when zone in Dembia was modeled after the lic Health. The University’s services the Addis Ababa Medical School ad- first Zone of Malaria Control Project encompass different forms of health mitted and graduated four [4] former in Alamata, Wello. care delivery including hospital-based health officers on a fast track of six out-patient and in-patient services, years instead of the traditional seven Sixty years ago the Ethiopian health community- based clinical and pub- year training in 1971. Awarding credit care delivery services was influenced lic health services and chronic illness for 4 year or more of primary health by the strategic location of Gondar follow-up. Other services offered in- care service in district health centers and the network of health centers clude veterinary clinical services, free in Ethiopia was a validation of the staffed by Gondar graduates that con- legal aid services, continuing and dis- college’s program and paved the way solidated the policy of new paradigm tance education, tourism development, for the transition of services from me- of partnership between the College of need-based training and consultancy diocre to excellent. By 1976, almost Public Health and Ministry of Health services, panel discussions, seminars 50% of the Gondar Graduates with in malaria prevention and control and conferences. a baccalaureate degree had made the strategy. In effect, the Health Officers transition to medical school. Thus, not only served as leaders of an inter- The University of Gondar has played the decision by Ministry of Health disciplinary team, but also spearheaded a vital role in promoting excellence by in 1961 to transfer the ownership of integrated primary health care delivery instilling the idea of institution and public health training to Addis Ababa services regionally and nationally. nation building to its graduates. The University as an institution of higher same passion is evident when we look learning served as a head start that Dr. Widad Kidane Mariam, the first at the leadership role played by Gond- enriched and cemented the new para- Ethiopian woman physician and ar graduates in the Diaspora in collab- digm of self-sufficiency and replace- Medical Officer, Dr. Arnt Myer-Lie, oration with organizations like People ment of expatriate medical doctors by a Swedish Medical Doctor second- to People (P2P). Gondar graduates former Public Health Officer/Medical ed to the Ministry of Health by the also play an active role in the Twinning Doctor who took charge of the decen- Swedish International Development Program which promotes exchange of tralized Provisional Medical Offices in Agency (SIDA), and I, as the Director students, health care professionals and Ethiopia in the 1970s. of Medical Services in the Ministry faculty between institutions of higher of Health, were engaged in develop- learning in Ethiopia and the United My experience in the Malaria Control ing strategic decentralized staffing States. Howard University, one of the Project both in Wello province and the patterns with the goal of promoting most prominent Historically Black Headquarters in Addis Ababa, and my Gondar Health Officers to Provin- Colleges and Universities, and other training in Public Health at the Amer- cial Medical Officers of Health after Universities such as Ohio State are ican University of Beirut where 75% obtaining their medical degrees from active partners in this program. Dur- of all doctors and health profession- Addis Ababa University. The journey ing the past sixty years, the University als trained in the 1950s-1970s, con- that started in 1954 reached another of Gondar has become renowned for vinced me that the decision to transi- milestone in 1992 when the institu- its global outreach where not only the tion Gondar School of Public Health tion elevated itself to a University gown meets the town, but also where 27 improvement of the quality of life of He received his doctoral and master degrees the End-of-Project Evaluation of the Carter underserved Ethiopian population from the Bloomberg School of Public Health, Center’s Ethiopia Public Health Training continues to be its core value and mis- Johns Hopkins University, Baltimore, Mary- and Curriculum Development Initiatives land and the University of Michigan at Ann with Ministry of Education and Ministry of sion in the twenty-first century. Arbor. He is a Visiting Professor of Ethio- Health including Gondar University, Jimma pian People to People Organization at Addis University, Haromaya University and Ha- Ahmed A. Moen, DrPH, MPH, MHA is Ababa University and University of Gondar. wasa University among others 2006. Dr. Chair/Interim Director/Associate Professor of He is also a mentor for exchange Fulbright Ahmed has also been active in various lead- the Department of Health Sciences and Man- Exchange Scholars from Gondar and Addis ership roles including Peace and Mediation agement and Public Health Administration Ababa University under the Howard Uni- efforts and has received several awards for his and Epidemiology at the Colleges of Nurs- versity Memorandum of Understanding. Dr. various roles. ing and Allied Health Sciences and Medi- Moen has served as USAID Chief of Party for cine, Howard University, Washington, D.C.

28 A unique tablish relationships with the opposite gender were watched like a hawk lest Health Training Foundation they be distracted from their main duty of learning. The telltale signs and that evolved into a University symptoms were recognized by many Kinfe Gebeyehu MD, MPH, FAAP among us and labeled Health Officer/ Nurse/Sanitarian syndrome. dis to Gondar. Once I joined the college, I could tell that it was the right However, college life was by no means fit and my interest in the health field a walk in the park. The rigorous aca- kept soaring. Moreover, who in his/ demic curriculum required hard work her right mind could turn down an and committing to memory a lot of opportunity for an excellent education information and proving to family, and training in a respected profession faculty and peer that one was up to the and the promise of one of the high- task. In the mid 60’s, a few years after est salaries at the time? A graduate of the college was established, the concept the Gondar PHCTC commanded a of inter-disciplinary team work which starting salary of 450 birr (equivalent was the core mission of the college was to US 180 at the prevailing conversion introduced by the Dean, Dr. Dennis rate). Student life was not shabby ei- Carlson. There were sessions focusing ther. We received a pocket money of on Ethiopian history, national geog- It has been a lifelong blessing to be 10 Birr a month after all our needs raphy and basic cognitive psychology a graduate of a unique institution in were met and Signora, our elderly and philosophy when I rejoined the Ethiopia, the first of its kind to train Italian chef and Aba Habtu her assis- college as a faculty member in 1964. teams of health care professionals with tant, made pasta and polpeti that was Smaller groups were organized for fine skills not only to heal and com- out of this world. A good sized sheep sessions in school health, community fort but also to prevent and eradicate cost 5 Birr those days and 100 eggs a health, maternal and child health and disease. Furthermore, Gondar Public mere 1 birr. The college had a robust health education followed by actual Health College and Training Center program of extracurricular activities weekly visits and program operations (PHC&TC) laid the foundation to and students enjoyed sports and clubs in the field. The three year preclinical the first medical school in the coun- such as debate and drama. Our soccer and clinical preparation with abun- try (Tikur Anbessa) and now has it- team which represented the town of dant lectures in general public health, self evolved into a full-fledged and re- Chechela, about a kilometer outside health administration and communi- spected university that the historic city of Gondar city, often went undefeated cable diseases followed by a full year of of Gondar so richly deserved. against all the High School teams, the internship prepared the newly minted Police and the Highway team. The city Health Officer well to the challenges I joined the college as a member of dwellers referred to our team as “beg of real life. Operation and mainte- the third batch of trainees and have lehulet” in exasperation and in refer- nance of a vehicle were part of the not had any regrets since. As most ence to the sound nutrition the college training to prepare students for life in other students, I was assigned to the offered its students. rural Ethiopia. college and it was not necessarily my first preference. I may have gone into Our student days were uncomplicated Internship at Dabat Training Health the Navy a year earlier which appeared by today’s standards. Our multi-tasked Center appealing to me or could have enrolled international faculty played parental in the college of agriculture as it was Internship was during the second roles and attended to the homesick closer to home. Instead, I took my first year of training for sanitarians, third and to those who were having a dif- train ride ever from Harar to Addis year for community nurses and fourth ficult time adjusting to life without and my first ever plane ride from Ad- year for Health Officers. There were family. Students who ventured to es- 29 centers located in Gorgora, Koladuba The year we spent at Dabat training and with them. The Health Officers and Dabat in Semien and Begemidir health center was one of the most and the Nurses in the group invested province as it was known at that time. memorable. We practiced medicine, considerable time identifying high These sites were accessible to faculty pediatrics, child delivery, minor sur- risk pregnancies and ensuring these who made weekly overnight visits to gery, pharmacology and public health women delivered under medical su- provide technical and administrative with confidence; and consultation pervision and educating mothers to consultation and supervision. I and with faculty at Gondar and transfer of provide optimal care for their children. five other Health Officers, four nurses patients to the hospital was relatively Dabat also sticks out in my memory and six sanitarians were stationed at easy. As I will outline below, these ser- because of the camaraderie we enjoyed Dabat with its newly built facility for vices were not as easy to access when as a team. We took turns serving in patient care and staff residence. Ta- I served in Metekel as an independent the food committee and the nurses desse Tesfaye, (now MD, practicing practitioner a few years later. worked closely with Woizero Mamit, physician) who graduated a year before our gifted cook. Our competitive na- from the college, was in charge of the The residents of Dabat embraced us ture spilled to the kitchen and the food Dabat training center and well-liked as their own and included us in their was superb and the brewed beerth and by all for his work ethics and gregari- social lives. We were invited to wed- tela prepared for festive occasions ous personality. He, I and a few more dings, celebrations and memorials. outstanding. We invited prominent of my Gondar classmates met again Weekly trips to rural villages on mule community leaders for business and several years later when we joined the back went without incident except for pleasure including the celebrated war new and only medical school at Addis a few sore bottoms for the uninitiat- hero, Bitweded Adane, a tenacious and Ababa University (AAU) as the third ed. Our sanitarian colleagues worked morally principled middle aged man, batch to retry our God given aptitudes hard to improve water supply and in- who was serving as governor at that and build on our skills to serve those stall pit latrines through community time. in need, with only a slight shift of em- involvement. Their fearless leader was phasis. Ato Yimer, a towering giant who was Gondar PHC&TC has left an indel- dedicated and set deadlines for them ible mark in the country’s health care infrastructure spreading the concept of preventive care, environmental care, nutritional care and the critical importance of care of mothers during preg- nancy, child birth and infancy of their child. It trained young professionals who served their country, families and themselves well. One unintended but welcome consequence was the college’s role of unofficial match maker, more in the training centers than the college itself which was dubbed “The Vatican” for its restrictive rules by Solomon Desta, a classmate and close friend. I was one of many who at the end of their training did not leave only with their degrees and diplomas to face the world but also with a hand and a promise to start a profession and One third of the class of 1960 graduates interning at Dabat Training HC. family. The camera shy looking young lady- front left is my wife of 50 years, Yetnayet. 30 Has Gondar PHC&TC been a suc- I believe my observation on the de- ing center it built in Hawassa in 2011. cess story? ficiencies of our training during my The trained staff has been doing a good time still holds true. Ethiopia’s rap- job with much rewarding outcome. In I was stationed in Metekel, Gojam idly growing population coupled with the first year of operation, nearly 3 out from 1962 to 1963 after working at limited access to health care especially of 4 pregnant ladies assisted with their the ambulatory clinic in the college for rural inhabitants, justifies the time deliveries at the center had not re- for nearly two years. The Health Cen- and resources spent on future doctors ceived prenatal care there. The rates of ter was newly built and access to town to receive practical hands on training stillbirth, early neonatal death and the was on a mule’s back from Ingibara in those lifesaving procedures. The ex- need for intervention by C-Section or unless one lucked out and caught the ponential growth in medical schools instrumental delivery were twice as occasional truck that transported mer- and enrolled students in Ethiopia much for the walk-in cohort than for chandise. My brief assignment in Me- without matching resources in trained those who attended prenatal care. The tekel was both fulfilling and anxiety faculty, equipment and technology is intention here is not simply to justify provoking. I served a community with a challenge that cannot be ignored. the well known benefits of prenatal huge health care needs confidently Ethiopia has one of the highest ma- care services but also to make the point but I did not feel that my training ternal and neonatal mortality rates at that there is an urgent need for trained in surgical and obstetric emergencies 600+/100,000 and 37/1000 respec- emergency obstetrical and neonatal was adequate to handle Caesarian sec- tively. Although there has been sig- intervention staff in areas where time- tions, forceps deliveries and other in- nificant improvement in the last de- ly access to hospitals is difficult. This strumentations. I felt strongly at the cade, a lot of work remains to be done collaborative effort is paying off divi- time as I still do that more emphasis especially in the rural areas. Students dends as the trainees are now serving should have been given to hands on should graduate with the skills needed the population in Hawassa city and training of surgical skills needed to to deal with most obstetric and neo- neighboring villages. handle an emergency. Expectations natal emergencies. Often times, it is from a Health Officer were immense the woman who has been in labor for I have not had opportunity to directly in these communities where resources hours at home with no evident prog- assess the impact of PHC&TC grad- were lacking and there was no back up ress who makes the trek to the Health uates in the communities they served. specialist support. I feel that we made Center. These centers and commu- However, as I alluded earlier, my own a significant contribution especially nity hospitals should be staffed and experience in Metekel was gratifying in maternal and child health (MCH) equipped appropriately to bring down for the most part and I and my Sani- promoting safe mothering and early maternal, neonatal and infant deaths tarian colleague, Armidachew, did all child care. To me, the argument that in more rural settings. we could to serve the community we individual based practices are not effec- were entrusted with. During our year tive in making health care changes in The experience we gained in the MCH long stay in Metekel, we received no communities totally misses the point. and safe mothering collaborative pro- supervision or oversight of any kind. After all, individuals make commu- gram of Hawassa nities, regions, nations and the whole In 2004, 26 years after PHC&TC as world. The toll from loss of mothers Bureau of health and Ethiopian North we knew it ceased its training program, and their newborns and infants that American Health Professionals Asso- I had the good fortune of participating could be saved by simple intervention ciation (ENAHPA) inthe last three in the 50th anniversary celebration of country wide is multifold. If we keep years is worth emulating in various re- the college with my wife Yetnayet in on waiting for changes in the econo- gions of the nation. ENAHPA funded Gondar. That trip was combined with my, basic education and health edu- the training of three of the members of the task of evaluating the adequacy cation and changes in behavior alone Hawassa health staff namely a doctor, of health centers’ to train students of to bring down maternal and neonatal a nurse anesthetist and an OR tech- various disciplines from university deaths fast enough, we will be waiting nician in emergency obstetrical and programs. Consultant groups coordi- much too long and at a high cost of neonatal management for 3 months at nated by Dr. Carlson under the aus- lives lost. Yirgalem hospital for the safe mother- pices of the Ethiopia public health 31 training initiative of the Carter pro- years were in disrepair and piled up in ing the malaria control and small- gram (EPHTI) enabled me to take a the Health Centers’ compounds. Staff pox eradication programs and are firsthand look of service health cen- morale was low and the setup of the well represented in academia and ters. Our group was comprised of Ato clinic and laboratory areas left much research. Gebreamanuel Teka, a sanitary science to be desired. expert and former senior faculty mem- • Laying a firm foundation upon ber of the college, Dr. Fantaye Mekbib, Has Gondar PHC&TC been a Suc- which the Gondar School of a graduate of the community nurses cess story then? Obviously, this ques- Medical Sciences and Gondar program and former faculty of the tion could have been more accurately University were built. college, and Dr. Hailu Yeneneh, who addressed if the training program and graduated as a Health Officer from the team approach it fostered con- If this is not a success story, then what the college and was recently in charge tinued to graduate Health Officers, is? With fond memories of Gondar of EPHTI. We visited Health Centers community nurses and sanitarians. It PHC&TC and wishing Gondar Uni- in Dabat, Jimma, Agaro, Haramaya is also difficult to tease out how much versity a happy diamond anniversary... and Harar. In every stop we made, of the improvement in maternal and tDr. Kinfe Gebeyehu is one of the early alumni the footprints of Gondar PHC&TC child mortality, perinatal and neona- of Gondar Public Health College and Train- tal care, etc…is directly attributable were apparent in some modified form ing Center as a Health Officer. Currently he to fit local administrative priorities. It to the college and its graduates. Inad- is an Emeritus Attending Pediatrician at the was a pleasant surprise for me to meet equacy or total lack of such measur- Stroger Hospital of Cook County in Chicago a Health Officer I knew as a student able data however, should not deter us IL, where he previously served as Division while I was faculty at the college. He from making a valid assessment as to Chair of Pediatrics Emergency and Continu- ity care. He is also Vice President of People to was in charge of one of the health cen- how history will remember Gondar People, a non profit organization in the USA ters we visited. PHC&TC. established by Physicians of Ethiopian origin with the objective of supporting the health- History will highly acknowledge and The clinics we visited were very busy care system of Ethiopia. with full waiting areas. Health Of- respect Gondar PHC&TC for: ficers and nurses worked side by side providing conventional clinic care. • Its unique motto of prevention Administrative and leadership func- and education in tandem with tions were not solely entrusted to healing and rehabilitation Health Officers but were shared by nurses and laboratory technicians. The • Its emphasis and orientation nurses and sanitarians we met were to rural and health care deprived more recent graduates from university regions programs after the Gondar program • Its exemplary footprints for many closed. All the facilities we visited, re- college and university programs in ported lack of basic supplies including the country laboratory reagents and chemicals, inadequate supervision and support, and • Its strength for preparing gradu- difficulty in repairing and replacing ates not only for clinical service malfunctioning equipment. Preven- but also for positions of leader- tive health care such as MCH, prena- ship and administration. Gondar tal and environmental health were on PHC&TC graduates have served the service activities program but team as leaders in the Ministry of visits to the homes and villages were Health up to the rank of minister, not carried out with any regularity headed notable national and in- or consistency. The motorcycles that ternational organizations includ- have been in good use in the bygone 32 Salvaging MARAKI: the issue became a standing agenda in all public meetings. The untold story On the other hand, the quest for live Tesfaye Tessema, MD. Dean of GCMS 1998 -2002 and documentary evidences were put in place. Thanks to the administrative tunately, he was overthrown just four office of the college, very old but well years after laying the corner stone. preserved documents depicting the de- Since then the site was looked after by cisions by the Emperor and payments security guards employed by the then made for the farmers for their reloca- Public Health College and later the tions were retrieved from the archives. Gondar College of Medical Sciences, With these in hand, an executive deci- even though it was used now and then sion was made to take the case directly by either the municipality or the zonal to the court, ready to pay any sacrifice administration for some other activi- and face all consequences. The result ties. The college stewardship has pre- of suing the municipality which was vented any legal or illegal encroach- Maraki , the place where University of backed by all hierarchy could have ment of the would be university site Gondar is located, is one of the best been futile. until the turn of the century. The big- scenic areas in Gondar City, and the gest threat of tenure came one morn- 60th Diamond Jubilee anniversary of Surprisingly, three weeks down the ing in the year 2000. Investors from UOG will be a high time to look back line our legal officer came up with a the diaspora, who claimed that the site at its genesis. breaking news- We won the case, and was sold to them by the municipality, the court gave a verdict in our favor invaded the site with heavy construc- Who laid the corner stone of “Gondar - Maraki shall be returned to the col- tion machines. The lonely armed secu- University” in Maraki? When did it lege. happen? I believe many of us may not rity guard put his maximum effort to stop them by firing his rifle. have pondered about it. Subsequently, the law of the land was respected by all officials from top to The management’s effort to convince The corner stone at Maraki was laid bottom. Round table negotiations the municipality, the zonal adminis- by the late Emperor of Ethiopia, Em- were made. Maraki remained to be the tration, the Regional Government and peror Haile Sellasie l. It happened in property of the College. 1963 Ethiopian Calendar, i.e., more the Ministry of Education on the college’s tenure of the plot failed. Rather a than 40 years ago!! For many it will be Some six months later, the decision of thin order passed to the College man- quite a surprise, which could be due the Government to open University agement not to block the investment to our poorly developed tradition of of Gondar was made public. What a plan of the country. As a result, the documentation or lack of attention to great news! By then, Maraki with its investors continued their construction people with historical knowledge. gracious and undulating elevations activities. was quite ready to realize the long The Emperor had always been ac- awaited vision!! knowledged on his relentless effort to For the management, it was a devastat- ing and demoralizing historical failure. expand modern education in Ethiopia, Beyond having secured this majestic In order to avert that, certain strate- which included donating his own pal- and charming place for our university, gies were put in place. These include ace for Addis Ababa University. The the four decades long stewardship of involvement of the elders of the city beautiful panorama of Maraki must the hilly maraki enabled to retain the to mobilize the community and raise have caught the eye of the Emperor indigenous flora of the region. It was their voice on the return of the plot for his vision and ambition to open frequently visited by various national to the college using all opportunities, another University in Ethiopia. Unfor- teams for botanical research, medicinal especially public meetings. As a result, 33 plants herbarium , etc. The acacia and tion to make wise, and environmental- Congratulations!!! other rare endogenous trees that grace ly sound use of the resource with care- the Tewodros and Maraki campuses ful consideration of its unique natural Tesfaye Tessema Gudu are the result of decades long shield- features. Medical Student at GCMS 1979 - 1984 ing of this stunning place by successive Academic Staff of GCMS 1992 - 2002 responsible college managements. It is Medical Director of GCMS hospital 1994 the responsibility of the new genera- - 1996 Assistant Dean - GCMS 1996 - 1998 Dean of GCMS 1998 - 2002

34 The Journey of Nursing that stands out most in my personal assessment is the existence of the de- at University of Gondar: partment under the strong shadow of public health and medicine. Gondar personal reflections on is a national and continental heavy weight in terms of public health and the training for the noble medical training which eclipsed the other health sciences. This has resulted profession in knowingly or unknowingly in di- Tigist Alemu Kassa version of attention and resources. It is apparent to outline that until re- has worked to improve patient safety cently there was no trace of nursing in by promoting quality in nursing train- the naming of the institute (to recall ing. The department of Nursing was Public Health College and College among the three pioneer departments of Medical Sciences as a forerunner that formed the College of Medical of College of Medicine and Health and Health Sciences and finally the Sciences). Nursing remaining under University. The Gondar nursing de- the umbrella of medical school has its partment is in the forefront in pro- own pros and cons. Certainly, it could moting quality education at local and impact the advance of the depart- national level. The department was ment and its professional goals. But an active participant in the national from my experience having nursing quality enterprise and recognized as school adjoined to medical school is a leader in the field. It collaborates not problems free, especially related to with a number of governmental and professional autonomy and authentic- Two of my professional development non-governmental organizations to ity. Medicine and public health are an chapters are written by the Gondar positively impact the healthcare sys- overwhelming and dominant presence ink. I got my first higher education tem of the country. This collaboration in all the administrative, academic, qualification in Nursing from Gondar. includes discussions with stakeholder and leadership spheres. Nursing has its I was one of the instructors in the de- such as Ministry of Health, Ministry own approach to the art and science of partment of nursing. Though, I some- of Education, other universities en- healing. Nursing science and nursing times feel that I am hardly qualified to gaged in nurses training, professional pedagogic have unique features. Slow make serious reflection on my mother societies and civil organizations work- drift and alignment towards the other institution, I am strongly compelled to ing in quality of nursing education and health sciences and medicine is a vis- do it this time. After all, it is a civilized patient safety. ible dilution to the profession which and intellectual discourse that would makes any nurse uncomfortable. The shape our action. Here in this jour- One of the essential reflection I want practice in many nations world wide nal I thought it might be courageous to make here is the progress of the de- is that Nursing stands by its own as a to shout out loud about few issues of partment. It goes without saying that college or as school that might be un- concern that we sometimes gossip in a department has significant contribu- der certain university. All great nurs- closed door. It is based on my observation to the development of nursing ing institutions are autonomous nurs- tion of nursing practice at University profession in the nation. Here I want ing schools or colleges. For instance, of Gondar and as well as my own ex- to make an argument, however, it has Johns Hopkins University School of periences as a nurse and nurse instruc- not evolved sufficiently as expected nursing, the London Florence Night- tor, from 1996/97 to 2006. from a department which has 60 years ingale School of Nursing & Midwife- of existence. Many factors could be ry and the Faculty of Nursing science For the last 60 years, Department of sited for the nursing not flourishing to of Khartoum University are a good Nursing at the University of Gondar its full potential. The factor, however, illustration for my point. Hence, it is 35 high time to let the Gondar School of indispensable parts of Gondar nurs- for women than men. In the majority Nursing to evolve and stand separate ing. The testimony lies in that nursing of the world, nursing society is domi- from the College of Medicine and along with the other departments is nated by female and there are coun- Health Sciences. the proud winner of the 1998 Global tries that have strongly argued against Sasakawa prize in its team training, the need for recruiting male nurses. The argument for greater autonomy and community based practical edu- For example London has declared that shall not lead to misunderstanding cation. Those strong collaboration and nursing is “an intrinsically female pro- that there is no communality. Nursing joint activities should be strengthened fession based on female values, morals shares many values and principles of and cultivated. Nursing being a sepa- and holistic world view.” healing, disease prevention and health rate and truly autonomous entity can promotion with medicine. The nursing still be part of this joint missions and In recent years, however, there has school use the same resources shared resource utilization. Undoubtedly, it been an increasing number of nursing with all other health science streams. will be a more brighter, visible and scholars and organizations advocating The focal points in resource sharing flourishing arm of the Gondar team. for greater gender diversity in nursing. are the teaching hospital, rural prac- Even though men account for 50% tice sites, libraries, teaching faculty, etc. Let me take you to a different perspec- of the population, only about 7.9% Further, nursing shares and treasures tive on which I want again share my of registered nurses in the U.S. are the educational principles of the col- opinion. One of the things that have male. That’s a smaller percentage than lege that are the hallmarks of Gondar. occurred during the last decade is a in other developed countries, such as Team training, community based edu- major shift in perceptions. For a long 10% in the United Kingdom, 18% in cation, joint rural attachment pro- time Nursing has been understood Germany and 23% in the Netherlands. grams, and the equal emphasis in both primarily as a traditionally female pro- But those numbers are beginning to public health and clinical nursing and fession and more suitable career choice rise as nursing schools keep reaching

36 out to recruit more male students into that the mismatch between the num- their programs. ber of students and the resources available. Nursing schools in most of the In relation to the above fact only very universities of Ethiopia are designed little is known about the real figures to handle only few students at a time. related to the proportion of male and Responsible bodies should address female nurses in Ethiopia. However, issues like adequacy of class rooms, to be completely candid, my observa- demonstration materials, clinical prac- tion is that in recent years it seems we tice facilities, student-faculty ratio and are producing more male nurses than adequacy of other material resources female nurses. Many nurse profession- needed for effective teaching. Besides, als, however, had the feeling that this instructors in nursing schools should masculinisation of nursing in Ethiopia have at least minimum professional has a negative impact in the quality experience as practice/clinical nurse and consider it as unhealthy trend. As before getting involved in teaching. to my opinion, I think the big issue is Nursing education needs not only not of having a lot of men or women in knowledge but also art and skills. Such nursing but the way people end up be- traits are gained mainly in practical ing a nurse is more important. Even if professional life not only from school the masculinisation in Ethiopia is not based instructions. I finally underline what I wish to see in nursing, as long the need for research to understand as the profession is loved and accepted the issues related to nursing education by men, and as long as they get proper in a scientific way and to find appro- professional training it might not be a priate solutions for them. problem. However, this is something that should be studied and understood Tigist Alemu Kassa graduated in Associate before saying it healthy or unhealthy. degree of Nursing from Gondar College of Medical Sciences (GCMS) in 1998, did her bachelorate at Jimma University in 2004, Another major issue of concern re- MPH in 2008, at Addis Ababa University volves around admission and student and currently a graduate student at PhD assignment. Large number of students level at University of Leipzig, Germany. Her are assigned in to the department of professional career includes teaching Nurse nursing to get trained as a nurse with and other Health Science students at UGR out taking their interest and the avail- from 1998 -2006, nurse coordinator, con- able resources in to consideration. I sultant, senior public health and Anti Retro Viral therapy (ART) technical officer at Uni- think this has a negative impact in the versity of California San Diego- Ethiopia quality of the training and quality of from 2006 - 2011. She is currently living the health care system of the country. in Leipzig, Germany with her 5 years old I think students should not be pushed daughter Saron Yewunetu. in to nursing. It is a profession that needs deeper commitment, fitting attitude and willingness to help people. It is a profession that deals with the precious human life directly and in- timately. Therefore there has to be a way to motivate students to join the profession than just assigning them blindly. Additional point of concern is

37 University of Gondar: ness and wellness oriented programs for healthier and more active lifestyles. The pioneer in Physical Therefore, the physical therapy education in Gondar extends from structure Therapy Education in Ethiopia to function, from wellbeing to aliment Elleni Estifanos and from acute care to community based rehabilitation. That is the place us for being in a stream that is little where we, the first batch of physical known. Not only we the new higher therapists in the country, attained all education entrants, but also consid- the skills and the knowledge in re- erable segment of the academic staff gards to the outstanding human body has imprecise knowledge about the mechanics, its function and ways to fix profession and the role of the phys- it when the mechanics is out of order. iotherapist in the healthcare system (1). The course began with the defini- The University has a long history of tion of physical therapy as “a health quality education in health related care profession primarily concerned subjects. This helped the newly estab- with the remediation of impairments lished department to have less wor- and disabilities and the promotion of ries in regards to delivery of courses in mobility, functional ability, quality of the biomedical sciences. However, the life and movement potential through clinical teaching and learning opportunities were the most valuable learning The story of ‘Movement science’ begins examination, evaluation, diagnosis and experiences, and apparently it is where in Ethiopia long time ago. However, physical intervention.” (2) This is when the college was challenged to deliver the commencement of intense train- the word ‘functional’ caught my atten- it to our expectations. The clinical ex- ing of this science started at the fore- tion and to this day I endorse in it. runner Gondar College of Medical Science (GCMS), the current Univer- sity of Gondar (UGR). The University is the first in the country to incorporate the restoration and enhancement of movement potential in its mission statement. Hence, the department of physical therapy was established in collaboration with British NGO (Vol- untary Service Overseas). The first two volunteers arrived to Gondar from the periences included demonstrations of Netherlands in the year 2002. One of the main goals of every physical therapy intervention is returning the patient management, discussion, feed- At the beginning of the second semes- functional capacity of an individual to back and assessment. ter of the same year, the two volunteers, the previous level of function. Physical Marieke Boersma and Pouline Hen- Individual student contact with the therapists perform examination and derson, met up with the first thirty five teachers was a very valuable task in build up a plan using treatment tech- students to be trained with a bachelor order to acquire basic and advanced niques to promote movement, reduce degree of physiotherapy. They started skills. However, there were consider- pain, reinstate function, and prevent our induction by explaining the cur- able lapses when it came to clinical disability. In addition, the prevention riculum they developed and stated education of the program. The biggest of the loss of mobility before it occurs that ‘Introduction to physical therapy’ challenge was the non existence of is one of the duties of physical thera- will be the first course of the program. mentors at practice sites. Even though pists. This is done by developing fit- There was a feeling of anxiety among the instructors of the department of 38 physical therapy tried to provide good barely functional (5). The search done the expectation of the new graduates. clinical knowledge, the limitation of by the university to involve physical However, as the first graduates in the experienced clinical instructors in the therapists in the curriculum design country, we should have expected that placement sites was a big shortcoming. and in the training revealed that those and prepared to establish the work The effect of this is apparently visible who could potentially help this tod- environment and the equipments we to this day in the suboptimal knowl- dler department were not in a position needed to practice. And I believe we edge and skill sets in differential diagnosis and medical screening. Gondar physiotherapy, just like public health education and medical doctors training, was again truly a result of international effort. Beyond the two Dutch flag bearer professors, we have been trained by Japanese, Indian, Nigerian, Australian, and British professors with their unique international flair and slightly different focus on their approach to the profession.

The most strong element of Gondar physiotherapy education was its community based rehabilitation, and training in a multidisciplinary team. In its to help as most of them were living and the prospective graduates have a graduates profile the department has outside the country. Our education in responsibility to grow the profession, also anchored these time tested unique the core courses and clinical skills was, to practice it to the fullest and to give values and principles of the Gondar as a result, entirely dependent on ex- our expertise to the needy. Personally, team. The physiotherapist will be able patriates. I am willing to lend a hand to fulfill to perform physiotherapeutic commu- the dream of University of Gondar in nity diagnosis and provide community The world of work was not different growing this science that is mainly fo- based rehabilitation services by incor- from the school experience because cusing on function. porating physical therapy, functional again we were the first batch of phys- Reference: 1. Kutty RK, Gebremicheal H, et al. Knowledge, attitude, rehabilitation and advocacy for chil- iotherapists for the healthcare fa- practice and associated factors of physiotherapy among medical doctors in Tigray, northern Ethiopia- across dren, adults and older people with dis- cilities that dare to hire us. The other sectional study, Global journal of Biology, agricalture & health sciences Vol 2 (4):74-81. abilities (3). healthcare professionals working with 2. Physical Therapy. 02 March 2014. In Wikipedia. Re- trieved March 06, 2014, from http://en.wikipedia.org/ us have either vague or no idea who wiki/Physical therapy. First batch of physiotherapists gradu- 3. http://www.uog.edu.et/en/?s=physiotherapy we were. It was surprising for most 4. Higgs J, Refshauge K. Portrait of the physiotherapy ated from Gondar in 2006. By 2013 profession. Journal of Interprofessional care. 2001 vol 15 Ethiopian that we (with the white pages 79-89. Gondar has graduated 223 bachelor- 5. Frantz. Challenges facing physiotherapy education in coat) were neither nurses nor physi- Africa. Internet journal of Allied Health Sciences and ette level physiotherapists and lay a cians. In a study done by one of my practice 5 (4), 2007. solid platform for the growth of the classmate and his colleagues in Tigray, Elleni Stefanos was on of the first Physiother- profession and development of the only 67% of medical doctors have a apy graduates of the University of Gondar in service (1). It is historically relevant to workable knowledge about the service 2006. After working at the First Chiroprac- separate the progress of physiotherapy of physiotherapy and duties of a phys- tic and Physical therapy wellness clinic in Addis Ababa for three years, she went to USA in Ethiopia as pre and post Gondar- iotherapist. Furthermore, standard physio era. In 2005 Ethiopia has only for her Masters education. She subsequently working environment was nonexis- completed Doctor of Physical therapy program 15 physiotherapists with training lev- tent. This was a big factor that caused at Northeastern University and is currently els ranging from as little as few months frustration to many of us as getting the working in an outpatient orthopedic, pedi- to full bachelorette (4). The association right working area after training was atric and second phase cardiac rehabilitation of physiotherapists of Ethiopia was clinic in Northern Virginia. 39 Training of medical doctors colleges within it. (“50 years teaching, research and community service: Past, in Gondar, Ethiopia: the current and the way forward”) Gondar-Leipzig Link It was a historical moment and land mark for Gondar to start training Dieter Reissig, Prof.Dr. Med. medical doctors in 1979. The Ethiopi- an government was looking for a for- the Gondar-Leipzig link and to high- eign counterpart to help establish the light some of the success stories of second medical school in the country. International partnership and capac- Based on its political ties with Ethio- ity building. The Gondar College of pia at that time, the former East Ger- Medical Sciences of the University of many, (GDR) agreed to support the Gondar and the Faculty of Medicine effort and a treaty was signed between of the University of Leipzig made his- Karl Mark University of Leipzig and tory when they started training medi- Addis Ababa University. The newly cal doctors in Gondar in 1979. As accepted medical students in Gondar we celebrate the diamond jubilee an- were finishing their freshman year in niversary of this august Institution, I 1979 and a pre-clinical department Dear Gondar University alumni and am also reminded of my report for the needed to be set up post haste. The first especially my former students; 50th year anniversary in October 2004 group of German experts tasked with detailing the long journey of the col- It gives me great honour and pleasure setting up anatomy, physiology and lege from the then Public Health Col- to be invited to share my experience of biochemistry classes arrived in Gond- lege to today’s University with many

40 ar in October 1979 with all the nec- booster for both faculty and students The German group continued to sup- essary equipment. Within two weeks and it propelled us to the fresh chal- port Gondar University until October of their arrival, the German profes- lenges of the next year. 1980/1981 1989 when the tense political situation sors were able to set up all the needed saw the establishment of brand new in Gondar and the surrounding area teaching material and the histology, departments in pathology, pharmacol- made their return to Leipzig necessary. biochemistry and physiology labs with ogy and microbiology. It was a second The formal treaty ended in 1990 with the assistance of the college’s adminis- historical moment as we established the unification of Germany. However, tration staff. The anatomy lab started functional departments complete with the Federal Republic of Germany con- instructing students on dissection af- laboratories which performed autop- tinued to support the training program ter receiving three cadavers from the sies, biopsies, microscopical examina- until 1998. The Gondar-Leipzig link department of anatomy of the medical tion of tissues and bacterial cultures. In has resulted in the training of nearly faculty of the Addis Ababa Univer- parallel, faculty and technicians were 40 Ethiopians in different disciplines sity. The preservation unit was under sent to Leipzig for training in prepa- at the University of Leipzig. The cli- construction and soon, the dissection ration for transition of responsibilities nicians received full five year training room (DR) was ready for business and from Germans to Ethiopians. before they returned to teach. Gondar open 24 hours a day. Students were 1981/1982 was even more exciting. graduates who excelled were given the sometimes obliged to do dissection Our students were starting their first opportunity to pursue specialty train- using candle light as power was not clinical year and the hospital needed to ing in Germany. This concerted effort always available. You will all remember be upgraded to 300 beds. 12 German in capacity building made the transi- the pungent odour of phenol (a key clinicians joined the faculty: 3 sur- tion of teaching responsibilities from chemical for long-term preservation geons, 3 gynaecologists-obstetricians, Germans to Ethiopians smooth and and refreshing the bodies for good 3 paediatricians and 3 internists. These these trainees now form the nucleus of dissection) as the special character of clinicians were all academic teach- the teaching body in Gondar Medical the DR. Since then, it has been the ers and involved in both training and School. rite of passage for all Gondar College clinical care. To round up the clinical of Medical Science (GCMS) students Although the official treaty between training and comply with Addis Ababa to study cadaver anatomy in first-year Gondar and Leipzig ended in 1990, University requirements, the so called of medical school. Most of you will some clinical and pre-clinical depart- minor subjects were also included in also remember that the first specimen ments continued to have a healthy the clinical training. The out-patient- for the anatomy museum was a human relationship with their German coun- department (OPD) was rearranged to heart from an autopsy executed in the terparts. I have been coming to Gond- install units for ophthalmology, ENT morgue. As part of the treaty between ar every year since 1998 because of (ear-nose and throat), neurology, der- Gondar and Leipzig was capacity my personal interest and the enduring matology and dentistry. The X-ray de- building, five faculty members from collaboration between the Depart- partment of the college was used for the college were selected for a Masters ments of Anatomy of the University of the training. These new departments level training in Germany in the field Gondar and the University of Leipzig. were equipped with the necessary in- of anatomy, biochemistry, physiology, This helped maintain the relationships struments and our students were able microbiology and public health. Tech- during the different phases of the Uni- to complete all the rotation required nicians for the laboratories were also versity. The two Institutions signed a to qualify for Internship. Our first sent to Leipzig for special training. new agreement on academic coopera- batch of medical students completed tion in 2002 which was renewed in their Internship in July 1984 and the The final examination in anatomy, bio- 2008. Article II describes criteria for magnificent and colourful graduation chemistry and physiology for our first a fruitful collaboration and is a good ceremony held in legendary Gondar, batch of medical students was held in model for a sustainable development the capital of Ethiopia during the me- July 1980. It was a huge success de- project: dieval times, was truly historic. Since spite the challenges of setting up all then, we have had medical doctors the departments from scratch. This • A functioning hospital with mini- graduating from Gondar for 3 full de- accomplishment was a confidence mal infrastructure is needed to cades. 41 establish a Medical College de Berlin and Rostock to replace the tion of a structured PhD program in novo. German teaching staff. The re- Microbiology at University of Gondar placement was successfully com- which I believe is scheduled to start in • Departments can be developed in pleted by 1989. the coming academic semester. Such three phases with the partnering an international partnership, which organization providing the faculty • The Ethio-German partnership at is sustained mainly by commitment and equipment as per the curricu- Gondar University has been a suc- and hard work of individuals, can be lum. cess by all measures. showcased as best practice in initiat- ing, expanding and strengthening col- • Both the pre-clinical and clinical The academic link between the two in- laborations for institutional capacity departments must be fully staffed stitutes has been further strengthened building in education, research and and supported. by the agreement signed between Col- community service. lege of Medicine and Health Sciences • The training in pre-clinical sub- (CMHS) of University of Gondar and I look forward to seeing most of my jects is as important in developing Faculty of Medicine of University of student during the 60th year anni- countries as in developed countries. Leipzig. The new agreement has re- versary at Gondar, Chechela in July Although there is less emphasis in sulted in continued staff and student 2014! detailed gross anatomy in under- exchange and research collaborations. graduate courses in the developed Since 2008, 3 academic staff have final- Prof. Dr. med. Dieter Reissig is professor countries currently, countries in ized their PhD work at Leipzig and 4 emiritus of Anatomyat Leipzig University’s School of Medicine in Leipzig, Germany. He Africa including Ethiopia will be are pursuing their PhD studies at dif- was also the team leader of the German group well served if they maintain the ferent institutes at Faculty of Medicine from 1979/80 to 1988/89. Professor Reis- current curriculum for at least an- of University of Leipzig. The link also sig has been member of the Gondar Project other generation. helped in winning a grant from DAAD of the Medical Faculty Leipzig from 1980 for “Advisory Program in Capacity to 1990 and the authorized representative of • Capacity building should be a ma- Building” for University of Gondar. the Dean of the Medical Faculty of Leipzig jor component of any such treaty. The Advisory Program helped the ef- for the academic cooperation between Leipzig and Gondar Since 2002 This formed the basis for the forts of biomedical laboratory capacity training of Ethiopians in Leipzig, building and the initiation and execu-

42 Physiotherapy: Member of the aimed to use the already existing professional institutions and knowledge Gondar Team for ten years in Ethiopia. Since physiotherapy was a relatively new profession in the Ethio- By Pauline Henderson & Marieke Boersma pian health care, in the beginning years the meaning of and need for physical rehabilitation was new to the medical staff, patients and the physiotherapy students in Gondar University.

Now, ten years later the physiotherapy department in Gondar is well-known and frequently visited. For example, children with clubfeet are now coming in at earlier ages so their treatment is more likely to be successful. Early 2002, Gondar University (GU) stated to be both highly supportive approached VSO-Ethiopia to form of the development of an appropri- As a result, Ethiopian physiotherapists a partnership for the development of ate contextualized (Ethiopian) phys- are now able to make a living, either physiotherapy training. These partners iotherapy curriculum. The curriculum in government services or in private have signed a partnership agreement. In September 2002, the education of a new generation of physiotherapists for Ethiopia has started in Gondar. In order to launch this BSc degree course in physiotherapy, two Dutch physiotherapists were recruited by VSO The Netherlands and sent to Ethiopia in order to facilitate this development.

VSO (Volun- tary Services Overseas) sees development as a complex and continu- ous process that empowers people and communities to fight disadvantage, take control of their future and fulfil their potential. Human rights, including an education, a livelihood, health care, a safe environment, a say in the future and equal access to opportunity, are vital for development. Internation- al volunteering is at the heart of VSO’s contribution to development.

The Ministry of Education (MOE) Picture 1: Pauline and Thewodros and Ministry of Health (MOH) have treating a child with clubfeet by applying cast 43 practices. The Community Based Re- ciation (EPTA) and part of the World sadors of this new profession. When habilitation (CBR) Programme (as Confederation of Physical Therapy reading their critical discussions on part of the University) is serving peo- (WCPT). With the new Ministry of Facebook, when seeing them present- ple with disabilities in North Gondar Health Guidelines for Rehabilitation ing at a national rehabilitation work- Zone as far as the Simien Mountains. we hope the profession will continue shop and mainly when seeing them Many Ethiopian people have been us- to root in the Ethiopian Medical sys- working in every corner of the coun- ing the services, knowledge and skills tem and serve the many Ethiopians in try; we are proud to have been part of the physiotherapists working both need of physical rehabilitation. of the training of qualified Ethiopian in the Gondar University Physio- physiotherapists and the establish- therapy Department as well in many The GU, as the oldest health profes- ment of a physiotherapy department physiotherapy departments through- sional training institute in Ethiopia, within Gondar University. out the country. People have come and serves as a referral centre catering to healed from their disease or learned to the health needs of over three million Pauline Henderson received her Physiotherapy degree from the University of Utrecht in 1998 function better with the disability they people in the north-western part of the and worked in a rehabilitation center and a have. country. Physiotherapy is often an inhospital until she went abroad. She worked in Ethiopia from 2002 – 2004 where she was cofounder of the Physiotherapy department and the 1st BSc Physiotherapy at the Gondar College of Medical Sciences (GCMS), now known as University of Gondar. In 2006 she returned to Gondar for the graduation of the first Ethiopian BSc Physiotherapists . After leaving Ethiopia she obtained her Master’s degree and now works as a Physician Assis- tant (PA) in Radboud University Nijmegen Medical Centre, Department of Pediatrics. She currently lives with her husband and her son in the Netherlands.

Marieke Boersma came to Gondar in 2002 to help establish the physiotherapy department and BsC in Physiotherapy as a VSO volunteer. After two years she continued with the University to establish a Community Based Rehabilitation (CBR) project that still runs under the University in Gondar town Picture 2: Marieke as CBR worker in Ethiopia and the woredas around Gondar. Currently Marieke is working as the CBR advisor for Currently Gondar University is run- dispensable stepping-stone for people Light for the World and is still supporting the ning the only Bachelors and Master with disabilities to become fully inte- CBR work in Gondar from a distance. physiotherapy programme in the coun- grated in society and use their abilities try. They have had to concur a system to a maximum potential. that had no knowledge or understanding of the physiotherapy profession. As former teachers of the first batch of At present there are 10 rehabilitation Ethiopian physiotherapy students, we centres managed by the Ministry of are proud of them. Young individuals Labour and Social Affairs and there who have developed themselves, both are many more hospitals with a phys- personally and professionally, during iotherapy department. The Ethiopian their university years. They were the trained physiotherapists are united in first Gondar trained physiotherapists the Ethiopian Physiotherapy Asso- and we are glad to see them as ambas- 44 The Process of Affirmation teacher had his major in Sociology. A much complex subject was dialectics of the Gondar College of in Marxism and Leninism. Medical Sciences (GCMS) as a The Preclinical Years

Second Medical School Anatomy, Physiology and in Ethiopia Biochemistry By Dr. Mohammed Kedir This must be the toughest year of all. I 1984 Alumnus in Medicine, first batch of GCMS think it decided the fate of the College. So, the former East German Medical to accommodate the students. Forty instructors arrived at Gondar and the students shared a single big room classes started. as a dormitory. How a College, that teaches medical doctors, is using such In Anatomy, the bodies (cadavers) were a facility was mind boggling for us, ready for dissection. However, during particularly, as compared to the im- the lectures the instructor could not posing buildings and facilities of Tikur be understood. Nobody knew what he Anbessa. The girls had, I think, much was saying due to his limited language more problems. Biology and chemis- skills and his accent. Students became try classes went uneventfully. Howev- agitated and run to the Dean’s office. er, mathematics has to be thought by What can the Dean do about the ac- a Civil Engineer who was incidentally cent and language skills of a German available in the campus. What was he teacher? Actually, this teacher looked doing in the college? Really unfortu- on and off at three small different nate, because the students knew math- books, one after the other and deliv- Prior to 1978, Ethiopia had a single ematics better than him, and they had ered the non understandable lecture. medical school at Tikur Anbessa Hos- to correct him several times during the The students were told to be patient. pital under Addis Ababa University. It lectures. Physics was thought by a bor- So, they were patient and continued is at this moment that the Ethiopian rowed Indian teacher. The psychology to study hard both in the classes and government decided to open a second medical school at Gondar. The Public Health College at Gondar originally trained Health officers. These were midlevel health workers who were trained to prevent communicable diseases and do limited clinical work. In- stead of the Health Officers, Gondar College was assigned to train Medi- cal Doctors. The first batch of Medi- cal students, 120 in number, reached Gondar in September 1978 to start their education and training..

The Premedical Year

The fist year started without much fanfare. Somehow the college was able

45 dissection room, day and night. There totally new and tricky questions. She them. The teachers were wondering were tests almost every fifteen days. glanced at the questions for few min- what we can achieve by reading such The results of the tests were read open- utes, abandoned the whole thing and a vast and extensive Physiology book. ly in front of the class by naming each headed straight to Asmara. The other problem was lack of enough and every student loudly. This pattern number of frogs which were needed of tests continued for a solid on year In Physiology , we had two teachers to demonstrate physiological muscle which was followed by a real lethal full and they spoke excellent English. Their function. The students were furious. day Anatomy examination. One can lecture presentation was also fantastic. They accused the Dean and brought imagine the bulk of the subject. Many However, the students couldn’t be sat- him to the military governor of Gond- students hoped that the final examina- isfied because of shortage of books. ar, at the time. The Dean explained tion might contain substantial number It was frustrating to slowly develop a that he at most needed a biologist to of questions from the year long quiz- feeling that with all these compound- sustain the supply of frogs. In fact, the zes and tests and therefore might be ing problems, we are becoming Health reality was that our teachers travelled relatively easy. How unfortunate! The Officer level trainees and not Medical to the shore of Tana Lake by a Land final exam included none of the ques- Doctors. There were only two or three Rover and collected frogs. However, tions from those tests. One female Guyton’s Physiology text books. These the pond which was prepared by the student from Asmara did not bother are big complicated books. Despite College was not suitable for the frogs. to sit for the final examination full of this the students insisted in having Many of them died and floated on the surface of the water with their white bellies up to the skies. Even, the muscle of the surviving ones failed to contract properly during the demonstrations. I didn’t know what was going on in the minds of the military governor while listening to the arguments. It looks like he was wondering why we were quarreling over frogs.

Gradually, the dissatisfaction of the students was felt by our teachers too. Therefore, they went to Addis to check how the teaching is conducted over there. To their surprise, the Ad- dis Ababa basic sciences instructors were all biologists not medical doctors. Hence, our teachers pointed out that they have a real advantage over the instructors of Addis Ababa Medi- cal School. They claimed that it is a Medical specialist who teaches appropriate Medical Physiology than a mare Biologist . This was a significant turn- around of events. That means after all we had a point to be proud of. What we actually didn’t know was that we were probably learning the best physiology in the world, at the time. Because, the Physiology Institute form where our 46 teachers came was world renowned Hence, the bed side interaction & practically. The presence of three to (Leipzig Physiology Institute ). Who confrontation began. The Addis Aba- four clinical instructors in each clini- was just talking about becoming a ba interns were given the chance to cal department made the atmosphere Health officer? lead. They expressed their view and more interesting and exciting. This acted as bosses over the Gondar stu- reality gave the Gondar students the The Clinical Years dents who were holding their breaths opportunity to become knowledge- and following attentively. However, able and confident. It was evidenced With the start of the first clinical year there was nothing special or new the by their handling of normal deliveries, (the fourth year), the crucial time has Gondar students could hear! Is that cast application and major surgery as- begun. The students of the two Medi- all? The Gondar students would ask. sisting. Eventually, they carried their cal Schools of Ethiopia, Addis Ababa Is that really all? It was to the delight capacity to Addis Ababa where they and Gondar respectively, were going to of the Gondar students. A new real- worked extraordinarily as interns and come head to head. Those form Addis ization started to set in, that they can residents and beyond. were final year interns sent to Gondar become medical doctors, if not in a for rotations, while the students of better way. Therefore, the unavoidable With that, the strong reputation of Gondar were only junior clinical stu- offensive from the side of the Gondar Gondar College of Medical School dents. One group stood here and the students arrived. They started to grill was established. other there. They were wearing their the Addis Ababa interns in every op- gowns and stared at each other from a portunity. Do you know Pickwickian distance as if they were not willing to syndrome? Do you know this disease? unite. Obviously, the interns from Ad- Do you know that disease? dis were mature and their gowns were stylish. The gowns of the Gondar stu- The former East German clinical in- dents were more straight and stiff, not structors were experienced Doctors yet in sufficient use. The same question and teachers in their fifties. They were was being asked in the minds of both enthusiastic and dedicated about their groups of students, one could imagine. work. They were available in the hospi- That is, what do they know? Or, what tal day and night. Therefore, the teach- are they capable of? ing was intense both theoretically and

47 Volunteerism and I have included a sobering statistics to put things in perspective. The median Public Service: education debt for US medical school graduates in 2012 was $170, 000 and A Moral Imperative 86% of graduates reported having education debt. Total repayment amount for the Diaspora per student is more than $300,000. Anteneh Habte, MD This is a cause for pause for those of us who were not charged a penny through tics. They contribute more than 8 bil- the years of medical school. We clearly lion hours of service to local and na- owe a lot to the school and community tional groups, valued conservatively at which launched our careers. $173 billion. Children grow up selling boy/girl scout cookies, go around the Although accurate figures are hard to neighborhood fund raising for their come by, it is believed that there are schools and give a helping hand in thousands of Ethiopian health care soup kitchens during Christmas and professionals in the Diaspora. Those Thanksgiving. This pattern is not much of us who hail from Gondar are cer- different for the immigrant population tainly in the hundreds. There is no residing in the United States. We are doubt that most, if not all, provide fi- part of the community we live in and nancial support to family and friends very involved in all aspects of life. We back home. After all, the World Bank volunteer at our children’s school, help estimates the annual remittance from charities associated with our work Ethiopians in the Diaspora at over place and spend time at the free clinic 3 billion dollars. There is no readily Ask not what your country can which provides medical care to the less available data on what portion of this do for you — ask what you can fortunate of our fellow citizens at no remittance went to institutions out- do for your country. charge. side of immediate family and friends, John F. Kennedy but anecdotal evidence seems to sug- The volunteerism and public service I gest that it is not a significant amount. want to discuss in this piece is a little Wikipedia defines volunteerism as an A good number of Gondar graduates different than what is described above. altruistic activity intended to promote both from within the country and It is unique to first generation immi- goodness or improve human quality of outside the country have contact with grants who continue to have strong life with no direct financial gain. The their alma mater, visit when they hap- attachments with their countries of word was first coined in the 1600’s and pen to be in town, donate books and origin. Most of them made the con- primarily applied to the military to in- equipment and teach/deliver lectures scious decision as adults to settle in dicate soldiers who chose to enter ser- when the opportunity presents itself. their adopted country. This is certainly vice as opposed to being conscripted. However, these efforts tend to be frag- true in the case of alumni of Gondar The concept has permeated everyday mented, redundant and not responsive University in the Diaspora who are life since with volunteers serving a to the Institution’s needs. I am pro- beneficiaries of the excellent educa- critical function in most institutions posing that we extend this altruism to tion the school had to offer. When we including schools, churches and politi- communities and institutions outside choose to get involved in the activities cal organizations. of our immediate family and friends, of our alma mater by volunteering our and that we do it in a more organized In a typical year, about one-fifth of time, money and skills, we are really manner. This starts by identifying the American population, more than “giving back” as we are indebted to the groups whose visions align with ours 62 million people, serve as volunteers people and institution which helped and whose mission we would like to according to US government statis- educate us. advance. Below are a few suggestions: 48 Alumni Associations: One of the best resource gap and converting “brain ties as our actions speak louder than ways that graduates can demonstrate drain” to “brain share” or “brain cir- our words. Those of us who received their loyalty and gratitude to their culation” becomes even more critical. free quality public education should school is through alumni associations. Gondar alumni play leadership roles actually bring it up another notch as Active participation of alumni in their in P2P and other similar professional we are really indebted to the school school is also a signal to other chari- organizations with similar mission and community that invested in us. table organizations to be involved in and vision. the effort. The top ranked Universities in the US boast an alumni participa- Medical Specialty Associations: An- As we celebrate the Diamond Jubilee tion rate of over 50%. This provides other avenue for Diaspora health pro- of Gondar University, let us renew our the best opportunity to network, men- fessionals to make meaningful volun- commitment to be part of our alma tor, raise funds and stay updated on teer participation is through specialty mater’s future and not remain a fad- the activities of the school. We should groups who have established working ing memory of its past. Let this occa- all support our fledgling association relationships with their counterparts sion serve as a call for action and an and grow it to an entity which can be in Ethiopia. Examples of this in- opportunity to redouble our collective showcased to other Institutions in the clude the Ethiopian Diaspora cardi- efforts. We are well positioned to be country. ology group who has partnered with partners to the University’s leaders as Gondar and Mekelle through video they chart the future direction, and Professional Volunteer Organiza- conferencing, Infectious Disease phy- serve as mentors and role models for tions: An increasing number of health sicians and Endocrinologists who are the new generation of students and care professionals of the Ethiopia supporting fellowship training at Ti- graduates as they leave to make their Diaspora, either as individuals or col- kur Anbessa medical school in their marks in the world. This is indeed a lectively under an organization, have respective fields. A Hospice & Pal- moral imperative as “to whom much is been active in supporting various liative Medicine group has produced given, much will be required…” health related initiatives in their na- web based modules for free use by tive country. Alumni of Gondar are Ethiopian health care professionals, is Dr. Anteneh Habte is a 1984 graduate of the Gondar College of Medical Sciences. He active members of various Ethiopian spear heading the effort to incorporate is currently Medical Director of the Home Diaspora Health Care Organizations. the specialty into the medical school Based Primary Care Program at the Veterans One such group is People to People curriculum, and is supporting clinical Affairs Medical Center in Martinsburg, WV (P2P) which has been fostering part- service provided by Hospice Ethiopia. and Clinical Faculty at the University of West nership among institutions of higher Such associations provide opportuni- Virginia. Dr. Anteneh serves as Chairman of learning in Ethiopia and the US and ties for Diaspora professionals to vol- People to People’s Board of Directors and is a the Diaspora. In the 15 years since unteer and help streamline their efforts founding member of the Gondar University alumni steering committee in the USA. its inception, P2P has promoted par- to be more responsive to the needs of ticipation of Diaspora health profes- the beneficiary institution. They also sionals, their colleagues and respective lay the groundwork for the involve- institutions in the provision of clinical ment of non-Ethiopian colleagues and care, education and research in Ethio- their respective thus bringing more pia. P2P has also signed a memoran- resources to the effort. Successful fac- dum of understanding (MoU) with ulty and student exchanges have been Gondar medical school to be a partner made through these networks. in their effort to meet the rising need in transfer of skills and technology as Volunteerism is the ultimate expres- student enrollment ramps up. With sion of gratitude to one’s good for- over 3,000 medical students admitted tune. It transcends gender, ethnic into the country’s 13 medical schools, group or political affiliation. When the role of the Diaspora health care we volunteer, we are ideal role mod- professional in helping narrow the els for our children and communi- 49 THE ROLE OF THE DIASPORA IN of Diaspora organizations such as People to People (P2P)? EXPANDING MEDICAL SPECIALTY 3. What are prospects and challeng- TRAINING IN ETHIOPIA: es for the future of collaboration in those areas?

GENERAL OBSERVATIONS & 1. Why do we need to expand post- PERSONAL REFLECTIONS graduate medical training in Ethiopia? Elias Said Siraj, MD, FACP, FACE 1988 alumnus of GCMS As a resource constrained country, it is clear that Ethiopia has to prioritize the pride and gratitude for having been a areas of healthcare it wants to focus on product of this great and historic in- and allocate its resources accordingly. stitution. I can trace back whatever I From that perspective, the laser sharp achieved since, to the solid foundation focus the country has shown on im- I received during my medical school proving primary health services and years in Gondar. extension health workers was right on When I was asked to write an article the money. That way the country got on the occasion of this historic anni- the biggest “bang for its buck”. versary, I wrestled with the idea of what topic to focus on and how to approach it. After exploring several areas, I decided to focus on the area of medical specialty and subspecialty training in Ethiopia and the role of the Diaspora. I would like to begin by congratulating This is a topic which is near and dear my alma mater, University of Gondar, to my heart; on one side I have spent P2P Annual Diaspora Conference for reaching this momentous mile- a significant part of my career training stone- the 60th year Diamond Jubilee specialists and subspecialists in the US Once the primary care access prob- anniversary of its foundation. Since its and on the other hand, as a Diaspora, I lems have been improved though, it inception as the Public Health College have been a frequent traveler to Ethio- is obvious that Ethiopia will have to in 1954, this historic institution has pia to support various medical schools eventually address the huge short- been a trailblazer in the development and training programs in Ethiopia. of the healthcare system of Ethiopia age of medical doctors in general and which is unmatched by any other in- After some careful thought through specialists/ subspecialists in particular stitution. Congratulations again Uni- this complex issue, I decided to frame that it is faced with. versity of Gondar! it as follows: Chronic medical conditions such as When I walked into the campus of 1. Why do we need to expand post- diabetes, heart disease and kidney the then Gondar College of Medi- graduate medical education in disease are increasing in prevalence cal Sciences as a freshman student Ethiopia? in Ethiopia posing a huge challenge in September 1982, little did I know to the health care system. To man- that I was entering a historic institu- 2. What is the current involvement age those conditions, while the over- tion whose foot prints and impact in and role of Diaspora in the area of whelming portion of the population the healthcare system of Ethiopia will postgraduate medical education in will still have to rely on low and mid- be enduring. I look back now with Ethiopia? What has been the role level health care professionals, special-

50 ist physicians are needed to staff refer- specialty and subspecialty training right trend as all specialists training ral hospitals and academic teaching programs while simultaneously main- cannot be expected to take place at institutions. taining and improving the primary AAU alone. care network which has been estab- The impressive economic growth the lished successfully. When it comes to subspecialty train- country has registered over the past ing (such as Cardiology, Endocrinol- several decades has led to an increased 2. Experiences of collaboration be- ogy as well as Surgical Subspecialties), urbanization and the creation of an tween Diaspora and Ethiopian focusing on AAU only might be the emerging middle class/ upper class institutions in regard to specialty most practical approach to start viable which affords and demands specialist training and the role of organi- and meaningful training programs. care for conditions such as diabetes, zations such as People to People Some subspecialty (fellowship) train- heart disease etc. This has also led to (P2P). ing programs have already been started an expansion of private medical institutions and hospitals which in turn leads to an increasing need for specialist and subspecialist care.

Looking from a different angle, with increasing expansion of educational opportunities in Ethiopia, more medical schools are being opened and more medical students are graduating. The number of medical schools has ex- pended from 3 to more than 25 in a span of about 20 years. If the current trend continues, the number of medical school graduates will increase from about 150-200 per year in the 1990s to more than 5000 per year by the year 2020. This degree of expansion in medical schools is expected to lead to increasing demand for specialist and Diaspora Medical Professionals at World Bank Meeting subspecialist physicians to staff the medical schools and affiliated teach- Addis Ababa University Medical Fac- over the last few years at AAU/ BLH. ing hospitals. ulty (AAUMF) and Black Lion Hos- The results so far have been mixed. pital (BLH) have been at the forefront Some of the fellowship programs are It is with these premises in mind that of specialty training in the country. doing well while others did not do as I make the argument that specialty More recently they have also started well. While the reasons for the differ- and subspecialty training in Ethiopia subspecialty (Fellowship) training ent outcomes are multiple, the contri- should be strengthened and given ad- programs. bution of the Diaspora has been very equate attention to keep up with the positive in most of them. ongoing shift in the country’s demog- On the other hand, other medical raphy, economic status and chronic schools including the ones at Uni- As an Ethiopian Diaspora physician disease spectrum. versity of Gondar, Jimma University myself and through my role within and Mekelle University have started People to People (P2P), I have been I personally feel that at this stage of various residency training programs. working closely with members of its development, Ethiopia is well po- Given the massive expansion of medi- AAUMF and BLH to help out with sitioned to address the expansion of cal schools in the country, this is the launching specialty & subspecialty

51 programs. People to People (P2P) is an University has created a formal part- a US University) and Ethiopian insti- organization established by Ethiopian nership with Addis Ababa University tutions (such as an Ethiopian Univer- physicians in the Diaspora with the which has been helpful in my efforts sity). While those collaborations do purpose of supporting the Ethiopian to support Endocrine fellowship. work to a certain degree, adding the healthcare system. Over the years, P2P Diaspora dimension (thereby creating has supported various specialty and Another area where P2P worked hard the Triangle) will have a synergistic subspecialty programs at AAU as well to promote and encourage Diaspo- role quantitatively and qualitatively as other universities in Ethiopia. ra involvement has been the An- and bring about sustainability. The relationship the Diaspora has to its country of origin is unique and should be effectively mobilized in the process of creating partnerships. This is a new model and paradigm which the Ethi- opian government as well as Funding agencies should look at.

Another area where the Diaspora medical professionals can help Ethiopian institutions is through involvement in alumni associations. While the 3 oldest medical schools in Ethiopia (AAU, Gondar and Jimma) have large number of alumni in the Diaspora, an effective linkage of the alumni with their Diaspora Medical Conference alma mater has not been created to the As an Endocrinologist, I was particu- nual Global Diaspora Conference desired degree. Part of the problem is larly interested in the launching of an on Healthcare and Medical Educa- that while there is a rich tradition of Endocrinology, Diabetes & Metabo- tion, which has been conducted by alumni associations in the developed lism training program at AAUMF. P2P since 2009. This conference has world, it has not been customary in With help from myself and many oth- been bringing together hundreds of Ethiopia. In the USA for example, ers, the fellowship program was start- Diaspora physicians as well as repre- alumni associations are created by the ed in 2012 with 2 fellows who gradu- sentatives of Ethiopian institutions Universities with appropriate alloca- ated in April 2014. The program was including Ministry of Health, medical tion of resources and manpower. They conducted with a collaborative model schools and funding agencies. Sup- maintain a data base of all graduates involving several external supporters porting the postgraduate medical edu- and create an ongoing mechanism of consisting of Diaspora Endocrinolo- cation has been one of the key themes lifelong communication. Alumni are gists as well as North American and over all those years and this conference always updated regarding what is go- European Institutions which I helped has contributed towards increased in- ing on in their alma mater through to coordinate. volvement of the Diaspora in medical regular news letters via e-mail or regu- education of Ethiopia. lar mail. That also creates an ongoing The other area where Diaspora physi- fund raising mechanism from alumni. cians can help is by creating links and More recently, P2P has championed One should always keep in mind that partnerships between Ethiopian Insti- the concept of ‘Triangular Partner- most successful and influential people tutions and Foreign Institutions. P2P ship”. This concept which has been are alumni of a university somewhere. has also played a significant role in widely accepted by various stakehold- If their university has created a very fostering partnerships between Ethio- ers, challenges the traditionally accept- good communication channel with pian and Foreign Institutions. Among ed paradigm of bilateral collaboration them as alumni, they are more likely to others, my own institution Temple between foreign institutions (such as bring money and connections to their 52 alma mater. As an example, Temple cation and training of specialists and Previous experience of collaboration University (USA) in 2013 received subspecialists. has shown that there are several chal- about 70 million US dollars from lenges which need to be addressed for alumni donations, while Ivy League 3. Prospects and challenges for fu- an effective launch and maintenance universities such as Harvard regularly ture collaboration of specialty and subspecialty programs get more than 500 million dollars per in the future. Some of them include: year from alumni. Alumni are power- The ongoing efforts to start and ful assets and universities have to rec- strengthen specialty/ subspecialty • Adequate education and training ognize and nurture the relationship training in Ethiopia should be contin- of specialists and subspecialists with them. ued with more energy and focus. The will need significant participation collaboration demonstrated between of expatriate and Diaspora spe- A new area of involvement of the the Ethiopian medical schools and cialists. This will need identifica- Diaspora medical professionals is in foreign and Diaspora groups should be tion of potential collaborators in the private sector. Recently, Ethio- strengthened further. One should keep various countries. A mechanism pian Diaspora physicians have come in mind that the Ethiopian Diaspora has to be created how those will together with the purpose of open- in the health care field is right now be involved in training including ing state of the art private hospitals relatively well established and is look- short term travels, longer travels, in Ethiopia. This effort has to be sup- ing for opportunities to get involved if videoconferences, teleconferences ported by all stakeholders as it can po- appropriate mechanism can be created etc. tentially have a transformative role in to tap into it. the areas of health care, medical edu- • Adequate local budgetary and

Diaspora and P2P provide support to emergency medicine at AAU

53 structural support is necessary to It has become increasingly apparent Society. He also serves as the Vice President support the training. While the that the need for medical specialty for Medical Education of People to People, a role of Diaspora and foreign in- and subspecialty training in Ethiopia non profit organization in the USA established by Physicians of Ethiopian origin with stitutions to support such training will continue to grow. Collaboration the objective of supporting the healthcare programs is very important, there between Ethiopian institutions and system of Ethiopia. In 2014, he received the is no substitute to a significant Diaspora physicians promises to be a “Outstanding Service Award for the Promo- and strong commitment from the very effective way of starting specialty tion of Endocrine Health of an Underserved institution for the success of this and subspecialty programs and should Population” from the American Association endeavor and its long term suc- be utilized to the fullest possible ex- of Clinical Endocrinology primarily for his cess tent. It is very important that mecha- active and leading role in supporting the Ethiopian Health Care, Medical Education nisms be created to strengthen such & Research. He is a founding member of the • Recently, the sustainability of the collaborations so that the huge poten- GCMS Alumni Steering Committee. He new subspecialty training pro- tial of the Ethiopian Diaspora can be lives in the suburbs of Philadelphia with his grams over the long term is be- brought back home to effective use. wife Muna and 2 kids, Reehan and Noah. ing challenged as some programs could not get funded candidates Long term sustainability of such a during the second year. I person- specialty and subspecialty training ally feel that this is not due to lack programs will need incorporation of of interested candidates, but rath- those efforts into the existing plans of er due to inadequate coordination the country in line with the country’s mechanisms at a national level, emerging priorities as well as ongo- between the training programs ing expansion of medical services and and the various medical schools medical education. to properly match the demand and supply. I do hope that this is In conclusion, on the occasion of the a temporary set back and it will be 60th year anniversary celebration of fixed soon. the establishment of the University of Gondar, it is my sincere hope that this • Frequent travels of key Diaspora historic institution continues its pio- and foreign teachers to Ethiopia neering role in the health care arena may need some type of sustained and becomes a center of excellence support mechanism. in medical specialty and subspecialty training. Along these lines, one area where the Diaspora groups and the Medical Elias Said Siraj is a 1988 (5th batch) MD Schools in Ethiopia have to collabo- Graduate of Gondar College of Medical Sci- ences as a Gold Medalist. He received resi- rate on is to create a strong partnership dency and research training at the Univer- which will create a capacity to garner sity of Leipzig, Germany. He later completed big international grants which could his residency and fellowship training at the be used to support training programs Cleveland Clinic, USA. He is currently Pro- as well as joint research ventures. Both fessor of Medicine at Temple University the Ministry of Health and Ethiopian School of Medicine in Philadelphia, PA, as Universities should recognize the po- well as Director of Diabetes Program and Director of Endocrinology Fellowship Train- tential benefits of such collaborative ing Program. Among his many leadership endeavors at a bigger scale and use ap- roles in professional societies, he is a current propriate resources to promote those Member of the American Board of Internal collaborations. Medicine’s Endocrinology Board as well as Past President of Philadelphia Endocrine

54 Reminiscing Gondar College riage and would be my classmate for the next 6 years. None of us imagined, of Medical Sciences knowing her throughout the six years that she would go into preventive Yared Aytaged Gebreyesus medicine and be one of the leading school in Gondar. My friends and I public health professionals in Ethio- went into the research mode after we pia. I would have never imagined that heard the news and started gathering the Indian looking boy that took the all the information that we can get bus with me would not only be my about Gondar. We met Dr. Getachew classmate but would be one of the best Bolodia through family friends. He republic health specialist working for an assured us that there is indeed a medi- international organization saving the cal school to start with. He also told us world. that he has been an external examiner at the medical college and reassured us Our College journey began with 98 that they have a good faculty and stan- freshmen of the 120 assigned to the dards. After we got all the reassurances Gondar Medical School, who de- that we could get, my friends and I descended into the historical city of cided to join the college and travel to Gondar. Our first exposure was at the Gondar together. registrar office where we met some of Who would remember that day, Sep- our classmates while registering. I re- tember 15, 1982 when a young soul I remember that day when I left home member this very young looking boy who has no idea of the world that early in the morning. I can still smell registering and filling his forms. We would await him left his only home the exhaust from the diesel powered happened to be looking at his form that he knows for the first 18 years buses at “autibus tera” where my likes and saw that all his ESLC grades were of his life? I do remember, as I was gathered from all over the country to A’s! Wow!. We looked at each other in one of those boys. I was one of seven take the long bus ride to Gondar. I re- amazement but none of would have children from a small school in Ad- member fellow students whom I met predicted that this 16 years old boy dis who were embarking on a journey at the bus station who were crying would eventually be our Gold Medal to the unknown historical land. As a and bidding farewell to their families Winner, an Endocrinologist and Pro- senior in high school I decided to pur- before the bus took off for a two days fessor in one of the best Institutions sue a career in medicine, eventhough, ride to reach Gondar. Starting the first in the World!! After registration, we through elementary and high school, I days together there is so much to re- were assigned to a dormitory where always wanted to become an engineer member! There was a very friendly guy 40 of us would spend the first night or an architect. I decided to switch at who introduced himself to everyone together. Nearly all from different cit- the last minute after my visit to Addis in the bus and was taking pictures at ies, schools, and backgrounds had to Ababa Medical Faculty, where I got every stop. Who would have thought spend their first night together. What one of the best tours from friends who that this guy would become a derma- a first day in College to start with -- changed my perception of medicine tologist, an internist, a professor and a sharing rooms, bathrooms, books etc. forever. Following the release of the clinical mentor 25 years later? I never which would eventually continue for Ethiopian School Leaving Certificate imagined that the little boy in our next six years and possibly more. For Examination, I was assigned to Gond- company on the bus would spend nine most of us it was our first day to sleep ar College of Medical Sciences. years with me in the Medical College outside of our homes. and graduate school and would later I remember that seven of my high turn out to be one of the finest plastic So, we were supposedly the fifth batch school classmates were also assigned surgeons in Addis. Who would have of the medical school or “the class of to Gondar. We were pleasantly sur- thought that the girl I met in the same 1988”. So we stayed together through prised that there was even a medical bus would be related to me by mar- dark and bright days, through Gondar 55 and later through life. The bond that we so much uncertainty. We heard that plain sight of the dissection room dis- established from the first day we met the Philosophy and Political Economy play. Our professors were all Germans has stayed strong with us and we still Lecturer was notorious for giving “F” and we were forced to learn their Eng- meet every other year and whenever to a lot of students and everyone was lish accents and had to adapt to their we get a chance. We celebrate together scared of him. On our first day in class way of lecturing. I would not forget weddings, birthdays, christening’s and with him, he proved himself the same the rush to the Library after lecture life’s special events. We have also de- by asking which one of us were peas- hours to grab the very few reference cided to celebrate our 25th graduation ants and started comparing us to local books available in the Library. We anniversary in Gondar which is also peasants. Verbal abuse was so rampant! memorized and crammed all the facts the 60th Golden Jubilee of the estab- In general, first year was not too kind about the human body; the endless lishment of the University of Gondar. to the class of ’88! We lost about 40 cycles in biochemistry and the graphs percent of our classmates, and friends. in Physiology. When June came and Class of ’88 were counted one by one Nevertheless, it’s so much comforting the External examiners descended the first few days. We always recall the to see that after so many years that to Gondar, we had to prove to them guy who was asking everyone about all those brilliant young friends who how much we had in our brains. The their ESLC grades, the guys who were forced to leave us then have be- second big round of hammer thrown started studying Zoology the first day come successful in their life. I met one on us then. This time we lost another that we arrived. There was so much of them in Michigan, where he at- third of our friends. What a tragedy! new information and as much confu- tended Michigan State University to It make us to doubt ourselves by ask- sion! So many of our classmates were become a physician and was doing his ing the big question -- “Will I ever get terrorized by the deeds of their peers residency. There were others who fol- there?” in those first few days! What a learn- lowed different paths to become engi- ing and lifetime experience that was! neers, physicians and other seasoned In the third year, confidence level is professionals. much better. You have matured and We were welcomed by our seniors and are well versed with the way of study- were reminded that we have to respect Second year was exhaustive. Com- ing in medical school. You will have the hierarchy in the school. Seniors are ing back from a month long vacation, started sympathizing for your juniors. seniors and they had to be respected with not so many tears as last year, we Even though, You still had to fetch the and bowed to. We followed the tradi- indulged directly into Anatomy, Phys- water from the Hospital, and wash tion as our predecessors did. First year iology and Biochemistry. Days turned your clothes yourself. At least you will was a new experience for all of us. We into nights and the year went by fast. arrive at the Cafeteria early and would had to learn how to daily fetch water There were plenty of sleepless nights get the ‘efeta’ and the big ‘atinet’. It was from the only supply in the College and exams every week. There were also a year where most of our class- in the Hospital for washing, drink- some events that we could not forget mates started looking for girlfriends ing and showering. We had to wash like when the Lecture Hall for the ba- and started dating. Who would forget our own clothes, which for many of us sic science caught fire and everyone in our classmate who was in love with was a first time experience . We had to the campus ran at night to help stop one of the freshman girls? He would learn to sleep in a dorm with 10 to 40 the fire. We lost our lecture rooms to come to the dormitory and tell us that other students, while some are study- fire and were forced to take lectures in she saw him on his way to the cafeteria ing, and the lights are on 24 hours a the dissection room, the labs and even and he was sure that she was also in day. Some were observed to be strug- in the famous “Tukul” – our recreation love with him. We later found out that gling to stay awake by tying cold water center! No one who went to medical this girl had no idea that our friend soaked towel to their legs. Some would school will forget the smell of the dis- ever existed. This is what was locally stand by the pole on their double deck section rooms with phenol and form- known as ‘aynuka’. Oh my god, we had bed studying so that if they happen aldehyde especially those ones like lots of fun in the third year. Class of to fall asleep they could hit the pole myself who have allergies. We would ’88 started a soccer tournament in the which would wake them up and so spend 4-6 hours lectures daily in that College and organized soccer games that they continue studying! There was room with the suffocating smell and within the different batches. Who 56 would forget the day where most of cine. What they showed us those three room with only one roommate!! Have us avoided the Youth Meeting and years became the fundamental basis of you own cook, and with money left to went to play soccer? That day the our future practice of Medicine. We spend for beer and entertainment – all Youth Committee called the Police were witnesses to life’s first moments, out of the 385!. The famous Hotels and rounded many of us for which life’s difficult moments and life’s last of Quara, Terrara and Fogera used to we spent 2 days at the Police station minute struggles. At a tender young have Lunch buffets and most of us -- just because didn’t attend the meet- age of 21-22 we were able to help de- the Interns would spend quality time ing. It was an eye opening experience liver babies, heal the sick, do the sur- there with our colleagues, and notably for most of us spending a night with gery to heal the wounded. Some of us with our German Professors. prisoners in a small room and living were sick in our minds with what our their experiences. It was mandatory to patients were sick from. We laughed, Overall, our six years stay at Gondar attend the Political meetings at that cried and mourned with our patients. Medical School was one of the best time. What an idiocy!! Who would forget running to the formative years of our life. There were wards to see patients, write H & P’s a lot of struggles, obstacles and limita- No one can also forget the “Zemecha” and do some labs at the side labs to tions. The medical school at the time time at the end of our third year where show to Dr. Teshale (RIP) I bet there was not an ideal place in terms of stu- we were ordered to go to ‘Metekel’ to are many of us who ran and tried to dents living conditions, physical infra- build cottages for new settlers from hide when we saw Dr. Teshale in town structure and manpower development. the north of the Country! Our seniors – fearing the consequence of his tor- Despite all the shortcomings everyone in the clinical years were assigned to menting the next day in ward!!! including the professors, lecturers, work in the clinics at the different support staff and the students worked camping sites while we were tasked The rural field trip to Kola Duba was hard towards the main objectives of the to provide First Aid at the cottage one of the unforgettable moments in College - to produce compassionate sites all over. We had to walk about College life. Who would forget the and competent physicians that could 1-2 hours daily to our respective as- first day that we were on call for after serve the human race. We the Alumni signed sites to build those cottages for work hour duty at Kola Duba Health are the living witnesses of this fact. The the incoming settlers. Many a times, Center? All sorts of problems present- alumni of Gondar College/University it rained, it used get very hot and hu- ed, including laboring mothers, folks have proven themselves that they are mid. In these forests, no human beings wounded with bullets and obviously second to none. I would like to quote have stepped a foot before. Just the the febrile child. Though we were anx- what Dr. Zein Ahmed Zein (RIP) the thought of that was really scary -- you ious and stressed, we learned to handle then Dean of GCMSc wrote on our never know what can happen in the emergencies and had a successful stay graduation yearbook in 1988. unknown! There were those who lost at Kola Duba. We were also able to their life to animals. Luckily Gondar visit places like Gorgora, the islands “It’s deeply gratifying to learn that students were spared. Many later de- and monasteries on Lake Tana during our graduates are second to none. The veloped Malaria after we returned to our rural practice period. correct attitude of our alumni towards Gondar. duty has earned them in general, and Who would forget Internships? This patient care in particular, further praise. The clinical years are among one of was the first time that we were paid I do hope these desirable attributes the best years that we spent in Gond- salaries and surly everyone remembers would constitute the hallmark of sub- ar. What we learned in the first few what they did with their first salary!! sequent cohorts of Gondar Physicians years had to be interpreted in practice Most of us were 23 -24 years of age and too” Dr. Zein Ahmed Zein, 1988 in the patient wards, clinics and rural our first gross salary was ETB500 and practice sites. Our German Professors after tax we would get about ETB385 I sincerely hope that his dreams are were very instrumental in this and they in our pockets. This used to be a lot of being fulfilled as we see the current showed us how to work hard, showed money then!! Internship was the year 2014 and future Gondar Univer- us what compassion meant. They made where we had all the luxury those days sity graduates walk the isle to receive us observe and learn the art of Medi- could afford! Imagine having a bed- their degree and say the Hippocratic

57 After graduation he worked at Dangila Oath. You can find our Alumni in na- Health Center as a general practitioner and rora Sinai Medical Center. He is Board certi- tional and international organizations District Health Manager. He later worked fied in Internal Medicine and is currently a and teaching institutions all over the as Deputy Regional Health Manager at partner and in a private practice in Northern West Gojam Regional Health Bureau. He Virginia. world, contributing to the wellbeing of also served as the Medical Director of Bahir the human race. Dar’s Felege Hiwot Regional Hospital. He then joined graduate school at the Surgical Congratulations to Gondar University Residency Program at Addis Ababa Uni- on its 60th Diamond Jubilee. versity Medical faculty in Addis Ababa for three years. After moving to the USA Dr. Ge- Yared Aytaged Gebreyesus graduated from breyesus did his Internal Medicine residency Gondar College of Medical Sciences in 1988. training at the University of Wisconsin Au-

58 The life of an international who have been unable to secure a position even after several years of repeated medical graduate applications. Some of them abandon the quest and work in different profes- By Mulugeta Z Fissha, MD, FACC sions. Residency is 3 years for Internal Medicine and Pediatrics (4 or more dous hardship IMGs encounter to get years for non-internal medicine fields). into residency and eventually practice After completion, there is the option medicine. The largest share of IMGs of practicing as a primary care provid- comes from India accounting for er (which is the most common path) 20%. Ethiopian IMGs are far below or applying to a specialty fellowship. 1% of the total IMGs.(5) An edito- Fellowship may take an additional 2-4 rial in JAMA published in December years. After a total of 3-7 years in resi- 2012, indicated by 2015, the number dency and specialty graduate training, of graduates from US medical schools a final board exam and certification is is expected to exceed the number of needed to join the work force. positions available in United States residency programs.(6) This is likely to Medical practice in the US is very di- make it increasingly difficult for IMGs verse. Some physicians are employed The US health care system is the most to find positions in US residency pro- by private practices or hospitals. A intricate system that consumes 18% grams. Most IMGs (37%) remain in few go to academia or open their own of GDP (gross domestic product), internal medicine and its specialties private practice. Generally physicians roughly 2.8 trillion dollars in 2012.(1) and very few make it to surgical spe- work long hours than other non-phy- Eighty percent of US health care facil- cialties (<20%).(7) sician professions, on average 52hours ities are largely owned and operated by per week in 2007.(8) IMGs work even private sector, while the government Ethiopian IMGs have been in the US longer hours than their US medical owns 20%. This, however, is in con- physician work force for significant counterparts. They also tend to work stant flux given economic challenges. period of time. The total number is in low socioeconomic places and rural There are several important players in unfortunately unknown as there is no areas.(6) the US health care system including unified Ethiopian medical society in physicians, hospitals, insurance com- America. The path taken by an Ethi- I relocated to US in 2002. I completed panies, pharmaceutical industry and opian IMG to become a practicing residency in 2007 and fellowships in the government. physician, much the same as any IMG, 2011. I found practicing medicine in is a long stressful and arduous process the US very fulfilling despite its set of The WHO estimates there were that starts with taking a series of ex- challenges. The system allows you to about 750, 000 physicians in the US ams called USMLE step 1, USMLE practice based on established evidence- in a 2009 survey. (2) The actual num- step 2-CK and USMLE step 2-CS. based guidelines. This reduces vari- ber of international medical gradu- These tests are complementary and ability of care with different providers ates (IMGs) actively practicing is not should be completed before applying and institutions. There is a tremendous known, however, it is estimated to be to residency. Obtaining a residency emphasis on continuing medical edu- 23.5% of the total US physicians.(3) In position in turn requires application to cation (CME) to keep pace with new a survey of students entering residency different programs and subsequently data and published guidelines. Every programs in 2007, 35% of applicants undergoing in-person interview with physician has to have a certain number were IMGS, however, only 15% suc- each program. Securing a position has of CME credits to remain in practice. cessfully obtained residency programs. become more difficult as the number For most physicians, it is also a re- (4) The disproportionate number of of US graduates competing for the quirement to pass board certifying ex- applicants to those accepted by resi- same position continue to grow. I per- ams every 10 years to maintain board dency programs indicates the tremen- sonally know several Ethiopian IMGs certificate. All in all, the system is well

59 References designed to keep you sharp with re- medicine (beyond reading what is in 1. WHO Department of Health Statistics and Informatics (May 16, 2012). “World Health Statistics 2012”. Ge- cent advancements and up-to-date Harrisons), interpretation of several neva: WHO. with practice changes. diagnostic tests which were not widely 2. http://apps.who.int/gho/data/view.country.20800 3. AMA Physician Master file [database]. Chicago, Ill: available during my time in Ethiopia, American Medical Association; 2009. 4. Jolly, Paul PhD, Boulet, John PhD, Garrison, Gwen Reflecting back on my training in working in a multidisciplinary team PhD, Signer, Mona M. MPH. Academic Medicine. 2011;86(5):559-564. Ethiopia, both medical school and (from nurses, dieticians, physical ther- 5. Origin by Country, American Medical Association, http:// www.ama-assn.org/ama/pub/about-ama/our-people/ residency, there are several positive apists, pharmacists, social workers, to member-groups-sections/international-medical-graduates/imgs-in-united-states/imgs-country-origin.shtml attributes that have prepared me to different specialists taking care of the 6. Traverso G, McMahon GT. Residency training and international medical graduates: coming to America no be a competent physician here in the same patient) and electric documenta- more. JAMA. 2012;308:2193-2194. 7. IMGs by speciality. http://www.ama-assn.org/ama/ US. Our medical school curriculum tion. Residency training in the US has pub/about-ama/our-people/member-groups-sections/ was rigorous especially in basic sci- international-medical-graduates/imgs-in-united-states/ also made me realize that a great phy- imgs-specialty.page ences, which gave me a great founda- 8. Trends in work hours of physicians in the US. Douglas sician is not only the one who has a O. Staiger, PhD; David I. Auerbach, PhD; Peter I. Buer- tion. Our clinical practice, including breadth of medical knowledge but also haus, PhD, RN. JAMA. 2010;303(8):747-753. internship and the countless hours of has several other attributes described Dr. Mulugeta graduated from Gondar Col- bedside teaching, made me learn tre- as “core competencies” including pa- lege of Medical Sciences in 1998. He loved mendously and stay competent for the tient care, medical knowledge, profes- playing tennis at Tikul. He worked as a gen- fierce international competition as an sionalism, communication and inter- eral practitioner at Axum St. Mary Hospital IMG. However, my training was not personal skills, practice based learning for two years and subsequently joined internal by any means complete as I am learn- and system based practice. These core medicine residency at Tikur Anbessa Hospital. ing a completely different epidemiol- attributes are evaluated separately and After two years of training he relocated to the US. In the US he completed internal medicine ogy of diseases. I had to discover and I believe have broader way of evaluat- residency at the Johns Hopkins University/ acquaint myself with metabolic related ing a trainee than the medical knowl- Sinai program. He then joined the Medical diseases that are far less common in edge-centered evaluation I received in College of Georgia for cardiovascular fellow- Ethiopia. On the other hand, I had to Ethiopia. ship. He underwent further training in inter- quickly abandon all the extra expertise ventional cardiology and peripheral vascular My advice for young trainees who as- I acquired in acute tropical diseases. interventions at Newark Beth Israel Medical pire to pursue further education abroad Lacking in our education include use Center in New Jersey. Dr. Fissha is board- is to take into account the complex and interpretation of evidence based certified in Internal Medicine, General Car- challenges encountered in the process. diology, Interventional Cardiology, ECHO Although the challenges can be man- and Nuclear Cardiology. He works at New- aged, the process of acquiring residen- man Regional Health, Emporia, Kansas, as a cy training has become far more chal- staff interventional cardiologist. lenging than during my time. Having a broader understanding of the process and creating a solid connection with fellow Ethiopian IMGs to share information is critical to success.

60 On the Path to Excellence, ing highest possible quality of education. Perspectives of an Alumnus Quality education has multiple mov- Yared Wondmikun Endailalu, MD, PhD, FIME ing components including avant-garde curriculum development, innovative teaching methodology, visionary leadership and governance systems, state of the art technology, motivated academic and support staff, and engaged and empowered students (1,2). It will be presumptuous to attempt to address all these aspects in a few pages. What I set out to do in this piece instead is highlight a few salient points which I believe are doable and will have fundamental repercussions going forward if left unaddressed. Why am I taking the time to do this? It is because I firmly believe, as does every engaged reader of this note, in the value of a constructive discussion and pluralistic debate about the destiny of our alma mater. On this momentous occasion of the efforts and resources wisely. There is The intent is not to be prescriptive but Diamond Jubilee, we come together ample ground for optimism as the fu- rather advocate for my convictions; a to celebrate and honor the aspira- ture can be reasonably presaged based duty of every scholar in my opinion. tions, values and achievements of on the amazing resilience, can-do-it generations of Ethiopians and expa- attitude, and achievements Gondar The strategic decisions that Univer- triates who built this great institution has registered in the past 60 years. The sities make today set the stage for a of higher learning in the historical city transformation of this institute, par- future of mediocrity or world class of Gondar. We applaud all students ticularly in the last 15 years, is nothing performance. The critical difference who entered the gates of University short of phenomenal. A health Science between the high performing univer- of Gondar (UGR) and came out on college of 500 students has morphed sities of Africa and those who are not the other side thoughtful and accom- itself into a multi-faculty University doing as well is a choice of destiny. plished citizens prepared to make a with high profile schools and train- Ethiopian Higher education act gives difference in their lives and those of ing streams catering to the teaching- Ethiopian universities unprecedented their fellow Ethiopians. We would be learning and research undertakings of autonomy to chart their strategic di- remiss though, if we do not use this over 25,000 undergraduate and grad- rection for their destiny (1,2). Hence, significant milestone as an opportunity uate enrollees. For those of us who delivering quality education is a con- to take stock of today’s challenges and participated in this breakneck speed scious choice and not a random act or engage in a constructive dialogue that transformation, it is a source of pride a roll of the dice. charts the future for UGR to be one of and accomplishment. UGR’s history is full of firsts as it implemented its the best in Ethiopia and Africa. 1. Equipping the learner with the pioneer academic endeavors ranging right tool UGR is well poised to join the elite from public health to tourism. These club of the top 100 African Universi- remarkable achievements should now Recently, the alumni steering commit- ties within a few years if we identify be the springboard to squarely face the tee in the US received an email from a our priorities carefully and allocate our next big challenge of our time: ensur- concerned professor of UGR request-

61 ing textbooks for his students. This The 2013 NMC Horizon report themselves alphabet and numbers plea for help generated a flurry of email makes a convincing case for the rel- within two weeks just by being pro- exchanges and a couple of conference evance of tablets in teaching, learning vided tablets but no teachers. In five calls to discuss the merits and demerits and creative inquiry (3). It is increas- months, they had attained sufficient of carrying luggage-full of text books ingly clear that tablets are not a new skills by themselves and were able to for the homecoming event. As one of kind of lightweight laptops, but rather hack Android. The message beyond the early group of medical students a completely new technology. It is easy the sensationalism is that they dis- of the college who navigated through for students to carry tablets from class played a level of creativity, inquiry and the famous library policy of the time to class, using them to seamlessly ac- discovery that is essential to learning “One Textbook for One Hour for One cess their textbooks and other course just by having the tablet (4). With the Student”, I can fully empathize with materials as needed. A student’s choice same analogy, the effect of a laptop on the distress of the faculty. Drought of apps for his or her tablet makes it the learning & inquiry of a university and binge purchases of textbooks were easy to build a personalized learning student is boundless. my own experience as a manager. The environment, with all the resources,

email brought to light that availability tools, and other materials they need In the past years some universities of textbooks and reference materials on a single device, and with most tab- have started to provide students tab- continues to be a formidable chal- lets, the internet is woven into almost lets pre-loaded with course materials, lenge to quality education and calls for every aspect of it. Productivity apps, digital textbooks, and other helpful a radical solution. There are numerous including Evernote, Dropbox, any.do- resources including access to grades, readily available catalogues of sugges- Cal, and many more enable learners university news and other resources. tions and proposals on how to increase to take and share notes, create-to-do- Where one-to-one learning is not access to educational material and it is lists, store all of their files, and orga- possible, students can borrow tablets not my intention to clutter my limited nize their academic schedules. It cre- to do coursework, watch instructional space discussing the pros and cones of ates engagement of students with their videos, and conduct project work that all the available options. I would like training at a deeper level and widens is specifically designed to be complet- however, to shine light on one useful the scope of the learning environment. ed with the devices. It helps in adopt- tool that could radically change the In a bold experiment by the One Lap- ing social networked and self guided trajectory. top Per Child organization, children learning (4,5). Its requirement for from Wonchi and Wolonchete taught 62 technical and administrative support, Coursera courses (7). Imagine how Appropriately improvised integration infrastructure, system interactivity, quality of education can be trans- of at least 1-2 MOOC courses as elec- budgeting and accountability is far less formed if UGR finds a way to inte- tives to start with, could make a signif- than a fixed network. Many universi- grate MOOC into its regular courses. icant difference in terms of quality of ties are surprised to find out it is much The future experts of Ethiopia could graduates. If system wide implementa- cheaper and more flexible than brick have access to world class courses and tion seems too radical or not feasible at and mortar libraries and computer instructors at no cost including some this time, we can still experiment with centers. Hence adapting laptop based that have never been offered in the our graduate students and the best and educational resourcing will be a huge menu of Ethiopian universities. This brightest 10% of undergraduates to of- step forward. option could also be a support scheme fer them advanced bachelorette. for our understaffed departments and 2. Semester based education, a relic aspiring young instructors. Do we have 3. Brain gain/share/circulation and of the past? any open time to incorporate MOOC not brain drain is the name of the in our curriculums? I argue there is game The tablet at the center of personalized enough unused instructional time. learning creates a synergy between Here I want to be a bit hypothetical Dr. Tesfaye Tessema (Dean at the turn our existing educational platform so that the reader could leap into in- of the century) shared with me a story and new modes of teaching-learning spired imagination. Ethiopian higher of his own Department of Pediatrics. and exploration. This system auto- education institutions provide 16-18 It is a heartbreaking story of a depart- matically opens the gate to the next credit hours per semester for full time ment in a free fall; from the height of new thing that is shaking the world’s students that lodge and board in the planning a graduate program in pedi- higher education establishment at its campuses. This is roughly equivalent atrics and child development to ground core; Massively Open Online Cours- to the course work load of university zero as its entire internationally ac- es (MOOC). MOOC is designed to students of the western world. How- knowledged staff hit the road within provide high quality, online learning ever, North American and European the span of three months. Deans at at scale regardless of the learner’s lo- students waste plenty of their in- Gondar University and elsewhere in cation or educational background. It structionally valuable time in prepar- the country have to constantly con- enables massive number of students to ing their food, cleaning, riding to and tend with the prospect of losing their participate in a single course, working from their campuses, part-time work best and brightest to greener pastures at their own pace, relying on their own and moonlighting to pay some of their abroad. When this happens, institu- style of learning and assessing each expenses. The time saved by providing tional capacity, tradition and memory other’s progress (6,7). MOOC present services to the students can be used for inevitably get eroded. I am suggesting opportunities for avid learners to free- MOOC. that mass exodus of staff while dev- ly experiment with a variety of subjects astating when it happens, should not and acquire new skills that may not be necessarily severe the umbilical cord. directly associated with their major degree courses. A tourism management major could enroll in courses on nutritional anthropology and founda- tions of computer graphics. A Physical Therapy student can still have a course in creative writing and the politics of transboundary rivers.

Many universities are reviewing MOOC to supplement traditional university classes. The University of Washington is giving credits for its

63 The number of former UGR faculty and exchange of knowledge between Ethiopians are slowly getting the and former professors of other Ethi- scholars in the Diaspora and their col- message and are networking to con- opian universities living outside the leagues at home. Such non-traditional tribute in the development of their country continues to grow as people pragmatic approaches will bring the home country by establishing knowl- migrate with no intention of return- brain power back into the circulation edge webs that span across the world. ing in the short term. As careers get to help in capacity building and nation There are several virtual communities established and life settles down, the building. that discuss various social, political, attempt to physically return those ideological, economic, developmen- scholars back to their homeland be- Some nations in Africa have policies tal, scientific, and technological is- comes an uphill battle. Globalization that consider the movement of their sues. People-to-People, AHEAD, has become the modus operandi as scholars not as a brain drain but rath- UGR-Alumni Activity Steering the world shrinks and travel becomes er as a brain gain. Egypt for example Group in North America, EIPSA are more frequent. It will be the norm looks at its Diaspora as treasures kept few among those networks. People- rather than the exception that more abroad. They are cherished assets that to-People, for example, established a and more Gondar (Ethiopian) schol- serve as another window to the in- platform between Ethiopian health- ars will find themselves working in dustrialized world, another arm for care professionals at home and abroad. some faraway land. On the flip side, projecting soft power and agents of Meaningful collaboration resulted in the forces of globalization are making foreign policy, as another conduit in tangible knowledge transfer in health- physical distance irrelevant. Forward knowledge transfer, and an additional care training. Another commend- thinking institutions are positioning catalyst in fostering knowledge doable work is the recently established themselves to draw maximum lever- mestication (9). To bring the message EIPSA to support Ethiopia in the age from these realities and change closer to home, Egypt brings the pow- diplomatic, legal and scientific front the brain drain to a brain gain through er of its Diaspora in every conceivable pertaining to the omnipresent Nile is- extensive networking. Teferra (7) walk of life to bear when it makes the sue. Association for Higher Education argues that concerned institutions assertion that the Nile starts and ends and Development (AHEAD) that is should take advantage of this devel- in Egypt. Egyptian Diaspora experts concerned about the migration of ex- opment by actively involving in the have been instrumental in sniffing out pert Ethiopians is another interesting creation, maintenance, promotion, and and sabotaging Ethiopia’s attempts to diaspora network. moderation of effective networks that explore international financing op- make possible the invention, transfer tions for the development of the Nile The networking between professionals Basin hydro-infrastructure. in Ethiopia and abroad is an impor-

64 tant tool for uplifting quality of edu- Dormitories are now the size of mini housing operations. The new not-for- cation in many ways: participating in cities and take up sizable portions of profit corporation could be established modular teaching, channeling newest the universities’ infrastructures (2). with a board comprised of university advances, creating collaboration and Students’ dormitory construction con- as well as outside individuals. Once partnerships, acting as local liaisons of sumed more than 65% of the capital the corporation is in place, the univer- their home intuitions in maintaining budget of Ethiopian Higher Educa- sity could donate the residence halls partnerships, partaking in technology tion during ESDP III. The furnishing, and cafeterias to the corporation to selections, conducting collaborative maintaining, staffing, and managing provide an asset base for the new not- research, virtual mentoring of gradu- of these mini cities are provided by for-profit organization. The corpora- ate students, etc. Hence, University the universities themselves. This huge tion then can run the facilities, issues of Gondar should have a mechanism task demands an ever increasing slice debt to fund renovation and/or new to embrace its graduates and expatri- of university resources and consumes construction activities. The other op- ate faculty that are willing and eager 90% of the administrative staff. These tion could be University leasing land to contribute. This requires active en- are resources diverted from advancing or dormitories to private developers gagement and steering of the develop- the core missions of the university. in exchange for annual lease payment ment in the direction that is beneficial and/or percentage of operating profits. for the university. Our choice is not Deterioration of research and educa- The developer will renovate the exist- passive swimming along the waves but tion quality results from lack of fo- ing residence halls, and/or erect new partnership based on common mission cused and meaningful efforts for a construction projects, and is generally and vision. As the internet is becom- sustained period of time. Complaints responsible for financing new projects, ing increasingly a fragmented network in food quality however, catapult to the maintenance and the operation of of likeminded brains, networking with main campus issue within an hour facilities. Off campus amenities is an- all daughters and sons of Gondar resulting in disruption of the campus other option. The ultimate goal will be wherever they are residing is the new environment. No progressive universi- to gradually disassociate universities frontier of brain gain. ty management can afford to entertain from the lodging and boarding busi- repeated disruptions due to service ness. 4. Farming out ancillary services to quality issues. As a result, more focus focus on core mission will be given to the day to day service The Ethiopian universities along with delivery rather than a long term core the Ministry of Education and Qual- When modern higher education education, research and innovation ity Assurance Agency have made edu- started in Ethiopia, the objective was issue. Thus, coming up with an inno- cational quality a major priority area total academic immersion by provid- vative model for student lodging and (1,2). Multiple quality initiatives have ing residence, meal, educational ma- boarding will go a long way towards been in progress for many years and terials, pocket money and study space. addressing educational quality (2,10). they are bearing fruit. As educational This model made perfect sense in the quality is an ongoing process, the re- post second world war Ethiopia where I strongly argue against using the flections made here should be regard- there was little infrastructure around brain power of the universities for a ed as a continuum of that process. the institutions to provide service to job that can be done by other service References 1. Ketty Ashcroft. Emerging models of quality, relevance and the students. It was also a manageable providers. It is a grave wastage to allow standards in Ethiopia’s higher education institutions, The task as the number of students was in the national treasure (brain power of Ethiopian Journal of Education, 2003. 2. Teshome Yizengaw Alemneh: The Ethiopian Higher the few hundreds. universities) to be consumed in such a Education: Creating Space for reform, 2007, St. Mary’s UC printing press. way. It is time to try other options. We 3. NMC horizon Report 2013, Higher Education Edition. 4. David Talbox; Given Tablets but no Teachers, Ethiopian Astoundingly, this model of total aca- can look around to neighboring coun- Children Teach Themselves; Forbes, October 29, 2012. 5. Chris Blundell; How a classroom of ipads Changed my demic environment continued in 21st tries to learn from their experiences approach to learning, Edudemic, October 30, 2012. 6. Amanda Ripley; College is dead. Long live college! Time. century Ethiopia with little modifi- and adopt a model that will work for 18 October 2012. 7. Jordan Weissman; The single most Important Experiment cation. All universities run multiple us. One model could be, for instance, in Higher Education; The Atlantic, 18 July 2012. 8. Damtew Teferra; Brain Circulation: Unparallel Oppor- industrial scale students’ cafeteria creation of corporations that would tunities, underlying challenges, and Outmoded Presump- preparing meals almost from scratch. tions. Journal of Studies in International Education, finance and manage the university’s 9:329-250; 2005. 65 9. Ayman Zohry and Debnath Priyanka. A study on the dy- of North Dakota (2001). Yared was the co- Medicine & Health LLC. He lives with namics of the Egyptian diaspora; strengthening development linkages. IOM Cairo, 2010. chairman of the National Medical Education his wife Degie F. Gelaw and two daughters 10. Yared Wondmikun: Inventing the future of Gondar Uni- versity; strategic direction and the university charter, Council (2002-2006) and Board Member Mahlete and Selome in the greater Washing- proceeding of the inaugural symposium of university of of the Ethiopian Health and Nutrition Re- ton DC metropolis area. Gondar: July 24, 2004: pp 70-76. search Institute (Formerly Pastor Institute) (2002-2006). He was an academic faculty Yared Wondmikun Endailalu is the 1986 of the GCMS from 1995-2007 and attained MD graduate of GCMS. He has received his the rank of professorship in 2004. He served PhD in Human Physiology from the Uni- his home institution as the Dean from 2002- versity of Leipzig, Germany, and specialized 2004 and as the Founding President of the in Internal Medicine at Howard University, University of Gondar from 2004-2007. USA. He is an ECFMG fellow in Interna- Currently he is working as an internist for tional Medical Education at the University the Mary Washington Health Group, USA, and Higher Education consultant at TFSI

66 MEMORIES FROM GONDAR change for several weeks. He should persevere, though. IN THE 1960s My knowledge about the reversible By Louis Molineaux, M.D., Ph.D. soft goiter of adolescent girls was en- My wife Josiane and I got married be- tirely theoretical. I had never seen, let fore leaving Europe for Gondar by way alone treated, a single case. That type of a Greek Island where we stopped of soft goiter had disappeared from for our honeymoon. most of Europe, thanks to the addition of a small amount of iodine to salt My preparation for working in Ethio- to processed food. pia included a careful and intensive reading of a reputed standard British About two months later he brought textbook of tropical medicine as well back the girl. Her goiter had almost as a book of dermatology of people disappeared. He then introduced sev- with darker skins. (I never held any eral (3 or 4) similar cases from his fam- degree in tropical medicine) ily. I asked him why he had not brought them all at once. He answered, “Doc- In addition to clothing, crockery and tor, I wasn’t sure you knew anything FOREWORD that sort of things, Josiane and I spent about the problem” They received the time in Paris in bookshops, looking for same treatment and were all cured. I I worked as a clinician and teacher books on Ethiopia and bought some was rather reassured. of the Health Officers in the Gondar of them We also browsed in the book- Public Health from 1962 to 1967 i.e. shop of the “Institut der Hauter Et- from my thirty-second to my thirty- uoler Orientaler” (Institute of Higher ETHIOPIAN MEMORY NO. 2: seventh birthday. I am now 82 years Oriental Studies) where we found an Large Hard Goiters old. I did not keep a diary nor in fact extraordinary Amharic-French dic- any kind of record, but my time in tionary. Large hard goiters were known to be Ethiopia was for me a very rich ex- We flew from Athens to Asmara where frequent in the Ethiopian lowland. perience, and I wish to put in writing we took our first Ethiopian Airlines On a survey with our Health Officer some of my memories from that peri- flight to the Gondar airport. We were students, we found many such goiters. od. I think that some of those memo- met by Dr. Franz Rosa, then Director We asked some apparently promi- ries may be of interest to my friends of the Public Health College. nent persons why we never saw such including those made in Ethiopia and cases coming to the Gondar Hospi- my former students at the Gondar tal. They answered that previously, in Public Health College. Doctor Bassovitz’s time, several cases ETHIOPIAN MEMORY NO. 1: had been operated and cured in the How did I get to Gondar? Towards Small Soft Goiters hospital. When Dr. Bassoviz left and the end of my specialization in In- a new surgeon arrived, the community ternal Medicine in the University of An Ethiopian pharmacist brought debated about what to do and decided Louvain (Belgium) I decided to look me his niece, an adolescent girl with to send a case for surgery to the hos- for a job of internal medicine toward a soft goiter that had appeared about pital. She didn’t come back and they teaching in a developing country. I two months earlier. I told him that the decided to wait for the next surgeon. found in the British Medical Journal goiter could be cured completely with- an advertisement for a job of internal in less than three months with daily My unverifiable hypothesis is that the medicine and teaching in the Gondar drops of an iodine solution (one of new, probably younger, surgeon was a Public Health College. I applied and the simplest and cheapest drugs avail- perfectionist and aimed at removing was selected. able) but that he would not notice any all the goitrous tissue, which would 67 make it delicate to respect the small that they mostly achieved satisfac- the recovery had become a catastro- parathyroid gland, which is indispens- tory functional results, which is rather phe. From an essential food provider able for living. The more experienced impressive, considering that they had he had become a heavy burden for surgeon would be careful not to get only history taking, inspection, careful his family. I became somewhat more too close to the parathyroid at the palpation, and even more important, modest. When I diagnosed, by exclu- negligible cost of leaving a small rem- prudent mobilization and no x–rays. I sion, a mental disorder for which I was nant of the goiter. suggested that by definition, our sur- incompetent, I suggested to the family geon saw only their failures, and that, to take the patient to the traditional perhaps, they only saw our surgeon’s mental health specialist. ETHIOPIAN MEMORY NO. 3: failures. “Traditional” Ethiopian medicine But I soon found out that this prob- vs. our “Scientific” medicine: a clash lem applied to me as well. A man of ETHIOPIAN MEMORY NO. 4: of civilizations? about 30 years was brought to the “Favism” A young and enthusiastic surgeon hospital, unconscious and febrile. He The Fava bean is known to produce joined the Gondar Hospital. After had been treated by the traditional in a small fraction of the consumers a some three months he tells me that specialist for mental disorders, with- neurological disorder with severe pare- some of his patients had been treated out improvement. I examined him sis of the legs and there is a risk known by traditional bonesetters with “cata- with my students, explaining to them by local farmers. I asked one of them strophic” results. I had learned that why I suspected meningoccal men- why they ate the Fava bean. He replied traditional medicine had generalists ingitis. The lab results confirmed this that, in a period of famine poor villag- and specialists, such as bone-setters, diagnosis and I pointed out the time ers could afford only the bean and that mental healers, and some others, a bit lost because of ignorance. The patient he knew it could be poisonous, but like the medical profession in Europe. recovered but had become blind. Ethi- that he preferred that risk rather than The bone-setters were respected by the opian friends explained to me that be starved. This “uneducated” man was local population, which must mean

68 comparing several probabilities vary return to their village without a doctor. tiring ups and downs for me. But the rationally. I told my students that such a clear call landscape was fantastically beauti- from the most rural areas could not be ful! We camped a couple of nights at ETHIOPIAN MEMORY NO. ignored. I decided to go, even though locations with breathtaking sunsets 5: Queen Elizabeth II of England at that time I was the only physician and sunrises. We eventually arrived at Camps on the Kossoye Escarpment in our small internal medicine depart- Chilga and went to the Governor’s of- and Meets Emperor Haile Selassie ment. I must admit that curiosity for fice. I think the Governor was Dejas- of Ethiopia. further exploration also influenced my match Araya. He took good care of us decision. and arranged comfortable transport to The timing of the meeting was im- Gondar. I do not remember who ar- portant for both sides: it was the 25th The most experienced Health Of- rived first in Gondar, the main team or anniversary of the liberation of Ethio- ficer at the College at the time was our trio. A few weeks later Dejasmatch pia from Italian occupation and the appointed “chief ” of the department Arraya brought a lion cub to show me location was very significant as Brit- during my absence. The lowlanders at the hospital. ish troops had camped on the site in had also brought a mule “to carry the the 1940s, similar to the many times doctor.” We mounted a small expedi- Ethiopian kings had done for many tion for which the mule became the centuries. most important luggage carrier. ETHIOPIAN MEMORY NO. 7: Cultural Expedition for Gondar The meeting was a demonstration of We camped several nights. On the Health Officer Students. luxury: the palatial Imperial trailer, the first evening I experienced exquisite royal tents. The camp was also com- Ethiopian hospitality. A boy washed It was part of the educational philoso- fortable and supplied with cold and my very tired feet. A chicken was phy at the time that Health Officer hot water in an area without any mod- cooked for me. On my asking whether students should be exposed broadly ern water distribution system. this was not a fasting time, the reply to Ethiopian history and culture. A was that I was not expected to fast as young Ethiopian professor was re- The camp was accessible to outsiders a foreigner. cruited for the purpose. An Ethiopian at restricted times in limited sites. We “cultural voyage” was directed by him. I could observe some spectacular gallop- We continued on our way. Our labora- was invited to accompany the trip. My ing games by Englishmen and Ethio- tory technician confirmed that it was God, was I happy! We visited several pians (the latter without saddles). The indeed meningococcal meningitis. We important sites: Axum, Debre Damo, camp was dismantled in the end, and distributed a prophylactic medicine, a and probably the oldest monument in the water pipelin long acting sulfonamide, but were not Ethiopia that I call “the perfect cube.” equipped to cover a large population. e system taken away. When it was decided that we should Axum probably is the oldest Ethiopian capital. Its giant obelisks erected from ETHIOPIAN MEMORY NO. start on our way back, I saw on my about 300 B.C.E. until 500 C.E. are 6: A Group of Lowlanders Fetch a old Italian map that we were close to Axum’s major attractions. The carving Doctor the town of Chilga, where it would be easy to find transport to Gondar. One of the obelisks is remarkable and their A group of lowlanders arrived in knowledgeable Ethiopian told me that erection must have been an impressive our hospital carrying a patient on a one could not reach Chilga on foot. engineering performance. stretcher. They reported an epidemic Debre Damo is an old monastery in their village and had brought a case In my uninformed “ferengi (foreigner) built on top of one of the many flat- “so that we could see what the disease arrogance” I wondered whether they topped mountains (ambas) of Ethio- was.” It was clearly meningococcal could read a map and started on my pia. It was the highlight of the trip. meningitis. way to Chilga with two students. I was rapidly reminded that my map had no The monastery had never been con- They announced that they would not altitude curves. It was a succession of quered by the Muslim armies, even at

69 the height of their power. The sheer was at that time an empty roofless Dictionary. mountain is very hard to climb as we cube, with three sides standing. The experienced. A deep well provides wa- large stones were perfectly adjusted! In the Foreward I told how Josiane ter and some agriculture is possible. and I bought in Paris an “Extraordi- When we reached the amba’s almost The last stop of the voyage was at sea nary Amharic-French Dictionary.” vertical wall, we still had to negotiate level on a beautiful sandy beach on the What was extraordinary in that dic- our admission. The monks wanted to Red Sea. Most of the students had tionary? First, it had been written be- check whether some of these young- never seen the sea. They jumped into fore the Italian invasion by a French sters were rebelling against Ethiopian the water with a joyful great splash! Missionary who had lived for twenty traditions, including the Ethiopian We picnicked on the beach. After a years in Ethiopia. I don’t know wheth- Orthodox Church. We had a letter few words about protection of the en- er he preached much, but he became of recommendation from Gondar’s vironment, we cleaned the beach and extraordinarily fluent in Amharic, Archbishop Petros. After verification, restored it almost to its previous state. gained the Emperor’s protection and we were allowed to start climbing, Then we returned to Gondar, very wrote the dictionary. one at a time. We could see a monk happy! climbing and were astonished by his The dictionary is a large beautiful an- technique. He was pulling himself up cient book in perfect condition. It was by a rope fixed at the top, putting his ETHIOPIAN MEMORY NO. 8: printed on a special paper in Amharic naked feet into small holes carved in language and Ethiopian characters. the rock. We started climbing. As we One of my Books gets Stuck in the Asmara Customs. Why did we buy an expensive book were many, it was nightfall before we that we would never be able to read, let all made it to the top. A strongly built I was waiting in Gondar for my lug- alone understand. Did we dream that monk helped us with a strong rope to gage. It was stuck in Asmara. The colour unique marvel that our visitors make the ascension. I have to admit lege’s administrator traveled with me could take in their hands and would that in my case he was mostly pulling to Asmara. We had to wait one day. In give our modest living room more me up! I arrived at the top scared and the evening we went to a restaurant style than the very expensive collec- trembling. About half of the students where our administrator recognized tions of books never to be read, deco- had to camp at the foot of the rock some friends and introduced me. One rating the living rooms of many. I don’t until the next morning. The monks re- of them asked me whether I was the know, but the book became a curiosity ceived us with quiet hospitality, with person who had 2 books by Manfred in Gondar, in particular with my stu- the traditional gray teff pancakes (in- in his luggage. I said, “Yes,” but was dents. I remember showing it to two or jera), traditional beer (tella) brewed in flabbergasted! He told me, very po- three good students. They could hardly the monastery and comfortable straw litely, that the book would circulate put it down. For each word, the author mats. We slept two nights in the mon- in a circle of friends, but that it would gave one or more Ethiopian proverbs astery and food and drink was car- safely arrive in Gondar within a couple to illustrate the use of a word in an ried by rope to the students camping of weeks. We drove back to Gondar actual sentence. I saw them pointing at the foot of the “amba” before their the next day and the book reached me out to each other with quiet joy many ascent the next day. The atmosphere as promised. proverbs they knew and bursting into in the monastery was peaceful and the laughter for the man proverbs they prayers of the monks quietly impres- Was this a case of temptation by the didn’t know. They translated a few of sive. The sunrise seen from the edge of “forbidden fruit”, as Manfred’s books both types of proverbs, many very fun- the amba was overwhelmingly beau- were forbidden in Ethiopia? ny, for Josiane and me. More students tiful. I think that many of us carried followed their tracks. away from Debre Damo something precious to our hearts. I know we left the book in Gondar. I ETHIOPIAN MEMORY NO. 9: hope they were added to the cultural The third and last cultural marvel of An Extraordinary Amharic-French library created with a special donation our voyage was The Perfect Cube. It 70 from “Point Four”, the predecessor ing his five years exemplary service in Gond- his retirement in Geneva a few years ago, of USAID. I remember a bit vaguely ar, he completed a Ph.D. in Epidemiology at where he lives in close proximity to his fam- that somebody suggested that talented the School of Public Health, University of ily. California at Berkeley, doing research on the bilingual persons should be found to epidemiology of meningitis in Sub-Saharan translate the proverbs in English and Africa. Throughout his career at WHO he in French in memory of the author worked on the epidemiology of malaria in and to satisfy my Francophilia. many parts of the world including countries in Africa, India and China. He led the clas- Dr. Louis Molineaux, M.D., Ph. D., was a sical research project on malaria in northern leading clinician, teacher and the medical di- Nigeria that was published by WHO as the rector of the regional hospital at the Gondar “Garki Project”. His continued research work Public Health College in the 1960s. Follow- in areas of mathematical epidemiology until

71 Being an even number* soon. One sunny day, the governor of the region, a fine former army of- Sirak Petros, MD ficer, summoned us to his office a few 1984 Alumnus, Medicine weeks after we have arrived in Gondar. That fine gentleman was sitting on a podium in front of us brandishing an Israel-made Uzi submachine gun, and his bodyguards trying their best to do the same standing along the isles. It was not a happy affair, as one can surely imagine. That fine army officer – turned - governor welcomed us to Gondar and told us in a friendly voice that we may end up with a bullet in our heads should we come up with different ideas other than our medical textbooks. He was indeed a fine gentleman.

The first year passed with an appre- I was a boy when I came to Gondar were also going to be tested. I did not hension over what may turn up around in 1978. I did not have any idea until remember that anyone was happy at the corner and the hope that this un- then what I was going to face in the all to be a guinea pig. That sense be- fortunate adventure may come soon to coming student years. A simple whim came even worse while we were roam- an end and we return back to Addis. of someone at the Addis Ababa Uni- ing around the campus. The buildings But nothing happened. Instead, we versity office at Sidist Kilo, who de- were not something to boast about, if were asked to select the textbooks we cided that September 1978 to send you compare them with those in Ad- will need in the coming years. I was freshman medical students with even dis. We were sleeping with more than not sure whether this was supposed to numbers on the roster to go to Gondar twenty students in one room. Not that be a privilege or a joke. Anyway, we sat and those with odd numbers to stay I missed my privacy; I never had any in our classroom and racked our brains at the Addis Ababa Medical Faculty, better sleeping place at home. But that trying to figure out the appropriate sealed my fate to have to take the two- crowding gave most of us the feeling books. Of course, we must have to day bus ride from Addis to the town of being in a military barracks. Imag- have the same books like our fellows of Gondar. Well, having an even num- ine having a Smartphone at that time! in Addis. No, even better than theirs! ber seemed to be a bad idea. It was the You could not have sent pictures of Gray`s Anatomy must be our anatomy first time in my young life that I was those rooms to your friends some- textbook. I still wonder whether any- so far away from home. For me it was where else. That would have been un- one of us ever read a single chapter of the biggest challenge in my life until cool! Fortunate enough I could not that monumental book without risk- that time. I believe it was more or less even have dreamed of the cheapest ing an epileptic fit. Davidson´s Text- the same with my other 119 fellow camera ever to be found. The nagging book of Medicine? No! God forbid! It freshmen, although a few of us were feeling that we might not come up must be Harrison! veterans of other hard times. to the standard at the Addis Medical Faculty or beyond remained through- And then came the Germans! Not that Although Gondar was already fa- out my student years, although with anybody was thinking about the World mous for health personnel training dwindling intensity. Wars. I did not have the slightest idea in Ethiopia, we were the first to be about Germans. Of course I have read trained as medical doctors. We were That sense of being at loss paled com- world history during my school years, the first to test this challenge and we pared to what was going to happen as it was the custom of Ethiopians of

72 those days (probably still today too?) including the officials, might have not Hospital Leipzig, where he completed his fel- to read world literature but having no appreciated it at that time. You cannot lowship in intensive care medicine. After he hint of our own legacy. The years with wake up one day and find a fully fur- became a consultant intensivist in 1997, he undertook his training in hemostaseology. our German lecturers and professors nished medical school around the cor- Following that, in addition to his ICU posi- were full of hardships, surprises and a ner; surely not in a country like ours. tion, he became in 2000 head of the clinical few misunderstandings on both sides. hemostaseology and adult hemophilia center. But one thing stands out anytime. Al- Gondar, harboring the oldest health In 2009, he was appointed as head of the most all our German teachers were training institution in Ethiopia, has medical ICU and in 2011 also head of the dedicated professionals, who did their been contributing to the welfare of center of hemostaseology at the University best under the circumstances they and the country at large. Health officers, Hospital Leipzig. He is board certified educator in intensive care medicine and hemo- we were into. One should also never nurses, sanitarians, laboratory techni- staseology. He is also chairman of the board cians, and finally medical doctors from forget our few Ethiopian teachers, of examiners in intensive care medicine at the who did their best, although coping Gondar are part of the history of the Chamber of Medicine in Saxony and member with much frustration of their own. expanding health service in Ethio- of the advisory board of the German Society pia. All those generations of students, of Medical Intensive and Emergency Medi- I left Gondar for Addis in the summer teachers and officials of Gondar can cine. of 1983 to do my internship. My first after all be proud of this heritage. For months in Addis were aimed at show- the Gondar University of today, this ing those guys in Addis that we were as heritage is not only reason for pride, good as anybody, or a few of us thought but also a great responsibility. that we were even better. Why should we not claim that? Where could you I am grateful that I have got the chance have gone in Gondar in your leisure to be part of this history of Gondar. My time? You could walk in the evenings successes of today are tightly bound to along the campus road and drink tea what I have learned in Gondar. After in one of the shacks or else tela, tej or all it was indeed a good omen that I dagm depending on your mood. So have got an even number on that ros- you may keep on studying as well. Af- ter at the Addis Ababa University of- ter all, watching your fellow students fice at Sidist Kilo that September in studying until midnight and beyond 1978. was enough to keep you nervous. And those poor souls in Addis had to fight *This short reminiscence is dedicated back all the distractions of a big city! to my fellow graduates Dr. Alemay- hu Bayou, Dr. Debebe Firdu and Dr. In retrospect, I asked myself about Matheos Wakbulcha, who died trag- the remains of those years in Gondar. ically so young. Those undergraduate years were by all Sirak Petros is one of the first graduates in standards full of hardship. But after human medicine in 1984 from Gondar Col- all, why not me? Why should that be lege of Medical Sciences (GCMS), Addis somebody else? We were after all not Abeba University, Ethiopia. Immediately guinea pigs, but young men and wom- after graduation, he worked at the GCMS en with the opportunity to be part of Hospital in various positions before he joined history. I believe that those students in in 1986 the department of medicine at the the 1970s and 1980s contributed that University Hospital Leipzig, Germany, for his residency in internal medicine. Following Gondar became a success through his successful board examination in internal their relentless demands and ques- medicine in 1990, he began his fellowship in tions, time and again sending faculty gastroenterology. In 1993, Sirak joined the officers to exasperation. Most of us, staff of the medical ICU at the University 73 We have come so far Dr. Selamawit Tessema Toronto, Ontario, Canada Alumnus, Class of 1988

We have come so far, Our student days AND nights may have been a while back But indeed, we have come so far. Though some of us, May have been dealt harder blows than others down life’s path We have achieved so much. It really does seem like yesterday, That we were glued to our dorm room windows, Or sat on those famous front steps, Waiting eagerly, for the cafeteria doors to open, Dr. Selamawit Tessema is a Class of 1988 To satisfy our grumbling stomachs, MD graduate of Gondar College of Medical And hush our appetites for a while. Sciences. We felt triumphant first in line. The years rushed by with a blink of an eye. She is presently working as an Inhospital Science Amba became the hospital grounds, Coordinator for a Cardiac Research Team at Mt. Sinai Hospital And our Anatomy Lab The OR. “I will survive” our eternal song, in Toronto, Canada. Selamawit is best As each exam came and went by. known by her fellow classmates as the popular After graduation we went our separate ways, Lecture Note Never forgetting where it had all started, Trying in earnest to hold on to that bond, Librarian, for those who were ill or just dis- That kept us connected. inclined to attend classes on any given day. And so here we are today, Personally In praise of our Alma Mater. Telling our sons and daughters, our friends and our colleagues, speaking, she is married to Dr. Assefa Fersha who was also a student at GCMS. They live The unforgettable times we had, in Toronto, Both good and sad, That side by side shaped both our personal and professional lives. Canada, with their two children Aklil and So Fellow Alumni, Mattias. Let us never forget our humble roots, And our generous Alma Mater However distinguished we may be today. May the memories of our dear friends, Who graduated beside us, But are no longer with us, Keep us grounded, As we strive to honor, Our oath of commitment, Faithfully sworn, Oh, so many years ago, To serve others, When they desperately need us most. Congratulations Everyone ! 74 A Reflection on scenarios to the larger medical community for brainstorming, and at Bedside Teaching the same time for gathering expert opinion from other colleagues. Small Dr. Hiberet Tessema Belay group teaching, clinical skills practice GCMS graduate Year 2001 groups, problem based learning, bed- Dr. Workineh Getaneh Tadesse side teaching and simulation exercises GCMS graduate Year 2000 serve to consolidate knowledge acquired via interactive discussion and We are honored to be contributing to ‘ He who studies medicine without clinical skills practice. the 60th GCMS anniversary publi- books sails an uncharted sea, but he cation. In this article we are going to who studies medicine without patients Modern day pedagogy has placed dry reflect from our college years focus- does not go to sea at all.’ Sir William and didactic teaching methods under ing on bedside teaching. As we might Osler (1849 – 1919) scrutiny. all remember, bedside teaching is one of those student teacher interactions, This stands true in today’s modern day Some even argue the merits of dry and which is taken quite seriously by both medical pedagogy. Medical education didactic lecture style teachings and the student and the facilitator. A lot can be delivered through various for- their contribution to true, deep and of preparation goes into it by both the mats. To cite a few, lectures, clinical lasting learning (Prober, 2012). Works student and the facilitator. It gener- skills practice groups, case conferences from established learning theories ally starts with a crescendo mode, goes and grand rounds, small group teach- such that of Kolb and Fry recommend into peaks and troughs, has its own ing and problem based learning, bed- that for deep and effective learning to eureka moments, some awkward mo- side teaching and simulation exercises occur, one should learn by practice and ments, periods of silence and times of can be mentioned. The advances and complete a cycle of concrete experi- ‘just not me please’. Oh yes, bedside availability of modern technology has ences, reflective observation, abstract teaching as we remember it is a period seen major transformations in the way conceptualization, and active experi- of heightened emotions and on reflec- medical students are educated now. mentation (Kolb, 2010). tion a period in time when deep and E-learning modules designed to grab lasting knowledge and clinical skills attention and enhance the learning ex- Such unease in educators has led edu- are transferred and acquired. We the perience are on the rise and for some cators to works such that of Tucker et authors, seasoned clinicians few years medical schools in industrial countries al that promotes a flipped classroom later from our good old Gondar days are the norm. Virtual patients can be approach. In this model, educators can now easily reminisce the feel of viewed and treated online, complex are encouraged to make effective use Kalazar splenomegaly, easily recall brain anatomy can be accessed via of the online space for podcasting bronchial breath sounds heard in pul- various application programs etcetera lectures and making available vari- monary tuberculosis, seagull murmur etcetera all with the aim of enriching ous eLearning resources that students of aortic stenosis and tympanic reso- the learning experience of the medical can go through prior to coming to the nance of the ascitic abdomen, just to student. flipped classroom. In their popular mention a few. flipped classroom model, they advice The various formats of teaching have educators to utilize classroom time Most importantly we will put forward their own merits. Lectures can be ben- for hands on and interactive teaching our reflection through the years as to eficial to capture a large audience all and learning. They argue that this ap- how valuable bedside teaching is in at the same time. This arguably saves proach will result in deeper learning of today’s medical education. We can’t faculty time, and also maintains con- the subject matter. thank enough the doctors that had the sistent delivery of the subject matter. dedication, the time and the patience Case conferences and grand rounds All these changes indicate that medi- to have delivered one of the most ef- are beneficial to create a platform cal education is taking strides with fective teaching methods in the peda- for discussing challenging clinical technology, where availability of tech- gogy of medicine. 75 nology is no object. With today’s fa- of questions from the facilitator will hospital and various health care set- cebook and twitter generation of stu- be directed at the presenter, but other tings, the use of bedside teaching may dents such changes in the realm of members will not be ‘spared’. Snow- be daunting to some patients. Under- medical education is inevitable. The balling technique and rounds will fol- standably the consent of the patient to medical student of today Google’s, low through; with the entire group ex- partake or not in the teaching process YouTube’s and obtains educational pected to have come well read on the should always be respected. material through various medias, not topic for discussion. The presenter will just the traditional library and lecture. also be asked to demonstrate his/her A declining trend of bedside teach- While this is quite progressive and in clinical skills by examining the patient, ing we fear may lead to a reduced up- keeping with the times, subjects like and the facilitator will guide and dem- take of clinical skills in today’s medi- medicine cannot be delivered solely onstrate examination skills that need cal student. Reported over-reliance of through the means of online resources. to be sharpened. doctors on biochemical and imaging They require a blended approach - an results may foster a culture of unorth- approach that combines the informa- The bedside teaching is a space for stu- odox hands off approach while prac- tion obtained in the virtual world to dent teacher interaction. Not only is the ticing medicine. Modern imaging and real time clinical experience. This can case presented discussed at length in biochemical studies no doubt improve be accomplished, via direct contact an interactive fashion, but also clinical diagnostic accuracy and are necessary. with patients. This ensures the medical skills are demonstrated and practiced However taking a thorough history, student is fully armed for his/her fu- in real time. However daunting it is to and conducting a thorough physical ture clinical practice and is not merely the presenter to do just that in a small examination maintains the crucial role a virtual geek. group and be open to scrutiny and of the doctor as a diagnostician. More ‘weketa’ there is no doubt that such a over it puts the patient at the center of The bedside teaching in Gondar’s teaching method that affirms existing clinical medicine. Intently listening to context fits the bill for the flipped knowledge, corrects misunderstand- the patient, being alert and observing classroom model at many levels, albeit ing and demonstrates clinical skills in for clinical cues, examining the patient it’s difference being the limitation in real time is undoubtedly an effective is as important today, as it was in the availability of online resources. teaching tool. In addition with a lot times of Hippocrates. Diagnosis can of emphasis placed on todays medi- be arrived at swiftly, and appropriate The bedside teaching as we remember cal student to metamorphose into an investigations and treatment can be it took place in a small group teach- effective communicator, the bedside initiated as soon as possible. Ethio- ing setting. A rota is drawn and one teaching offers an excellent opportu- pian born doctor and author Abraham student is nominated to be the case nity for learning and acquiring the fa- Verghese in his 2011 ted talk entitled presenter. It mostly lasted an hour or cilitator’s communication style. ‘A doctor’s touch’, cites the case of a 40 a bit, even though if one is presenting year old patient, that was brought in it felt like forever! The presenter is re- Various literatures now report a de- with confusion and high blood pres- sponsible for selecting a ‘case’ to pres- cline of bedside teaching in current sure to the emergency department. A ent, clerk and examine the patient well day medical schools. The contribution CAT scan performed post a period in advance and prepare a written for- of bedside teaching to medical educa- of stabilization revealed palpable and mat for the presentation. Typically the tion is estimated at 8-19% since the visible breast mass with metastasis to presentation took place at the patient’s 1960s (Williams, 2008). Factors that various body parts. The patient would bedside. The presenter then outlines are believed to be contributing to the have visited four or five health care in- the patient’s history to the group and decline of bedside teaching include stitutions in the preceding two years, the facilitating doctor. The presenter is the ever-increasing clinical duties and and Dr. Verghese argues that if any expected to be the expert on the case, responsibilities, coupled with manage- one of the four/five opportunities were with full knowledge of what ails the ment and research engagements of taken to examine the breast, a much patient and having read through diag- doctors. While most literature points earlier intervention would have been nosis, differential diagnosis and treat- to the fact that patients like to engage possible. ment guidelines. As such the ‘brunt’ in the teaching and learning process in

76 References We certainly have been lucky for hav- 1. Abraham Verghese (2011) A doctor’ s Touch, http://www. ted.com/talks/abraham_verghese_a_doctor_s_touch.html ing had the privilege of having bed- 2. Kolb AY, Kolb D, (2005) Learning Styles and Learn- side teaching as a primary means of ing Spaces: Enhancing Experiential Learning in Higher Education, Academy of Management Learning and Edu- teaching during our medical studies. cation June 1, vol. 4 no. 2 193-212 3. Neil M, Alan H, James Y, James S (2013) Just imagine: We have no doubt that it has made New Paradigms for Medical Education, Academic Medi- cine Vol 88, pp 1418-1423 our colleagues and us better clinicians. 4. Prober C & Khan S (2013) Medical Education Rei- magined A Call to Action, Academic Medicine Vol. 88, pp Of course we were anxious and ner- 1407–1410 5. Prober C, Heath C (2012) Lecture Hall without Lec- vous being placed under scrutiny, of tures- A proposal for Medical Education, http://www. um.es/c/document_library/get_file?uuid=c538d7e7- course we dodged being questioned at, 52a4-4f9a-93c7-92ac04c80b06&groupId=115466 6. Rhonda Wynne (2005) Facilitation Skills: Work- of course we pretended we were busy ing with Adults Learners, http://www.ucd.ie/t4cms/ UCDTLT0035.pdf looking at the floor during bedside 7. Tucker B, (2012) The Flipped Classroom: Online In- struction at home frees class time for learning, education- teaching in order to avoid thrown ques- next.org, http://educationnext.org/files/ednext_20121_ tions from landing on us. This prob- BTucker.pdf 8. Williams K et al, (2008) Improving Bedside ably is the same for bedside teaching Teaching: Findings from a Focus Group Study of Learners,http://journals.lww.com/academicmedicine/ and any other interactive teaching and Fulltext/2008/03000/Improving_Bedside_Teaching__ Findings_from_a_Focus.9.aspx#P123 learning methods as a means of saving face. However in interactive teaching and learning styles, both parties the student and the facilitator come with the same agenda- the acquisition and transfer of knowledge and skills. Dif- ferent students have different learning styles, and different facilitators have different facilitation styles. While there is no one formula as to how the dynamics of such interactions should best be led, advance preparation by all those attending the bedside teaching is deemed mandatory.

Correspondence to:

Dr. Hiberet Tessema Belay, MRCPsych, Senior Registrar and Special lecturer in Psychiatry, Depart- ment of Psychiatry, St. Vincent’s Uni- versity Hospital, Elm Park, Dublin 4 Ireland, [email protected]

Dr. Workineh Getaneh Tadesse, MRCPI, Senior Registrar in Gynecology and Obstetrics, National Maternity Hospital, Holles Street Dublin 2, Ireland [email protected]

77 Serving Our Continent Types of Pastoralism The following are the major types of The Pastoral Sector- The pastoral livelihoods seen in the Horn region.Transhumance: Transhumance is Lost Opportunity in Regional the seasonal movement of people with their livestock between fixed summer Integration and Development and winter pastures. In montane regions Zelalem Attlee, MD, MHCM, DRPH(c) (vertical transhumance) it implies movement between higher pastures in summer pioneered in issues that have never been and lower valleys in winter. Herders have addressed before while in school or dur- a permanent home, typically in valleys. ing my job life. In this essay I will focus Only the herds travel, with the people on the areas of pastoralism and health necessary to tend them. In contrast, hori- systems strengthening in the pastoral zontal transhumance is more susceptible sector. to being disrupted by climatic, economic As a clinician with public health training or political one of my first encounters after gradu- change (Blench , 2001) Pure nomadic: ating from Gondar College of Medi- Nomadic pastoralism is a form of pas- cal Sciences, was the enigma concept of toralism where livestock are herded in pastoralism. In medical school our cur- order to find fresh pastures on which ricula never addressed the pastoral sector, to graze following an irregular pattern and because of that I had to start work- It has been 24 years since I graduated of movement. This is in contrast with ing on this key issue from scratch in the from AAU-Gondar College of medical transhumance where seasonal pastures field. I volunteered for free service in the sciences. During my time as a student are fixed (Blench, 2001) Semi-Nomad- pastoral sector without fees and salary from 1983-1989, GCMS had a small ic: One of a people whose living habits just to support the pastoral population student mix that were studying medicine, are largely nomadic but who plant some in Somali-Borena region in Ethiopia, sanitary science, lab tech and nursing. crops at a base point. Agro pastoralism: which later extended and took me to the We were taught by knowledgeable Ger- Agro-pastoralism describes the coexis- Horn of Africa. Approximately 52% of man professors that came from the then tence of both agricultural and grazing ac- the total land mass in Ethiopia is inhab- East Germany. They trained us to be tivities, although there may be different ited by pastoralists. Pastoralists constitute researchers, clinicians and philosophers degrees of integration of these activities, around 15% of the total population, and in medicine at the time. With the mini- with specific consequences for land use have a patriarchal society. Pastoralism mum resources the college had at the (Swift, ibid). Agro pastoralists are more is a livelihood and subsistence modality time, to be trained extensively required a of settled type of pastoralists. where pastoral communities herd live- wealth of knowledge from our professors. stock. Pastoralists often use their herds to Geographic and Livelihood That enabled me later in my career to be affect their environment. Grazing herds Perspectives observant, open minded, risk taker and on savannas can ensure the biodiversity The pastoral sector of Ethiopia geograph- team builder. The way the curricula were of the savannas and prevent them from ically extends to the greater Horn of Af- designed at the time was open ended and evolving into scrubland. Pastoralists may rica region which includes the low lands that gave us the capacity to unfold new also use fire to make ecosystems more of Eritrea, Djibouti, Somalia, Northern issues that emerged later in our career. suitable for their food animals. Mobility Kenya, Northern Uganda, North and Being a medical doctor and public health is the hall mark of pastoralism, where the South Sudan. The pastoral sector of sub scholar has opened up great opportuni- pastoral communities move their herds Sahran Africa further extends up to West ties to serve my country in different ca- in search of pasture and water. Africa including the nations of Mali, Ni- pacities. In my 24 year tenure ger, Northern Nigeria, Mauritania up to I have worked and in some areas, and Senegal. The major pastoral groups that

78 reside within our borders are include the or political issue for the Digodi tribe. On the cause of the frequent instability and Borenas, Guji, Gedeb, Gebra, Hamer, the other hand for the Borenas, the Abba violence in the region. The deteriorated Tsemay, Benna, Ari, Geleb, Mursi, Anuak, Gada holds the ultimate power and au- peace and prolonged conflict in Somalia Nuer, Somali (Ogaden, Issa, Gura, Mari- thority regarding the Borena tribe. How- is just one face of this political impasse han Digodi, Gerri, ) Afar, Berta, Gumuz, ever the Gada system unlike the Digodi, and it led to the birth of international Surma, Bench, Burji, Dizi, Murle, and devolves power to lower hierarchies. This terrorism in the region. To resolve this Zulmam. tells us that the pastoral sector is entirely gridlock the countries in the greater horn heterogeneous in its structure, geography, region began forming critical institutions The climate in the pastoral sector exhib- culture and decision making. like IGAD. its the arid and semi-arid type of climate with two small rainfalls in spring and au- Why pastoralism? Disparity Issues in the tumn that basically last only 2-3 weeks Pastoral Sector Why is the pastoral sector and address- on average. The rest of the year is literally ing pastoralism important and different? One of the burning issues as far as pas- dry with high temperatures in the 40s The pastoral sector has the imperatives toralism is concerned is the issue of mar- and 50s in Celsius. Major draining riv- of harsh climate with repeated cycles of ginalization in many of the national poli- ers run year round to the most part, and drought and food insecurity, pastoral con- cies and programs in the countries of the smaller rivers dry up during the dry sea- flicts, shifting population and high mo- Horn region. This has led to disparities son. Water and pasture scarcity and inad- bility, repeated cycles of border disputes, in the major social determinants between equacy propels pastoralists to move from slow infrastructure and systems develop- the highlander and the pastoralist. For their temporary settlement area to a new ment, extensive land use, and it covers instance, there is a gross disparity in ac- one near a water point and pasture. The a huge geographic area crossing several cess to education in all the states in the mix of livestock is also different from one African territories. While pastoralism is region. In Ethiopia, the national average pastoral group to the other. For example one of the greatest opportunities at hand gross enrolment rate for the primary level the Somali pastoralists have camels and to provide a great entry point for regional is 64.4 per cent. For the Afar and Somali goats as their majority asset, while the integration and systems development regional states it is 13.8 per cent and 15.1 Borenas have cattle as their majority as- in politics, and socioeconomic develop- per cent. In Uganda, the national primary set. Because of this the Borenas live in a ment, to this day it has been entangled enrolment rate is 64.6 per cent, while in savanna type of range lands where there in the colonial political chains that shad- the pastoralist districts of Kotido, Mo- is grass as a key fodder, while the Soma- owed its developmental glory. Because of roto and Nakapipirit it is 12 per cent, 9 lis live where there is majority acacia as a the unique imperatives and structure of per cent and 9 per cent respectively. The key fodder. In recent times in some areas the pastoral sector any capacity building Somali regional state in Ethiopia has the in the key southern rangelands like Diid effort in any one of the developmental lowest (10 per cent) gross enrolment rate Liben, the grass has been encroached by facets had been difficult. The pastoral for girls at the primary level in the coun- acacia bush commonly known as Fu- sector’s fragility is expressed by the lack try. Health statistics are even more dispa- lessa (in oromic language). This bush of basic services (in health, education, rate. The under five years mortality rate encroachment was one of the reasons for infrastructure) and basic security (food, in Addis Ababa is 113.5 per 1,000 live the pastoral conflicts between the Somali peace) to its population. At present, al- births, in the Afar region it is 229.3. and the Borenas. though at the stage of infancy , a new at- Health systems’ strengthening is es- tention has been given to the pastoralists The patriarchal nature of the pastoralist pecially easier when it is implemented of the Horn of Africa region in the past culture provides men as heads of their settled populations. The challenge to 20 years. Before that governments liter- households. Most pastoral groups are led achieve access, coverage, safety and qual- ally were unable to meet or manage the by tribal ‘kings’ at the top which manage ity health care to the target population is pastoral populations’ expectations and the different sub-clans in that specific visible in the above statistics. Improving capacity through any kind of political tribe. Decision making on movement, health and education needs peace and process. There has never been an efficient war, religion and marriage follows dif- political stability. In areas where there is institution that addressed the pastoral ferent sub-clan hierarchies depending conflict, programs should prioritize on and the regional issue, along with poor on the pastoral tribe. For example the humanitarian assistance and peace build- governance which at the same time was ‘Weber’ decides on any socio economic ing which later on would have a cumula- 79 tive effect towards decreasing the under 5 agement and sustainable development. sector putting it as a key area to be ad- mortality, improving life expectancy, and IGAD is working towards promoting dressed in any systems building. Insti- improving health care. Health sector per- joint development strategies and gradu- tutions like Gondar University public formance is directly correlated with the ally harmonize macro-economic policies health department will play a significant political performance of the leadership/ and programs in the social, technologi- role if they further enrich their curricula state in place. Wherever there is sporadic cal and scientific fields. On top of that, in public health for both under gradu- conflict, resolving the issues leading to IGAD will promote peace and stability ate and graduate students by adding potential conflicts should be addressed in the sub-region and create mechanisms continental issues affecting health care, first in order to have a well-functioning within the sub-region for the preven- it would have a profound impact in the government. In places where there is tion, management and resolution of in- future of health care development in the conflict and peace is fragile as in most terstate and intrastate conflicts through continent. As for me I am so grateful to pastoral areas around Africa, government dialogue. The key programs of IGAD are my teachers in medicine at the GCMS, programs are incapable of delivering basic CEWARN-conflict early warning sys- and I want to take this opportunity to health services. In the past 40 years inter- tem, IGAD capacity building program thank the late Professor Zein Ahmed national NGOs and civil society organi- against terrorism(ICPAT), and IGAD for being the source of my public health zations tried to fill the gap in the health Climate Prediction and Applications passion. It is an honor for me to be in- system. Due to its geographic, political Centre (ICPAC) (IGAD, 2014). Anoth- volved in the 60th year of founding of the and socio economic context, any capac- er key strategic frame work is NEPAD. institution and I want to thank Profes- ity building effort in the pastoral sec- The New Partnership for Africa’s De- sor Yared Wondimkun for coordinating tor calls for regional coordination. Side velopment (NEPAD), an African Union this effort here in America. As alumni I by side with the peace building to have strategic framework for pan-African would be more than glad to support our a quicker and effective health systems socio-economic development, is both a university in my field of Horn of Africa strengthening, governments and NGOs vision and a policy framework for Africa studies in public health. should primarily focus on how to boost in the twenty-first century. NEPAD is a References 1. Markakis, J. (2004). Pastoralism on the Margin. Retrieved the economy, by focusing on the natural radically new intervention, spearheaded from http://dev135.buchwald.ca/docs/MRG-Pastorialists- resources and the pastoral sector (agri- by African leaders, to address critical Markakis%202004.pdf igad.int. (2014). 2. Intergovernmental Authority on Development. Retrieved culture, livestock production and land challenges facing the continent: poverty, from http://igad.int/ www.nepad.org. (2014). tenure) which in turn have a direct cor- development and Africa’s marginaliza- 3. New Partnership for Africa’s Development (NEPAD). Re- trieved from http://www.nepad.org/about www.oecd.org. relation with efficiency and effectiveness tion internationally. By encouraging re- (2014). of the health system. An integrated ap- gional co-operation NEPAD is posi- 4. Aid Effectiveness. Retrieved from http://www.oecd.org/dac/ effectiveness/parisdeclarationandaccraagendaforaction.htm proach of government, communities, and tioned to assist countries in being better 5. Blench, Roger (17 May 2001). ‘You can’t go home again’ actors from the different sectors should able to trade, share resources and build – Pastoralism in the new millennium. London:Overseas Development Institute. p. 12. Swift, J. (1988) Major Issues work in tandem to address each facet of mutually beneficial infrastructure (NE- in Pastoral Development with Special Emphasis on Selected African Countries. Rome: FAO the health system. PAD,2014). Dr. Zelalem G. Attlee graduated from Gondar What Do We Have In Place? Recommendations and Reflections College of Medical Sciences in the year 1989 In the Horn of Africa in the past twenty An integrated and collaborative approach and he was the 6th batch of medical doctors from years we have key institutions in place that between institutions and all stakehold- the then Gondar College of Medical Sciences. He did post graduate studies in health care man- would address pressing issues of peace ers building health system components agement at the University of Phoenix, and is building, and socio economic develop- is imperative to achieve a quicker pace finalizing his PhD in epidemiology and inter- ment. IGAD and the strategic frame in development in Africa. Because the national health policy in United States. Over work of NEPAD are two key examples. malady of one country in certain region the years he had distinguished career spanning IGAD is positioned to expand the areas in the continent will have a ripple effect from various roles in the Ministry of Health of of regional co-operation, increase the within its region, scholars and develop- Ethiopia, several NGO, and international do- members’ dependency on one another ment workers should not narrow down nor agencies. Currently he teaches graduate and undergraduate health professionals in health and promote policies of peace and stabil- broader issues to one local area context care management and public health at Univer- ity in the region in order to attain food where ever they operate. More than 80% sity of Stratford in Virginia, USA. security, sustainable environment man- of all conflicts reside within the pastoral

80 DOCTOR: WHO SHALL BE NAMED? America was an honorary Doctor of Divinity degree conferred by Harvard Yared Wondimkun Endailalu University in 1692 on its president, In- crease Mather. The University honors Nuru Abseno Robi individuals for distinctive achievement in the creative and performing arts, humanities, social sciences, sciences, public service, philanthropy, business, the learned professions, social justice, Jewish life, International understanding and human rights. It is to be noted also that several renowned universities, including the Massachusetts Institute of Technology, London School of Economics have a policy not to award honorary degrees.

In the Ethiopian traditional higher level of education, schools award hon- orarium to those excel in their merits. In the academic world you earn a Doc- ing of the nature of the contribution of “Lique Liqauewent” is one of them. tor title either when you have complet- the awardees. The Doctor of Sciences is The age old higher education that ed the three ladders of post secondary bestowed upon an exceptional persons rely on peer-to-peer education, direct education (Bachelorette, Master’s and to recognize revolutionary scientific coaching and mentorship by the mas- Doctorate) or after 6-7 years of train- research and discovery. In appreciation ter has slowly gave way to the Western ing for MD/MD equivalent degrees of achievements in the humanities, system. Accordingly, the practice of in the healing professions. Though it philanthropic work or academic dis- awarding western style Honorary De- is not widely spread, the Doctor title is tinction, the awarding of the Doctor gree was started by the Addis Ababa used also in some other circumstances. of Humane Letters is in order. Other University. The University has admira- Honors Doctors and Associate Doc- examples of honorary degrees include ble track record of recognizing merito- tors are cases in perspective. the Doctor of Laws, Doctor of Fine rious Ethiopians and foreigners alike. Arts (conferred primarily to musicians, The awarding is consistently twined University of Gondar has recently actors, athletes, architects and artists), with the major annual commencement recognized a prominent Ethiopian Doctor of Humanities (signifying ex- exercise. It generates enthusiasm, live- women, Eleni Gebre-Medhin, with its emplary public service) and Doctor of ly media discussion and speculation first honorary Doctorate degree based Divinity (bestowed upon exceptional of the intent. Recipients of Honorary on her extraordinary contribution for religious figures). European universi- Doctorate have included authors, dis- the advancement of Ethiopian society. ties began granting degrees “for the tinguished scholars, business leaders, Many colleges throughout the world sake of the honor” (honoris causa) in athletes and prominent entertainers. recognize excellence by awarding hon- the 15th century, and the first such Haddis Alemayehu, Kebede Mikael orary degrees to individuals with long degree was awarded at Oxford Uni- Mekuria, Tilahun Gessesse, Moham- records of achievements in particular versity in 1479 to Lionel Woodville, med Al Amoudi, Abebech Gobena, area. The practice of awarding honor- Dean of Exeter, the brother-in-law of are few to mention. ary Doctorate degrees dates back to Edward IV and the future Bishop of the 15th century to recognize and en- Salisbury. These were essentially aca- The vetting and selection of awardees courage ideas, values, and accomplish- demic peerages, entitling the recipient to Doctorate of Human Letters or ments of individuals from all walks to full privileges in the university, priv- other honorary degrees sometimes of life who significantly contribute to ileges that were much more extensive generates hullabaloo or at least raises discussion and debate of thought, sci- then than now. At the same timeuni- eyebrow in many occasions. Jimma ence, social development, humanitar- versities conferred degrees on certain and Haromaya Universities awarded ian pursuit, beauty, and freedom. scholars whose career achievements Mr. Karl Heinze Boeme (a philan- warranted such recognition. thropist) their honorary degree just The Honorary Doctorate degree are of few days apart. The undercurrent to be many types. They are awarded depend- The first Honorary degree awarded in the first one was felt as one of them decided to pull the ceremony ahead of 81 the annual commencement spectacle. the University of St. Andrews in 1759 the depth of training and legal scope Today, Ethiopia has over thirty Uni- and from the University of Oxford of practice of PA is much more lim- versities some of which are with re- in 1762 for his scientific accomplish- ited than the Ethiopian HO. Similar cently instituted practice of honoring ments, and thereafter referred to him- occupation mushroomed elsewhere. exceptional contributions to societal self as “Doctor Franklin.” The Ethio- Popular examples are Clinical Officer advancement. This is a remarkable cul- pian media and society adore to attach in neighboring Kenya and Feldschers tural shift that shall be supported and the title of doctor in addressing honor in the former Soviet Union. cultivated. This practice also made ap- recipients. One frequent observation parent that the universities shall brave in this regard was the use in honoring If you happen to visit Ethiopian health- to develop structured vetting system to the late Tilahun Gessesse. Similarly, care institutions, you will observe that keep the dignity and honor of the title. it is a common observation that we any male with a lab coat is the Doc- In many countries, universities tend to Ethiopians seem to like affixing titles tor or Haakim. That is amazingly just provide honors degree in an area they to our names, especially in public. For right with the recent growing diver- feel comfortable, and in disciplines instance Ambassador instead of Ato is sity in healthcare professionals at the they possess commanding authority. ubiquities that can be used to address doctoral level. Not everyone who calls It is discomfiting when an institution any one who served as first secretary in themselves “Doctor” in a healthcare that has neither vigor in the study of Ethiopian missions. Engineer is also a setting has the letter “M.D.” behind Law nor possesses Legum Doctor as common prefix haphazardly used. The their name. More and more medical academia ventures to award Honorary criteria why someone is prefixed with professionals in the white coat who Doctors in Laws. engineer in public while others with introduce herself as “Dr.” may not be the same qualifications are not is a physician but a nurse, nutritionist, In Ethiopia it is rare to award hono- mystery. Artist and activist are also in optometrist, pharmacist, or physical rarium doctorate to political figures. a full momentum in recent times. All therapist. Furthermore, it is customary It could be a matter of being cau- titles are mixed and combined at will in the western world to name associate tious from the side of Universities resulting in a complete puzzlement doctors to professionals having Mas- as the wisdom of a politician is usu- in the public. One of the graduate of ter’s degree in health care fields (as- ally not understood in short while. UGR is stylishly named “Yetekebru sociate doctor of anesthesia, associated Ambo has stepped up recently to this Doctor Pastor and Activist Mamo” doctor of chiropractic, associate doctor plate by honoring the previous Ethio- when addressed ex officio (real name of dentistry). In a similar analogy, why pian President Girma Weldegiorgis. replaced to maintain anonymity). not also the HO? It is rational to place Though, our head of states are not be- assistant and associate doctoral title stowed on honoris causa at home, they To go back to the title of Doctor, be- depending on the level of the train- have brought the honor from abroad. yond its academic achievement level, ing of the HO. An HO with Masters Emperor Haile Sellassie and Prime it is also widely used in Ethiopia and in one of the specialties designed for Minister Meles Zenawi have received in the broader world to address a per- the profession could be named asso- multiple honors from foreign Univer- son in a healing profession. This im- ciate Doctor. Assistant and associate sities. Among Ethiopian current lead- plies the use of the doctor prefix in titles are not new for Ethiopia either. ers, Deputy Prime Minister Demeke synonymous with the Amharic word Assistant and Associate Professor- Mekonnen, chairman of the board of ‘haakim’. The medical doctor and the ship are titles that could be obtained the University of Gondar in the recent health officer are literally the haakim. prior to full Professorship. The naming past, is the latest recipient of honorary Health Officers are professionals who provides recognition, acceptance and degree from overseas university. are licensed to practice medicine in professional steadiness. It is a recent Ethiopia. They are concerned with memory that the profession of HO Recipients of an honorary doctor- preventing and treating human illness was nearly extinct as HOs abandoned ate do not normally adopt the title of and injury by providing a broad range the career either by conjoining medi- “doctor.” In many countries, including of health care services mostly indepen- cal schools or turning to administra- the United Kingdom, Australia, New dently and often under the direction of tive and managerial work. This was Zealand and the United States, it is a physician. The title and the profes- partly because of lack of appropriate not usual for an honorary doctor to use sion HO has originated in Ethiopia, recognition. Other cited reasons are the formal title of “Doctor,” regard- particularly in Gondar in the 1950th. the non-existence of tailored graduate less of the background circumstances This occupational category latter emu- training programs, omitting the HO for the award. An early and notable lated by many countries. In the US, it from the national statistics of doctor- exception is Benjamin Franklin, who was adopted in the 1960s with the title population-ratio, hastily closing the received an honorary doctorate from Physician Assistant (PA). However, training program in favor of human

82 medicine and inadequate policy analysis. Honoring starts with the way we address this valuable Ethiopians.

Dr. Nuru Abseno Robi graduated from Gondar College of Medical Sciences in 1988. He worked as a general practitioner at Mi- zan Teferi Hospital in Keffa region for two years. His desire to pursue specialization training in the field of Obstetrics and Gyne- cology became a reality when he was selected for training in Germany by Gondar College of Medical Sciences. After completing the OBGYN residency, he returned back to Ethi- opia and worked as an assistant professor of OBGYN in GCMS hospital. He served as the medical director of the hospital as well. Dr. Nuru introduced minimally invasive surgery using laparoscopy in the hospital. He worked at AAU medical faculty from 2002 till 2005. Dr. Robi has upgraded his OBGYN knowledge and skills at Howard University Hospi- tal and became board-certified in Obstetrics and Gynecology. Currently he is working as gynecologist and obstetrician at Providence hospital in Washington DC.

83 Values and Beliefs from: https://sg.news.yahoo.com/ ethiopia-once-again-looks-indian- of Abyssinians: teachers-063604076.html accessed on An Expatriate Experience 11.04.2014). Starting from the first class in the Dr. Hardeep Rai Sharma* Institute of Environmental Studies, Kurukshetra University, PIN 136119, Haryana, India Maraki campus, the time was moving faster. Days, weeks, months even Served as an Expatriate in University of Gondar, Ethiopia during years are flying by. I enjoyed my work October 2004-March 2012 of teaching young Ethiopians. Before I realized, I became more accustomed to Ethiopian culture and traditions elling towards the main campus at including the food and social life. Af- that time, “Science Amba”, the words ter about a 1000 days of stay my col- of my mentor were reverberating in leagues acknowledge me by comment- my mind; “You must be open minded ing “you are no longer an expatriate, to experience the new place and the now you are a Habesha”. Labelled as new people to the fullest. However, it Habesha, I became more engaged in is up to you to decide the time period the society beyond teaching. I became of your stay. Leaving must be in a re- more fascinated to know that the spectful manner”! country is the sole place where human evolution started with “Lucy” as a Indian teachers and instructors are testimony in the National Museum in not as such new faces for Ethiopians. Addis Ababa. I am aware that Coffee As Her Excellency Dr. Genet Ze- is Ethiopian gift for the world and the wde, the Ethiopian Ambassador in river Blue Nile originates and cascades India, former Minister of Education to Sahara from Ethiopian highlands. (1992‒2005) has recently stated to With curiosity, little fear, enthusiasm The country famous for its Orthodox IANS (India Private Limited), in the and new dreams I landed at Bole In- Christian values and beliefs were al- 5th and 6th decade of the twentieth ternational Airport, Addis Ababa ways welcoming and supporting for century, Indian teachers were in pri- in cool October night in 2004. The me. mary and secondary schools of Ethio- Ministry of Education of Ethiopia, pia participating in Ethiopia’s recovery All the memories are not possible to through UNDP special country pro- as there were few Ethiopian teachers. narrate but one must share what one gram, has provided me an opportunity In a similar fashion, Ethiopia has liked and what makes me to serve in to work as an expatriate faculty in En- started an ambitious plan of expand- UGR for more than seven years. Start- vironmental Sciences at University of ing tertiary education at the turn of ing from work place, all departmental Gondar. After completing the joining the century. According to Dr. Genet, colleagues were always helping me formalities in the first two days in Ad- there are close to 500 Indian profes- in guiding, providing care, shopping, dis Ababa, the 50 seat Fokker plane sors working in Ethiopian universi- translating, and learning the Amharic took us to Gondar. I was welcomed ties and colleges. Ethiopia has more language. I am grateful to all my col- by blossom of yellow flowers carpeting than 500 would be professors doing leagues including Prof. Mengesha the valleys and hills. It was spectacu- their graduate studies and researches Admasu. Being a vegetarian is a chal- lar and delightful sight of colour and in Indian institutions at this historical lenge. It is not so simple to get vari- landscape. I was made aware that the juncture. I met enthusiastic University ety of vegetables in Gondar market. “Meskel flower” is the national flower of Gondar (UGR) faculty who have This problem was partly solved by of Ethiopia and a symbol of new life, fond memories of their Indian teach- my colleagues. Whenever some local happiness and friendship. While trav- ers from high school years (Extracted colleagues travel to Addis Ababa, it

84 became a part of the routine to carry difficult time is thought to lessen the They are creating awareness in local fresh vegetables and other essential grief and depression associated with schools and inspiring others to plant food items for my family. These acts of the loss of loved ones. Also the imme- more tress in their surroundings. W/o care make me feel homely and happy. diate collection of money at these oc- Wubalem’s opinion is “women are the I remember the occasional discoveries casions and timely helping out is also primary victims of environment dam- and plucking of beans (Fosolia) and a good idea in sharing the burden as- age” in many ways. She said if water is amaranth leaves in some of my col- sociated with funereal. polluted it will cause water borne dis- leagues/neighbours households which eases among children. She designed a made me feel as if I am exploring a From environment point of view, the less smoke producing stove for cook- hidden treasures. The gardening hob- yellow bed of Enkutatash flowers, the ing. Too much smoke may cause re- by of my wife, Reema, and myself has heavy downpour during the rainy sea- spiratory problems among women is matured during our days of Ethiopia son, the pristine beauty and the clean her principle. In 2009 Wubalem and in our quest to supplement the vege- environment of Siemen mountains, Mulualem received “The Green Hero” tarian menu from our garden. You can the vast spread of Lake Tana, the award from His Excellency, Ato Gir- imagine the deeply fulfilling experi- monasteries on the islands of Tana, ma W/Giorgis, President of the Fed- ence of an environmental specialist to and the Blue Nile waterfalls make me eral Democratic Republic of Ethiopia. grow his own food organically. happy even today. The caring attitude UGR has also recognized their deeds. towards nature, the collection and use The meeting with them made me to I will always remember and cherish of rain water, the reuse and recycle of think that when a landless farmer with the greetings of the local people with many items that might be tossed away just 12th grade education could bring a broad smile on the face along with in other cultures, and the love towards such a remarkable change in the soci- hugging and kissing. Students respect trees and plants needed to be men- ety, why we educated people with bet- their professors, attentively listen to tioned here which one can learn from ter resources cannot? I always remem- views, and work in cooperative atti- the natives. The one incidence which ber these inspiring couple and tried tude. I tried to understand, and also has touch my soul and awakened my to do some constructive and fruitful experience the customs and way of mind was when I met a farmer couple; work for the environment. life of the people around me. I deeply Ato Mulualem Birhane and his wife appreciate the concern and support W/o Wubalem. This couple is working I observed a little preference of male of the Gondar people for each other. for over 18 years in Dembecha town child over females in Gondarian soci- Whether it is in birth, marriage, sick- on environmental conservation and ety but never witnessed an incidence ness or death, relatives, neighbours, women health issues. Dembecha town of discrimination against the female colleagues, friends near and dear is about 370 Km away from Gondar. child. I have not encountered any come together to help in every pos- On asking the question “why are they case of dowry or expensive gift system sible way they can. Especially, during so concerned about the environment from the bride family. It is rather an the mourning period, the “Common when HIV is causing more deaths in Ethiopian way to see the bride get- Dinner System” is appreciable. Neigh- the country?” Ato Mulualem replied ting jewelleries and all sorts of gifts bours and relatives carry warm dinner “HIV can destroy one generation but from her would be husband. The equal to the mourning family every night environmental degradation can de- treatment and respect to the parents for a week or so. They eat communal stroy our all incoming generations”. of both husband and wife is so natural traditional Ethiopian dinner, Injera This was unforgettable moment for and unquestionable value of Ethiopi- with Stew, together. The reason behind me. He explained to me his indig- an society which should not be taken might be that the mourning household enous understanding how the forest as granted. Wives keeping and caring could be overwhelmed by the loss and acts as a sink for carbon emission, to their elderly parents and grand- not caring for itself. The neighbours/ reduce soil erosion, and improve air parents in her household touches my relatives try to share the sorrow and quality. He and his wife are running a heart with respect and admiration. The assist the distressed to refocus in life. nursery in which they are distributing concept which stroke and inspired me The wisdom is that being surrounded the saplings for free to interested peo- most was “equal treatment” to every- by neighbours and relatives at such ple. They only took donation if offered. one, where people greet and meet oth- 85 er people with the same gesture irre- to develop and flourish. Ethiopians to retain and carry its moral values and spective of financial and social status. should be cognizant to these outstand- contribute more in the country’s de- While driving giving way to pedes- ing human values of their society. They velopment. trians especially to women, and lend- should treasure and cultivate it further. ing a helping hand to senior citizens I wish a great success and bright future Dr. Hardeep Rai Sharma is an Assistant Professor (Energy and Environment Man- is honourable. During my stay, I did to the country and its people who gave agement) in The Institute of Environmental not encounter any bitter experience to me the recognition and opportunity to Studies, Kurukshetra University, Kuruk- share. Those values took generations serve. I request the Abyssinians youth shetra, Haryana, India since April 2012. He served as an Expatriate (Assistant and As- sociate professor) in Department of Environ- mental and Occupational Health and Safety, University of Gondar, from October 2004 to March 2012.

86 Sasakawa Health Prize Winner had brought up a high level of recognition to the college; a great feeling Gondar College of professional accomplishment for all the staff involved in the inception, of Medical Sciences leadership, conduct and follow up of the projects; a huge incentive to the May 1998 college community as a whole and a Tesfaye Tessema. MD national honor and pride. Dean of GCMS 1998-2002

On May 1998 the 51st World Health regular activities. The three projects Assembly took place in Geneva, Swit- that won world wide recognition were: zerland. As this day marked the 50th The team training of health workers, anniversary of World Health Orga- The Dabat Health and Demographic nization, the assembly was specially Surveillance Project and The Chronic attended by prominent leaders which Illness project. include Dr Fidel Castro, President of Cuba, His Excellency Henri Ko- The team training project had based its nan Bédié, President of Cote d’Ivoire, experiences from the 1950s “Gondar the Honourable Tofilau Eti Alesana, Team”. Students from different dis- Prime Minister of Samoa, Mrs Ruth ciplines, who are expected to work Dreifuss, Vice President of Switzer- as team after graduation, are getting land, Mrs Hillary Clinton, First Lady community based preventive, cura- of USA (who was winner of UAE tive and rehabilitative team approach prize) and by delegations of 191 mem- training. The project was revitalized ber states. and run by the college’s highly committed and diligent staff using a mea- On this colorful event Gondar Col- ger resource. The approach had been lege of Medical Sciences was awarded adopted and become a national flag- the 1998 Sasakawa Health Prize. The ship training approach. The chronic Sasakawa Health Prize is awarded for illness project arise out of the inac- outstanding innovative work in health cessibility of treatment and follow up development, such as the promotion services especially in North Gondar Crystal Statue Won by GCMS 1998 of health programs or notable advanc- Zone confounded with lack of well Sasakawa Health Prize. es in primary health care. The college trained professionals in health centers was selected among 230 other institu- and the socio-economic problems that tions worldwide. The prize comprised are associated with chronic diseases. It a 90 cm long crystal statue weighing primarily focused on diabetes mellitus, 10 kgs, the picture of which is depict- epilepsy and cardiovascular disorders. ed below, and 40,000 USD. The Dabat Health and Demographic Surveillance Project was initiated with The college won this prestigious award the objective of establishing a sur- in recognition to its contribution to veillance system of health and health health promotion and development related characteristics of the popula- through innovative, participatory and tion at a district level, and providing affordable approaches of the three a study base and sampling frame for projects it was running alongside its community based research. The award

87 Gondar-Leicester (UK) sionals in Leicester wanting to make a difference in the developing world Link: a fruitful long-term and the Dean in Gondar, Dr Tesfaye, wishing to create a partnership with partnership a UK medical school. The deal was Professor Mike Silverman, Emeritus Professor of Child Health, ‘brokered’ by the Tropical Health and University of Leicester (UK) and former Chair of the Link Executive Education Trust (THET) led at the Committee time by Professor Eldryd Parry. The Link with Gondar College of Medi- Dr Heather Dipple, Consultant Psychiatrist, Leicester UK and cal Sciences was established in 1996. Current Chair of the Link Executive Committee Over the years, the many projects have been beneficial to both Leicester and Destination Leicester that Leicester City Football team is Gondar including a fully indepen- not yet in the Premier League. dent Masters degree in Public Health Leicester in the UK must be the single training health workers from all over Destination Gondar most popular European destination for Ethiopia. clinical and academic staff in Gondar. The 18 years of partnership has seen in Since the first visit to Leicester by In 2004, when Gondar College of the region of 180 visits by UK mem- the then Dean of Gondar College of Medical Sciences evolved into Gondar bers of the Link to Gondar. Again Medical Sciences (GCMS), Dr Tes- University, the University of Leicester there have been a wide range of pro- faye Tessema in 1996, some 150 visits became involved. A Memorandum of fessionals, mostly (because of the his- have been made by Gondar profes- Understanding was then signed be- tory of the Link) health professions, as sional staff to Leicester. These have in- tween the two institutions, giving rise well as senior clinicians from a range cluded clinicians, academic staff from to the Leicester-Gondar University of disciplines (psychiatry, surgery, pae- many departments (public health, Link. The aim of this link is topro- diatrics, general medicine, ophthal- applied sciences geography, tourism mote international fellowship and mology, midwifery and more) a large management, law etc), senior universi- friendship, mutual respect, improved number of visits have been made by ty managers, nurses, physiotherapists, communications and cross cultural senior nursing staff. From the Univer- clinical audit clerks and librarians. For working leading to joint research and sity of Leicester academic staff from many this was their first experience of mutual development and support. In public health, microbiology, econom- Europe. 2010 the other Leicester-based univer- ics, medical education, biological sci- sity - De Montfort University which The opportunity to see any health or ences, genetics and other disciplines provides many degree programmes for academic system other than you own as well as senior managers have spent allied health professionals, joined the is always thought provoking. There are time in Gondar. differences in training and teaching partnership. methods and, for health professionals, Visitors from Leicester always com- In Leicester, the Link has become a in the delivery of health care. The chal- ment on just how much can be achieved formally recognised UK charity. The lenge is to understand what aspects of with the limited resources available to advantage of this is that we can re- the experience may be relevant to the professionals in Gondar. They are also claim an additional 25% from the UK Gondar situation and which are not. impressed with the depth of knowl- Government for every £1 donated. In Staff in Leicester value feedback and edge of Gonderey in the fine detail of return, the UK Charity Commission comments about the UK system from the UK Premiership and Manchester demands a high standard of gover- our Gondar partners . United in particular. nance. The Link has a full-time UK First impressions of Leicester by vis- How the partnership evolved administrator (Mrs Nichole Bruce) iting staff have generally focussed on and a part-time Gondar administra- the terrible weather, the vast size of The Leicester-Gondar Medical Link tor (Solomon Assefa), both funded by supermarkets, and disappointment started as a result of health profes- Leicester. 88 What has been jointly achieved? cal training programme), for which an tion. The long-term aim, is to create entirely new curriculum was developed research partnerships between Gond- Over the years, the partnership has in Gondar. Again this acknowledged ar and Leicester to enable the success- been awarded many external grants, the importance of integrating theory ful graduates from this programme to and also has been involved in signifi- and practice during professional train- build internationally competitive re- cant fundraising, particularly within ing. Gondar has continued to generate search programmes themselves, within Leicester (Appendix 1). We estimate surgical trainees in large numbers and Gondar. that over the lifetime of the partner- at a high quality – the envy of other ship some £600,000 (about 20m Birr centres in Ethiopia. b. Research and publications at current exchange rates) has been raised in support of programmes and In recent years, a partially integrated A small number of publications have projects within the partnership suite of masters degrees in a range of resulted from the partnership (Ap- clinical disciplines has been jointly pendix 2). These give a flavour of the a. Academic Achievements developed by Gondar University and range of research work carried out. the two universities in Leicester (Uni- While all projects and programmes versity of Leicester and De Montfort c. Clinical undertaken by the Link are expected University). These have allowed health to have long-term sustainable out- professionals with bachelor degrees, to As well as providing training, main- comes, this is best illustrated with experience interactive teaching, learn- ly in Leicester for a range of health examples from academia. Amongst ing in clinical practice, and an under- professionals (physicians, surgeons, the new academic programmes which standing that advanced practice is far nurses, laboratory staff, librarians, au- have been jointly initiated, the Mas- more than better ‘bedside’ skills, but dit clerks, and others) there have been ters Degree in Public Health (MPH) includes leadership and management, similar training visits by Leicester staff has been the most successful. A Brit- teaching skills, evidence-based prac- to Gondar. These exchanges are mu- ish Council grant enabled several tice and research skills. Of the suite tually beneficial. While those form members of the department of public of programme, the Masters Degree Gondar may gain first-hand experi- health in Gondar, to spend periods of in Advanced Clinical Nursing and ence of the skills and organisation of 1-2 months in Leicester adapting and in Clinical Laboratory Practice now health professionals in the UK, those modifying a modular programme in both completely managed and taught from Leicester are exposed to clini- public health run by the University by Gondar University staff, whereas cal situations which are rare or non- of Leicester, to the requirements of the Masters Degrees in Physiotherapy existent in the UK, and organisational Ethiopia in general and Gondar in and Anaesthetics still require teaching problems (health provision in the a particular. From the small beginnings input from overseas. resource-poor environment) which of the MPH, Gondar in 2003, the teach resourcefulness and adaptability. programme has expanded into a suite The research-based PhD programme of masters degrees encompassing ma- is well established and producing its The two most successful clinical proj- ternal and child health, health service first graduates. The programme was ects have been in the fields of ophthal- management, health informatics and set up 5 years ago, well before Gondar mology and mental health. In the field many others. The part time, modular University was able to award its own of ophthalmology , the Link has con- nature of the programme, suitable for PhD’s, in order to build research ca- tributed significantly to the establish- practicing health professionals, was at pacity in Gondar, in fields relevant to ment of the Eye Hospital in Gondar. the time a novelty in Ethiopia. This research within the Ethiopian context. Link members and clinicians within model has been copied and adapted The programme is underpinned by the the UK have been involved from by many other universities throughout universities in Gondar and Leicester the very concept of the new hospital Ethiopia. and awards University of Leicester de- through to helping to equip the build- grees. Of the first three postgraduate ing, establish a library, and train staff. Another innovative programme was students in the programme, two have One associate member of the Link in the Masters Degree in Surgery (surgi- completed and one is close to comple- the UK, Dr Sandy Holt-Wilson, es-

89 tablished an independent charitable learn how health services and univer- time; this should help us to maintain organisation to raise funds to support sities are managed in the UK. In return contact with each other. It also offers ophthalmic services in and around a number of staff from Leicester have opportunities to develop innovative Gondar. been involved in training programmes projects which will strengthen the within Gondar and have gained a bet- link. Mental Health services within Gond- ter understanding of the challenges ar have for many years have consisted of managing rapidly growing services There are many achievements to build of two mental health nurses, without with a high level of staff turnover in on. Over the next year we will work to the support of a psychiatrist. The joint the Ethiopian context. Creating a cad- develop a renewed Leicester- Gondar mental health programme in Gondar, re of managers within the health sys- Link strategy agreed by partnership headed by Dr Heather Dipple, one of tem and university in Gondar is likely leaders in Gondar and Leicester. the authors of this article, has con- to be one of the greatest challenges structed an inpatient and outpatient to achieving the changes necessary to Acknowledgements Mental Health Unit within Gondar, keep up with demands. helped to train mental health nurses The Link owes a debt of gratitude to and others and created an fully inte- e. Teaching and Learning Professor Eldryd Parry for suggesting grated programme of clinical work and that a partnership between Leicester training which is set to expand over Visitors to and from Leicester and and Gondar could be fruitful. Succes- the next few years. The inpatient unit Gondar are almost all involved in some sive Deans in Gondar – Drs Tesfaye is the first in the Amhara Region. form of teaching, whether formal lec- Tessema, Yared Wondmikum, Mensur turing or participating in small group Yassin, Assefa Getachew and Sisay Other clinical firsts include the es- learning. However a very innovative Yifru – have all been supportive as tablishment of a Clinical Audit Unit programme has recently been set up by have the three Presidents – Professor within Gondar which has run two a Leicester Group (Leicester-Gondar Yared Wondmikum, Yigzaw Kebede workshops for others in Ethiopia in- Link Collaborative Link – www.le- and Mengesha Admassu. Many oth- terested in establishing clinical audit icestergondarlink.com) to provide a ers have worked hard for the success of within their own health facilities. platform for clinical teaching in any the venture. We thank them all.t health discipline. This programme is With a grant from WHO under in its infancy but is already receiving the African Partnerships for Patient much attention. Safety (APPS) scheme Gondar has pioneered the development of patient Where next for the partnership? safety procedures within Africa. For example it has lead the way in Ethio- The fact that the partnership has been pia in introducing alcohol based hand in existence for nearly 18 years dem- gel within clinical areas, and has set up onstrates that with determination a manufacturing unit for the gel with- and perseverance it is possible to keep in the pharmacy department. Other the Link going. Our joint aim is for aspects of this programme include a sustainable link that will facilitate infection control, staff safety, waste the projects that are already in place management and surgical safety. and develop new initiatives that will improve the health care of people in d. Management skills Gondar and Leicester. For this to be achieved Link partners need to agree Many visitors from Gondar (and in- their priorities for future projects and deed from other universities through- establish clear leadership in Ethiopia out Ethiopia) have spent time in Le- and UK. Communication methods icester, on structured programme to across the world are improving all the

90 Appendix 1 — Major Grants Fundraising

1998-2003 Children’s Research Fund, Liverpool UK – Funds towards developing the Link £65,000

British Council Higher Education Funding Scheme – Establishment of MSc in £49,000 2001-2003 Public Health

England-Africa Project (British Council) £75,000 to support three projects: 1. Management & Leadership Programme: a joint venture with the Staff Develop- ment Centre, University of Leicester and Skillshare International. Supported by the Institute of Leadership & Management, London. £75,000 2006-2009 2. Economics: programme to strengthen links between the Faculty of Management Sciences & Economics, Gondar University, and the Department of Economics, University of Leicester. 3. Transnational Community of Academic Practice: a programme to create working links between individual academics in a range of faculties in the two universities.

British Academy Grant to Dr Emma Pitchforth, Understanding Patient Safety: Obstetric Care in Ethiopia 2006-2007 This project has established a working collaboration between academics in the Univer- £5,264 sities of Leicester and Gondar, in the field of Health Sciences and Sociology. Leic- ester medical students have participated in data collection during elective periods in Gondar.

Isle of Man Award to Sandra Kemp 2008-2010 £21,620 Improving Maternal & Child Health in Gondar through the upgrade of the Mater- nity Unit

British Council - Education Partnerships in Africa (EPA) Programme. 2009-2010 £41,910 Auditing the undergraduate curriculum for employability – a method and its application to the Degree of Tourism Management, Gondar University, Ethiopia

Tropical Health and Education Trust (THET) Supporting the core modules of the £8,530 2010-2011 MSc in Clinical Practice, Gondar University (disciplines inc. Laboratory Practice, Anaesthetics, Physiotherapy and Midwifery)

Sir Halley Stewart Trust Supporting the development of an MSc in Advanced Clini- 2010-2012 £32,868 cal Laboratory Practice for Gondar University

THET – Strengthening Surgical Capacity Programme Project to support the £6,150 2011-2012 development of an Operating Theatres management team and governance of the OR, Gondar University Hospital.

WHO African Partnerships for Patient Safety Gondar was one of the 3 pilot sites Total sums 2008 -2012 in Africa for Link partnerships to develop and apply patient safety procedures for never African hospitals. disclosed

Norton House Support towards the building and development of an in-patient psy- 2012-2013 £25,000 chiatry ward on the Gondar University site; completed in 2013.

Nuffield Foundation Supporting the development of an MSc in Advanced Clinical £95,600 2010-2013 Nursing for Gondar University. This programme is now fully independently established within the Nursing Department, Gondar University. Local Fundraising in Leicester. To support mental health work, maternity services in 2008-2014 £170,000 Gondar hospital and the Koladiba Health Centre and more.

91 Appendix 2 — Some Partnership Publications

2001, A Nicoll, E Carter, B Golden, J Robson, D Southall, ‘Developing sustainable international partnerships in child health and paediatric care’, Archives of disease in childhood, Volume 84, pp. 315 – 319.

2003, Sirak Hailu, Tesfaye Tessema, M Silverman, ‘Prevalence of symptoms of asthma and allergies in schoolchildren in Gondar town and its vicinity, northwest Ethiopia’, Pediatric Pulmonology, Volume 35, pp. 427 – 432.

2005, N Kulkarni, B Prudon, S L Panditi, Yekoye Abebe, J Grigg, ‘Carbon loading of alveolar macrophages in adults and children exposed to biomass smoke particles’, The Science of the total environment, , pp. 23 - 30

2007, R Major, ‘Leicester-Gondar: an International Medical Student Link, The Lancet Student, 2007.

2007, Y Mensur, B Gebretsadik, Gashaw Getahun, J. M. S Johnstone, ‘One Year Audit of Surgical Admissions at Gondar University Medical College’ East and Central African Journal of Surgery, Volume 12,.

2008, E Carter, Sisay Yifru, C Archdeacon, C Barbrook, Mistir Gebremedhin, ‘Setting up a Clinical Audit in Gondar Hospital, Ethiopia’, Ethiop Med J, pp.243-50

2008, M Edelstein, E Pitchforth, Getahun Asres, M Silverman and N Kulkarni, ‘Awareness of health effects of cooking smoke among women in the Gondar Region of Ethiopia: a pilot survey’, BMC International Health and Human Rights, Volume, 8, p. 10.

2010, A M J Leather, C Butterfield, K Peachey, M Silverman, R Sheriff. ‘International Health Links movement expands in the United Kingdom’, International Health 2, pp 165-171

2010, E Pitchforth, R J Lilford, Yigzaw Kebede, Getahun Asres, C Stanford, J Frost, ‘Assessing and understanding quality of care in a labour ward: a pilot study combining clinical and social science perspectives in Gondar, Ethiopia’, Social Science & Medicine, Volume 71, pp. 1739 – 1748.

2011, M Goodwin, Gojjam Ademe, M Pennington, C Bartle, P Jackson ,‘Engaging students, staff and employers in enhancing graduate impact: Tourism Management at the University of Gondar’, Chapter 2 in Patsy Kemp and Richard Atfield (eds) Enhancing Graduate Impact in Business and Management, Hospitality, Leisure, Sport, Tourism, Newbury, Threshold Press, pp.9–20.

2011, J Hightower, M Fahmi, Gashaw Getahun, A Derso, ‘African partnerships for patient safety: a catalyst for change in Ethiopia’, BMC Proceedings, Volume 5 Suppl 6, p. P322.

92 In Memory of Dr Teshale Seboxa By Ermias Diro, MD Elias Said Siraj, MD Makeda Semret, MD Wondwossen Amogne MD Yewondwossen Tadesse, MD

The completely unexpected news caused doctors to join the newly opened inter- of tens of thousands of patients. While profound sadness among all Ethiopian nal medicine residency program of the in Gondar he did a Masters in Clini- health professionals on December 22, School of Medicine, Addis Ababa Uni- cal Tropical Medicine at the London 2013: the passing away of a pioneer versity (AAU) (1979 - 1982). School of Hygiene and Tropical Med- physician, educator and researcher Dr icine completed in Oct 1988. Teshale Seboxa (1947 – 2013) Dr. Teshale was one of the first Ethio- pian general internists who joined Dr. Teshale spent the last 19 years of Dr Teshale was born in Quiha, Tigray the German teachers at Gondar Col- his professional life in the Department in 1947. He went to school in Negelle lege of Medical Sciences (GCMS) to of Internal Medicine of the School of Borena and then Addis Ababa. Later teach internal medicine in the early Medicine in AAU. He served as Head on, he joined technical school at the days of the medical school. He taught of the Infectious Diseases Division of Jimma Agricultural School. He subse- and practiced at GCMS for more than the department for several years and quently graduated with an MD from 10 years. In Gondar he distinguished coordinated the activities of the big the Medical Academy of Lodz, Po- himself for his dedication to teaching, HIV clinic of Tikur Anbessa Hospital. land in 1974. clinical care and for his research on He was instrumental in the launching various infectious diseases, and par- of the Infectious Diseases fellowship Dr. Teshale was a physician who served ticularly malaria. Dr Teshale worked program from which 4 fellows have so his country with distinction over a peas Medical Director of the Gondar far completed their studies. riod spanning four decades. After serv- Hospital which, at the time was the ing as a general practitioner at Kuyera only referral hospital in North-West In the last few years of his life Dr Te- Hospital in Shashemene (1975 -79), he Ethiopia, and led the team of health shale worked diligently as the clini- was accepted as the first group of ten professionals that catered to the needs cal team leader of a team from Addis

93 Ababa that investigated an outbreak “Dr Teshale was a man of such kind- cal knowledge he had particularly in of Veno-occlusive Liver Disease in ness, great integrity and a wonderful malaria and leishmaniasis. He was the a village in North-West Tigray. The sense of humor. He was a constant, de- first person to arrive every morning at team was able to identify a plant toxin voted and very steady presence at the our department, and the last person to in the drinking water of the village as hospital. Curious, he was always on leave always availing himself for con- the cause for the liver disease. Only a the look-out for a project, an outbreak, sultations. He carried out his respon- few weeks before his death the team a new disease... and always functioned sibilities as well as duties with utmost received an award from the Ethiopian marvelously well in team efforts. He sincerity and diligence. Whenever I Science and Technology Ministry at a embodied team spirit: he connected remember him, his wonderful sense ceremony presided over by H.E. Prime with people with ease, humor and of humor resonates in my ears. He re- Minister Hailemariam Desalegn. grace, was committed to getting the minds me the good old past genera- job done but always acted with the tion of doctors. I have not yet accepted When the news of his death was an- utmost integrity and purity of heart. the fact that he is dead. I still expect nounced on an online forum, several Even during periods of hardship he in the morning for his greetings and people posted touching comments on seemed to maintain a lightness of be- hear the verses he sites for me from the type of person Dr. Teshale was. ing, and had a very affectionate, almost the holy bible. May God the almighty Below are some representative com- fatherly, rapport with so many of us. As rest his sole in peace!” ments. a former visiting student, then a col- laborator and guest faculty of AAU’s “Sad news! Dr Teshale Seboxa passed “As one of his students in Gondar, I ID unit I have had the privilege of away last night. He was a great servant know how dedicated he was to the spending a lot of time with him, par- of Ethiopia - an excellent physician & care of the patient and to the teaching ticularly when he served as the unit di- researcher. May his soul rest in peace” of medical students. He was a person rector. We forged a very special bond said H.E. Dr. Keseteberhan Admasu, whose life was centered around us and and I will dearly miss him and mourn Minister of Health of Ethiopia and watching over us… When I say us, I this loss” said Dr Makeda Semret, an an alumnus of Gondar, via his twitter mean both the patients and the medi- infectious disease specialist at McGill feed. cal students. As students, we used to University in Canada. say his home was Ward C and Ward Over the decades that he served his D, where the bulk of internal medi- “Dr Teshale was a very friendly and country, Dr Teshale has completed cine patients were at that time. You approachable colleague in the depart- and published a great number of sci- can find him there in the morning, ment who was always available for help entific studies. Most of his work was in the afternoon and in the evenings. to students, residents and fellows. He on different infectious diseases in the He used to put a lot of emphasis on will be sorely missed by his colleagues country and includes malaria, HIV, hard work and diligence as the bed- and students in the department and cryptococal meningitis, tetanus, relaps- rock principles of being a good doctor. the Tikur Anbessa Hospital commu- ing fever, anthrax and brucellosis. He For Gondar medical students in that nity” said Dr. Yewondwossen Tadesse was always in the upfront in outbreak era, internal medicine simply meant who is the Head of the Department investigations in the country among Dr. Teshale. He will be missed… but of Internal Medicine at Addis Ababa which are veno-occlusive liver disease like any good teacher, his products University Medical faculty. in Tigray region, adult measles (un- have gone out to conquer the world published) and epidemic dropsy syn- and his principles and teachings will Dr Wondwossen Amogne, a faculty drome in Addis Ababa, and ergotism. live in them.” said Dr Elias Said Siraj, in the infectious disease division of He also worked on health systems and an Endocrinologist and a 1988 MD the Department of Internal Medi- non-infectious diseases in the country alumnus of Gondar who is currently cine said, “Dr Teshale was as dear fa- such as SLE, byssinosis and other re- an Associate Professor of Medicine at ther to most of his students and col- spiratory diseases, epidemiology of gy- Temple University in the USA. leagues. He was a person to find in necological tumors, skins diseases and moments of personal crisis. I used to diabetes. His legacy is significantly be fascinated with the depth of clini- more than the numerous publications

94 he authored (several of which predate ease community. May his soul rest in Makeda Semret, MD Assistant Professor of the era of subscriptions to electronic peace! Medicine, Infectious Disease Specialist and databases); his legacy is in the students Medical Microbiologist at McGill Univer- sity, Montreal, Quebec, Canada he mentored, the patients he cared for, Ermias Diro, MD Associate Professor of In- ternal Medicine at University of Gondar, the teams he built, and the energy he Gondar, Ethiopia Wondwossen Amogne, MD Associate Profes- brought to every endeavor. sor in Internal Medicine and Infectious Dis- Elias Said Siraj, MD Professor of Medicine, eases at Addis Ababa University Faculty of The authors of this piece would like Director of Diabetes Program and Director of Medicine, Addis Ababa, Ethiopia to pass their condolences to his fam- Endocrinology Fellowship Program at Tem- ily, the whole Ethiopian medical comple University, Philadelphia, PA, USA Yewondwossen Tadesse, MD Nephrologist munity, and the global infectious dis- and Head of Department of Internal Medi- cine at Addis Ababa University School of Medicine, Addis Ababa, Ethiopia.

95 1973 Kinfe- pediatric rounds with HO students PHC

1982-83 pathology students with Prof Taubert

96 1980s Interns

1983 Anatomy-lab

1980s Students Picture at Photo Shop 97 1983 Anatomy-lecture

1983, Second-year Students with Physiologist Dr. Robine

98 1983, Second year Students with Biochemist Dr. Peters

1985, 5th year medicine soccer team

1988 Graduation-group- stairs 99 1985, 4th Year Soccer-Club 1986 Graduation-third-batch

1986 interns, among others the renown scientist Dawit, Ambasado

100 2012 Alumni Steering Comittee Visiting Gondar

2012 Alumni Steering Committee Visiting Gondar

101 Alumni of 1988 in USA with Families

Alumni of 1988 in USA 102 The victorious 2002 Women Vallyball team of Gondar College

Happy faces as Gondar won all games of the Gondar-Bahir Dar tornament 2002

103

Congratulations to the University of Gondar and all those affiliated on the occasion of your 60th anniversary

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