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Developing emergency medicine from scratch in Ethiopia

Toronto, March 28, 2016

By Greg Winson

Dr. James Maskalyk speaks to a class of residents
Dr. James Maskalyk speaks to a class of residents in the emergency medicine program at Ethiopia’s Addis Ababa University. (Photo courtesy of Dr. James Maskalyk)

Ethiopia, Africa’s fastest-growing country, has ambitions to become a middle-income country by 2025. However, a virtually non-existent emergency medicine infrastructure keeps many of the country’s poorest citizens from matching the ambitions of their leaders.

“The people who are the poorest are the sickest,” explained Dr. James Maskalyk, an emergency room physician at St. Michael’s Hospital and a visiting professor of emergency medicine at Ethiopia’s Addis Ababa University. “Many families live day to day with little savings. If someone gets sick, or injured, they will spend what they have, even if it was for school fees or better housing. Often, because there are few places to treat such emergencies, the family member dies, and their savings are wiped out, perpetuating the vicious cycle of poverty and sickness.”

Soon after returning from a six-month tour with Médecins Sans Frontières in Sudan in 2007, Dr. Maskalyk was tasked with setting up an emergency medicine training program in Ethiopia.

There was some precedent for this type of program. Dr. Clare Pain of Mount Sinai Hospital developed the first residency program for psychiatry in 2003 in collaboration with Addis Ababa University.

Establishing a similar program for emergency medicine would be even more challenging, as there were no emergency doctors in the country and no well-resourced emergency rooms to train them.

“No one was doing a program like the one Ethiopia wanted to embark on, not in the country nor anywhere nearby,” said Dr. Maskalyk. “Too often, this type of engagement sees a well-resourced partner bring in supplies and training intermittently, for a short time. The merits of that seemed transient. We wanted this to stick, so we took a different approach. We brought teachers.”

   
Did you know?
Dr. James Maskalyk has written two books – “Six Months in Sudan,” which was published in 2009, and “Life on the Ground Floor” is due this year.

Forty doctors from the Toronto area have participated during the first five years of the program, along with 20 senior residents from the University of Toronto. Each residency lasts three to four months.

The program, which commenced in 2010, has graduated 15 doctors over three groups. A fourth and fifth group is being trained. Notably all graduates of the program have continued to practise medicine in Ethiopia.

The surprise benefit of this project has been the positive reaction of the doctors and residents who have participated in the program.

“Almost 100 per cent of participants want to go back once we take them there,” said Dr. Maskalyk. “Their inspiration is most often not the medicine, but the resolve of the doctors and nurses who work there.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.