Cardiff Medics reach out to Ethiopia · Issue 858, by Yousar Jafar

gair rhydd’s Heath Park correspondant, Yousar Jafar, reveals all about the partnership between Cardiff University and Hawassa Medical School in Ethiopia

In 2006, Cardiff University Medical School established a link with the Debub University College of Health Sciences in the city of Hawassa, Ethiopia led by Dr Yifru Berhan of Ethiopia and Professor Helen Houston and Dr Mujataba Hasan of Cardiff Medical School.

This partnership builds on the existing link between Southern Ethiopia and the Gwent Healthcare NHS trust which was launched in 2000.

This unique health link between South Wales and East Africa is bridging thousands of miles to provide better healthcare to one of the world’s poorest countries by helping and supporting health professionals in Ethiopia.

The purpose of the University link is to further co-operation between the 2 educational institutions and the exchange of students and staff in order to build on international understanding and further academic co-operation. These aims are to be achieved by a programme of exchange visits, one of which has already taken place in March 2007 between staff, that target the development of leadership skills, teaching and clinical practice as well as to share teaching innovations and conduct collaborative research between both institutions.

In 2008, three final year medical students from Cardiff University will have the opportunity to go on an exchange to Hawassa Medical School in Southern Ethiopia for their elective period. This is the number of medical students that Hawassa Medical School can accommodate.

The student response from Cardiff Medical School in support of this link has been very promising with brave efforts being made to fundraise for the Ethiopian Appeal recently set up by two third year medics, Arla Gamper and Beatrice Baiden. On 14th October 2007 the Cardiff half-marathon took place with over 5,000 people taking part in the 13 mile run. Arla Gamper and Beatrice Baiden trained for 2 months in order to participate in the Cardiff half marathon and to raise money for the Ethiopian Appeal. They ran together in their scrubs and successfully completed this exhausting task in a respectable time of 2 hours 14 minutes, managing to raise nearly £500 for a cause they’re both extremely passionate about. Both medics claimed that it was ‘an awesome experience’ and ‘a massive personal achievement to run that distance and raise money to help train Ethiopian medical students.’

The money raised for the Ethiopian Appeal will help support two Ethiopian final year medical students to come to Cardiff University for eight weeks, also as part of their elective. Events that took place during RAG week have contributed to the Ethiopian Appeal and future events such as the annual ‘Dining Out’ will also help to raise money for the Ethiopian Appeal with many more activities in the pipeline. Third year medics will also be selling handmade Christmas cards to students at the Heath Campus and the Biosciences building.

Professor Houston, the Dean of Undergraduate Studies within the School of Medicine, claims that ‘the response from the student body has been fantastic’ and that she is ‘delighted about our student response to the suggestion that they help to raise some funding to allow two Ethiopian students to come from Southern Ethiopia.’

Ethiopia is situated in East Africa and is one of Africa’s poorest nations. The main industry in this developing country is agriculture, where coffee is essential to the Ethiopian economy. The agricultural industry accounts for over 40% of the gross domestic product (GDP) of Ethiopia but sometimes the agricultural sector suffers from frequent drought and poor cultivation practices which can further hinder Ethiopia’s economical growth. Ethiopia has a population of 77 million people in comparison to the nearly 60 million people living in the UK. The life expectancy of males and females in Ethiopia is 49 years and 51 years respectively whereas in the UK the life expectancy is 30 years higher on average. Infant mortality in Ethiopia also shows worrying statistics. The number of deaths per 1000 live births in Ethiopia is 110 compared to only 5 in the UK.

One of the chief aims of the collaborative research between both institutions is to ‘carry out research in maternal and child health because the levels of childhood mortality and morbidity in Ethiopia are very high’ Professor Houston explains. The objective of conducting collaborative research is to research topics that are relevant to the health problems faced in Southern Ethiopia with the facilities that are available and can be supported by Cardiff University. This includes research being conducted in infectious diseases such as Tuberculosis (TB), Malaria and HIV/AIDs which are all rife in Ethiopia due to the lack of sanitation and health education in the local community. Not only is the childhood mortality in Ethiopia painfully high (and easily preventable), the deaths of mothers during delivery is also drastically high because of the shortage of modern medical equipment. Maternal deaths are nearly 100 times more than in the UK with statistics from the World Health Organization showing that in Ethiopia there are 850 maternal deaths per 100,000 live births in comparison to 11 in the UK.

One of the benefits of undertaking this research is that it will enable the faculty of the Ethiopian medical school to become researchers.

Across the UK, research is an important part of medical school life but in Ethiopia they don’t have such training programmes or active researchers in the more peripheral cities, not to mention the lack of resources. In turn, it will allow researchers from Cardiff University to have the opportunity to experience and have some understanding of health problems in a different country at first hand, hence making this link mutually beneficial.

In Hawassa Medical School, there are 80 medical students in each year. However, in the first cohort, who are now in their fourth year of study, there were only 40 medical students. The Ethiopian medical school also trains 40 health officers who are exposed to the same clinical experience as medical students. At any one time, there are 80 medical students and 40 health officer students learning in the same environment each year. This varies considerably to the intake at Cardiff University Medical School who have accepted 305 students in the 1st year this September.

Another difference that was evident during the staff visit in March 2007 was the male to female ratio in the Ethiopian medical school. Cardiff University medical school is largely female dominated with a male to female ratio of 1:3 on average. However as one might expect, this ratio doesn’t hold true for Hawassa Medical School which is male dominated with between 20 – 35% being female. This is because families with limited resources generally prefer to educate their sons rather than their daughters but there are also other reasons behind this decision. Secondary school education in Hawassa is private and entry into medical school is based entirely on academic attainment.

The first staff exchange enabled 4 members of staff from Cardiff University to visit the small city of Hawassa in South Ethiopia. In the report published of their first visit, the Cardiff team explained that the ‘laboratory services were rudimentary’ and that the library building was ‘excellent but lacked modern facilities, computers and internet access as well as new text books’ which are resources taken for granted by all students studying at a British University. The medical school in Hawassa have a limited number of journals in their library and are keen to acquire recent journals and learning materials. Cardiff University are helping to provide these essential resources by sending surplus journals donated by staff and also support the university with CD-rom material.

Despite the lack of resources, the Cardiff team mentioned how impressed they were by the diligence and enthusiasm of both the staff and medical students and their perseverance to pursue medical education with limited resources. Professor Houston describes the attitude of Ethiopian medical students as ‘very industrious, studious and focus very hard on their studies.’ She also goes on to say that ‘their workload was probably too high because they didn’t have much time for any social engagement, sports or other outside activities as they felt it was important to work all the time.’

Not only do these students show commitment on an academic level, but they have the motivation and desire to be at the forefront of medical advancement in their home country, despite the hardships they face. Many of these students live 100-150km from their homes and live in dormitories on campus.

In Ethiopia there are 139 hospitals for a population of 77 million people (that is 1 doctor for 550,000 people) and of those, 36 are in the capital city Addis Ababa. Further to this, 85% of the population live rurally but many of the hospitals are over 150km away from the rural population. In some towns there is only one local hospital with no more than 50 beds to serve a community of half a million people.

For developing countries the WHO recommends that the doctor to population ratio should be no more than 1 doctor for 10,000 people. In the WHO annual report this ratio was 1:355 in the USA and 1:500 in the UK but for Ethiopia it reached a shocking 1:118,000 in 2006. This is due to the shortage of medical doctors as well as other non doctor frontline health workers. The retention of doctors was very high in 2006, where there was increased internal and international migration. The unattractive career options also contributed to driving Ethiopian doctors away. Another reason for the low number of doctors in this country is due to the low production rate of doctors however one way of improving this situation is to increase the intake of medical students. Hawassa Medical School aims to increase the intake of medical students from 80 to 200 by 2008 which is a step in the right direction.

With the help of Cardiff University, Hawassa Medical School will be able to rise to the challenges they have set themselves and achieve their goal of improving the medical course and taking clinical practice to the next level in Southern Ethiopia.