No Amount of Doctors’ Training Can Change the Equation, but a Just System that Motivates and Continues to Inspire the Educated to Serve, and Serve Again!

By Ibrahim Elemo*, M.D., M.P.H.

The following piece is in response to an article published onAyyaantuu.com about the brain-drain of physicians and other skilled professionals from Ethiopia and other parts of Africa to Canada and other western countries. This is not a new story to many people. What is rather new to some of us is the Ethiopian government’s strategy to deal with this tragedy by over producing physicians.

I read this story a day after I called a 36-year school director, who ended up in a hospital, 100km away from his home town only because he had a headache and was found to have high blood-pressure, and given some medicine to control it. Actually, he lives in a town where there is a district hospital. I spoke with the same person 2 days before, and to my best knowledge, he was in good state of health. When I called to speak with him again, his phone was answered by his wife, who told me that he was receiving an urgent care in a hospital. I asked to speak with him, asked him how he felt and what medicine he was given. His blood-pressure, at the time I spoke with him, was not elevated. I realized that the unfortunate teacher was suffering not from hypertensive emergency, but the side effects of the wrong blood-pressure medication, about which neither the patient nor the health professional had any idea that it could be causing his symptoms. His wife initially told me that they were planning to take him to a higher-level immediately if he had not felt better. He had been given two medicines, which he continued to use them thinking that his blood-pressure was getting out of control and causing his profound dizziness. You can imagine the financial impact of such poor quality of care. It could cost this teacher thousands of Birr/dollars until he gets to a tertiary care level or a dedicated physician who reviews his medication, listens to his story well and tells him to stop taking the wrong medicine he had been put on. This is the story of thousands of people – if not every day, every week, in a country where the government’s policy is to deal with the massive exodus of physicians by overproducing physicians and saturating the domestic market.

They have no strategy of retaining the best of the best, but have strategies to use the worst of the worst from all communities of people to rule over them indefinitely. To get back to the main reason why I decided to write this short piece: reflecting on my own trajectory from a “committed subject” willing to serve his country to someone soon-to-be-a-professional selling his service for a fee in a western country.

“According to Canada-based CUSO International, between 1990 and 2006, Ethiopia trained 3,700 doctors. Only 700 of them stayed to work there. Africa’s health-care system isn’t the only sector hemorrhaging skilled workers — there are more African-born engineers and scientists living in Canada and the U.S. than in all of Africa.”

Reading this story on Ayyaantuu.com made me think about circumstances that forced me to leave my country for a time being. Fresh out of a medical school, I went to the Oromiya Health Bureau and asked the Head to assign me to the Borana zone, which was, back then, one of the few zones physicians avoided going to at any cost. There was tremendous violence, even against physicians, and the economic deprivation of the local communities was unparalleled anywhere in Ethiopia, except Ogaden and parts of Hararge. Borana was occupied by thousands of TPLF soldiers stationed in almost all towns and major checkpoints and camps. Nobody wanted to go to Borana unless they had no other options – that was the situation 13 years ago.

Per my request, I was assigned to Borana, and I went there with a letter and asked the Head of the Zonal Health Department, Dr. Assefa Sime, to assign me to the most disadvantaged Health Center (HC) so that I could serve the poorest of the poor, and the most marginalized and difficult to reach population of the zone.

Here are some of the facts; Borana was the most liked place by physicians before the fall of Derg regime (because of lucrative contraband business, and the good financial status of the Borana and a grateful community), and it became the most unpopular few years later after the coming to power of the current regime. Moyale was a thriving business town which even attracted the sister of a Prime Minister to invest in a hotel industry. Years later, it became a military garrison – home to thousands of TPLF soldiers watching, at times, arming local communities to destroy each other. A few years before I came to Borana, there were 13 physicians in the Nagelle Borana Hospital (NBH), and 2-3 physicians in almost all Health Centers (HC). When I came there in 2000, there were only 3 general practitioners (GP’s) and 1 surgeon in NBH. They all had left in a matter of few years. There was a similar trend in almost all zones of Oromiya. There were more doctors in the capital, Addis Ababa (Finfinne), than in the rest of the country. Oromiya’s health facilities were to be “ghost places.”

The zonal health administration told me that they could not assign a doctor to HC when the zonal hospitals were almost empty. There were only 3 physicians in the brand new Bule Hora Hospital. Each of these hospitals were serving more than 1.5-million population at the time. As a result, I was assigned to work in the Nagelle Borana Hospital. A few months later, I had to go to the Taltalle District to supervise the National Polio Eradication Campaign.

Taltalle is a 10,000-sqkm wide district – its size is bigger than the North Shawa zone of Oromiya. We had only one car to conduct supervision, which lasted only for a few days in this big district. A certain European expatriate working for an international NGO (non-governmental organization) – who worked in Kosovo before coming to work in Taltalle – told me that Taltalle was actually bigger than Kosovo. There was no vehicle assigned to the HC, and there was no district health office. El-Dima, a police post at the Ethio-Kenya border during the Haile Selassie regime, is 105km from Millami, the main town. I had to travel to El-Dima from Millami on foot, back and forth – fresh out of high school. That was how teachers and health care workers used to travel to reach several communities in the Taltalle district. It was a difficult campaign to supervise.

Once I was there, I decided to go to Waata Wondo, a place no physician had ever set their feet on. It is only 60km from Millami. However, because of lack of road infrastructure, we had to take the longest route, through Birindar. Konso, across the Weyto River and the desert to reach Waata Wondo from the back. We had to take a better route – better is a relative term. Look at the picture below if you want to know how good that road had been.

The difficult road at a place called Abba-Roba, before crossing the Segen River to reach the Konso District

However, getting there was similar to making a spiritual journey. I lack words to express the feelings afterwards. The pride of being there, taking all the risks and personal hardships. It is, after all, a service to my country and my people. Being there for my people, against all odds and challenges! That is what I ask all physicians in training back home to consider. Graduate, be bold, and go to even the most disadvantaged and hard to reach areas, serve! You will be proud of your service to your country at the prime of your life. Always think about staying and working, and of course, cooperating with others in changing the political system to a system which is based on the best interests of all its peoples. Our vision to have a government of the people, by the people is probably the panacea. No amount of doctors’ training can change the equation, but a just system that motivates and continues to inspire the educated to serve, and serve again!

Kaayo Qabna!

Locating a village in Waata Wondo, a remote and hard to reach area of the Taltalle District in South Oromiya in 2000 during the National Polio Immunization Campaign

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* Dr. Ibrahim Elemo is the President of the Oromo Studies Association (OSA), a scholarly, multidisciplinary, non-profit international organization established to promote studies on issues relevant to the Oromo people.

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