FDN journey to Ethiopia 2020 – report from 21^st of February to 7^th of March

 

We started our trip to Ethiopia together with a big group of members from Ethiopia Witten e.V. in Frankfurt airport in the evening of 21^st of February 2020. Some of the members were part of the Education group, for example some teachers and pupils from Witten, and some of them belonged to the medical team from different origins all over Germany. It was a very interesting mix of people coming together for one common goal – they are all working together to help improving the conditions for people in Ethiopia. The main focus is on school education and medical care, but there are also other projects with the fire department and campaigns for clarification of the general population about different topics. So it was going to be a very interesting journey with a lovely group of people working together on a great project – and we were very thankful for the chance to be a part of it. The reason for our journey was to get to know the project better and especially to get in contact with the medical students to look for a topic for us to work on with them together – just like we do it in Albania since 2002.

 

After a short stay at Addis Abeba airport in the morning of 22^nd of February we arrived at Mekelle airport. Ahmedin Idris, the head of the project, was already waiting for us there. He and Jürgen Jeremia Lechelt arrived one week earlier because of the urban partnership between Witten and Mekelle. We first did a short group photoshooting and then went to the Axum hotel by bus and headed up to the rooms. At 2 pm we started our short sightseeing tour around Mekelle and visited Ayder hospital – the main place for the medical team. They took us around in the whole building  and showed us the different departments. We finished our first day in Ethiopia with a joint dinner in the Karibu restaurant.

 

In the early morning of 23^rd of February the whole group left by bus to get to the big opening of the Kile Ethiopia Witten school. After a four hour bus ride through the dry landscape we arrived at the place of happening. There was a mass of Ethiopians singing and dancing and celebrating the new education center in the desert. We where overwhelmed by the enthusiasm of the people. They came from many different places in the area to be part of that big event. Even some Ethiopian TV channels where there to report the ceremony. After the official opening of the school, the German pupils from Holzkamp school in Witten planted some trees for the school garden. After that the whole group was led around the school grounds and the responsibles showed us what they have achieved together over the last year. We also saw the big tree, where the birth place of the school was located. The first pupils where taught in the shadow of it before the regular school was built with the support of Ethiopia Witten e.V. The Ethiopians prepared a big ceremony with several speeches of responsibles, delicious food and presents for the people from Ethiopia Witten who enabled the building of the school. In the end of the ceremony Dr. med. Gabriele Wehr gave a speech to inform about the riscs of the rheumatic fever in order to avoid the early development of the disease in childhood. We left the place in the early afternoon to visit another school supported by the association: the Chekon school. This is a school that is supported for many years by Ethiopia Witten e.V. We also were welcomed there very warmly by the pupils and teachers. They invited us for a traditional coffee ceremony. We promised them to come back on Tuesday with some materials for the school and then moved to our hotel in Mekoni with the whole education group. The medical team got back to Mekelle the same day to start their work in the Ayder hospital on Monday morning.

 

We made our way to the Basale Holzkamp school in the morning of 24^th of February. The education group planned to leave some school materials there – some new school books in their own language, pencils and sweets. A highlight was the set of tricots for the soccer team and the brand new footballs sponsored by a German sports teacher. We visited the classes during their regular lessons and the three German pupils had the opportunity to talk to the Ethiopian children about their future plans and wishes – with the help of our kind translator Aynealem. There was a little time left to inaugurate the new footballs in a common soccer game in the schoolyard. After school was finished and the pupils went home we were invited to try some self crafted beer before we had to leave to get back to our hotel. In the early evening we visited the market in Mekoni to get an impression of the city life there. We ended our third day with a joint dinner with the whole group to recap he recent events.

 

On the 25^th of February we made our way up to Chekon school again to bring them some materials and look for the room of the Dignity period project. This is an initiative started by the Americans to support young girls to cope with their menstrual period. They found out that many of the young ladies are blamed for it by the other people in their surroundings and that they are forced to sit above a hole in the ground until it stops after a few days. So they decided to produce some reusable sanitary pads and build some rooms for them to withdrew from public. We visited this room at the Chekon school and tried to find out what should be improved there. For that reason Aynealem talked to one of the female teachers who is responsible for the project there and to some of the female pupils in the age of 13 to 15 years. During following coffee ceremony the school materials were given to the rector of the school so that he could distribute it to the teachers and classes. We were really surprised when we we all got some traditional clothes as a present from the school team as thanks. Our next program item was set in the evening in Mekelle, so we had to get back to the Axum hotel in the afternoon. The whole group was invited to a film presentation by the daughter of Ahmedin Idris. Anisa showed us the film “Elsewhere. Alone in Africa” by Anselm Nathanael Pahnke. It is a documentary film about a young man travelling through Africa by bike – most of the time on his own. Anisa asked the audience in the end if they could imagine that a female may have done this on her own. We got back to the hotel for a dinner with the whole group, so the both groups – education and medical team – could exchange their experiences of the past few days. For us it was planned to spend the rest of our time together with the medical team in Mekelle at Ayder hospital to get an impression of the everyday clinical practice and also to get in contact with the medical students. The rest of the education group planned to visit some other schools in the other direction from Mekelle in the following days. So the first part of your journey was finished at that point and we were really excited about the upcoming events of the remaining 10 days in Ethiopia.

 

From Wednesday 26th until friday 28th our FDN Team and the German physicians and nurses, went to Mekelle’s Ayder Hospital. The hospital, which is the biggest in the Tigray Region, is the main hospital attached to Mekelle’s Faculty of Medicine. It has a total capacity of 500 hospital beds. The hospital is constantly developing and modernizing it’s departments and technical facilities. Over the years people from various nations and organizations helped the local developers with financial and material contributions, so that today complex interventions e.g. coronary catheters, can be done. Since some of these procedures are very costly and the majority of the patients cannot afford them, they are not often performed.
The university campus is on the same terrain as the hospital and many student residences are on campus as well. We got to know Lydia and Gedam, both heads of the student department, who we talked to during the following days. During these days at the hospital, we got the chance to attend some of the medical morning meetings, case and research presentations, which where held by resident doctors. The presentations where mostly held in English, the main language used in the medical field, and the sheets where projected on a wall. It was interesting for us to see, that studies and data from all over the world where presented and discussed.

 

Later these days we were permitted to join the residents and the chief of department on their doctor’s visit round in the cardiological ward. During their round the residents talked to patients, performed supervised examinations and were questioned about the following treatments and possibilities. Overall the ward round was thoroughly but very time-consuming and the residents were questioned about many therapies, which cannot be accessed in Ethiopia.

Through Dr. Ahmedin Idris’ good connections with the hospital staff and directors, we got in contact with many important people at Ayder Hospital and scheduled appointments for the following days. Our focus while interviewing various directors, heads of departments, student coordinators and students, where to collect as many information as possible about the medical course of studies in Ethiopia and to find a common ground on which we could enable a partnership and cooperation.

Studying medicine in Ethiopia takes 6 years in total. The first six month are filled with „pre-study“ classes, which cover a general formation in anthropology, sociology, psychology, IT, medical ethics and English. The following six months consist of classes about anatomy, physiology, embryology and biochemistry. In the second year, the students learn about pathologies and attend preclinical preparation courses. These preclinical classes are so called „bridging“ classes in which students learn how to perform clinical examinations and how to obtain information about the history of the present illness and the clinical history of patients. The next 3 years of medical school consist of many ward rounds and bedside teaching, as well as sciences of diagnosis and examinations. Examinations are divided into „minors“ and „majors“. Minors are theoretical examinations, whereas majors are always combined with a practical part, in which the students shadow the residents and perform small interventions. The sixth and therefore the last year, is an internship, during which the students work at the hospital. This internship is rewarded with a basic salary. After graduating from medical university physicians can continue their medical careers by doing a specialization. The specialization training does not cost the physician but he or she commits to stay at the hospital for a certain amount of time, before he or she is permitted to work at a private office.

 

As mentioned before, our team got the chance to interview many important people at the Ayder University Hospital. The following represents a summary of the various interviews, since the opinions and responses had many resemblances. We asked about what they think could be improved in order to create a better study course for their students and their future. One of the most mentioned topics was communication. Furthermore the doctors wished the students would communicate more with their patients, which sometimes presents itself to be difficult due to language barriers within the country. In Ethiopia over 80 languages are spoken and verbal communication can get complicated if two parties do not speak the same mother tongue. Another point which was emphasized by both students and doctors, is that the communication between students and physicians seems to be difficult and lacks honest feedback. We were taught that due to cultural reasons there is a strong hierarchy between doctors and students and that it is hard to overcome these barriers and find a common ground. To be more precise: e.g. the students wish they could give more honest feedback and also negative to their professors and teachers. They do not feel safe doing so, because they fear consequences of upsetting their counterpart and having to deal with the consequences. The term „lack of professionalism“ was often used by both doctors and students. We were told that there had been a training covering professionalism but it was only done once a few years ago. The reaction towards this training program was positive and the wish of reenacting  something similar was very present.

We mentioned that our university emphasizes the doctor-patients-communication and that we have to participate in several classes in which we learn about its importance and challenges. We explained that our training consists of many role plays and group analysis of fictive situations or videos of such situations. This insight was received very positively by both, student and doctor groups and we asked wether it would be possible to elaborate something similar at Mekelle’s Medical University. The responses were very positive towards the idea and we started to discuss further how this could be approached.

For us it was very important to get a deep insight on the students’ perspectives and what they would want such a training to cover. A few topics we agreed to work on for a future training were: group discussions with students and physicians, a safe space where answers and opinions do not get judged; a theoretical part, in which verbal and non-verbal communication is covered; role-plays and reflection.
We decided to approach these topics step by step, while exchanging and working together towards a training program, which could be integrated into the curriculum. For further collaboration and keeping in touch we created a messenger group on Telegram and exchanged emails. For the future we decided that we would get more in contact when we have ideas to work on.

After the interesting interviews and discussions at the hospital, we visited more of Mekelle and its beautiful surrounding landscapes. Our group visited an ancient rock church in the Tigray Region, which gave us an insight on the history of the country. We felt very grateful to get to know more about the country we were visiting.

 

In the morning of 5^th of March we drove to the clinic with all the remaining doctors and joined them on the weekly early meeting where one of the residence presented an interesting talk about “Hypertensiva and their application”. Afterwards we had an informative conversation with Dr. Fasika – the head of the Department of Medicine at Ayder Hospital. He gave us interesting input on the curriculum and the medical studies here in Ethiopia. In particular we focused on Doctor-Patient-Communication and Communication between Students and Professors, as in the previous week the student coordinators told us that they wish to learn more about communication. So far the curriculum only includes 5 weeks of bridging (between the preclinical and the clinical years) where they focus on professionalism and ethics – but nothing more about communication.

Dr. Fasika arranged for us to speak with multiple other doctors, teachers and students during the rest of this week. During the next days we spoke to two pediatricians – Dr. Abraha and Dr. Abel, to the pediatric surgent Dr. Seye, to the medical director and cardiac surgeon – Dr. Kibrom, to the gynecologist Dr. Ermias, to the internist and cardiologist Dr. Samuel and to a couple of students. Throughout these conversations we could gather lots of interesting facts and information – we got a really good overview about the Ethiopian curriculum, the apprenticeship, the medical system and their ideas and wishes regarding Doctors-Patient-Communication, Communication between Doctors and students as well as constructive Feedback-mechanisms.

 

Some of the most important points for us to focus on:

• Give students more security in communication with patients using some theoretical inputs and role-modeling including group feedback
• Focus on the anamnesis interview, verbal and nonverbal communication
• Improve the communication between students and teachers, work on a better feedback-system
• Respectful communication between all participants of the therapeutic process as aim.

 

On Friday – our last day at Ayder Hospital – we accompanied the remaining German doctors to the morning meeting of the Radiology department to listen to an interesting presentation from one of the German doctors. Afterwards we were able to shadow some of the doctors on their round through the ward, which gave us a good overview how things are done in Ethiopia compared to Germany. We enjoyed our last evening in Mekelle with a few of the remaining colleagues of Etiopia Witten e.V. and packed our things to go back to Germany the next day. On Saturday, the 7^th of March 2020 our exciting journey ended and we took our flight back to Frankfurt.

 

 

 

We are very thankful that it was possible for us to gain all these exciting experiences in Ethiopia together with all these amazing people and hope we will return soon to realize our plans for a cooperation with the Ethiopian medical students. Our plan is to set up a concept for a communication seminar in cooperation with the Ethiopian medical students. Dr. Fasika will enable us to get some lecture time to do a test run of the seminar when the time is right, as a longterm plan it should be integrated in the Ethiopian curriculum if our concept is successful. There were also some ideas for other projects in the future, so we hope that this cooperation is the start of another working partnership between medical students from different countries – just like the one we already have with the Albanian medical students.