Making a difference in Ethiopia

Hope and healing for the country’s trauma victims

In Ethiopia, proper fracture and trauma care is not always attainable. As commonly seen in other low-income countries, a plethora of local factors contribute to a far-from-ideal surgical environment, leaving much to be desired in terms of fracture management.

The number and distribution of surgeons specializing in Trauma and Orthopedics (T&O) is not optimal. There are only about 50 T&O surgeons for a country with a population of more than 96 million, and 80% of them practice in Addis Ababa, Ethiopia’s only city with a population of more than a million.

The T&O residency program at the Black Lion Hospital (BLH) in Addis Ababa is the country’s main program, where about 20 residents are trained per year. However, the quality of training requires further development. Most residents remain in Ethiopia after their training.

To address the situation, the Ministry of Health (MoH) of Ethiopia developed a strategic plan to put up regional hospitals that should be able to cover the increasing trauma burden.

Assessing needs and identifying areas of intervention

The AO Alliance Foundation also recognizes the fracture treatment gaps in Ethiopia and convened a needs assessment meeting that took place in Hawassa, Ethiopia, on 23-24 September 2015. The attendees included 18 participants, residents, surgeons and healthcare executives, including the CEO of Australian Doctors for Africa (ADFA), Dr Graham Forward. ADFA, a nonprofit organization based in Perth, Australia, has had a presence in Ethiopia for over 20 years, helping to develop fracture care, mainly in supporting infrastructure development and equipment.

AO Alliance meeting participants

The consensus at the needs assessment meeting was that there were two large axes of intervention where AO Alliance Foundation can make a difference:

  1. Education, with emphasis on the residency program at BLH and the regional hospitals being developed
  • Educational support for the BLH residency program (a 5-year plan based on discussed and determined needs per year)
  • Facilitation of various fellowships with emphasis on AO Alliance Foundation fellowships within AO Alliance Foundation Reference Centers
  • Reverse fellowships with established terms of reference
  • Operating room personnel training support in provincial hospitals
  1. Infrastructure support based on the strategic plan of MoH, in collaboration with the ADFA
  • 2015: Bahir Dar
  • 2016: Hawassa, Mekelle, Harar
  • 2017: Jimma, St Paul Hospital and Menelik II Hospital in Addis Ababa

The meeting participants also agreed on a progressive rollout with clear goals, key performance indicators and exit strategies, and that the plans should not completely stray from Addis Ababa.

Ethiopia meeting participants discussing

Positive changes over the next 5 years

The AO Alliance Foundation Board has approved the following educational events for 2016:

  • Bahir Dar: AO Alliance Foundation non-operative course
  • Hawassa: AO Alliance Foundation operative course for operating room personnel
  • Addis Ababa (BLH): Pre-basic course for residents

A full proposal for Ethiopia will be presented to the AO Alliance Foundation Board in December 2015. The proposal will emphasize educational support for the main residency institution (BLH) and support for one to three regional referral operative centers, developing up to five surgeons in each center over 5 years.

Although the general guidelines have already been set and discussed during the meeting, other details regarding skill setting, for instance, will be fine-tuned over the next years.

It is hoped that, together with the MoH of Ethiopia, these plans will come to fruition over the next 5 to 7 years. For the fracture victims and their families, these changes could mean the difference between despair and healing.