Sunday, 13 May 2012

No longer a Ferenji

Been back in Toronto for a week now, more or less over the jet lag, and trying to put things in perspective.

I was quite relieved in a way to study the UN Human Development Index (a measure of wealth, education and health) and find that Ethiopia was 174th out of 187 countries listed.So what I saw was fairly close to the bottom of the barrel, almost as bad as things get anywhere in the world. One way to look at is that in Ethiopia they only have two phones for every 100 people (including both cell and land-line phones!).

There is some money in the country - a lot of stuff is getting built in Addis and in Gondar, and there are some nice restaurants, hotels and shopping malls, but overall its still a very poor country with little money. GDP is $848 per person, of which 2.2% or $19 is spent on health care.

This explains why everything in the hospital was pretty much as cheap and nasty as you could imagine, from the IV tubing which always kinked to the IV bags which had no injection port, the re-used endotracheal tubes and spinal needles and to the paper in the charts which was thin, grey and friable.

Medical education does seem to be a priority, and there are lots of smart students at all stages getting quite a thorough book knowledge of how to provide medical care. I cannot imagine that, despite the best efforts of TAAC and similar groups, they will choose to stay in the country. As we talk about dining in Ethiopian restaurants in Toronto, we make it obvious that they could emigrate and yet preserve much of their cultural life overseas. As we talk about how we care for our patients in Canada, it shows how much better medical care they could provide for their patients if they practised in a developed country. When we fly to Lalibela for one weekend and Gondar the next, we display mind-boggling disposable income to people who have lived all their lives in Ethiopia but only sees a few of the sites of their own country. Why stay and work in a hospital with an intermittent supply of running water in the operating rooms and only one ventilator and no ABG machine in the ICU when you have heard of what else is possible? I don't think you can build a modern health care system on the money currently available in Ethiopia. Maybe if these residents go to work overseas and send money back to develop the Ethiopian economy, that's the best thing they can do.

On a more personal note, Addis is just not my kind of City. It is too new, too big, too polluted, too lacking an natural or man-made beauty. If it was in Europe or North America, there  would be no reason I would ever go there. Also, maybe teaching residents is not what I do best. I found the university atmosphere , where everyone watches and assesses everyone else, rather constricting., and our mandate, to do what we are asked to do and only teach the residents, without looking at the broader system in which they work, too limiting.

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