Tomorrow, I’m going to Ethiopia to watch a dream come true. On Monday, Addis Ababa University (AAU) will launch the country’s first training program in Family Medicine and five residents will begin their training. I’ve been working on this with colleagues at AAU and the University of Toronto since 2008. There were many times over the past five years when I wondered if we would see this day. My Ethiopian colleagues tenaciously clung to the vision. Early on, they taught me a favourite Amharic proverb: Kes be kes inkulal be igru yehedal which means: “Slowly, slowly, the egg will grow to walk”.
Ethiopia has been severely affected by recent migration patterns in the global physician workforce. There are about 2100 doctors working in a country of more than 90 million people. Hundreds of physicians have left the public sector in the last 20 years to work other countries or to work locally for private facilities or non-governmental organizations. In response, the Ethiopian Ministry of Health and Ministry of Education have undertaken a massive expansion of medical education. There are now more than a dozen medical schools in the country and enrollment in some medical schools has quadrupled in recent years. As an additional retention strategy, AAU has introduced new post-graduate training programs in several clinical specialties. Hence, there was a dream to create the first program in Family Medicine.
Until now the specialty of Family Medicine has not existed in Ethiopia. About half the doctors in the country are GPs (general practitioners) who have completed medical school and internship but have no postgraduate clinical training. For decades, there have been discussions about the potential of creating a new specialty in Family Medicine. In 1995, Professor Emeritus Jemal Abdulkadir, an Ethiopian endocrinologist and longtime advocate of new training options for GPs, wrote: “…the place of general practice in Ethiopia’s health care system is still undefined. There are very few incentives to attract young doctors to it as a career. As a result, most see it as a temporary occupation…” Two years ago in an editorial for the Ethiopian Medical Journal, Professor Pawlos Quanaa entreated “Is it not time to launch the forgotten Family Physician graduate program?”
A strong program in Family Medicine can make a vital contribution to the improvement of health systems. It will prepare a cadre of comprehensive-care physicians who should be well trained, fairly distributed and appropriately resourced. Graduates will be competent in a broad range of technical, surgical and emergency skills. Family physicians will help provide better access to services and prevention along with early recognition of undifferentiated illness. The training will prepare family physicians to be an essential part of inter-professional primary care teams.
Dr. Dawit Wondimagegn, Associate Dean of the Addis Ababa University School of Medicine is the inaugural Program Director for Family Medicine. When asked for his sentiments about the future of this new specialty, he said “I think family medicine is going to change the face of primary care in Ethiopia.”
It will be my privilege to witness the birth of this new program. Stay tuned for an update next week and an introduction to Ethiopia’s Family Medicine pioneers.