Black Lion Hospital

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This is a tough blog post to write – not because the content is upsetting or controversial – but because I really want to get it right. I want to document some lessons I have learned from Ethiopian friends and colleagues over the last five years. One of the risks is that it will sound overly sentimental and therefore not be perceived as accurate. Another risk is that I will create stereotypes by making overly broad generalizations. Despite the risks involved, it’s an important reflective exercise for me. I have been profoundly influenced by my interaction with Ethiopia’s people and culture. It’s time to share what I’ve learned.

First 5 Family Medicine residents in Ethiopia

Colleagues from the University of Toronto and I have been working with the incredible faculty of Addis Ababa University (AAU) for the past five years. I’ve just returned from an exceptional visit where we celebrated the launch of the Ethiopia’s first program in Family Medicine.  We met the five remarkable young physicians who are the pioneers of the discipline of Family Medicine in their country. My prevailing sentiment this week was intense gratitude that I have had the opportunity to participate in such meaningful work. I have learned so much from watching my Ethiopian colleagues. Here are some of the things they have taught me:

1. Don’t be discouraged by data.

The data about human resources for health in Ethiopia present a daunting picture. With only 2000 physicians for over 90 million people and a continual trickle of doctors leaving the public system or leaving the country altogether, it would be easy to feel discouraged. Instead, Ethiopia has embarked on an ambitious scale-up of medical education including several new postgraduate programs like the one in Family Medicine.

2. Persevere.

Though the roots of the program date back much longer, it was in 2008 that the vision was revived to start a program in Family Medicine at AAU.  It has not been a simple linear process to get to point of the launch. Many times, I feared it might ever happen. But I was always inspired by the determination and perseverance of my Ethiopian colleagues. Their commitment did not waver.

3. Respect others.

I learn so much from watching the respectful manner that Ethiopians consistently display toward others. I have watched when visitors have said or done things that must have seemed crazy or hurtful toward Ethiopians.  But the response is always dignified and respectful. Everyone gets the benefit of the doubt when it comes to deserving respect.

4. Respect yourself.

One of the reasons I love working with Ethiopians is their very strong sense of self-respect.  If we do make foolish or uninformed suggestions about how to proceed on a matter, they will always listen to the ideas of outsiders. But if they know that the suggested approach is wrong, they will confidently guide the program in the direction that they know to be best.

5. Don’t be limited by humble beginnings.

Humble beginnings are not necessarily an impediment for individuals or programs. When our first five resident physicians introduced themselves this week, I was struck by the fact that they had not come from advantaged backgrounds. At least three of them said that their parents were farmers. They have lived and worked in the poorest parts of the country. But now they are inspired by the reality that they will be the first family doctors in Ethiopia – a new specialty that could revolutionize the health care system.

6. Listen first; ask questions next; then share your opinion.

This is the tradition I really need to learn from Ethiopians. I am so prone to jump in with my opinions quickly and perhaps thoughtlessly. I have observed carefully how my AAU colleagues discuss important issues. They listen well. They ask questions. They ask for advice. Then they are in a position of strength when they share their opinion that has been informed by the respectful process of letting others talk first.

7. Speak softly. This is not only pleasant but powerful.

I have noticed that my Ethiopian friends and colleagues speak gently even when they are sharing a most emphatic message. The quiet voice is not a sign of timidity – quite the contrary. It is a sign of strength and a position of power. I hope I can learn to emulate this.

8. Be patient.

I described above the determination and perseverance of many Ethiopian colleagues. But I also observe that when patience is called for, they have it in abundance. I marvel at their long-suffering spirit in the face of so much inequity, injustice and disappointment. I see how they graciously accept certain circumstances that are beyond control. My dear friend Dr. Dawit Wondimagegn taught me a new proverb this week that relates to patience. He said “You cannot push a river. It just flows.”

9. Be hospitable

For decades it has been my observation that the most generous and hospitable people are often those who have the least resources to share. This is described in the Hausa proverb “Dukiya ba ta sa kyauta, sai zuciya” which means “Wealth does not cause generosity; only the heart does”.  My Ethiopian friends and colleagues demonstrate over and over again the huge value they place on hospitality and generosity. I have a great deal to learn from their example. A Bassar proverb notes that “If you are rich and not generous, it is as if you had nothing.”

10. Be loyal

My good friend Dr. Clare Pain first invited me to Ethiopia for a meeting in 2008. One of the first things she told me was that if you become friends with an Ethiopian, they will be a loyal friend for life. I am convinced this is true. This kind of reliability and devotion is a powerful trait that I have both observed and enjoyed.  This spirit of loyalty reminds me of a Malian ritual chant which says: “I am nothing without him. If he takes a false step and trips, I trip with him, if I cannot hold him back.”

So now I’m back home – much enriched by my time in Ethiopia. The Family Medicine program has been birthed. It will be strongly led by the faculty of AAU, along with continued support from the University of Toronto. I hope that the lessons I have learned in Ethiopia will dwell deeply in me, so that I may honour those who have taught me so much.

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