Long-Distance Collaboration Proves Helpful to Ethiopians, Canadians

Abstract

Back to table of contents Previous article Next article Professional NewsFull AccessLong-Distance Collaboration Proves Helpful to Ethiopians, CanadiansAaron LevinAaron LevinSearch for more papers by this authorPublished Online:3 Aug 2015https://doi.org/10.1176/appi.pn.2015.8a6AbstractPsychiatrists from the University of Toronto travel far to help colleagues develop an expanded capacity for training.Starting from the most modest beginnings, a few Ethiopian psychiatrists, with some help from some visiting Canadians, have developed a program to train new colleagues and expand the profession within their country.A dozen years ago, there were only nine psychiatrists in all of Ethiopia, then a nation of 77 million people. As in many developing countries, there was no psychiatry residency program. When young medical graduates wanted to train as psychiatrists, they had to travel abroad. Too often, they remained overseas and never returned to practice in their homeland.However, three insightful Ethiopian psychiatrists—Atalay Alem, M.D., Mesfin Araya, M.D., and Abdul Rashid Bakali, M.D.—decided to change that. They invited the University of Toronto’s Department of Psychiatry to help them start the country’s first psychiatry residency program in January 2003.The university, which also sends psychiatrists to some of Canada’s most remote northern villages (Psychiatric News, July 17), began work with the Department of Psychiatry at Addis Ababa University in Ethiopia in November 2003, when the first in a long line of Canadians arrived for a month-long training visit: Brian Hodge, M.D., Ph.D., Lisa Andermann, M.D., M.Phil., and one of their residents, Kevin Chopra, M.D.That was the start of the Toronto Addis Ababa Psychiatry Project (TAAPP). Soon teams of two University of Toronto faculty members plus one resident were heading out to Ethiopia three times a year to teach, observe, and clinically supervise trainees as part of an initial three-year training program. Before each visit, the Ethiopian faculty planned with the Canadians the content of the mission. Some of the Ethiopians have also traveled to Toronto for fellowships.Part of expanding community mental health services in Ethiopia means involving local healers, said Clare Pain, M.D., shown above with Yonas Baheretibeb, M.D. (center), chair of the Department of Psychiatry at Addis Ababa University, and a guard as they visited an important Holy Water site, the traditional way Ethiopians have sought treatment for physical and mental health issues.TAAPP“The Ethiopians are our colleagues and partners in every respect,” said Clare Pain, M.D., an associate professor of psychiatry and director of the psychological trauma program at Mt. Sinai Hospital.“The government has invested heavily in education at every level,” she said in an interview. “Since 2008, they have opened more than 30 universities. They have an enormous need for faculty to train medical students.”Dawit Wondimagegn, M.D., now an associate professor in the School of Medicine at Addis Ababa University, was among the seven psychiatrists who finished the residency program’s second class in 2007. During the month-long visits by the Toronto teams, he and his colleagues were directly supervised in clinic for two full and two half days per week, with the rest of their time occupied in didactic training.“One nice part was that the Toronto people didn’t impose their practices on us,” said Wondimagegn in an interview. “We had the freedom to be creative and adapt or modify what we learned to suit conditions in Ethiopia.”The program also helped him learn methods of teaching psychiatry, he said. A total of 44 Toronto faculty members and 29 residents have taken part so far, said Pain. In reality, many more Canadians are involved, counting the stay-at-home colleagues—who all pitch in and fill the gaps created by the team members’ absence.In the 12 years the residency program at Addis Ababa University has operated, 60 Ethiopian psychiatrists have graduated, and there are now 41 psychiatrists working in the country. A second residency program has begun at Jimma University, about 200 miles from the capital. Capacity among the local psychiatrists has grown sufficiently that the Toronto contingents now visit just twice a year.The model’s success led to an expanded version, the Toronto Addis Ababa Academic Collaboration (TAAAC). Today it includes representatives from the University of Toronto’s Faculties of Nursing, Pharmacy, Dentistry, Library Science, and Applied Science in Engineering, as well as a dozen specialties within the Faculty of Medicine.“Everyone who goes is a volunteer,” said occupational therapist Marci Rose, BSc.O.T., the administrator for TAAAC and a co-leader of its rehabilitation and occupational therapy unit. “It’s not service delivery; it’s educational capacity building. We feel that co-training and co-teaching is the best model to build capacity.”One-third of Ethiopia’s psychiatrists now work outside the capital and have opened departments in six different university-affiliated hospitals, helping to expand mental health services in the country’s periphery. As the number of Ethiopian psychiatrists has grown, they have lobbied the government to move away from the former asylum model of care to integrate psychiatric care into every level of health care.With their recent Grand Challenges Canada grant, the Toronto teams are now helping to provide basic psychiatry training to nurses and primary care clinicians so that they can provide some mental health services and interpersonal therapy, said Pain.Also, several team visits in recent years have addressed forensic issues at the request of their Ethiopian hosts. People with mental illness who were accused of crimes were often jailed for extended periods before psychiatric evaluations could be performed. Now, with the help of Toronto’s Philip Klassen, M.D., and Judge Richard Schneider, the Ethiopians can divert some of those defendants through a new mental health court that opened in May 2015, believed to be the first of its kind in Africa. A forensic fellowship and a master’s degree program in psychiatry for mid-level health workers are both in the planning stages.“The program has had a huge impact on the development of medicine in Ethiopia,” said Wondimagegn.The learning works both ways. A survey of 11 residents who took part in the program found that they valued the opportunity to teach others while learning to adapt and collaborate with colleagues from another culture.“We are privileged people who get to support remarkable change in Ethiopia, one of the poorest countries in the world now set to achieve its aim to be a middle-income country in the next decade,” said Pain. ■More information about the Toronto Addis Ababa Psychiatry Project can be accessed here. ISSUES NewArchived