Ethiopia and the quest for modern health care 2010
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Ethiopia and the quest for modern health care 2010

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Ethiopia and the quest for modern health care 2010

Ethiopia and the quest for modern health care 2010

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  • 1. Ethiopia and the Quest for Modern Health Care Enawgaw Mehari, MD Consulting Neurologist St. Claire Regional Medical Center/University of Kentucky Honorary Staff BLH FM Addis Ababa University Founder and President People to People Inc. www.peoplepeople.org
  • 2. The Quest Begins
  • 3. Emperor Lebna Dengel 1508-1540 Appealed to the Portuguese King for… “ men who make medicine and physicians and surgeons to cure illnesses…” Joalo Bermudes: surgeon-barber (1520-1535) First record of a foreign practitioner in Ethiopia
  • 4.
    • Emperor Fasilades ( 1632-1667 )
    Peter Heyling, a German Lutheran missionary practiced medicine in Gondar.
  • 5.
    • Seeking help for a skin aliment afflicting both he and his son, Emperor Iyasu sent his agent Haji Ali to Cairo in 1698.
    Emperor Iyasu ( 1682-1706 ) The French Consul in Cairo sent physician Charles Jacques Poncet. Poncet arrived in Gondar on July 11, 1699 bringing a “little chest of chemical medicines”.
  • 6. 1768 : Although not formally trained, James Bruce, the Scottish traveler, treated many including Queen Iteghe and her family for small pox in Gondar.
  • 7.
    • GONDAR
    • Armauld D’Abbadie (French) treated Emperor Sahla
    • Samuel Gobat (Swiss) treated numerous patients, including the brother of Wayzaro Wallata Teklit, the “First Lady of Gondar”
    Emperor Sahla Dengel (1832-1840) 19 th Century Modern Medicine Expanded
  • 8. Emperor Sahla Dengel (1832-1840) 19 th Century Modern Medicine Expanded Formal French and British scientific and diplomatic missions to Ethiopia in the late 1830s and early 1840s brought modern medicine to sizeable portion of the populations in Tigre and Shawa.
  • 9. Emperor Sahla Dengel (1832-1840) 19 th Century Modern Medicine Expanded French physician Petit imported smallpox vaccine from Europe. However, the vaccine was “spoilt in transit”
  • 10. Emperor Tewodros (1855-1868) 19 th Century Modern Medicine Expanded
            • Napoleon III sent a French physician,
            • Legard to Emperor Tewdros.
    • In June 1866 epidemics of cholera ,
    • smallpox and typhus broke out.
    • Understanding the infectious nature
    • of these diseases, Tewdros ordered
    • the move from Qorata to Begemder.
  • 11. Emperor Yohannes 1872-1889 19 th Century Modern Medicine Expanded Although regarded as a traditionalist Yohannes accepted Western medicine Greek King George I of the Hellenes sent Dr. Nicholas Parisis who practiced during the smallpox epidemic in 1886.
  • 12. Emperor Yohannes and Small Pox Vaccine First monarch to be vaccinated against smallpox - His commander, Ras Alulu - The Abun (head of church) - King Menilik of Shewa - King Teklehaimanoy of Gojjam - Many Children He forbid the OLD Practice of vaccination
  • 13. Dr. Andre from Hungary specialized in the manufacture and repair of weapons made artificial arms and legs for bandits and thieves whom Emperor Yohannes ordered amputation and punishment Foreign missionaries were excluded by the Emperor from working in Ethiopia proper. Emperor Yohannes IV
  • 14.
    • A keen friend of science.
    • Like his father Sahlesellasie, had
    • a pharmacy/clinic at his palace.
    • Introduction of Italians doctors
    • and medicine into Eriterea.
    • Compulsory vaccination for small
    • pox was decreed on Feb 21 , 1889.
    Emperor Menelik 1889-1913 Russian mission “pharmacy fairly extensive, every kind of drug”.
  • 15.
    • The original red cross mission of 1896 was replaced in 1897 by a second group of doctors and established Ethiopia’s first hospital.
    The Russian Red Cross Hospital - 20 beds - Several nurses and pharmacists - Absolutely free service -Cost the Russian government 7000 pounds a year
  • 16. Donated surgical instruments. The first Italian medical mission of four doctors. It was short duration due to the Italio- Ethiopian dispute. Dr. Leopold Traversi, Italian physician
  • 17.
    • -The most important
    • non-governmental
    • group to visit Ethiopia.
    • -Dr.Goffin treated many
    • including Empress Taytu’s
    • mother in Wayzero Wubdar,
    • a village in Gojjam.
    French Duschesne-Fournet The original papers describing the visit to Ethiopia (available on eBay).
  • 18.
    • Besides qualified doctors many foreigners dispensed medicine for the Ethiopian public.
    • “ from the moment you are a Ferenji, you become a Hakim”
    • Between Feb and August 1898, Drs. Wurtz and Fenski vaccinated (small pox) no less than 20,700 people mainly at Addis Ababa and Ankobar
  • 19.
    • Born in Oct 1865
    • He was not yet 3 yrs of age when his parents along with other prominent people of Gondar were seized by Emperor Tewodros and taken to Maqdala.
    • On the arrival of the Napier expedition the child was found wandering on the battlefield by British-Indian forces
    • Sponsored by Colonel Charles Chamberlain and Colonel Martin, he was taken to India and trained as a physician in Britain.
    Hakim Martin Workineh The First Ethiopian Doctor
  • 20.
    • Born in Oct 1865
    • He was not yet 3 yrs of age when his parents along with other prominent people of Gondar were seized by Emperor Tewodros and taken to Maqdala.
    • On the arrival of the Napier expedition the child was found wandering on the battlefield by British-Indian forces
    • Sponsored by Colonel Charles Chamberlain and Colonel Martin, he was taken to Chamberlain’s home in India and trained as a physician in Britain.
    Hakim Martin Workineh The First Ethiopian Doctor
  • 21.
    • Chamberlain died in 1871
    • Workineh was sent to the mission school at
    • Amritsar at the expense of Colonel Martin
    • The Missionaries christened the boy Martin
    Hakim Martin Workineh The First Ethiopian Doctor
  • 22. Hakim Martin Workineh The First Ethiopian Doctor
    • In 1986, hearing that the Italians had invaded his native
      • land he rushed to Aden, British Somaliland
    • stopped by British district officer, J. I. Harrington who
      • told him he could not proceed because of the war.
    • Subsequently, Harrington was appointed British agent
    • in Addis Ababa
    • He informed Emperor Menilek about the young
    • Ethiopian doctor.
  • 23.
    • Going Home….
    • In 1898, Dr. Martin received a letter arranging the trip to Aden to convey him to Addis Ababa.
    • Dr. Martin arrived in the Ethiopian capital
    • and presented to the Emperor.
    • Dr. Martin sent up a tent and
    • began treating patients for free
    Hakim Martin Workineh The First Ethiopian Doctor
  • 24.
    • Dr. Martin was intrigued by an old woman going back and forth in front of his tent.
    • He sent an interpreter to inquire what she desired. She replied that she wished to examine his arms and legs as she believed him to be her grandson. who had been lost at Maqdala as a child.
    • She expected a long scar on the left arm and another on the right leg.
    • Sure enough the scars were there. He reunited with his family members.
    Hakim Martin Workineh The First Ethiopian Doctor
  • 25.
    • The Emperor arranged with the British government for Dr. Workeneh to obtain leave of absence for a year. He remained in Addis Ababa till February 1901, before setting forth for Burma.
    • On the journey back he met Ras Makonnen, the governor of Harar from him he learned that the British Government at Menilek’s request has extended his leave for another year, without pay.
    Hakim Martin Workineh The First Ethiopian Doctor
  • 26.
    • In Feb 1902, Dr. Martin returned to Burma taking
    • with him Five boys to secure their education.
    • In 1908 was appointed temporary medical officer to the British legation in Addis Ababa. Where he was assisted by one of the young men he had educated in Burma.
    • Dr.Workineh stayed in the country five years until June 1913 during which period he treated the emperor and did much to popularized modern medicine.
    Hakim Martin Workineh The First Ethiopian Doctor
  • 27.
    • The first Ethiopians to be sent abroad for medical studies left during the Menilek period.
    • Gezew of Tegulat and Dagne of Allobarat both
    • of whom were dispatched to Russia.
  • 28. Ras Teferi Mekonnen Governor, Harar
    • After attending the coronation of
    • King Edward VII, he arranged for
    • British missionaries to visit Harar.
    • Ras Teferi Mekonnen gave
    • French Capuchin missionary Monseigneur Jarosseau land
    • to build a hospital
    • 1903 established first modern
    • leprosy hospital.
  • 29. Ras Teferi Mekonnen Governor, Harar
    • Established a second hospital at
    • his own expense
    • Run by Dr. Vitalien, a physician
    • from French island of Guadeloupe
    • He was called the “tekwur hakim”
    • by Ethiopians
  • 30.
    • The Russian Red Cross mission
    • was withdrawn and its
    • Addis Ababa Hospital closed.
    Set Back in 1906 1907 In Flux of European Physicians and a Dentist Among these was Dr. Vitalien, who served as Menilik’s personal physician during his prolonged illness.
  • 31.
    • Dr. Merab founded the first pharmacy in Addis Ababa on Dec 1 st 1910.
    • It was a valuable and well stocked establishment.
    • Dr.Merab’s Pharmacy closed in 1914, when he went to fight in WWI.
    First Pharmacy, 1910
  • 32.
    • Founded by the Emperor himself on the site of the old Russian hospital.
    • Gezaw and Dagne were staff ,who studied medicine in Russia.
    • Run first by Dr. Vitalien, then by several of his french successors.
    • 100 beds, 3 Eth dollars for first class, 75 cents for third class .
    Menilik II Hospital, founded in 1910
  • 33. Pre-WWII
    • Ras Taferi Mekonnen Hospital
    • 1923, Gulele
    • Ethiopian Medical Association 1927 with 25 physicians in the capital.
    • The Bet Sayda Hospital: Established in 1924.
    • “ There was no better hospital in Africa”
    • Charges were high 10, 5 and 3 Ethiopian dollars per day for 1 st , 2 nd and 3 rd classes respectively.
    • The poor were treated for free of charge.
  • 34.
    • Established Missionary Hospitals
    • Empress Zewditu Memorial Hospital, 1934, Filwaha
    • Government and Private Clinics established
    • Dentistry
    Emperor Haile Selassie (reign 1930-1974)
  • 35.
    • 1935-1940
    • War preparations in Ethiopia.
    • In 1935 founding of the Ethiopian
    • branch of Red Cross.
    • Ethiopian women’s work association, a voluntary society established mainly to supply bandages and medical comforts to the troops.
    • “ Ethiopian forces were virtually without any doctors, without any nurses and without any bandages.”
  • 36.
    • 1930: Modern Medical Legislation Began
    • 1935: A school for medical axillaries was
    • established at the Menelik’s School
    • In 1942 a Public Health Proclamation and Medical Registration was issued.
    • In 1945 Ato Araya Abebe was appointed director general of health to run the health department.
  • 37.
    • The Emperor established
    • seven ministries and
    • appointed ministers
    • and vice ministers
    • to direct them.
    • Department of Health
    • was established within
    • the Minister of Interior.
  • 38.
    • In 1947 after WW II, Formal Medical Education in Ethiopia began.
    • Department of Health started to train pharmacy assistants and dressers using the Kotebe secondary school laboratories.
    • Later in Menilek Hospital a school for laboratory , pharmacy and x-ray technicians and dressers was opened.
    • The first nursing school was started in 1950 by the Ethiopian Red Cross in the Haile Sellasie I Hospital with assistance of Swedish.
    Post-WWII
  • 39.
    • 1947
    • Ato Abebe Retta become the Vice Minister still under the Ministry of Interior
    • 1948
      • The Department of Public Health was made the Ministry of Public Health
      • First Minister was Blatta Zewde Belaineh
    • Medical Practitioners registration proclamation:
    • “ to Recognize the existence and authority of the Minister of Public Health, and function responsibility of the board for licensing and disciplining of medical practitioners”.
    Post Liberation Period (1941-1973)
  • 40.
    • The first to become qualified since Hakim Workineh
    • Dr.Melaku Bayene (India, Ohio State University and later at Howard)
    • Edited a news paper the “Voice of Ethiopia”
    • Other medical students include:
    • Hizgias Finas, (Italy) Binega Tesfa Mariam, (Italy)
    • Getahun Tessema, (American University in Beirut)
    • Abraham Abera (Austria and France)
  • 41. Dr.Melaku Beyan
  • 42.
    • 1954
    • The Gondar Public Health College established through the cooperative efforts of Ethiopian Government, WHO and USAID.
      • In the following years others returned from abroad as graduates from the American University in Beirut, and McGill University in Canada.
    Professor Asrat Woldeyes (1928-1999) Founding Member of EMA
  • 43.
    • 1962
      • The Ethiopian Medical Association Journal published.
    • 1964
    • Ethiopian Medical Association launched first annual medical conference.
    • Country’s first Medical School AAU Medical Faculty was established.
    • 1968
    • First Medical School Graduate.
    • 1972
    • The Deanship of the Faculty become Ethiopianized. The first acting dean Dr. Getachew Bolodian and the first dean was Prof. Asrat Woldeyes.
  • 44.
    • 1980s the number of physicians started to double every 5 years
    • 1987 MOH began registering doctors. Since 1987, 5,743 have been registered. Of these, 76.5% were Ethiopian
    • 1989 reached the peak with 1658 doctors of all types with 1:28,000 physician to population ratio
    • -
    • 2006 Steep decline with nadir of 638 doctors in the public sector
    • 1964-
    • 2006 AAU, Gondar and Jimma graduated 3,728 medical doctors
    • 2006 Physician to population ratio was 1:118,000
    • In 20 Years
    • 73.2% ETHIOPIAN DOCTORS LEFT
    • Ethiopia!
    DOCTORS and HEALTH PROFESSIONALS Berhan, J. 2008 Ethiopian Medical Journal 46:1-77
  • 45. 2005 139 hospitals, 87 public, 52 other 2006 The average physician to hospital ratios were: Tigray 3.6 Oromia 6.1 Amhara 4.3 SNNPR 5.3 From 76 Public Hospitals outside of Addis in 2006, there was no specialists in 36, and no doctor at all in 3. Brain Drain Hospitals Berhan, J. 2008 Ethiopian Medical Journal 46:1-77
  • 46. We have come so far! Where will we go from here?? 2010
  • 47.
    • Recommendation
    • Integrate this genesis and evolution of Ethiopian Health Care History as an element of the core medical education curriculum.
    • Testimonial rational to incorporate into the curriculum have been forwarded by distinguished scholars.
    • Develop a teaching manual for the course.
    Ethiopia and the Quest for Modern Health Care
  • 48. Ethiopia and the Quest for Modern Health Care Dr. Richard Pankhurst We extend special appreciation to Dr. Richard Pankhurst, from whom the information presented here originated.