Vascular Surgeon Leads Program to Build Emergency Services in Ethiopia

In the United States, there is wide availability of free HIV testing services to ensure the population receives routine screening and is aware of their status.


In Ethiopia, there is no standardized system of preventive care for HIV/AIDS. It is common for individuals to learn they have HIV entirely by accident when they visit the makeshift emergency department in urban centers like Addis Ababa, the Ethiopian capital city.


"There are literally no planned emergency medical services in Ethiopia," says Girma Tefera, MD, of the country where he was born and raised.


In recognition of these needs, in August 2009 the American International Health Alliance (AIHA) selected Tefera, a vascular surgeon at UW Hospital and Clinics, and his colleagues to lead an HIV/AIDS Twinning Center program funded by the President's Emergency Plan for Aids Relief (PEPFAR) to build institutional and human resource capacity for Emergency Medicine Services (EMS) in Ethiopia.


Tefera's first goal? To train dedicated Ethiopian health professionals at the University of Addis Ababa's Black Lion Hospital in how to build, manage and lead a successful emergency department. Eight fellows, four nurses and four physicians, will be the foundation of the new emergency department.


"The fundamental difference between our system and theirs is that when you go to an emergency room in Ethiopia, if you have a medical issue, you're seen by a medical specialist. If you have a surgical issue, you're seen by a surgical specialist," explains Ryan Wubben, MD,an emergency medicine physician at UW Hospital and Clinics who has joined Tefera in his quest to improve ER care in Ethiopia. "In this country, you're seen by the same physician no matter what the problem is, and then the specialists are brought in once the diagnosis has been made."


Using grant dollars, Tefera, Wubben and UW Hospital and Clinics nurse Peter Rankin, RN, spent time in Ethiopia last year and in February 2010 to study the system of health care-delivery. Last fall, two nurses from Ethiopia spent four weeks in Madison at UW Hospital. In April, two veteran Ethiopian physicians, Dr. Aklilu Azazh and Dr. Nebyou Seyoum, began a 10-week stay in Madison, where they shadowed Wubben and other UW physicians, studying the ways staff at UW handle anesthesia, cardiology, infectious disease, pediatrics and intensive care.

According to Wubben, the biggest surprise for the Ethiopian physicians so far has been the multidisciplinary paradigm - the notion that pharmacists, nurses and physicians work both informally and collaboratively to provide patient care. They've also been impressed by the way staff at UW Hospital self-critique and look for ways to improve patient care processes.

"They've really taken that aspect to heart," says Wubben. "The doctors have begun working with the UW School of Medicine and Public Health's Center for Global Health on several quality improvement projects."

The efforts of Tefera's team have already won attention and attained success. The original grant has been both renewed and doubled to include a pediatric element. That happy development is great news for Tefera's project, which was always structured for the long-term. Within the next year, Tefera and Wubben hope to return to Ethiopia to help establish an ER residency in Addis Ababa. If they succeed, it'll be the first such residency outside South Africa.

"We recognize that you can't cram into 10 weeks all these doctors need to know," admits Tefera. "But it's an important start. The bottom line is, unless we help them to build a structure, we cannot improve care."