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Educators Without Borders Teaching psychiatry in Ethiopia

Educators Without Borders Teaching psychiatry in Ethiopia

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Educators Without Borders Teaching psychiatry in Ethiopia

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  1. Educators Without BordersTeaching psychiatry in Ethiopia John Teshima Staff Psychiatrist Division of Youth Psychiatry

  2. Learning Objectives At the end of this presentation, participants will be able to: • describe some of the distinctive features of mental health care in Ethiopia • debate the role that educational institutions in developed countries can play in the training of health professionals in developing countries • reflect on the challenges and rewards of teaching psychiatry in Ethiopia

  3. Ethiopia • population 81 million • half of the population is under 18 years old • one of the world’s poorest countries • gross national income per capita is 1190 international dollars (WHO, 2008)

  4. Prevalence of mental health problems • 12-18.7% for all disorders • 0.9% for schizophrenia • 1.8% for bipolar disorder • 10.8% somatoform disorders • 2.7-3.7% problem drinking • suicide rate 7.8 per 100,000 (Alem, 2001)

  5. Mental health beliefs • most Ethiopians believe that psychiatric symptoms are due to spiritual causes • they first seek out traditional healers • typical treatments: herbal remedies, holy water, exorcisms • only when such methods fail, do families seek modern psychiatric treatment (Alem et al., 1999), (Alem, 2001)

  6. Mental health services • 54 outpatient clinics • staffed by psychiatric nurses • 6 inpatient wards in general hospitals • only in 4 out of 9 federal regions • one psychiatric hospital • Amanuel Hospital in Addis Ababa (Desta, 2008)

  7. Mental health services • in 2002, there were 9 psychiatrists • all practicing in Addis Ababa • all foreign-trained

  8. How to increase Ethiopia’s psychiatrists? • continue to send medical graduates abroad for training • establish a training program locally with Ethiopian faculty • import a curriculum and faculty from an existing training program

  9. Problems with sendinggraduates abroad • they don’t come back “…there were more Malawian doctors practicing in Manchester than in the whole of Malawi.” (Broadhead & Muula, 2002) • roughly 80% of Ethiopian medical school graduates leave to work in other countries (Araya, personal communication, 2008) • they come back with knowledge and skills that are not specific/relevant to the local context

  10. Problems with establishing alocal training program • not enough faculty to teach and supervise • challenging for a small number of faculty to create a curriculum

  11. Problems with importing acurriculum and faculty • curriculum is usually the same as for the original institution (Harden, 2006) • thus can be insensitive or irrelevant to the local context • focus tends to be revenue generating • e.g., Cornell University in Qatar, Duke University in Singapore (Harden, 2006) • not feasible in a poor country such as Ethiopia

  12. TAAPP’s solution • in 2002, the Toronto Addis Ababa Psychiatry Project was created • a collaboration between the Departments of Psychiatry at U of T and Addis Ababa U • combines the numbers and strengths of U of T faculty with the local experience of Addis Ababa U faculty • U of T faculty providing their services pro bono

  13. Format of TAAPP • teams of two psychiatrists and one resident from U of T spend 1 month each in Ethiopia • each team collaborates with the Addis Ababa faculty to develop a curriculum • 3 trips per year initially • trips focus on a specific theme, e.g., Psychotic Disorders, Child Psychiatry

  14. Teaching duties of TAAPP • formal seminars and workshops 3 afternoons per week • clinical supervision: • inpatient wards • outpatient clinics • emergency department

  15. My TAAPP experience • in the summer of 2007, my wife and I agreed to go on a TAAPP trip in 2008 • after months of meetings and many hours of preparation, we left for Addis Ababa on March 8th

  16. Formal teaching challenges:the content

  17. Formal teaching challenges:the content • some mental health problems have very different prevalence rates in Ethiopia • e.g., 1.5% for ADHD (Ashenafi et al., 2001) • only 14 psychiatric medications are available in Ethiopia • a few typical antipsychotics, a few TCAs, lithium, valproic acid, a few benzodiazepines, fluoxetine

  18. Formal teaching challenges:the process

  19. Formal teaching challenges:the process • engaging the residents in interactive teaching methods was initially slow going • teaching in Ethiopia is almost exclusively didactic • limitations to the classroom environment

  20. Clinical supervision challenges

  21. Clinical supervision challenges • high volume of patients to see • patients were very ill • treatment and disposition options were very limited

  22. Teaching rewards • after a warm-up period, the residents did engage well in interactive teaching • the residents were very quick to implement new knowledge or feedback on their performance

  23. Conclusions • Ethiopia desperately needs more mental health professionals • international collaboration is a feasible approach to developing training programs • teaching can cross borders, languages, and cultures