By Tom McBrien |

Three patients who would have normally died of kidney failure received the first kidney transplants in Ethiopia thanks to a partnership between the University and Ethiopian doctors.The partnership between the University Hospital and St. Paul’s Hospital Millennium Medical College in Addis Ababa aims to train Ethiopian doctors in sub-specialties such as transplantations and obstetrics while also helping the University train its students and faculty.

By focusing on building the kidney transplantation services first, the program intends to train Ethiopian specialists and improve hospital services such as laboratory facilities and the intensive care units — all improvements that can then be spread to hospitals across the country.

Senait Fisseha, adjunct professor of obstetrics and gynecology at the University and a native Ethiopian, has dreamed of participating in a program like this since she started her medical training.

“When I came here for school, all along from undergrad I had a conception of going back to work on building the healthcare system in Ethiopia,” she said.

As a medical fellow, Fisseha traveled to Ethiopia about two times per year, building connections she hoped would someday benefit her country. First, she established ties with the Ethiopian Ministry of Health, which was supportive of her efforts.

“Unless you accept that many men and women will be left to die, there is no other option,” Fisseha said. “And transplants are much more cost-effective long-term than dialysis. So the government is committed to making this work.”

In 2011, Fisseha reached out to Surgery Prof. Jeffrey Punch, a transplantation specialist with experience doing mission work in Africa, and Internal Medicine Prof. Akinlolu Ojo, a Nigerian nephrologist with research projects in Africa.

The three, motivated to enact lasting change, agreed that the program had to focus on training.

“There are many universities around the United States and Europe where faculty or large groups of people will go and do these big fancy surgeries and leave,” Fisseha said. “That usually does more harm than good in that country because they’re not thinking of complications or teaching the local faculty. So (Punch) was really careful from the beginning to say that that’s not what he wants to do.”

Though the program focuses mainly on transplantation services, Punch said all sub-specialty care should improve due to associated infrastructure and training changes.

“The lab has to get better, the nurses have to get better, the ICU has to get better. Even housekeeping has to get better because everything needs to be cleaner,” Punch said. “Everything has to get better for transplant to be a success, and that’s why it took so long. They have other needs, too, like open-heart surgery, and many of the things that they needed to put in place for kidney transplant to be successful will be there when they get around to initiating an open-heart program at St. Paul’s.”

Fisseha and Punch both said despite the success of the first three transplants, many Ethiopians who need dialysis or a transplant will not be able to receive medical care. From observing their neighbors’ efforts, Ethiopian officials realized the training and infrastructure improvements need to be methodical and thorough.

“Many of the other countries that have started kidney transplants like Ghana, Nigeria and Kenya, they’re honestly not doing it in a systematic way and honestly I think it’s hurting the development of that process in their countries,” Punch explained. “The way it’s going to work in Ethiopia is there will be one major center that will be very well established and will become hopefully a high-volume place, so then it will have the resources to train additional people that can start other programs in surrounding cities.”

The program organizers hope the supply of life-saving surgeries can match the demand within 20 years. Despite the slow training progress, Fisseha explained, the new program provides additional cause for optimism.

“We are seeing a fascinating trend of a lot of young faculty who would otherwise leave the country staying in-country to train and serve their people. So really it’s been quite rewarding,” she said.

There is no predetermined end to the partnership. Even after the formal program ends, program organizers hope collaboration will continue.

“I suspect it won’t end in a year, but it will probably end by three years. I don’t know how that timeframe will work exactly. And then we will hopefully continue to collaborate because I think it’s mutually beneficial,” Punch said. “It’s an opportunity for our residents to train and see diseases they don’t see back here. I’ve seen more cases of tuberculosis in Ethiopia than I have during my 25 previous years as a doctor. And that will benefit me if I ever run across a case of TB around here, which may happen.”

Source: The Michigan Daily
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