Ethiopia and the Quest for Modern Health Care

Enawgaw Mehari, MDConsulting NeurologistSt. Claire Regional Medical Center/University of KentuckyHonorary Staff BLH FM Addis Ababa University

Founder and PresidentPeople to People Inc.www.peoplepeople.org

The Quest Begins

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

Emperor Fasilades ( 1632-1667 )

Peter Heyling, a German Lutheran missionary practiced medicine in Gondar.

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”.

1768:

Although not formally trained,

James Bruce, the Scottish

traveler, treated many including

Queen Iteghe and her family

for small pox in Gondar.

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)

19th Century Modern Medicine Expanded

Emperor Sahla Dengel (1832-1840)

19th 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.

Emperor Sahla Dengel (1832-1840)

19th Century Modern Medicine Expanded

French physician Petit imported

smallpox vaccine from Europe.

However, the vaccine was “spoilt in transit”

Emperor Tewodros (1855-1868)

19th 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 natureof these diseases, Tewdros orderedthe move from Qorata to Begemder.

Emperor Yohannes1872-1889

19th Century Modern Medicine Expanded

Although regarded as a traditionalistYohannes accepted Western medicine

Greek King George I of the Hellenes sent Dr. Nicholas Parisis who practiced during the smallpox epidemic in 1886.

Emperor Yohannesand 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

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

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 Menelik1889-1913

Russian mission “pharmacy fairly extensive, every kind of drug”.

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

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

-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).

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

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 WorkinehThe First Ethiopian Doctor

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 WorkinehThe First Ethiopian Doctor

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 WorkinehThe First Ethiopian Doctor

Hakim Martin WorkinehThe 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.

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

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

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

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

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.

Ras Teferi MekonnenGovernor, 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.

Ras Teferi MekonnenGovernor, 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

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.

Dr. Merab founded the first pharmacy in Addis Ababa on Dec 1st 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

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

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 1st, 2nd and 3rd classes respectively.

The poor were treated for free of charge.

Established Missionary Hospitals

Empress Zewditu Memorial Hospital, 1934, Filwaha

Government and Private Clinics established

Dentistry

Emperor Haile Selassie(reign 1930-1974)

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.”

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.

The Emperor established

seven ministries and

appointed ministers

and vice ministers

to direct them.

Department of Health

was established within

the Minister of Interior.

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

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)

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)

Dr.Melaku Beyan

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

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.

1968First 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.

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

1989-2006 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

2005 139 hospitals, 87 public, 52 other

2006 The average physician to hospital ratios were:Tigray 3.6 Oromia 6.1Amhara 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

HospitalsBerhan, J. 2008 Ethiopian Medical Journal 46:1-77

We have come so far!

Where will we go from here??

2010

• 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

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.