Story of Internal Medicine in Ethiopia

By Ismael Shemsedin (MD)

Medicine has changed over the last 60 years more than it had over the remainder of its history. Diseases thought as death sentences a century back are not a concern any more, with the unraveling of the human genome this has become all more auspicious. As the field grew there arose a need for dedication of the professional’s effort to the study and practice if a specific aspect of medicine. Thus emerged specialization and ultra-specialization as the epitome of current medicine. 

As a result of the evolution of medicine the generalist omnipotent physician who is a clinician, a scientist, a teacher, a philosopher, a priest, and all in one man became extinct except a tail tail of its legacy in the internist. Internists are considered heir to this legacy by virtue of their crucial ownership role in medical education and their stewardship for the Hippocratic Oath.

Ethiopia had kept pace very well to the change spirit early in its inception. Some claim western medicine in Ethiopia dates back to the time of Libne Dingil (1520-1535). The establishment of the first hospital after the battle of Adwa in 1896; the ministry of health in 1948; the Ethiopian medical association in 1961 and the first medical school in 1964 testify how the country was running head to head with the more advanced world when most African countries were under the yolk of colonization. The medical schools can still proudly cite alumni of renowned physicians and scientists abroad.

Internists have played a paramount role in most of these early developments. They take a lion’s share in the list of EMA leadership over its fifty years of existence. It was never by chance that all but few of the Deans of the medical schools came from internal medicine. We all remember an internist was a minister of health at a very difficult time in our country. Last but not least, every physician started the ABC’s of clinical medicine under the giant professors of internal medicine and of course with the ‘Green Book.’

To the anticlimax of what we reiterated above the current state of practice of the art is not as boastful. African countries that were even not independent at the time we started the race have overtaken us by the quality of their medical facilities, most publish more articles. Some have obliged us to send them medical tourists.

Unparalleled by the achievements in prevention made possible by the health system of the country the therapeutic service is gasping for air. No wonder as, besides other problems, the system is not benefiting maximally from physicians supposed to be the leaders and owners in the matter. Coming to the case in hand, dedicated internists involved in teaching and research full time area rare species nowadays. Today internists struggle to make a survival running around private hospitals at late hours instead of settling down to enrich their capacity and prepare for research. There are those who preferred to work in NGO’s to escape the dilemma. Others not an insignificant fraction, have fled the country looking for better practice and better remuneration. The choice is a difficult one when it is between what is right and what pays.

Our hospitals are mismanaged and ill equipped. Diseases long forgotten to kill since 1950’s and 1960’s with the advancement of critical care and intervention medicine claim the vast majority of mortality in our setup. Our situation reminds one of post second world war Europe of the above dates marked by professional disillusionment and despair. It is rather gravely harder to practice in 1950 when the medicine of 2014 in only 18 hours away via the Ethiopian Airlines. It is tempting to give up, shall we return to the easier choice?

No!! Ours’ is a solemn profession. The prophet’s life is always full of more lamentations than of the bandit’s. It has never been otherwise in recorded history. We have the ethical responsibility of making sure our people benefit from evidence based medicine founded on sound practice and research – up to date not in the 1950’s but in 2015. To achieve this a new wave of vibration is badly needed. A vibration that can change current practice, enable us move forward and envisage the future, such is born out of coming together to deliberate on our issues.

The establishment of the Ethiopian Society will sure provide such a platform and is a wise first step in the right direction. It must, however be emphasized it is only the first step. Commitment and active participation of every internist is indispensable to arrive at its goals. Enhancing the awareness of members in the challenges facing the practice; working to improve their professional and ethical capacity; advocating their rights encouraging and facilitating research plus working in the collaboration with concerned governmental and non-governmental organizations in the area are next to ideal. They are however life less if their journey ends on paper. Our rigorous effort alone can give them life.

The optimistic changes we are witnessing in the ministry of health, the fast growing pharmaceuticals in the country willing to sponsor such endeavors and the myriad of new universities with health faculties provide rich opportunity. The same also pose a challenge as working too close to the ministry could risk transforming the professional society into a government functionary. Connections with the industry are ethically soft than not; hence farsightedness without losing momentum is required from leaderships to come. All said I hope the time comes when we cite guidelines from the Ethiopian Society of internal Medicine or grants of enormous clinical trials made possible through our society. Last but not least, I hope the time comes when membership to our society be looked for in CVs as a proof of quality.