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Your
editorial headlined, "Compromising Quality for Quantity?"
[Volume 10, Number 473, May 24, 2009] deserves thumbs up. It
suggested that stakeholders in higher education chart their
boats in the right direction.
In the
context of what you have said in the editorial, there is
probably no discipline that would suffer more than the
medical profession by such deranged emphasis on the number
of graduates, instead of their quality. There are also other
multifaceted plagues that have damaging consequences on
medical education in Ethiopia.
The
impetus of medical education in Ethiopia, which had at its
inception been probably one of the best in Africa, has long
been blunted and, as of late, seems to be dangerously
decelerating, edging towards deplorable mediocrity. Although
at first - taking, for example, the medical faculty of Addis
Abeba University (AAU) - there were a sizable number of
expatriate staff handling the task of training, much of the
impressive developments occurred under the leadership of
visionary and dedicated Ethiopians.
Many of
the faculty staff returned to Ethiopia after attending world
class education in the west, and were consummate physicians,
academics and researchers, even by world standards. Their
tireless efforts to produce generations of responsible and
well educated medical doctors are indeed remembered with
great respect.
Unfortunately, the era of such charismatic, selfless giants
in the medical profession has become history.
Many of
the medical doctors entrusted to train the next generation
of physicians in Ethiopia, particularly in the newly founded
"medical schools," are well below par; this should be a
cause for concern, if not shock, for all.
Research
output in the field declined drastically in terms of
quality. One can poignantly recall the years when medical
professors laboured not only to cultivate student doctors,
but also to augment the medical knowledge in the country
with highly praised original research, published in
internationally reputed journals, that truly benefited the
medical field in Ethiopia. Today, original medical research
in the country has become a rarity; and much of what comes
out in local journals these days are mere descriptive
hospital statistics, hardly meant to critically analyze and
solve the prevailing health problems of the country in a
manner in keeping with academic and moral principles.
Rather,
they are done only for academic advancement and are
redundant reproductions of what has already been done by
someone and somewhere else. This would not be surprising,
though. Most medical gurus today are part-time teachers.
Their eyes are set more on the lucrative private practice.
They have no guilty feelings about cutting classes and
seminars to rush to their respective private clinic or
hospital, where the big bucks come from.
I am not
condemning private practice, or the right of such physicians
to engage in such a practice, without which it would really
be difficult to make ends meet for many Ethiopian doctors.
It is also a practice that would also benefit many patients
in the process. In fact, private hospitals and clinics have
beneficial sides, particularly in making available
investigative facilities and treatment modalities that would
be hard to come by in government hospitals for those who can
afford them.
I do
rather question their set of priorities. Inevitably, working
astride such divided lines of responsibility would create a
conflict of interest. The choice many would make when they
have to is less gratifying. They simply use their tenure in
the medical faculty as a way of promoting their private
practice. However, I would admit that there are those who
handle this in a responsible manner.
Department
positions are filled in a non transparent manner, based
largely on personal affiliations, and sometimes because of
an individual's availability rather than by merit, as should
be the case. Interpersonal belligerence and feuds are
rampant in departments; senior personalities are more intent
on showing their personal and intellectual supremacy over
junior staff than on sharing their much valued knowledge and
experience.
Unfortunately, there have been times when opportunities for
further training are deliberately denied to aspiring
physicians for dubious reasons. There are quite a few staff
members who do want to advance their respective fields and
have made exemplary moves in providing training in hitherto
unavailable special areas in Ethiopia. Sadly enough, these
"good guys" have encountered antagonism rather than praise
from professional colleagues who are just bent on thwarting
this positive move.
It is not
surprising that units organized under departments are headed
by individuals who have no formal qualifications in the
respective field. Lack of stability and dependability of
such government institutions is partly to blame for the
brain drain of medical professionals, not only to developed
countries, but also to local private set ups and
non-governmental organizations (NGOs).
The
Ministry of Health has handled health workers in general,
and doctors in particular, in an irrational and volatile
manner, to say the least. It has all too frequently chosen
to use the stick and not the carrot to move the donkey.
Take, for instance, the decision made by the ministry to
deny graduating doctors from getting their credentials from
universities when they graduate, a decision supposedly made
after discussing the issue of brain drain with medical
students. It is such ill-fated decisions that are made off
the cuff, without properly considering better studied
alternatives, or the repercussions, that end up frustrating
doctors and push them to leave the country.
To its
credit, the Ministry of Health has recently made genuine
strides in its policy of devising a "low" cost and problem-centred
approach to address major public health problems in the
country. The results obtained thus far seem to be bearing
commendable fruits.
The
government's effort to expand and establish new universities
is plausible. However, beyond investment in infrastructure,
the attention given to manpower development in universities
in general, and in medical schools in particular, is dismal.
The emphasis placed on the training of low and middle tier
health workers makes a lot of sense, given the overwhelming
burden of communicable diseases in our country, which can
effectively be prevented and treated by such cadre of health
workers. But thinking that this is the panacea to all
prevailing health problems in Ethiopia is off target by a
long shot.
Admittedly, medical training is demanding, takes longer than
other disciplines and is resource intensive. It may be mere
wishful thinking to try to establish expensive,
sophisticated, state-of-the-art medical centres in Ethiopia
that would give training and services comparable to any
First World countries. But it is equally ridiculous to turn
a blind eye to the threat posed by non-communicable diseases
that are on the rise, not only all over the world, but also
in our own country, parallel to changes in life style
associated with urbanization, development and aging
population.
The
capacity to deal with such problems in Ethiopia at the level
of government health institutions and medical schools, both
in terms of facility and manpower, lags far behind that of
many countries in sub-Saharan Africa and in neighbouring
countries, such as Kenya.
The
top-to-bottom kind of directives issued by the government to
simply increase the number of graduate doctors by creating
more medical schools, whilst ignoring the issue of the
quality of the trainees who are supposed to deal with sacred
human life, is bound to lead to untoward consequences.
It is not always that numbers are measures of success.
Respective authorities and medical schools should have a
bidirectional relationship of feedback so that the issue of
feasibility is not ignored, and quality graduates not
compromised at all. After all, it is not the buildings that
make a university a good one. Such an undertaking should be
matched by an equally, if not more, enthusiastic effort to
train staff to man these universities with qualified
personnel.
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