VECDor Fellowship Site Directors:
Henry M. Blumberg, MD (Emory University)
Miliard Derbew, MD (AAU)
Site specialties: maternal and child health, tuberculosis, nursing, HIV/AIDS, mental health
The collaboration between Emory and Addis Ababa University (AAU) began in 1998 through the Carter Center Ethiopia Public Health Training Initiative (EPHTI). AAU is now considered a key strategic partner for Global Health for Emory, with major projects that serve as the platforms for hands-on experiences for VECD trainees. AAU is the largest university in Ethiopia and one of the largest in sub-Saharan Africa, with more than 48,000 students (including more than 14,000 graduate students) across multiple campuses in Addis Ababa and the surrounding area.
- Major collaborative projects between Emory and AAU include a study of intersections between water, sanitation and hygiene, gender, and psychosocial distress in Ethiopia; the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP), which leads the Birth-to-48 hours project, supported by the Gates Foundation, and a Gates-funded supplementation study to improve maternal and fetal outcomes at three AAU teaching hospitals.
- College of Health Sciences is a professional health sciences college comprised of four schools and one teaching hospital. They are the School of Medicine (SOM), School of Pharmacy (SoP), School of Public Health (SPH), School of Allied Health Sciences (SAHS), and Tikur Anbessa Specialized Hospital (TASH).
- The rationale behind the establishment of the CHS is to encourage cross-breeding across various disciplinary paradigms; standardize curricula across disciplines; set standards and quality checks for the teaching-learning process; maximize human resources utilization through joint planning in teaching common courses and in conducting research; create opportunities in collaborative research and publication; maximize shared use of facilities for effectiveness and efficiency in teaching-learning, research and services; and create opportunities to address the health needs of the community in an integrated manner as a health team.
- TASH is the largest specialized hospital in Ethiopia, with over 700 beds, and serves as a training center for undergraduate and postgraduate medical students, dentists, nurses, midwives, pharmacists, medical laboratory technologists, radiology technologists.
- AAU along with Emory University, Johns Hopkins University and University of Alabama at Birmingham has received a grant of $3.205 million for junior faculty training and research career development. It is sponsored by the National Institute of Health through Medical Education Partnership Initiative (MEPI) to support the career development of AAU faculty who have dedicated a career to clinical investigation. Training and career development will focus in the four selected scientific topics: HIV/AIDS and related infections, maternal and child health with focus on community interventions, non-communicable diseases with a focus on diabetes and cardiovascular conditions, and mental health.
- AAU SOM is a member of ACSMEL, an academic consortium to support medical education in Liberia, a non-profit organization established by leadership of University of Massachusetts (Umass). AAU College of Health Science has currently deployed five basic science faculties to Liberia medical school where they are teaching basic science courses to undergraduate medical students.
- Venous Thromboembolism (VTE) prophylaxis guideline was launched in December 2015 in the College of Health Sciences. This was initiated due to an interdisciplinary collaboration by the college community and FMOH. Similar protocols and guidelines are being produced in various disciplines in order to cultivate quality care in the institution.
- The number of publications from the College of Health Sciences has greatly increased over the past few years. In 2012, the college had 25 faculty who published 130 publications. In 2014, the college staffed 122 faculty who published 500 publications. The college collected 46% of the total research.
AAU is a training site for the Emory Global Health Residents and Scholars Program, with approximately 15 residents from Emory completing a clinical rotation in Ethiopia each year. Additional training capacity is being built through a number of D43 training grants, including the D43 Emory-Ethiopia TB Research Training Program (PI: Blumberg).
Through the Gates-funded MaHNEP project, Emory University established a legal presence in Ethiopia and an office in Addis Ababa to coordinate and support in-country human resources, finances, programming, and research, with strategic, technical, and financial backstopping from a small team based in Atlanta. Emory’s Ethiopia Country Office has an excellent working relationship with the Ministry of Health at federal, regional, and district levels. By working in close partnership with the Ethiopian Ministry of Heath, Emory has access to leadership and endorsement at the highest levels and access to opportunities to disseminate findings that promote global access.
AAU and Emory currently collaborate on a number of projects designed to build capacity in Ethiopia:
- The Medical Education Partnership Initiative (MEPI) Scholars Program for Developing Research Capacity of Junior Faculty at Addis Ababa University (NIH D43 TW010143, PIs: Derbew/Blumberg) is building local capacity by creating cohorts of core faculty with specialized research skills and careers in four priority areas: HIV/AIDS and related infections, maternal and child health, non-communicable diseases (e.g., diabetes, cardiovascular diseasese), and mental health.
- The Ethiopa-Emory TB Research Training Program (EETB-RTP; NIH D43 TW009127, PI: Blumberg) is focused on providing didactic and mentored TB research training with the goal of providing the skills and capacity to carry out internationally relevant TB-related research. An additional goal of the EETB-RTP is to enhance the TB-related public health infrastructure in Ethiopia.
- Current projects based in Emory’s School of Nursing include an integrated community case management of childhood illnesses and community-based newborn care pilot study funded by UNICEF (PI: Sibley) and a Gates Foundation-funded (through the WHO) implementation project to accelerate scale-up of kangaroo mother care in the Amhara region.
- The Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) project (PI: Sibley) is a community-oriented model for delivery of maternal and newborn care in rural Ethiopia. Initially supported by an $8M grant from the Gates Foundation, it has since been extended with funding from the Micronutrient Initiative, with discussions currently ongoing to add a maternal infant nutrients component and an infant and young child feeding component.
During a 2005 visit to Ethiopia by Emory President James Wagner, a Memorandum of Understanding (MOU) between Emory and AAU was signed by the schools’ presidents.
Goals of the Emory-AAU partnership include:
a) to strengthen the capacity of AAU and other Ethiopian institutions of higher education to train and educate professionals in the health sciences;
b) to conduct innovative research on pressing health issues in Ethiopia; and
c) to contribute to high quality, innovative and equitable health care services for the Ethiopian population.
With regards to Academic Health Center partnerships, two visits, one by an Ethiopian delegation to Atlanta in 2008 led by Dr. Miliard Derbew (Dean of the School of Medicine at AAU) and one led by Dr. Henry Blumberg (Emory School of Medicine), to AAU in February 2009 helped catalyze Emory-AAU collaborations, which were initially focused on infectious diseases, emergency medicine and medical education. Drs. Derbew and Blumberg are directing this Emory-AAU Academic Health Center collaboration.
The Emory University School of Medicine has had a growing commitment within Ethiopia in the past several years, with a specific focus on improving and supporting a scale-up in medical education. In 2010 Emory was awarded one of the NIH/FIC Medical Education Partnership Initiative (MEPI) grants, which were awarded to a number of academic institutions with the goal of expanding medical education and increasing the number of health care workers in countries currently receiving PEPFAR funds from the U.S. government. This award from the NIH partnered Emory with Addis Ababa University (AAU), the largest medical university in the country. In addition to supporting the existing medical faculty at AAU, there is an impetus to increase the subspecialty training available in the country, as training in numerous subspecialties is completely unavailable. This grant has been met with the enthusiastic involvement of numerous Emory medical departments at AAU, including the Department of Medicine (Infectious Disease, Pulmonology, and Cardiology), the Department of Radiology, the Department of Obstetrics and Gynecology (including Gynecologic Oncology), the Department of Surgery, the Department of Pathology and Laboratory Medicine, and the Department of Pediatrics (specifically, Pediatric Infectious Diseases).
There are several other areas of collaboration between Emory and Ethiopia. The Dean of the School of Medicine has pledged financial support and mentorship to engage residents and fellows in Ethiopian clinical care through the Emory Global Health Residency Scholars Program. There have also been two separate Bill and Melinda Gates Foundation grants received by Emory with a focus on maternal and child health. The first was a smaller project which focused on addressing pre-eclampsia and eclampsia, the second leading causes of maternal death in the country. Additionally, the School of Nursing (PI: Lynn M. Sibley, RN PhD) received an $8.1 million grant from the Gates Foundation to further address maternal and child health, with a project called Maternal and Newborn Health in Ethiopia Partnership (MaNHEP).
Emory recently received an R24 grant from NIH/FIC to support the Emory-Ethiopia Global Interdisciplinary Partnership (PI: C. del Rio; NIH/FIC R24 TW008825). This grant builds on the unique partnerships of Emory with the Centers for Disease Control and Prevention (CDC), CARE, the Carter Center, and the Task Force for Global Health and seeks to support multidisciplinary research training in Global Health for trainees both from the US and Ethiopia by bringing together trainees from diverse disciplines and fostering a culture of collaboration and multidisciplinary partnership when confronting Global Health problems.
GLOBAL SURGERY PROGRAM
In 2010, the Department of Surgery at Emory University forged a Global Surgery Program, with a particular focus on Ethiopia, through the work of surgical faculty member Dr. Jonathan Pollock, who is now based in Ethiopia full-time. In Ethiopia he is engaged in clinical surgical practice, the training of surgical residents through the PAACS surgical training program, and an active program of clinical research and surveillance. The PAACS surgical training program is a four-year, Western-style residency training program based at Soddo Christian Hospital in rural Wolaita, Soddo, Ethiopia and geared toward expanding the surgical workforce in Ethiopia. The training program is accredited by both the Ethiopian Ministry of Health (MoH) and the College of Surgeons of Eastern, Central, and Southern Africa (COSECSA). Recently the PAACS training program signed a Memorandum of Understanding (MOU) with Myungsung Christian Medical Center (Addis Ababa, Ethiopia) to further expand their capacity to train residents, both in number and in spectrum of clinical practice now including an urban setting. Dr. Pollock will therefore be splitting his time between the site in Soddo and Addis Ababa.
The Emory Department of Surgery has partnered with Dr. Pollock in this endeavor. The two primary objectives of this partnership are to assist with the training of American and African surgical residents and to develop mentorship for surgical and global health research. Emory has already begun to provide opportunities for surgical faculty and residents to travel to Ethiopia where they participate in clinical, research, and educational activities at SCH. Over the past year, the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee (RRC), as well as the American Board of Surgery (ABS), have approved this international involvement of residents. The approval from the ABS makes Emory’s international training experiences one of the first in the United States.
Soddo Christian Hospital (SCH), located in Wolaita, Soddo, Ethiopia, a rural southern region of the country, was opened in January 2005 by the non-profit St. Luke’s Health Care Foundation (Wheaton, IL). The hospital is a major referral center for the surrounding rural region with medical, surgical, subspecialty, laboratory, and pathology services. It functions as an academic medical center with specialty residency training in surgery and an active program of clinical research. The hospital is accredited by the MoH for 199 beds and currently 22 major buildings are in existence on the hospital compound. These buildings include a surgical wing with four operating rooms, an emergency department with radiology capabilities, two intensive care departments, two surgical wards, a maternity unit, a pediatric ward, a medical library and research facility, a laboratory, a building which houses the kitchen, staff dining, and laundry, two generator houses, two staff expatriate guesthouses, and three long-term housing duplex units. Construction on a large dormitory building to house further medical staff, including visiting residents and faculty, is now underway and nearly completed. There is an excellent ground water supply 127 meters below the surface with two wells providing service to the hospital. The hospital compound also has reliable electricity provided by a diesel generator and one of the only septic systems in the region. There are plans to open residency training programs at SCH in Orthopedic Surgery and Family Practice within the next two years. There is also a nascent affiliation with the new medical school (Wolaita Soddo University School of Medicine, WSUSOM) that is to open in November of 2012, with plans for the surgical faculty of SCH to be involved in surgical education of trainees at WSUSOM.
The PAACS surgical training program is based out of SCH with an essential component of the training being requisite clinical and surgical research for all surgical faculty and residents. There are ongoing research projects currently investigating the epidemiology and outcomes of patients with the surgical acute abdomen, as well as a trauma surveillance registry analogous to the American College of Surgeons National Trauma Data Bank (NTDB).
Myungsung Christian Medical Center (MCMC), located in the capital city Addis Ababa, is a recent addition to the training structure of the program, with an MOU being signed between MCMC and PAACS earlier this year. MCMC is a private, non-profit tertiary referral hospital whose construction was requested of the Korean Government by the Prime Minister of Ethiopia in 1993, with a building contract being signed the following year. After a long period of construction, the hospital was opened in 2004. The hospital has a reputation for excellent care within the city and offers high quality medical, subspecialty, surgical, radiologic, and laboratory services in a modern medical complex. There is also an on site apartment building complex where housing is provided for long-term and visiting medical staff. Previously an Academic Partnership Agreement was signed between MCMC and Johns Hopkins University in 2006. However, independent of this agreement MCMC has completed the construction of a new medical college, which is to take its first class of 45 medical students in August 2012. There will soon be SCH PAACS residents who will be doing rotations at MCMC and starting research projects comparing the disparate surgical disease burdens of urban and rural Ethiopian populations. Importantly, with the proximity of MCMC to AAU, there on ongoing discussions about points for collaboration between other Emory initiatives in country and those ongoing at MCMC.
Emory University and The Carter Center, its affiliated partner, have a nearly 20-year history of working in Ethiopia. The Ethiopia Public Health Training Initiative was launched in 1997 by The Carter Center in partnership with the Ethiopian government (Ministries of Health and Education) in an effort to improve Ethiopia’s overall public health status. The goal of the Ethiopia Public Health Training Initiative is to contribute to improving the health of Ethiopians by enhancing the quality of pre-service training that health staff receive. For Ethiopians, the single biggest contributing factor to poor health is a lack of access to trained health personnel. The project has received significant funding from USAID, which has allowed the creation of significant infrastructure (collaboration between universities, health centers, the Ethiopian government, and Emory) and enabled the establishment of a coordinating office with Ethiopian staff in Addis Ababa. The project is directed by Joyce Murray, PhD, who has a joint appointment in the Emory School of Nursing and the Carter Center.
Nebiat Gebreselassie, Ph.D.