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Ethiopia

Site Insitution: Addis Ababa Hospital
Research Areas: Health Systems Research, Surgery, Anesthesiology

Site Description:

Established in 1950 as the University College of Addis Ababa (UCAA), Addis Ababa University (AAU) is the oldest and largest university in Ethiopia. It has a current enrollment of 48,673 students (33,940 undergraduate, 13,000 master’s and 1,733 PhD students) and 8,709 staff (3,110 academics, 4,346 admin support staff and 1253 health professionals). The University has 10 colleges, four institutes that run both teaching and research, and six research institutes. AAU offered its first master’s degree program in 1979 and its first PhD program in 1987. Through its 14 campuses in Addis Ababa and other branches throughout the country, AAU runs 70 undergraduate and 293 graduate programs and offers various specializations in health sciences, biochemistry, epidemiology, public health, pharmacology, and behavioral/social Sciences. Over 222,000 students have graduated since its establishment.

In 2018, AAU started implementing a flagship program on surgical infection prevention based on critical perioperative standards outlined in the World Health Organization’s (WHO) Surgical Safety Checklist. Lifebox, a global nonprofit organization focused on improving surgical safety in LMICs, was created by the same individuals who developed the checklist. Dr. Tom Weiser, the GHES mentor at Stanford University who helped create the WHO’s Surgical Safety Checklist and is a member of Lifebox, played a key role in the implementation of the WHO’s Surgical Safety Checklist in Ethiopia. The checklist project, which eventually became known as the Clean-Cut Program, has since evolved into a robust partnership between Stanford and AAU. The work produced from this collaboration has evolved into a quality improvement program that has been implemented in numerous hospitals throughout the country. The program was recently incorporated by the Ministry of Health as part of its Saving Lives Through Surgery (SALTS) initiative, which the MOH aims to implement in every surgical hospital in the country. Research fellowships can build on this collaboration and effort by supporting the development of curricula for trauma care, operative maternal care, anesthesia care, and quality improvement, as well as implementation of team training and service delivery improvement. Depending on the level of the fellow, opportunities for engaging and collaborating with trainee and junior staff surgeons, anesthetists, and other clinicians through a process of organizing complex perioperative and emergency surgery care, approaching injured patients in a structured and standardized manner, and developing mechanisms for surveillance that will help strengthen the surgical health system and develop the skills of future clinical leaders.

AAU was part of the Medical Education Partnership Initiative (MEPI), funded by NIH/Fogarty, to promote faculty development and research skills. They extended this work into the Health Professionals Education Partnership Initiative (HEPI), to be able to continue their efforts to improve medical education. Through the MEPI and HEPI programs, AAU developed a strong infrastructure to support rigorous and innovative research, and cohorts of health professionals with comprehensive training in research methodology continue to work at AAU and could be a source of future GHES mentors.

Mentors

  • Associate Professor of Pediatrics surgery and Consultant General & Pediatric Surgeon, Department of Surgery, College of Health Sciences, Addis Ababa University ; Associate Professor of Surgery, Global Clinical Director, LifeBox Foundation

GHES Alumni

  • Dr. Deressa spent his fellowship year at Addis Ababa University in Addis Ababa under the mentorship of Teferi Gedif Fenta, PhD, B. Pharm, MPH and Purnima Madhivanan MBBS, MPH, PhD. His research focused on examining the determinants of overall survival and to investigate the quality of life of breast cancer survivors. Dr. Deressa is a clinical oncologist with a passion for improving cancer care in Ethiopia. Tn addition to his clinical care accomplishments, which include founding an oncology unit in a previously unserved geographic area and starting Ethiopia's first breast cancer patient support group, he is active in cancer teaching and research. Dr. Biniyam's areas of interest include cancer epidemiology, global cancer disparities, cancer survivorship, and quality of life in cancer survivors. He is one of the recipients of 2020 International Development and Education Award (TDEA) from ASCO and 2022 Mandela Washington Fellowship for young African Leaders from the US Government.
  • Fellowship Site: Addis Ababa University, EthiopiaUS Institution: University Of ArizonaProject Title: Cervical cancer screening uptake and preferences of Ethiopian women by HIV status: Comparing community- vs. facility-based practicesIn Ethiopia, a National Cancer Control Plan was first established in 2015, outlining ambitious activities to reduce cancer burden including rolling out a nationwide cervical cancer screening program using visual inspection with acetic acid (VIA) (Ethiopian Federal Ministry of Health, 2015). In recent years, providers have been trained to provide facility-based VIA cervical screening for all women, including those living with and without HIV, and were equipped with materials such as cryotherapy machines to increase coverage of single-visit “screen-and-treat” cancer prevention services. Still, Ethiopia experiences low uptake of screening, ranging from 0 to 24.8% in various communities (Tilahun, 2019; Aynalem, 2020; Tekle, 2020; Ruddies, 2020; Belete 2015). Provider-reported challenges to screening implementation include low community awareness, environmental barriers, inaccessibility of health services, and the perception that traditional cervical exams are embarrassing or culturally taboo (Gizaw, 2019; Tilahun, 2019; Getachew, 2019; Bayu, 2015). Therefore, there is an increased interest in community-based approaches to screening that increase accessibility of services, allow women to self-sample in the comfort and privacy of their own home, and reduce the burden of screening on patients (Gizaw, 2019). Some concerns exist for women living with HIV who may have client privacy jeopardized during home visits by health workers and who may prefer to access cancer screening services at a health facility, supplemental to regular antiretroviral therapy visits. This mixed method research project will explore women’s perspectives and preferences for screening in community and facility settings, critically assessing appropriateness of various approaches with regard to HIV status, and will culminate in a pilot study of an intervention to improve cervical cancer screening uptake through community-based HPV self-sampling. GHES Fellow, Breanne Lott, will apply her training in health promotion sciences, global health, and cultural anthropology to assess cervical cancer screening from a health behavior lens. She looks forward to returning to Ethiopia where she has previously lived and worked as a Peace Corps Volunteer and Cervical Cancer Epidemiology Education in Special Populations Fellow. Breanne will collaborate with mentors Professor Damen Hailemariam and Dr. Dawit Worku of Addis Ababa University and Dr. Purnima Madhivanan of University of Arizona.
  • Fellowship Site: University Of Gondar, EthiopiaUS Institution: Yale UniversityProject Title: Improving clinical cardiac care at the University of Gondar Comprehensive Specialized Referral Hospital by assessing the influence of organizational cultureGlobally, cardiovascular diseases are a leading cause of death (WHO, 2017), and have overtaken the disease burden due to HIV/AIDS, TB and respiratory infections, malaria and diaharria (WHO, 2018). There has been a transition from communicable to non-communicable disease, and cardiovascular disease is the leading communicable disease that causes mortality in Ethiopia. Improving organizational culture helps to improve clinical outcomes in different healthcare settings (Curry et al., 2018). Despite increased global awareness on the influence of organizational culture in hindering and supporting the success of healthcare centers, there is a scarcity of studies in a low-income countries including Ethiopia. The purpose of this study is to improve clinical cardiac care by assessing the influence of organizational culture at the University of Gondar Comprehensive Specialized Referral Hospital. The study aims to (1) characterize the organizational culture of the University of Gondar Specialized Referral Hospital (2) explore healthcare organizational culture change needs and identify barriers to culture change at the University of Gondar Comprehensive Specialized Referral Hospital and (3) improve clinical cardiac care services by assessing the influence of healthcare organizational at the Cardiac Unit of the University of Gondar Comprehensive Specialized Referral Hospital. The study is designed to follow a mixed research method to collect both qualitative and quantitative data from hospital employees. It is planned to use the organizational culture for the cardiovascular care scale to measure the organizational culture of the University of Gondar Comprehensive Specialized Referral Hospital. The instrument consists of 31 items to measure the five domains of hospital organizational culture including the learning environment, psychological safety, and commitment to the organization, senior management support, and time for improvement efforts.  Interview and focus group discussion with selected cardiac unit heads, workers and patients are preferred data collection tools to explore healthcare organizational culture change needs and identify barriers to culture change. The findings of this research will be used to improve clinical cardiac care at the University of Gondar Comprehensive Specialized Referral Hospital.
  • Dr. Nofal spent her fellowship year at Addis Ababa University in Addis Ababa under the mentorship of Thomas Weiser, MD, MPH and Miliard Derbew, MD. Her research focused on surgical infection prevention and control, in partnership with Addis Ababa University and Lifebox, a charitable organization that focuses on improving surgical safety. Dr. Nofal is currently a general surgery resident at Boston Medical Center. She hopes for an career in academic surgery while continuing to pursue sustainable interventions to improve the provision of safe surgical care in low-income countries.