For almost two months, two Italian doctors, Danilo and Agnese, have been working in the pediatric department at Attat Hospital, Ethiopia. In this interview with Ethiopian doctor Eyosiyas Arega, they discuss their experiences, challenges, and the invaluable lessons we can learn from each other through global healthcare collaboration. This conversation underscores the importance of cross-cultural exchange and the enduring impact it can have on healthcare practices worldwide.
1. Can you tell us about your background in pediatrics and what inspired you to volunteer at Attat Hospital?
We are two doctors in specialist training at the Meyer Hospital of the University of Florence. While for Danilo this is his fifth experience, with this project Agnese begins her journey in international collaboration with Africa. We both got to know the Engera association by working with its President Francesco Silenzi and Vice President Giuseppe Indolfi. Their passion and dedication to Engera's projects in Ethiopia immediately convinced us to actively participate in this group. The opportunity to inaugurate the collaboration with Attat Hospital, supported by the invaluable help of Dr. Maria José Caldes, Director of the Global Health Centre of the Tuscany Region, has filled us with great pride. For this reason, we would like to thank our specialisation school director, Professor Chiara Azzari, who made it possible for us to participate in this project.
2. What were your initial impressions of the healthcare system in Ethiopia, and what challenges have you observed within it?
Upon our arrival at Attat Hospital, we immediately realised the enormous number of patients this hospital must care for. Despite the large number, the hospital responds well to the needs of its patients, especially considering the scarce human and material resources available. The enlightened management by the medical director of the facility (Sister Rita Schiffer) is commendable.
3. How has the local community received you and your work at the hospital? Can you share any positive interactions you’ve had?
From day one, the local medical staff have been receptive to our suggestions about diagnostic and therapeutic paths of the young patients. At weekly meetings with the hospital's doctors, we have had the opportunity to share clinical knowledge. A valuable achievement has been the increasing trust that the nursing staff have had in us. Due to the presence of a language barrier and the need not to disrupt the rhythm of work on the ward, the local nurses were initially rather reluctant to accept our proposals to modify the usual diagnostic-therapeutic procedures (e.g., extending the duration of intravenous antibiotic therapy).
4. Walk us through a typical day in your role at the hospital. What tasks and responsibilities do you typically undertake?
The day at Attat Hospital begins with visits to the patients admitted to the pediatric ward. The medical rounds are done as a team with the help of a nurse and a doctor. During this time, care plans are discussed with the families of the young patients, listening to their particular needs in dealing with their large families. After the visits to the ward, support is provided to the Neonatal Intensive Care Unit, which functions excellently also thanks to the constant financial and professional support of the Trentino Alto Adige Association of Family Paediatricians (CCWW). The day continues with a visit to the Outpatient Pediatric Department, where every day about fifty children undergo specialist pediatric assessments every day. Our duties also include being on call for the shared management of paediatric emergencies at the hospital's Emergency Room.
5. Â Describe which medical conditions you have treated most frequently.
Infectious diseases in Ethiopia still account for the lion's share of paediatricians' daily work. Data collected to date show that the most frequent infections are pneumonia, gastroenteritis (including typhoid fever and parasitic infestations), skin infections and malaria. Another major area of intervention at Attat Hospital is traumatology, with a focus on animal bites, blunt trauma and burns. Â
6. Reflecting on your time at Attat so far, can you highlight some of the most significant experiences or moments that have stood out to you? Have there been any patient stories that have left a lasting impact?
Contact with the reality of a referral hospital for an estimated population of around one million people exposes one to strong emotions, both positive and negative. A great satisfaction came from having resolved an extensive boiling water burn on a three-year-old girl. This required more than twenty days of hospitalisation and numerous dressing changes, but the end result exceeded all expectations. On the other hand, a sense of total helplessness resulted from the impossibility of providing adequate care for a child who came to the emergency room with acute pulmonary oedema due to end-stage chronic renal failure and who would have needed dialysis treatment bridging to renal transplantation.
7. Collaboration is key in healthcare, Have you learned any valuable lessons from your colleagues out there?
The skill of the local staff in managing the available resources is a great source of learning for us. In Western hospitals, in fact, it may happen that tests are required that are not strictly necessary or that superfluous procedures are performed, whereas here, every clinical action is only implemented if it is really aimed at impacting the needs of the patient.
8. How do you envision your experience at Attat shaping your future practice and approach to paediatrics?
Being able to deal with highly complex and severe cases in a resource-limited setting allows us not to be influenced by less critical cases. In our regions, both due to parents' wishes and defensive medicine principles, there is a tendency to overly medicalize children who do not actually need it. We are convinced that having experience with children suffering from hyperacute or neglected chronic diseases will help us avoid unnecessary treatments for our patients in Italy.Â
9. Could you discuss the differences between Italian and Ethiopian cultures and share any cultural adjustments you’ve made during your volunteer experience?
A value that cuts across both Ethiopian and Italian cultures is hospitality. Although the rhythms of life differ somewhat, there has never been a lack of warm hospitality in the activities carried out together with the local population. From coffee ceremonies to snack breaks, it was always a pleasure to share conviviality. What has, however, required adaptation on our part is the way we calculate time in Ethiopia. For example, we celebrated New Year's Eve for the beginning of 2016 during our 11 September 2023 and calculated a patient's fasting hours differently than the locals because here 00.00 corresponds to sunrise.
10) . As you continue your volunteer work at Attat, what are your remaining goals and aspirations?
One of the objectives we care deeply about is improving pain management, related to both invasive procedures and the conditions themselves. A first step in this direction has been taken by promoting mild peri-procedural sedation during the execution of advanced dressings for young patients with burns, injuries, or skin abscesses. A long-term goal, on the other hand, is to be able to implement the internal protocols of the Attat hospital for the management of the most common pathologies, with the assistance of specialists from our Florence hospital.
11. What do you miss most about Italy while being away and what will you miss most about Ethiopia when you return home?
One of the great assets of our country is having a National Health System that allows universal and free access to treatment. Here in Ethiopia, we have on many occasions found ourselves having to revise our therapeutic interventions due to the financial constraints of some patients. In fact, access to paid treatment leads to worse management of chronic diseases, as they often require long and costly follow-ups. Of Ethiopia, we will miss the smiles of our healed patients, the support of our local colleagues and the hospitality of the nuns who welcomed us. We learned lessons from all of them that we will carry with us for the rest of our professional and personal careers.
12. Lastly, for aspiring medical professionals considering volunteering in Ethiopia with Engera, what advice would you offer based on your own experiences and journey?
To those who will receive our baton, we wish them to be as excited as we are to see how international collaboration among healthcare professionals can produce projects capable of changing people's lives. Our most valuable advice is to enter this world on tiptoe, in order to better understand the real needs of our counterparts. In this way, it will be possible to accompany the local population through a gradual improvement of the socio-health conditions in the area.