by Barbara Erny, MD, ASCRS Foundation Medical Liaison
250 per month. That is the salary of an ophthalmology resident in Ethiopia. You might think that works because of a lower cost of living. But in the cities, it is not much lower than in the U.S. Of course, gasoline costs more, as it is not subsidized, and an old used Corolla costs about $25K. The coffee shops charge about $1.00 for a drink, and clothing costs the same as in an American city! I saw the exact same pair of shoes in Addis as in San Francisco, and they were $45 in both locations. Because Ethiopia is landlocked and has huge import taxes, things are not cheap.
Ethiopia has five ophthalmology residency programs: two in the capital city of Addis Ababa, one to the north in Gondar, and two to the south in Jimma and Awassa. Some of these four-year training programs have most sub-specialties covered, but in Awassa, there is only one attending who has completed a fellowship. There is no neuro-ophthalmologist in the entire country of 105 million people and only a handful of retinal specialists. Ethiopia has about one practicing ophthalmologist per million people, and about 1 million people completely blind from cataracts.
During my latest trip, I had the opportunity to spend free time with several residents and learn about their paths to ophthalmology. Some had stories similar to those of US residents, and others were very different. Take Argaw, a third-year resident in Awassa. He is from a rural area where his parents were farmers. The nearest high school was too far away to commute, so he and his brothers rented rooms with other boys in the city. They lived without adult supervision during the week and returned home on weekends to help with chores. When I asked if they goofed off without an adult around, he looked shocked that I would consider such a thing. They did not take their situation for granted and were very grateful for the chance to go to high school.
After his 6 years of combined college/medical school/internship, he was assigned to work as a general practitioner (GP) in a rural area for 2 years, then in a city for 4 years to pay back his tuition. The pay is higher in a rural area though the cost of living is lower because, like in the US, doctors want to live in cities. He has a wife who travels internationally for work and a 6-year-old daughter. We drove to lunch in his beat up, bare bones, Toyota, where we ordered Cokes but were served Sprite, and talked with his colleague Getaye.
Getaye is a 2nd-year resident who thought he wanted to be a politician when he was a kid. In 10th grade, he was “detained” for “saying something good about the wrong politician” and then decided he would go into science instead. His father, a government worker, then pressured him to become the first doctor in the family. Most parents actually discourage their children from becoming physicians because the pay is much less than for many other fields and they are not well respected. Getaye, a guy who I would describe affectionately as “nerdy,” chose ophthalmology because of the combination of surgery and medicine. Being from remote Ginir, his accent was more difficult for me to understand than most. When I told him I live in California near Oakland (where a lot of Ethiopians have settled and was featured in Black Panther which was showing in Addis) he retorted, “But Aukland is in NewZealand!” No, Oakland, I said. “Oklahoma is not in California!” Sometimes it was not easy to understand each other’s English…
To become an ophthalmologist is Ethiopia is a long road. After high school, a student goes to college/medical school for 6 years. The last year is spent at that university hospital doing an internship. After that, the student is assigned to “serve” as a low paid primary care doctor somewhere in the region. During that time they can apply for any specialty, or decide to stay a GP. It is very attractive to become a general surgeon or internist I was told, because graduates can match right away, and “they will be rich.” OB/GYN is popular because of WHO and the government support it.
Ophthalmology is not well supported or well paid compared to other fields, as eye care is not a government priority. The young doctors wait a long time to match in an ophthalmology residency, having to serve between 2-6 years as a GP. Residency is 4 years long. After residency, the doctors have to serve again somewhere in the region assigned by their medical school, but some manage to stay at their residency program as an attending (an honor, I gathered). They can do a fellowship during their years of post-residency service, but still have to pay back 4-8 years total before being able to go into private practice.
Currently, there are “sandwich” fellowships (the doctor is trained in several other countries) set up by the Himalayan Cataract Project and paid for with donations. Dr. Scott Lawrence is starting a glaucoma fellowship at St. Paul’s hospital, and other Ethiopian training programs are hoping to follow suit.
Still, to train sub-specialists and support residency programs, the ASCRS Foundation relies on your kind donations. Because of you, the quality of ophthalmologist training is rapidly improving, and the number of residents is increasing each year. Only with enough funds to help pay for residency directors, the doctors teaching at Sinskey Eye Institute, and fellowship training, can we help tackle the cataract blindness and countless other eye conditions in Ethiopia. We are striving to make the training self-sustaining, but until then you can help Argaw and Gitaye become superb ophthalmologists, and make their parents proud.