March 2019


Insightful news from the ASCRS Foundation
Ophthalmology residency in Ethiopia: Would you have done it?

by Barbara Erny, MD, ASCRS Foundation Medical Liaison

Dr. Abera is a fourth-year resident in Ethiopia.

Dr. Fedoku is a third-year resident in Ethiopia.
Source (all): Barbara Erny, MD


The average salary of an ophthalmology resident in Ethiopia is $250 per month. You might think that works because of a lower cost of living. But that’s not necessarily the case in developed areas like the capital city, Addis Ababa. Gasoline costs more because it is not subsidized, coffee shops charge around $1.00 for a drink, and clothing costs about the same as in the United States. Because Ethiopia is landlocked and has huge import taxes, goods are not cheap. A $250 a month salary will not go very far.
Ethiopia has five ophthalmology residency programs: two in Addis Ababa, one to the north in Gondar, and two to the south in Jimma and Awasa. Most of these 4-year training programs have decent subspecialty coverage, but in Awasa there is only one attending who has completed a fellowship. There is also no neuro- ophthalmologist in the entire country of 105 million people and just a handful of retinal specialists. There is about one practicing ophthalmologist per million people.
At least 1 million Ethiopians suffer complete blindness from cataracts.
During my last trip, I had the opportunity to spend time with several residents learning about their paths to ophthalmology. Some had stories like U.S. residents, and others were very different. Argaw Abera, MD, is a fourth-year resident in Awasa. He is from a rural area and his parents are farmers. The nearest high school was too far away to commute, so he and his brothers rented rooms with other boys in a 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 suggest such a thing. They did not take the situation for granted and were very grateful to have the chance to attend high school.
After his 6 years of combined college/medical school/internship, Dr. Abera was assigned to work as a general practitioner 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 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 bare bones Toyota, where we ordered Cokes but were served Sprite and talked with his colleague Gelaye Fedoku, MD.
Dr. Fedoku is a third-year resident who thought he wanted to be a politician when he was a child growing up in remote Ginir. In 10th grade he was “detained” for “saying something good about the wrong politician.” After the incident, he decided science was a better career choice. His father, a government worker, then pressured him to become the first doctor in the family. Most Ethiopian parents discourage their children from becoming physicians because the pay is much less than many other fields and, surprisingly, they are not well respected. Dr. Fedoku chose ophthalmology because of the combination of surgery and medicine.
To become an ophthalmologist in Ethiopia is a long road. After high school, a student goes to college/medical school for 6 years. The last year is spent at a 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 general practitioner. It is very attractive
to become a general surgeon or
internist because graduates can match right away, and “they will be rich.” OB/GYN is also popular because the Ethiopian government and World Health Organization provide resources and subsidies.
Ophthalmology, by comparison, is not well supported or well paid because eyecare is not currently a government priority. The young doctors wait a long time to match in an ophthalmology residency, having to serve between 2 and 6 years as a general practitioner. Residency is 4 years long. After residency, the doctors serve again somewhere in the region assigned by their medical school, with only a few managing to stay at their residency program as an attending. They can do a fellowship during their years of post-residency service, but still must pay back 4 to 8 years total education before being able to go into private practice.
Currently there are “sandwich fellowships” set up by the ASCRS Foundation’s partner, Himalayan Cataract Project, and supported by private charitable donations. These fellowships allow doctors to train in several other countries before returning to Ethiopia. But there is progress being made for in-country training. ASCRS member Scott Lawrence, MD, is starting a glaucoma fellowship at St. Paul’s hospital in Ethiopia, and other Ethiopian training programs are planning to follow suit.
With your kind donations, the ASCRS Foundation launched the Ethiopian Residency Education Initiative a few years ago. Because of you, the quality of ophthalmologist training is rapidly improving under this program and others working in tandem. The number of residents is increasing each year. Your continued support will help pay for residency directors, the doctors teaching residents at Sinskey Eye Institute, and fellowship training. Together with our Ethiopian colleagues, we can help tackle the cataract blindness and countless other eye conditions plaguing the country. We can help Dr. Abera and Dr. Fedoku become superb ophthalmologists, make a difference in their country, and make their parents proud.

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Ophthalmology residency in Ethiopia: Would you have done it? Ophthalmology residency in Ethiopia: Would you have done it?
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