Some of the ideas we've come to associate with Ethiopia are sickness, disease, death and poverty -- extreme poverty. However, in my travels there I find it also to be a land of great natural beauty. I have personally visited several cities, towns, and rural villages to see the spectrum of conditions which are present there. In the most rural areas there is desert-like heat, lack of water and sanitary facilities. To the Western way of looking at things, Ethiopia is quite primitive and mostly a farm-based society. From a medical standpoint, there is a severe lack of money for modernization and medical advancement.

It has been a privilege to lecture at the Addis Ababa University at the invitation of Dr. Guta Zenebe, chairman of the departments of medicine and neurology. I led teaching rounds with staff, residents, and medical students, gave both giving patient care and resident training at outpatient clinics, and trained neurology staff in EMG and Evoked Potentials. However, the most thrilling thing for me was showing staff and neurology residents how to examine patients using techniques they never saw before. Being a clinical neurologist in private practice, I greatly underestimated the importance of what I could "bring to the table." We sometimes erroneously think that it is only the professors at major academic centers who can teach and train others internationally. I saw where one doctor who cared could make a real difference. A small effort can make a lasting impact by teaching doctors something new. Patients who might not have been helped now have a chance to benefit.

Another observation I had was that for a medical initiative to be successful, it must have as its foundation the formation of excellent relationships with people - that includes doctors, other health personnel, and patients. We might have excellent clinical skills or formidable learning in neurology, yet without a sincere desire to both impart knowledge in the context of getting to know and love people, I think our impact will be fleeting.

Working in cooperation with Dr. Atalay Alum, psychiatrist and Dr. Guta Zenebe, neurologist, I have initiated two programs (psychiatry and neurology/medicine) to help improve medical care in at the Addis Ababa University. Despite Ethiopia's 61 million people, there are only 10 psychiatrists and around 15 neurologists. There is only one mental hospital and no resident training program in psychiatry.

As a whole, Ethiopian healthcare face the problem of inadequate distribution of medication and health personnel, particularly in the rural areas. At Addis Ababa University's departments of medicine and neurology, outside funds are needed to improve training of medical students, residents, and staff by helping provide educational materials and opportunities, video course material, medical equipment, and making sure that the most critical housing, food, and health needs of doctors and doctors-in-training are met. In Ethiopia, neurology is a specialty of internal medicine. Specialty training last three years - two in Ethiopia and one year abroad.

Along with the above programs, we sponsor a visiting professor program for neurologists and psychiatrists. We also sponsor residents and medical students for rotations.

By helping doctors in Ethiopia, we help patients now and in the future. By training doctors in Ethiopia, we can impact for a lifetime-the lifetime of the doctor. Like many other very poor countries, nearly half of Ethiopia's medical school graduates leave the country because of better economic opportunity abroad. I hope that this "brain-drain" can be slowed and eventually stopped by programs that give doctors a hope for better training and create more lucrative medical practices locally. Any long-term success must address these issues.

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