The Heart of Lightness
Written by Dr. Zergabachew Asfaw
This is a short introduction to the history of Ethiopian surgeons, those who developed the practice of surgery in a war-torn and fragmented nation. Documentation is sparse, but I hope this short depiction will motivate younger Ethiopian doctors to do more research and write about the early Ethiopian doctors, the trail blazers of this profession. After the Italian invasion of Ethiopia, the country embarked in a rapid growth of educational opportunities. Schools were opened and teachers imported; several young students were sent abroad for higher education.
These students became the future political, educational and military leadership. Some of these students studied medicine and became the first crop of doctors to proliferate, fulfilling the need for addressing the nationâ€™s dire healthcare needs and medical-educational establishment. Several of the first doctors to return to Ethiopia were Drs. Asrat, Taye and Tewolde. Dr. Asrat was the first to come back and started practicing medicine as a general practitioner at Menelik II Hospital in Addis Ababa. While it cannot be confirmed, the fourth doctor to return was most likely Dr. Pawlos Kena. Soon after, both Drs.Asrat and Taye went back to England to be trained in surgery and returned to practice. These energetic doctors gave their best to their motherland, establishing a good reputation and dashing the myth of the practice of surgery being delegated to foreigners only.
Dr. Asrat was assigned to work at Princess Tsehai Memorial Hospital, which later moved to Tikur Anbesa Hospital. Till the day he left the department to be dean of the faculty of medicine in 1989, he remained head of the hospital for nearly 30 years. Dr.Taye was assigned to St. Paulâ€™s Hospital, where he remained chairman till he retired. The two surgeons opened the path for many others to follow, enriching the profession.
These surgeons were:
1. Dr.Adugna Makonen, trained in Canada, was a general surgeon and practiced at Haile Selassie Hospital. He passed away at a young age of 48.
2. Dr.Yitbarek was a general surgeon, who was trained in U.S., practiced in Ras Desta Hospital, and currently lives in California.
3. Dr Asgedom, who practiced for many years in Massawa and later in Bahar Dar. His current whereabouts is uncertain.
4. Dr. Gizaw Tsehai, cardiothoracic surgeon of the Armed Forces Hospital, was trained in Mexico and United States. He was also ex-minister of Health. He now resides in Minnesota. He single-handedly built the medical services of the Armed Forces. He was instrumental in bringing back many doctors after the 1974 Ethiopian revolution. This was later followed by the training of many doctors abroad, of which some returned to serve the Armed Forces.
5. Dr.Bekele, general surgeon of Police Hospital, was trained in Yugoslavia. His whereabouts is also uncertain.
6. Dr.Fikre Eshete, general surgeon, trained in Yugoslavia and practiced at St. Paulâ€™s Hospital. He later passed away from natural causes.
7. Dr. Mesfin, who was a general surgeon at St. Paulâ€™s Hospital. There is no information available as to place of his training.
8. Dr.Gaga, general surgeon of Armed Forces Hospital, trained in Yugoslavia and passed in early 90s.
9. Dr.Lema, general surgeon of Army Hospital of Harar, trained in Yugoslavia. No further information was found regarding his whereabouts.
10. Dr.Hussein Beshir, general surgeon, trained in Mexico, practiced at the Army Hospital of Harar and currently is in practice in Mexico.
11. Dr. Desta, general surgeon and urologist of Kagnew Hospital, trained in France and now practices in South of France.
12. Dr. Getachew Awoke of the Air Force, who was later murdered by the Ethiopian Army at Asmara, was trained in Yugoslavia and later practiced at Kagnew Hospital in Asmara.
13. Dr.Tadesse Melka, orthopedic surgeon, trained in Yugoslavia and practiced at Gejret Hospital, in Asmara. After Asmara fell, he was imprisoned and died from illness without receiving any medical attention. Dr.Asrat and Taye went back to Europe for fellowships in cardio-thoracic surgery. Both of them returned back and continued to practice surgery. In the late 60s, when the first Medical Faculty was established, they became part of the teaching staff in the department of surgery. Soon after, Dr.Asrat became the first Ethiopian dean of the faculty of medicine. Later both surgeons became professors of surgery. They both took turns in becoming chairman of the department of surgery in the faculty of medicine. However, both maintained their chair of surgery of Tikur Anbessa Hospital and St. Paulâ€™s Hospital respectively. Professor Asrat became dean of the faculty of medicine at least three more times. In the late 70s, when the emperor was dethroned and jailed, Professorâ€™s Asrat became famous as the private surgeon of the emperor. The media claimed, instigated by the ruling junta, that Professor Asrat did a prostatectomy on the emperor.
The day the emperor died, the government put up a news release stating that when the emperor got ill his personal doctor could not be reached, putting the blame squarely at his feet. Everyone knew at the time that he was murdered, even though we were unsure who did it or how. In 1975, the country was thrown into massive mobilization to crush the Eritrean rebels. For the next five years, all surgeons, especially Drs.Asrat and Taye, went to Mekele and Asmara several times to provide medical support to the fighting army. They performed exemplary services and gained respect from the ruling junta. In the early 80s, the faculty of medicine was in high gear to start post-graduate education in medicine, surgery, pediatrics, OB-GYN, pathology and ophthalmology. I would like to take this opportunity to mention individuals who had visions and put their effort to start this massive project. These doctors are Professor Edemariam, Demisie, Jamal, Nebiat, Pawlos and many other ex-patriots. Initially there was much resistance from the candidates, since we were skeptical that we would be short-changed in our training. Little did we know that we would get the best training in our careers. Somehow the program started, and slowly but surely, it progressed and started recruiting new candidates yearly. Professor Asrat, Taye, Johnson, Yoo, Gizaw were the primary teachers and were supported by many expatriates from Cuba, England, and the United States. Professor Asrat did all his teaching and surgery at Tikur Anbesa Hospital. By 1983, the first crop of surgeons graduated and the rest is history. A typical day at Tikur Anbesa Hospitalâ€™s department of surgery started at 8 a.m., when Dr. Asrat walked in to preside over the morning meeting. He went through every new admission and surgery performed in the hospital. The resident on call was usually present at each admission, consult and surgery. The resident had an easy morning provided Dr. Asrat was on call and he had contacted him at night. He never approved independent decision-making by residents without consulting the on-call attending, which was the basis of surgical training, even in the U.S. At 9:00 a.m., he would walk into the OR and change his cloth and be ready for his first case. He performed surgery till his last case, usually around 2:30 or 3:00 pm. If he had an afternoon clinic, then he continued to see patients till 5:00 p.m. He then visited some of the patients he had operated on before he left the hospital, especially those he thought may be unstable. At the end of the day, he went home and worked for an hour or two in his private clinic at Mobil Clinic. He usually got home around 8 or 9.
On a day when he had no surgery he would start his teaching round around 9:00 a.m. and continue till lunch time, around noon. Unlike rounds in the States, his teaching rounds took place by the bed side of the patient. He actually examined each patient presented by the intern and resident. He talked to each patient and carried a stethoscope. He actually used it! Once a week, he took the medical student for teaching to the floor preceded by classroom discussion. He gave lectures in surgery to medical students several times in a year. His lectures were always clear, concise and easy to follow. His bedside teaching went on for a long time, but he never rushed. He always insisted students be punctual and prepared with the x-rays, charts and lab results. Woe for the unprepared student or intern. He was quite easy on medical students and interns but tough on residents. In the operating theater, the mood changed as soon as he walked in. Everyone got tight and things moved faster. The staff stopped talking. You could feel the tension in the air. The best nurse was assigned to him and the nurse supervisor hovered around, to bring anything he requested that was not already on the tray. Once he finished his procedure, he went to the doctorâ€™s room, where he wrote a meticulous operating report. He never delegated any resident to write his notes â€“ unlike some surgeons in the States. Once he was finished and he had left for the day, the operating room staff relaxed. You could hear chatter and some laughter and loud talk in the hallway. He was very respectful of his patients and especially the elderly. He insisted that we get rid of our callous way of treating our patients. His patients, in return, accorded him adulation and appreciation. Most of his colleagues also respected him, though some thought he was too overbearing and dictatorial. Nevertheless Dr.Asrat and other department of surgery members, including Professor Taye, Johnson and Gizaw, played an important part in training many surgeons, some of who are now academic leaders, and practicing surgeons that are spread all over the country and around the world.
Though some of us abandoned our trained profession, we still remain grateful to all our teachers, who gave their time and expertise to us. We are where we are due to cumulative training provided by all our teachers in the faculty of medicine and in particular the department of surgery. Professor Asrat will be remembered for his superb surgical skills and teaching ability. I am sure he will also be remembered by the masses for his political leadership â€“ giving his life to the cause. Professor Taye practiced surgery for a long period of time and is now retired and lives in Addis. He is also remembered as an excellent teacher and superb surgeon. His presence in the operating theater did not cause commotion but rather calm and laughter. Some days he had classical music playing during surgery. His demeanor was easier than Dr. Asratâ€™s, but we learned a great deal from both of them. Professor Taye remains easy to reach, as he has honored us several times by visiting us in Manhattan. We were privileged to have him visit. He remains a healthy octogenarian. Professor Asrat was celebrated by family and friends at Howard University in Washington D.C. recently. His students gave testimonials to his professional life and contribution, but we left his contribution to the political struggle of the country to those who were more knowledgeable. All the pioneer surgeons performed a great service for their country, with minimal remuneration. They operated night, weekends and holydays without compensation, which I could not imagine at this time. Some of the working conditions were so poor that they had to improvise with the instruments and equipment. They are the unsung heroes of the profession, who worked relentlessly â€“ outside of the public limelight. These surgeons will be remembered by their colleagues and family, but, going forward, we need to document their history. Ethiopians are proud of our history left to us by fore fathers. It is our responsibility to leave a written history, so that future generations can understand where we came from â€“ with all its struggles and challenges. I invite all to contribute to our collective memory bank by adding more information.
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Ethiopian Medical History
Photo: Dr. Melaku Beyan. Dr. Melaku Beyan became the first Ethiopian medical doctor to complete his education in the United states in 1935 (Dr. Workneh Eshete became the first Ethiopian doctor to obtain a modern medical education in 1882)
The non-governmental organization, People to People, has just released The Manual of Ethiopian Medical History by Enawgaw Mehari, Kinfe Gebeyehu and Zergabachew Asfaw. The purpose of the publication is to teach the future generation of Ethiopian medical students and health care professionals about Ethiopiaâ€™s medical history.
Mekele University and Bahir Dar University have reportedly agreed to incorporate the study into their medical education curriculum.
Enawgaw Mehari, MD
Kinfe Gebeyehu, MD
Zergabachew Asfaw, MD
Senior Graphic Editor: Matthew I. Watt