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Why is Rheumatology for All in Ethiopia?

Shortly after Rheumatology for All was founded, a rheumatologist in the United States, Frey Ayele, who is Ethiopian, introduced us to the rheumatology clinic program at Tikur Anbessa Hospital in Addis Ababa. We investigated and found the conditions to be ideal for our first project.  The clinic: 1.  was not staffed by rheumatologists, but by the internal medicine department; 2.  had one exam table and no running water to enable joint aspiration, and 3. offered no privacy for consultation or examination.  The faculty and medical residents were acutely aware of the impact the lack of rheumatology expertise had on their patients.

Ethiopia’s population is over a hundred million people with no practicing rheumatologist.   Although disability generally increases with age, rheumatic diseases, which are among the leading causes of disability worldwide, often affect children and adults in their prime.   In addition to needless suffering resulting in under or un-employment or even mortality, the practical effect of the lack of rheumatology expertise is profound:

  • Untrained clinicians, unfamiliar with the diagnosis or treatment of the many rheumatic diseases, provide rheumatology care.
  • Simple diagnostic tests, imaging or surgery such as joint replacement and many commonly used medications are not available.
  • Documentation of key data elements associated with monitoring treatment safety and effectiveness is lacking.
  • There is no ongoing training in rheumatic diseases for doctors or other health care professionals and consequently no voice to advocate for treatment, medications, handicap access, etc.
  • Patients do not have the benefit of early diagnosis and management with relatively inexpensive and cost-effective therapy. Instead, they present at advanced stages of disease, with otherwise preventable morbidity and indeed mortality.
  • No one is documenting the severity of the damage from lack of rheumatology services and even mortality.

Fellowship in Rheumatology

Rheumatology for All has raised funds to enable Birhanu Demelash Desyibelew, MD and Becky Abera Adugna, MD to begin a two-year fellowship in rheumatology at the University of KwaZulu Natal in Durban, South Africa starting October, 2018.
Following their studies, they will return to Addis Ababa where they will have academic appointments at the Tikur Ambessa Hospital. There they will not only treat patients with rheumatic disease, but teach other physicians and health care professionals the diagnosis and treatment of rheumatic diseases. Birhanu and Becky will have the skills and credibility to advocate for necessary medications and diagnostic tools.

Over time, Rheumatology for All plans to establish an independent rheumatology fellowship in Addis that will improve rheumatologic care in the entire region. In this way, people with rheumatic disease will be evaluated and treated by well-trained physicians.

Visiting Professor Program

In order to address the lack of rheumatology expertise in Ethiopia until Birhanu and Becky complete their training, Rheumatology for All has started a visiting professor program to provide second (of three years) residents intensive training in rheumatology. Following a successful launch of the program by Dr. Meltzer in August 2018, Rheumatology for All has arranged for professors to visit Tikur Anbessa Hospital in September and December 2018.

The visiting rheumatologists serve as teachers and mentors to residents by lecturing and giving hands on instructions. The residents are required to give lectures and case presentations, as they are being groomed to teach the junior residents. Through this program, knowledge of rheumatology in Ethiopia will develop and grow, until such time that an independent rheumatology training program will be established.

Guidelines

One of the most effective and inexpensive drugs for treating rheumatoid arthritis is methotrexate. We are developing guidelines for the use of methotrexate in Ethiopia. This is needed because existing guidelines may not be adequate/applicable because of local infections such as TB, cultural differences related to toxicity, and the expense of blood testing.

Stories

Arthritis in a 6 year old boy

These are the hands of a six year old in Kenya with juvenile idiopathic arthritis who will never have a normal life. With therapy this child could have had a chance.

Older man with gout

This Ethiopian man has late stage gout and can no longer work. With inexpensive medication this severe arthritis could have been prevented.

30 Year old with rheumatoid arthritis

Shez is now in her thirties. Even a lay person can see the damage to her hips. Shez can no longer work because of the arthritis and is afraid she will not realize her dream of marriage and children because of the disability. It is likely that with proper treatment she would not have had such destructive arthritis and could have led the life she had hoped for.

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