Africa helps Africa
Five questions about such a renowned initiative
Dr. Amde-Michael Ketema, ophthalmologist and Luxembourg citizen of Ethiopian origin, is based in Guinea, Conakry since 2007 where he initiated, and now leads, the DESSO training program in ophthalmology. DESSO stands for Diplôme d’Etudes Supérieures Spécialisées en Ophtalmologie.
Dr. Ketema was already trained as a general practitioner before joining the 4-year specialty training in ophtalmology at the university teaching hospital in Nantes, France. He then worked at the Centre Hospitalier Regional in Metz, France, from 1992 to 1996. In. 1997, Dr. Ketema joined CBM International under the Vision 2020 program to work in Niger and then in Ivory Coast until 2006.
Dr. Ketema then became the Director of the post-graduate training program in ophthalmology for Francophone West Africa since 2007.
We met Dr. Ketema in Luxembourg, while he was visiting family, to learn more about the beginnings of DESSO and how we can use his insights for our project in Angola.
Dear Dr. Ketema. Gudde Moien. Nice to have you here.
Q: Over the years you have trained young doctors in medical and surgical ophthalmology. How many have been trained? How were they selected?
Dr. Michael Ketema (MK): The DESSO program initially was a fast track 2-year intensive post-graduate diploma training. The idea behind was to train a large number of eye doctors in a short time to help alleviate the acute shortage of eye doctors in rural Francophone West Africa.
This way, 67 general doctors from 6 Francophone West African countries were trained. After 2 or 3 years of rural service, they were called back to finish the additional 3rd and 4th year training to complete the full degree program.
Now we have established an uninterrupted 4-year training, and six students are currently doing their 3rd year.
The selection process is based on the following criteria: the doctor must be a general practitioner, have at least 2 years of clinical experience, be under 35 years of age and be francophone, as all the teaching at DESSO is performed in French.
Q: It’s wonderful to hear that so many doctors have been trained. However, how do you prevent them fleeing to a richer, better paying European or Arabic country?
MK: Indeed, the brain drain of African doctors is very alarming. In our case, we help our young doctors establish a private practice after 5 pm and on Saturdays. We offer slit lamps and IOLs (intraocular lenses) to those who accept such an arrangement for a few years. We also give access to our laser, OCT, etc. to their private patients.
So far, this seems to work. The doctors are willing to work in the public hospitals while earning money in their private clinics. It’s a win-win situation for everyone. We are also planning, together with a Swiss ophthalmology equipment provider and CBM Switzerland, to start an interest-free loan scheme for some selected eye doctors to help them procure some expensive equipment CBM-Luxembourg might also join this scheme to help limit the African brain drain of eye doctors..
Q: The DESSO program has been in place for years. Dr. Ketema, wouldn’t it be easier, and more efficient, to have European doctors flying in, flying out with their full equipment for several weeks?
MK:I agree, this has been the conventional approach for many years, and some charities still choose to work this way. I strongly believe that this approach isn’t sustainable, especially for the post-surgery follow up. To me, the training of young African eye doctors is the solution!
The costs of flying in doctors in such a way are also high. Consider the costs of flights, hotels, transport of equipment, etc. These costs could cover a significant part of the training for a local doctor.
We do make exceptions, such as bringing in expert doctors for areas where we lack the skills and equipment, such as retinal surgery, which works very well. But I believe training local doctors in eye surgeries is the best, more sustainable and cost-effective way to help.
Q: Could you imagine that such non-English programs are realizable in other African countries?
MK: I am aware of the Portuguese-speaking program which is being developed in Angola with the IONA (National Ophthalmology Institute of Angola) by CBM Luxembourg. It’s a challenge and you must be in for the long term, but it’s achievable and a wonderful vision for the lusophone countries concerned.
Q: What would you advise to help us? And what are the biggest challenges?
MK: CBM Luxembourg would need to encourage the few Angolan eye doctors train other young doctors. There is an urgent need to work with the Ministry of Health in Angola to allow IONA to be more financially independent and stable. This would allow IONA to reinvest in improving the eye care services it provides, encourage eye doctors and nurses with some top ups and thus facilitate the long term sustainability of the program.
Thank you for your time Dr Ketema. What would be your message to conclude
MK: Many thanks to CBM Luxembourg for its relentless effort to help train African ophthalmologists and ophthalmic nurses, and thus reduce blindness.
We thank you Dr. Ketema.
We wish you, your doctors and all your patients the best.