‘YOUR EFFORT WAS GREAT/YOU CARRIED ME NINE MONTHS’: The birth of medical humanities in Ethiopia


When I Hear Your Name

My thought is with you mum.

How can I imagine all your love?

I cannot guess all your love.

Time cannot determine it.

You gave birth to me With great labour;

Your favour for me is countless.

I will pay you in my life.

Your effort was great You carried me nine months Then carried me long after,

Grew me well Fed me food Fed me your breast

I saw light through you mum.

Thank you for that.

You are a mirror for me And for the whole world.

You encouraged me,

You taught me life.

Now 1 have learned and Grown through your labour.

I am thinking of you I am thinking of my country When I hear your name,

I feel at ease I feel at home.

(Demith Daniel (Ethiopia))

When I hear your name

1 sit nervously in a huge, freshly painted auditorium in the University of Wollega, Nekemte, Ethiopia. You’ll struggle to find it on a map—it’s not on the tourist trail. I witnessed this building’s construction: the poorest women binding eucalyptus trees together into makeshift scaffolding and pushing creaking, battered wheelbarrows over parched, uneven ground overfilled with gravel. I never believed the building would be finished, and yet here I sit, the only white westerner among a sea ot black, beautiful faces. Despite the women toiling at constructing the scaffolding, the audience is all men, wearing dowdy, ill-fitting suits and dour ties in the blistering heat, from the best universities and medical schools in the country. 1 concentrate on the key presentation. The ‘Road Map tor the University’ sounds ambitious—to become one of the top 30 universities in Africa within five years. Maybe it could happen. The long and detailed feedback from the floor to the presenter is delivered mainly in the Amharic language with smatterings of English. We are in Oromia, but nobody speaks Oromo at this event.

We had already felt the close pressure of the complex politics of the region, and later that week Nekemte descended into violence and chaos under our noses.

From our Truro (Cornwall, UK) outpost, Dr Robert Marshall, Dr Julie Thacker and 1 have evolved a regular cycle of visits to Wollega, with some of our medical students in attendance. Our link with an Ethiopian medical school is part ot the bigger rising tide of global exchanges within medical education.1 But ours is possibly unique in putting emphasis on the value of the medical humanities. My parent school, Exeter University Medical School, was once part of the progressive Peninsula Medical School that pioneered a core, integrated and assessed medical humanities programme within the undergraduate curriculum, led by Alan Bleakley and Rob Marshall.

I work as a doctor and am Associate Dean ot Education at the University of Exeter Medical School, and here in Nekemte 1 am about to give a lecture on the importance ot arts and humanities in medical education. 1 will then give all students and faculty a book of poetry written in Oromo by Ethiopian students and translated into English (see header poem to this chapter). For someone from a poorly performing inner city comprehensive school in Bristol who was brought up on a housing estate, was bullied, abused and somehow managed to escape by going to medical school, I feel rather proud and privileged at this moment. The medical humanities have helped me to get where 1 am, and this is how . . .

While at school in the 70s, I joined the drama club and landed the lead in the school play. I played Harry in ‘Zigger Zagger’—a troubled lad who decided against a life of football hooliganism and crime for one of education and work. 1 was 13. This didn’t help the bullying, but cut me out as different. In the Sixth Fonn the drama club members helped a local amateur dramatics society by providing extras for their summer plays. We travelled to the Minack Theatre in Porthcumo in West Cornwall in the summer months and our minds blossomed as we gazed out at the wide Atlantic sea with nothing between the wild Cornish coast and Nova Scotia, Canada (Figure 35.2).

At medical school, I organised and performed in Medic Reviews and on qualification as a doctor chose to move to the closest hospital to the Minack that 1 could find in the phone book, West Cornwall Hospital in Penzance. In 1994, I qualified as a General Practitioner and not wishing to end my personal development and ambition, continued to look for opportunities and openings. 1 became a member of the local Primary Care Trust in 2008. They needed an Education Lead, so I volunteered and persuaded them that they should support me to study for a Postgraduate Certificate in Education (PGCE) to inform this role. I was shocked that established GP educationalists behaved in an unsupportive and unkind way towards me at that time. I had spotted that there was a strong possibility of a new medical school opening in the South West region and 1 wanted to be a part of it. After a number of roles in the medical school I landed the Community Sub Dean Role and the Clinical Special Study Unit Lead. Responsibilities included overseeing and managing medical humanities in the curriculum. I was elected to the Committee for the UK Association of Medical Humanities, began to present my own work, and encouraged medical students to present their work, at international conferences.

My work in Ethiopia started over three years ago. The University of Wollega Medical School is a new school and part of a National Programme to increase the number of medical schools and doctors across Ethiopia. I am in a team that has visited the university many times over this period to help deliver the curriculum, develop the teachers and the faculty and quality assure their procedures. It seemed ridiculous to us at the time, but Dr Rob Marshall and 1 thought it would be interesting to explore the introduction of medical humanities to the new school. We were certain that this had never been attempted before and so agreed to run an event—a celebration and exchange of culture with some practical creative activity thrown in. We contacted the Head ot the Faculty of Arts and Humanities, Dr Zeleke Tesome, and made

The Minack Theatre, Porthcurno

Figure 35.2 The Minack Theatre, Porthcurno

a plan. We invited all ot the humanities students who were studying English, drama, art and music, and also the medical students in the University of Wollega. We also included the UK students who had ventured out with us. On the morning of the event, a room crammed full of happy, funny and excited students greeted us enthusiastically.

All the humanities faculty staff members were in attendance and we felt very much out of our comfort zones and wondered what lay ahead ot us. I opened the event with a welcome in the Oromo language: baga nagaan dhuftan (‘welcome’); maganke (‘my name is’) lan. The cheers were reassuring. My lecture on medical humanities was translated in real time by the Head of Drama, and included reflections on the work of the surgeon and writer Atul Gawande, and artists Grayson Perry and Frida Kahlo tor their impact on medical education. 1 stood back and wondered how the students would receive this—students who were living in extremely difficult conditions with barely enough money for a biro. 1 needn’t have worried. The response was phenomenal. The lecturers were really excited and were downloading articles to show me, while the students were clapping and buzzing. The day was off to a good start.

The Humanities department had been tasked to provide us with a piece of drama incorporating a medical angle. The play they had written and rehearsed explored physical and sexual abuse of women. We were not expecting that. We experienced and witnessed a completely different view ot the young Ethiopians, particularly the women. They behaved completely unlike the medical students that we had previously been working with, who were shy and unconfident. These students were amazing; they were intelligent, confrontational, boisterous and assertive. They were prepared to talk about difficult issues and in subsequent events the pieces ot drama addressed HIV infection, promiscuity, unwanted pregnancy and abuse of elder people. Emotive stuff. Our medical students could learn a lot from this bunch. I recalled that at Peninsula we had brought in drama and performance students from Falmouth University to run very successful workshops with our medical students on ‘managing identity.’ Years before, Rob Marshall, then head of postgraduate education at Royal Cornwall Hospital Truro, had brought in the Education Officer from the Royal Shakespeare Company to work with senior doctors on ‘self-presentation.’

Our last exercise with the students, and we included our own medical students who had travelled with us, was a poetry workshop. We gave them the first line—‘when 1 hear your name’—and set them off to write. It was all eyes down and the 100 or so students in the room got busy. After 20 minutes we gathered together and the Ethiopian tutors selected students to stand up to read their work in Oromo. Again, the Head of Drama translated this into English in real time. We witnessed students crying while they read, supporting each other and enjoying themselves. Dr Zeleke subsequently told me that this was the greatest day of his academic career. We decided there and then that we would collect the poems, translate them properly and publish the first Oromo-English poetry book (Figure 35.3).

We repeated these sessions and presented the humanities in medical education lectures again at the first ever Medical Conference held at the University of Wollega Medical School. 1 stand nervously on the stage of this huge, impressive building that can hold in excess of 2000 people. The building that I had seen a few years back, looking as though it would never be finished, is now an icon for the University of Wollega. In front of me are educators from around the country, Vice Chancellors of the top universities, representation from the Ethiopian Government and delegates from neighbouring countries; and 1 am going to give my lecture again and give them the poetry collection as a gift.

The talk is well received, there were no giggles when Frida Kahlo’s half-naked self-portrait filled the screen. The astonished reaction to the book, which looks beautiful, was incredible

to observe. How could these people from the UK have invested time, energy and money into producing such a thing and to validate our young oppressed people in this way? Is this another colonialist gesture, following the Italians’ long involvement in our land and culture? We certainly had no intentions of exporting our Western medical education ideals to Nekemte. But it is so hard to get out of your national skin and Robert Marshall’s piece following this raises some of those tensions. Importantly, we sowed the seeds of the medical humanities and perhaps that venture will flower over the years according to Ethiopian will.

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