Eyeworld

14 UPDATE by Barbara Erny, MD, ASCRS Foundation Medical Liaison T he average salary of an ophthalmology resident in Ethiopia is $250 per month. You might think that works because of a lower cost of living. But that's not necessarily the case in developed areas like the cap- ital city, Addis Ababa. Gasoline costs more because it is not subsidized, coffee shops charge around $1.00 for a drink, and clothing costs about the same as in the United States. Because Ethiopia is landlocked and has huge import taxes, goods are not Ophthalmology residency in Ethiopia: Would you have done it? Dr. Abera is a fourth-year resident in Ethiopia. Insightful news from the ASCRS Foundation cheap. A $250 a month salary will not go very far. Ethiopia has five ophthalmolo- gy residency programs: two in Addis Ababa, one to the north in Gondar, and two to the south in Jimma and Awasa. Most of these 4-year training programs have decent subspecialty coverage, but in Awasa there is only one attending who has completed a fellowship. There is also no neuro- ophthalmologist in the entire coun- try of 105 million people and just a handful of retinal specialists. There is about one practicing ophthalmol- ogist per million people. At least 1 million Ethiopians suffer complete blindness from cataracts. During my last trip, I had the opportunity to spend time with several residents learning about their paths to ophthalmology. Some had stories like U.S. residents, and others were very different. Argaw Abera, MD, is a fourth-year resident in Awasa. He is from a rural area and his parents are farmers. The nearest high school was too far away to commute, so he and his broth- ers rented rooms with other boys in a city. They lived without adult supervision during the week and returned home on weekends to help with chores. When I asked if they goofed off without an adult around, he looked shocked that I would sug- gest such a thing. They did not take the situation for granted and were very grateful to have the chance to attend high school. After his 6 years of combined college/medical school/internship, Dr. Abera was assigned to work as a general practitioner in a rural area for 2 years, then in a city for 4 years to pay back his tuition. The pay is higher in a rural area though the cost of living is lower because doctors want to live in cities. He has a wife who travels internationally for work and a 6-year-old daughter. We drove to lunch in his bare bones Toyota, where we ordered Cokes but were served Sprite and talked with his colleague Gelaye Fedoku, MD. Dr. Fedoku is a third-year resident who thought he wanted to be a politician when he was a child growing up in remote Ginir. In 10th grade he was "detained" for "saying something good about the wrong politician." After the incident, he decided science was a better career choice. His father, a government worker, then pressured him to be- come the first doctor in the family. Most Ethiopian parents discourage their children from becoming phy- sicians because the pay is much less than many other fields and, surpris- ingly, they are not well respected. Dr. Fedoku chose ophthalmology because of the combination of sur- gery and medicine. To become an ophthalmologist in Ethiopia is a long road. After high school, a student goes to college/ medical school for 6 years. The last year is spent at a university hospi- tal doing an internship. After that, the student is assigned to "serve" as a low paid primary care doctor somewhere in the region. During that time, they can apply for any specialty or decide to stay a general practitioner. It is very attractive to become a general surgeon or

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