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From Sweden to Addis Ababa: My experience as a research fellow at N4PCC

Hello, my name is Martin and I am a medical student from Sweden.

Last year I had the unique opportunity to spend several months in Addis Ababa as a research fellow associated with the Network for Perioperative and Critical Care (N4PCC). As part of my medical studies at my university in Sweden, we are required to perform a research project. During an earlier semester I had the opportunity to spend a semester as an exchange student in Kenya, which gave me a lot of experience in the subject of global health and awakened an interest in me that I wanted to pursue further. In Sweden, I was able to find a supervisor who had contacts in Ethiopia, and through her I came in contact with the team at N4PCC.

Critical illness and the accessibility of critical care is a global issue, but it is especially pronounced in low- and middle-income countries such as Ethiopia. Essential Emergency and Critical Care (EECC) is a concept that has been developed to address exactly this issue. EECC has created an evidence-based framework consisting of the most essential healthcare resources and processes to provide safe and cost-effective critical care. EECC was developed through a Delphi process where 269 clinical experts with experience from care in low-resource settings concluded the 66 most essential resources and processes for providing safe and cost-effective critical care.

N4PCC, in collaboration with the Ethiopian Ministry of Health, took the initiative to conduct a study of the availability of EECC resources in emergency departments in Addis Ababa. Using an assessment tool that EECC has developed, 29 emergency departments from 19 hospitals, including all tiers of Ethiopia’s three-tiered hospital system, were evaluated. My task in this project was to join the data collection and afterwards analyse the data and compile a report. I had no prior research experience before this, and traveling to a foreign country to conduct research for the first time felt like a daunting task, but I was excited by the opportunity.

Before traveling to Ethiopia, I was contacted by a team member who helped me choose a suitable and affordable accommodation and assisted with other preparations. Upon arriving in Addis, I was picked up at the airport and taken to the office to be introduced to the research team. I spent the first few weeks visiting hospitals to familiarize myself with the settings where we conducted our study, and then I spent the rest of my time analysing the data, with occasional hospital visits. Since I was relatively inexperienced in research, I relied on support from the team and always felt well supported, with frequent contact with both my supervisor in Sweden and my local supervisor in Ethiopia.

During my time in Addis, I lived in a guest house in the Arat Kilo area. It was comfortable and reasonably priced, conveniently located close to several restaurants, most of them serving Ethiopian food, but there were also a few international options. The guesthouse was well situated between the two offices that N4PCC has in Addis, and it was also close to local landmarks such as the National Museum, the newly opened Abrehot Library, and Addis University. On the ground floor of the guest house there was a nice café where I had coffee most mornings. The only challenge with my accommodation was that the staff spoke relatively little English, but this was easily solved with the assistance of a team member.

Ethiopian cuisine became one of the highlights of my stay and something that I really enjoyed. I ate the local staple injera, a soft, spongy flatbread made from fermented teff, almost every day. It is eaten together with different stews called “Wot,” which are often vegetarian but can also contain meat. Injera is eaten with your hands, and it is common to share one large plate with several people. This was a new experience for me, as I was not used to either eating with my hands or sharing a plate with others, but I grew to like it and really enjoyed the communal feeling of eating together like this.

Ethiopia has a very unique, vibrant, and proud culture that was a great experience to take part in. All over Addis there are cultural landmarks that remind of the ancient history of Ethiopia, and there are several museums that are interesting to visit. I also had the opportunity to experience several cultural events during my stay in Addis, for example the Ethiopian New Year, which is celebrated in September. On this occasion I was invited into the home of a team member to have some “Doro Wot,” which is a traditional chicken stew eaten with injera. It was a very nice experience and one of the highlights of my stay in Addis.

There were also challenges associated with traveling to Ethiopia. Traveling alone was a new experience for me, and at times it was difficult. Although I felt very welcome and well received, occasionally i felt isolated. Feeling lonely is always a challenge when travelling alone but i managed it by spending time with my colleagues and by joining a hiking group in Addis in order to meet new people and gain experiences. There are relatively few foreigners in many parts of Addis, and as a result you attract a lot of attention. Whenever I walked outside by myself, I was approached by people, most of them well-intentioned, but I also encountered beggars and scammers. Pickpocketing was another concern that required attention while being outside.

Living in a major city like Addis was very different from the small town in Sweden that I am used to.

For example, traffic in Addis is very intense at times, and when crossing the road you need to be very mindful, since drivers often do not respect traffic rules. The roads also become very congested during rush hours, which can cause major delays if you need to travel by car during these times.

During most of my stay in Addis, we were in the rainy season. This made the weather relatively cool, and the frequent and heavy rains somewhat limited the possibilities for outdoor activities.

These challenges were sometimes demanding, but the experience of overcoming them was also rewarding and something that led to personal growth.

Getting the opportunity to be a fellow with N4PCC and to be part of this project has been an incredibly rewarding professional and personal experience. I am very grateful for having received this opportunity and for the support I received from the N4PCC team, as well as from all the other colleagues and friends I met in Addis. Being able to work alongside dedicated professionals in a setting very different from what I am used to gave me a new perspective on the importance of international cooperation and what we potentially could achieve together.

Experiences like this highlight the value of international partnerships, as well as the need to create more opportunities like this in order to give more students and professionals from all settings the same opportunity that I received. I can warmly recommend anyone that is interested in a similar experience to collaborate with N4PCC.

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