Category: Blog

Published online: 4/4/2023 For any aspiring young professional, in any discipline, mentorship is key. Not many are lucky enough to have found themselves a mentor as I have when I made a career shift from clinical medicine to public health. Having gone through a career pivot herself, Sesnie Zemichael, Smile Train’s Senior Program Manager for East Africa, has a story that is truly one for the books. Today, I have the honor of sitting down with her; a great mentor, a supportive colleague, a phenomenal woman, and a dear friend. I am Eleleta Surafel, and I am hosting Sesnie Zemichael today. Have a wonderful read!   ES: Thank you so much for your time, Sesnie.   SZ: Of course! Thank you for choosing my story.   ES: Let’s jump right in, shall we? Let’s start off by a brief history of your professional background.   SZ: My training is in Marketing Management, but I have spent the majority of my career working in the humanitarian and development space with international organizations such as Department for International Development (DFID), Save the Children, World Bank, Irish Aid, Canadian International Development Agency (CIDA) and now Smile Train. I have also had the benefit of working in the private sector, including startup, and running my own business. My scope of expertise spans across program management, finance, human resources, operational and managing strategic partnerships across Africa, where I have led large programs with multidisciplinary experts, across a wide geographic area.   ES: Oh wow! So health management is quite different from all the other programs that you’ve managed prior to this role. What made you decide to take up this role? What was the transition like?   SZ: Taking on the role of managing a health program was indeed a bold move for me, especially considering that I had no prior experience in the medical field. However, when I joined Smile Train, I was excited to take on this challenge because I saw the opportunity to make a difference in the lives of people who were affected by cleft lip and palate. Believe me, the transition was not easy, as I had to learn medical terminologies, understand the science, and familiarize myself with protocols and procedures from scratch. But I was determined to succeed, and I employed a lot of innovation and tact to maneuver. One of the things that helped me move through this new terrain was my capability of building meaningful relationships quickly with a range of professionals in the medical space. They were willing to hold my hands, and I was determined to learn fast. I will forever be grateful to the surgeons, anesthetists, nurses, and other experts who helped me navigate, benefiting me and the program at large. The past 8 years of my career in this role have helped me build some of the most important relationships of my life. Even though cleft management was quite unique from all the other programs I had managed, it has been one of the most rewarding experiences that taught me the value of resilience, determination, and building strong professional relationships.   ES: That’s a beautiful way of putting it. How would you say your role at Smile Train relates to you as a person and as a professional?   SZ:My role at Smile Train goes far and beyond my professional development. This role has allowed me to grow emotionally and has given me a greater purpose in life. Working for an organization that is committed to transforming the lives of individuals with cleft lip and palate has been incredibly rewarding. The “why” behind what I do every day is crystal clear. Our programs are designed in a way that is unique and sustainable. We empower local medical professionals to provide free and comprehensive cleft care to patients in their own communities. This commitment requires us to have a deeper understanding of the different environment & landscape we operate in, we identify areas for improvement in the health system, and invest in the necessary resources to ensure safe & quality care for our patients. But beyond the technical aspects of our work, the true impact lies in the immediate transformation that we see in our patients’ smiles, as well as the ripple effect it has on their families’ lives. As a mother myself, I can empathize with the parents and guardians of children with cleft lip and palate. I understand the social, emotional, and economic burden that comes with having a child with a facial difference in a society where there is limited awareness, and support for people born with this condition. It brings me great joy to be able to play a role in alleviating some of that burden and make a significant difference in someone’s confidence and self-esteem. Therefore, my role has not only allowed me to grow professionally, but it has also given me a sense of purpose and a deeper appreciation for quantifiable impact in development.   ES: Anyone who works in the healthcare sector has that one story that changes or influences the entire trajectory of their perception, career, and behavior. This could be the story of a patient, an attendant, a healthcare professional, or even the healthcare infrastructure or facility itself. Can you share a story that has been pivotal for you in that regard?   SZ: I have been fortunate enough to encounter many patients whose lives we have been able to transform. However, in 2015, there was one patient in particular whose story has stayed with me and influenced the trajectory of my career. Akile Tosa, a 22-year-old young lady from the Oromia region in Ethiopia, had been labeled as “Broken Mouth” by some people in her community due to her cleft lip and palate. She grew up feeling isolated and rejected. She’s never been to school or had any friends. But what brought tears to her eyes was the fact that she was never invited to participate in the daily customary coffee ritual in her village. As she shared her

Published online: 4/4/2023 During the last decade, Ethiopia has made significant progress in improving its emergency medical services; one of the reflections of this could be that it has established an emergency medicine specialization program in medicine and nursing programs, making it one of the first nations in Africa to do so. In October 2012, with the support of the Ministry of Health, the Ethiopian Society of Emergency Professionals (ESEP) was founded as a national society to become a professional organization that can assist emergency care providers across the country in saving lives, protecting property and the environment during emergencies and disasters. Currently, ESEP has over 500 members in all corners of Ethiopia and is Ethiopia’s largest network of emergency professionals. A unique aspect of the society is that it is a multidisciplinary professional organization that includes physicians, nurses, pre-hospital providers, community representatives and many more professionals in Emergency Services. The mission of ESEP is to serve its members and the community by providing information, networking, and professional opportunities and to advance the emergency medicine and critical care profession. Considering the absence of a critical care society in Ethiopia and embracing the large community of early critical care providing community, the society has changed its name to the Ethiopian society of emergency and critical care professionals in 2019.  ESEP provides a platform for an alliance among professionals practicing in different parts of Ethiopia to assist its members, contribute to the expansion of emergency service by collaborating with government bodies for developing relevant policies & strategies to improve emergency service care, continue emergency education through curriculum development & implementation, work towards acquiring the financial capacity to conduct emergency medicine-related academic researches, encourage and advocate the rights of all emergency care professionals. Currently, ESEP is running multiple projects across the countries with multiple collaborators. It has gone a long way in contributing to the expansion of emergency and critical care services in Ethiopia; some of the achievements are; Improving research culture and capacity in acute care continuum, Establishment of African journal of emergency medicine and critical care (PAJEC).   Active role during COVID 19 Pandemic response Since COVID 19 is diagnosed in Ethiopia, emergency and critical care professionals had a great role in the response. Their role varied from clinical care delivery to leadership role. The professionals were front line workers who were triaging and initial stabilization of undifferentiated patients in all emergency rooms where they are assigned.  At the federal ministry of health the national COVID 19 clinical advisory team was assembled led by ESEP leadership and three professionals from emergency and critical background. The major treatment centers in Addis were Yekka Kotebe, Millennium treatment center, St. Paul’s millennium medical centers and St. Peter hospital with its affiliated Field hospitals. ESEP was given an assignment to training low level professionals to deliver care to critically ill COVID 19 patents. More than a thousand professionals were trained in critical care delivery all over Ethiopia. We believe the effort of ESEP has reduced mortality from COVID 19. Advocacy effort to make early critical care an agenda item in Ethiopia. As intensive care units require costly equipment and trained human resources, their accessibility is poor in developing nations. This critical care can occur at any point of patient contact–the pre-hospital setting, the emergency unit (EU), the general medical ward, or the ICU–and does not require a physical ICU space to be provided. Early critical care services emphasize vital organ support during the initial medical care provided to the critically ill patient who is still within the dynamic phase (usually within the first 24–72 hours) of critical illness. The continuum of care in early critical care delivery is very important. The readiness of the system, and the ability of the health care force to identify and treat these critical illnesses early in the course of the disease is paramount and important for the recovery of the patient and preventing deterioration of the illness. ESEP has advocated for strengthening early critical care services in Ethiopia, including advocacy to incorporate emergency medical training in undergraduate education, dedicated funding for research, and advocacy for policy change. We have seen a huge change in Ethiopia, with the Ethiopian government making tremendous efforts to improve critical care delivery at different stages of the healthcare system. The scale-up of emergency rooms to identify diseases and equip required health care professionals are some to mention. There are more than 120 emergency medicine and critical care physicians and more than 300 master’s degree graduates working in different emergency and critical care rooms. Improving research culture and capacity in the acute care continuum Several acute care research projects have been funded by ESEP, which has also given members training to enhance their research capacity. As part of the Asia-Africa critical care database collaboration and the University of Oxford, ESEP has taken the lead in establishing the expansion of critical care databases in Ethiopia. Currently, the database establishment has begun in about five centers in Ethiopia. Working relationships between ESEP and regional, continental, and international emergency medicine associations have aided in producing research outputs. Through this partnership, ESEP was able to host an international conference for emergency medicine in Africa in Addis Ababa in 2021. Establishment of the African journal of emergency medicine and critical care (PAJEC); One of the achievements of ESEP is the launch of this journal. PAJEC is an open-access, peer-reviewed scientific journal. The journal publishes materials relevant to various disciplinary, interdisciplinary, and trans-disciplinary studies, focusing on acute care settings, including pre-hospital care, facility emergency care, critical care, and related public health areas. The journal accepts original articles, case reports, perspectives, editorials, reviews, brief communications, and commentaries on all aspects of the acute care continuum. In conclusion, ESEP has provided assistance in the development of hospital and pre-hospital emergency and critical care to support government and private facilities all over Ethiopia and beyond through collaboration with local and international academic institutions; hence, we extend our call to all professionals working in the

Access to emergency and essential surgical services is an important element of an effective healthcare system. The attention given to global surgery has recently increased, and initiatives like the World Health Organization’s Resolution 68.15 have called on countries to make progress in providing safe surgical care. As a surgeon who lived and worked in a remote area without electricity and most surgical resources, and now as an Ethiopian state minister, I am aware of the significant burden placed on individuals and families due to a lack of access to surgical services in low-resource settings, and I am excited to be a part of the development of innovative solutions to address this problem. Hopefully, my story will support and inspire clinicians, researchers, leaders, and governmental and non-governmental organizations across Ethiopia and throughout the world, working to ensure equitable access to and quality surgical services for all. I was born and grew up in a small village in the rural part of Ethiopia, where access to good healthcare services was a distant dream for many people. I had the chance to witness countless deaths just due to a lack of access to essential health care, particularly emergency and essential surgical services. I shared the pain, lived with it, and lost many of my relatives and community members because of it. In this environment, I was inspired to pursue a career in medicine and eventually became a surgeon, determined to make a difference for the people of my home village. Figure 1. Merhabete Alemketema High School After finishing high school and two years of preparatory school in that poor village, I was fortunate enough to join one of the universities in the capital of Ethiopia, Addis Ababa University, which was an opportunity I never thought was possible at the time. During my internship at the medical school, every time a uterine rupture presented, the patients mostly came from rural areas after being referred, and upon their arrival, they were exhausted; some of them died on the roads. Amusingly, these patients were mostly from my village, Merhabete, where I was born and raised. This made me feel a profound connection to the suffering of these people, and I felt a strong sense of duty to help them in any way I could. Figure 2: Patient being carried to a health facility, where there are no roads or vehicles available. After graduating from university, I returned to the rural villages, whilst I could have been assigned to the capital city with better medical facilities and higher salaries, I chose to work in the rural villages, not just to provide better healthcare and improve access but also because I saw how much of a difference I could make. During this time, I began to understand the system challenges of providing surgical services in low-resource settings. The first challenge was a lack of human resources, as the village had no general surgery,  obstetrics, or anesthesia specialists, and I was only a general practitioner. As part of the solution, my nurse colleague and I took a three-month course in emergency anesthesia and surgery, respectively, and returned to work. These enabled us to perform emergency CS, hysterectomy, appendectomy, bowel resection, anastomosis, and trauma-related procedures, which are now called the Bellwether Procedures. At least pregnant women and people with severe injuries were spared having to travel 180 km by gravel road across deserts and steep cliffs to a nearby hospital, which would further complicate their situation. Figure 3: Gravel roads and bumpy roads Alem Ketema, 2017 The second challenge was the cultural norm of the community not visiting the health care facility early for medical care, often waiting too long to seek treatment. This was especially difficult for mothers who were forced to give birth at home with traditional birth attendants and considered going to the hospital a taboo, which resulted in life-threatening complications and came to the health facility when it was often too late. To combat these issues, the hospital staff worked diligently to develop a strong rapport with the local community by organizing education campaigns and programs. We also invited mothers treated at our facility to participate in promotional activities, and we met with birth attendants to address their concerns and ensure they referred mothers in need of medical attention earlier. All these efforts have increased the number of patients admitted to our hospital.  Figure 4: Alem Ketema Hospital, North Shewa, Amhara region, Ethiopia Despite the assistance we were receiving from the Menschen for Menschen program established by Dr Karl Heinz Boem, who was constantly donating and supporting this hospital with equipment, beginning with upgrading, and furnishing our hospital from a small health center, other challenges included insufficient funding and staffing levels, as well as a limited supply of some surgical equipment and blood products. We began contacting the Ministry of Health and regional health bureaus to address these issues while also attempting to use all preventive and treatment measures to help our patients with our limited resources. In such a situation, I worked for three years as an emergency officer and then I left the village to advance my education by specializing in obstetrics and gynecology. Following my specialty training, I returned to this community, and most challenges remained unresolved, and some had even worsened, though the community’s needs are increasing. People needing surgery could not be accommodated, so a substantial number of those cases were referred to the nearest hospital, located more than four hours away, where they also might be told to come back after a week or months. Often, I am asked to operate on brain tumors, which is not my area of expertise, because people think you can operate on anything if you open up an abdomen. This is the point at which I realized that I had to look beyond providing medical care and toward leadership to make a meaningful and lasting impact on these people’s lives that is not dependent on individual efforts. Figure 5: Surgical team in the OR