The ‘bolus’ model: a sustainable template for internationalisation?
Toronto’s collaboration with Ethiopian university has transformed the local healthcare system. Ellie Bothwell reports
A partnership between the University of Toronto and Ethiopia’s Addis Ababa University started out as just one joint psychiatry postgraduate training programme in 2003. Now academics across 24 disciplines from engineering to library science collaborate to build graduate programmes at the African institution, with 86 Toronto scholars visiting the university in 2018 alone.
Clare Pain, associate professor of psychiatry at Toronto and codirector of the psychiatry project, said that the universities did not intend to establish such a deep partnership. But the success of the psychiatry collaboration led AAU to ask Toronto to “expand in as many programmes as we had the capacity for”.
In 2003, about 80 per cent of doctors who went abroad to train did not return, leaving only nine practising psychiatrists in Ethiopia. But since the psychiatry residency programme opened, 80 psychiatrists have graduated locally. Overall, since 2010, the Toronto Addis Ababa Academic Collaboration (TAAAC) has co-trained 200 people, over 90 per cent of whom have stayed in Ethiopia, Dr Pain said.
The partnership also led to the first ever cohort of graduating emergency doctors in Ethiopia in 2013, and the country will see its first graduating class of speech-language pathologists this month.
Through these collaborations, Toronto academics travel to AAU to teach and supervise new graduate programmes for one month three times a year. The programmes are led and run by a small number of local faculty.
TAAAC has also resulted in some successful “spin-offs” and milestones for the country, Dr Pain said, including the establishment of Africa’s first mental health court programme, which diverts people with mental health problems away from prison if they have committed crimes as a result of their illness.
Meanwhile, the first cervical screening clinic in Addis Ababa launched because the residents in the family medicine training programme needed to learn how to do cervical smears, she said.
“I think [these initiatives are] secure because they’re attached to the actual academic needs of the learners,” Dr Pain said.
“Sometimes you see well-meaning projects pour money into some water project on the periphery of the country and you wonder if anything works three years later. We think that this way of moving out of pure academia and into other institutions in the country has a better chance of surviving.”
Marci Rose, programme coordinator of TAAAC at Toronto and the occupational therapy lead, added that the model was a more effective alternative to setting up a branch campus and more meaningful than partnerships that see academics “fly in [to an established institution] for a week, drop off some equipment or do some surgeries, and leave”.
“What we find is that we don’t want people there on the ground 12 months of the year and we don’t want to bring 20 family physicians at one time to teach because you push out all the Ethiopians who are there to learn,” she said, adding that new partnership requests “come from AAU”.
Referring to the method by which medication is administered in order to raise its concentration in blood to an effective level, Ms Rose said: “It’s kind of a bolus effect – come in for a month, teach and supervise, leave and then come back. By doing that, it’s the Ethiopians’ curriculum.”
Dr Pain added that branch campus models typically “exclude local talent and diversity and competence by coming in like the people who know everything and then take over”. That “seems to be the antithesis of partnership and any kind of expectation of real assisted growth,” she said.
Another factor contributing to the collaboration’s success is that one person in each participating Toronto department is responsible for their joint programme, visiting Ethiopia for a week at the start of the project and accompanying each team of academics that subsequently flies out, Dr Pain said.
“We realised early on that there are brilliant people who are interested and who want to go out and teach but if you just drop them off in Addis they don’t know how to hire a taxi or order lunch and all the logistical [challenges] distract them from the absolutely vital and generous gift of teaching and supervising that they want to do,” she said.
While Toronto academics come to Ethiopia to teach and train, the learning that takes place is reciprocal, Ms Rose said.
“We live in a very multicultural city here in Toronto. And having experienced the lives of people in a low-income country gives you a different perspective when you’re interacting with and treating people from different cultures,” she said.
On the mend a Canadian partnership has helped reverse Ethiopia’s brain drain and led to major medical milestones