The ‘bo­lus’ model: a sus­tain­able tem­plate for in­ter­na­tion­al­i­sa­tion?

Toronto’s col­lab­o­ra­tion with Ethiopian univer­sity has trans­formed the lo­cal health­care sys­tem. El­lie Both­well re­ports

THE (Times Higher Education) - - NEWS - El­lie.both­[email protected]­ere­d­u­ca­

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

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