The early context and background for Toronto Addis Ababa Psychiatry Program (TAAPP): in Ethiopia, 85% of 94 million Ethiopians live in rural settings, and less than half have access to primary health care. Shortages of physicians with a brain drain of 80%, and a scarcity of allied health professionals with 40% of the population living below 1$/day, has resulted in a health care infrastructure struggling to cope with emergent and lingering health issues.
Western mental health services are scarce, in 2003 there were only 11 psychiatrists in the country, three of whom were on faculty in the Department of Psychiatry at Addis Ababa University (AAU). A plan was underway to start a psychiatry residency training program at AAU because candidates who went abroad for training seldom returned.
In 2003 the Toronto Addis Ababa Psychiatry Project (TAAPP), an educational collaboration between the Departments of Psychiatry at the University of Toronto (UofT) and AAU, facilitated the opening of the first Ethiopian psychiatry residency program.
- Together we have shared in training the first 50 Ethiopian psychiatrists boosting the number of Ethiopian psychiatrists to 61; and over 90% of the new graduates stay and work in the country
- The Ethiopian psychiatrists, now a critical mass, have lobbies successfully to change mental health services from an asylum model of custodial care toward the integration of mental health services into all levels of health care; requiring the training of all health care workers in mental health and illness.
- The first six Departments of Psychiatry have been opened by new psychiatry graduates outside the capital Addis Ababa. Promoting accessibility of Western mental health services in partnership and integrated with the traditional and spiritual healers in the communities.
TAAPP the Model
Two UofT faculty and a resident travel to AAU three times a year for a month; during this month they teach on 3 afternoons a week. Each one month curriculum is developed in response to the educational needs of the program. It is flexibly pre-negotiated and sequentially adjusted between the two departments and organized to include significant time for on-site clinical supervision of the Ethiopian psychiatry residents by the Toronto team. As a result of this experience core competencies have been adapted from the CanMED roles to EthioMEDS. Although EthioMEDS include the 7 key CanMEDS roles, they are reformulated as: Clinical expert, Leader, Educator, Scholar and Advocate, this has involved the addition of two further roles seen as central in Ethiopia, that of Educator and Leader.
At the end of the first three years, TAAPP was experienced as sufficiently successful by both Departments of Psychiatry that further three year periods have been successively negotiated: TAAPP Phase II 2006-8: Phase III 2009-
2011: Phase IV 2012-2015: Phase V 2016-2019 – these include:
- Ongoing in-country educational support continues;
- A one year TAAPP fellowship in UofT runs concurrently for new Ethiopian psychiatry faculty, thanks for Ontario Shores hospital, an affiliated UofT hospital.
- British Counsel funding permitted UofT faculty visits to the new peripheral departments for three years.
- Co-development of 1-2 Continuing Medical Education days a year for the Ethiopian psychiatrists.
- UofT Occupational Therapists have started one month training visits annually to teach staff and residents rehabilitation theory and skills for severely mentally ill patients; led by Marci Rose.
- Forensic psychiatry led by Dr Phil Klassen at Ontario Shores, has facilitated in 2015 the establishment of a Mental Health Court with a Diversion Program in Addis Ababa which offers tailored psychiatric programming as an alternative to the criminal justice system for the severely mentally ill who commit felonies and who are found not criminally responsible.
Over 50 faculty psychiatrists at UofT and 30 residents have travelled to Ethiopia to teach for a month as volunteers, several of the faculty have been more than once. The transcultural curriculum in psychiatry at UofT has been revised and more than doubled as a result, and now includes global mental health topics. TAAPP has won six awards – the most prestigious is the American College of Psychiatrists’ Award for Creativity in Psychiatric Education.
We have obtained four research grants, although only one of these were for operating costs:
- 2008-2011: University of Toronto: Pain C (PI), Hodges BD, Verma S, University of Addis Ababa: Alem A, Derbew D, UK: Prince M, Hanlon C. Project: Strengthening the Capacity and Sustainability of Mental Health Research, Training and Practice in Ethiopia Agency: British Council, Development Partners in Higher Education (DelPHE), International Agency CAD$121,640 (GBP60,000)
- 2004–2009: Beiser M, Fenta, Pain C (Co-investigator) Project: Leavers and Stayers: A comparison of the Health and Development of Ethiopian Children Growing up in Toronto and in Addis Ababa. CIHR CAD$516,338.00
- 2012-2015: Clare Pain and Dawit Wondimagegn (PIs) The Biaber Project: Scaling up Interpersonal Psychotherapy (IPT) for Common Mental Disorders in Ethiopia. Grand Challenges Canada. $1 million dollars
- 2013-2016: Grand Challenges Canada Rising Stars round 4: “Oxen of the land – traditional healers” Dawit Wondimagegn US$ 100,000.00
Despite the differences between the Ethiopian and Canadian cultures and resources, TAAPP recognizes the similarity and mutual learning possibilities between faculty and residents in the two departments in a transcultural experience that is similarly relevant to both countries. This experience becomes translated into an increased capacity to improve the understandings and treatments for the mixed ethnic communities in Toronto and Addis Ababa. With 80 different ethnic groups and over 200 languages in Ethiopia, our increasingly poly-cultural city of Toronto, province and country have much in common. As we continue to work together one of the benefits of a long and productive educational partnership will be the switch in the next 10 years to co-facilitating the opening of local psychiatry fellowships (child, forensic, alcohol and drugs, consult liaison) and building shared research activities.
The 13 year history of TAAPP has produced a workable, effective model for accelerating the creation of medical specialists in Ethiopia, preferred by AAU as the partnership model with all western partners. The extension of this project in 2008 is the Toronto Addis Ababa Academic Collaboration (TAAAC).