Execution of the programme
The Department of International Collaboration at Haukeland University Hospital was responsible for the practical organisation of the programme. The neurosurgery project was funded by the partner institutions, but the main sponsor from 2010 to 2015 was FK Norway. During this period, the project had an average annual budget of NOK 3.1 million (USD 391 000). This funded the exchange of healthcare personnel between Ethiopia and Norway.
A total of 25 Ethiopian and 14 Norwegian healthcare workers participated for exchange periods of 6 to 12 months. Of these, 19 were Ethiopian specialist candidates in neurosurgery, while the remainder were nurses. The total cost of the project during the period 2006 – 2015 (grants from FK Norway, the University of Bergen and Haukeland University Hospital) was approximately NOK 20 million (USD 2.5 million). Some of the funds were spent on equipment. In addition, a private sponsor from Bergen provided funds for the purchase of new monitoring equipment and a neurosurgical microscope. As far as possible, the equipment has been purchased locally in Addis Ababa, but the larger pieces of equipment were imported, which has been a time-consuming process due to the Ethiopian customs authorities’ extensive documentation requirements. Together with the Black Lion, Haukeland has solved this problem by compiling a detailed list of the customs authorities’ documentation requirements.
The Department of International Collaboration assisted the candidates with visas, courses, housing, wages, taxes, national registration etc. Many of the candidates came to Bergen in November, when the limited daylight and the climate are a challenge even for those who are used to them. They received instruction in neuroradiology, neuropathology and intensive care, assisted in surgical procedures and participated in the department’s routines as observers.
The candidates were each assigned a Norwegian specialty registrar as a contact person, and participated in the annual Scandinavian course in neurosurgery at Beitostølen in Norway. One nurse stayed in Norway at the end of her training. Consequently, only nurses with family in Ethiopia and no relatives in Europe were recruited to the project after this. The Norwegian immigration authorities have made it more difficult for Ethiopian citizens to obtain a visa into Norway in recent years.
There are two aspects of neurosurgery in Ethiopia in particular that are distinct from Norwegian conditions: one is that patients are often in an advanced stage of disease, and the other is the imbalance between the large influx of patients and the scarcity of available resources. This leads to situations that Norwegian doctors are unaccustomed to, both in terms of diagnostics and treatment.
Some examples: Norwegian patients who are diagnosed with a tumour near the optic nerves normally only have moderately impaired vision. In Ethiopia, patients are often not diagnosed until they have been blind for several months. Norwegian children born with hydrocephalus are almost always intercepted at an early stage. In Ethiopia, children may be diagnosed at the age of one or two with a significantly enlarged head and permanent brain damage.
Norwegian patients requiring an operation on a spinal fracture or with a cross-sectional injury are operated on and then rehabilitated in a special unit. In Ethiopia, surgery is only an option if body supports are available and the patient can afford to pay for the screws. Rehabilitation is almost non-existent.
The disease panorama allows Norwegian doctors to gain experience in treating conditions that are less common at home. This applies, for example, to congenital malformations such as hydrocephalus and meningocele, and intracranial infections such as tuberculosis. Norwegian specialty registrars have therefore also had enormous professional benefit from working in Ethiopia.