Co-Creating a Psychiatric Resident Program with Ethiopians, for Ethiopians, in Ethiopia: The Toronto Addis Ababa Psychiatry Project (TAAPP)
ABSTRACT Globalization in medical education often means a "brain drain" of desperately needed health professionals from low- to high-income countries. Despite the best intentions, partnerships that simply transport students to Western medical schools for training have shockingly low return rates. Ethiopia, for example, has sent hundreds of physicians abroad for specialty training over the past 30 years, the vast majority of whom have not returned. This represents a highly problematic net transfer of financial and human resources from the Ethiopian people to Western countries that have failed to develop their own adequate health human resource plans.
With this background in mind, in 2003 Addis Ababa University invited the University of Toronto to collaborate on the first Ethiopian psychiatric residency program to be run entirely in Ethiopia. Called the Toronto Addis Ababa Psychiatry Project (TAAPP), it was established on the principle of supplementing the ability of the small Addis Ababa University Department of Psychiatry to teach, provide clinical supervision, and to help develop educational capacity. Over the last 6 years the model has involved a large number of University of Toronto faculty and residents who have spent blocks of 1 month each in Addis Ababa.
This article describes the first three phases of TAAPP (I) Development of a model residency program; (II) Enhancing clinical, educational and leadership capacity; and (III) Sustainability, faculty development, and continuing education. Between 2003 and 2009, the number of psychiatrists in Ethiopia increased from 11 to 34; the Addis Ababa University Department of Psychiatry faculty increased members from three to nine. There are new departments of psychiatry established in four other university hospitals in Ethiopia outside the capital city. Mental health services are now being integrated within the national system of primary care.
An important issue that underscores such a partnership is the risk of simply exporting Western, America-centric psychiatric training versus creating culturally appropriate models of education.
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ABSTRACT: The Toronto Addis Ababa Psychiatry Project (TAAPP) is an international collaboration between University of Toronto and Addis Ababa University. University of Toronto psychiatric residents may participate in TAAPP as an elective. The authors explored the Canadian resident experience in a qualitative study of the project. Eleven residents were interviewed using a semistructured questionnaire. Grounded theory was employed to organize participants' experiences and highlight emerging themes. The computer software NVivo7 was used to facilitate data analysis. Participants described gaining competency as health advocates, collaborators, scholars, and teachers. They endorsed increased sensitivity to cross-cultural issues and greater awareness of global health issues, including practical and ethical ramifications of working at an intersection of cultures. Residents gained international perspective psychiatric practice. The elective provided unique opportunities for acquiring clinical, teaching, collaborative, leadership and advocacy skills. It prompted participants to consider ethical and cross-cultural issues and allowed them to be mentored intensively by Ethiopian and Canadian teachers and peers.Academic Psychiatry 11/2010; 34(6):433-7. DOI:10.1176/appi.ap.34.6.433 · 0.81 Impact Factor
- Academic Psychiatry 11/2011; 35(6):354-9. DOI:10.1176/appi.ap.35.6.354 · 0.81 Impact Factor
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ABSTRACT: A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries.The Lancet 11/2011; 378(9803):1654-63. DOI:10.1016/S0140-6736(11)61093-3 · 45.22 Impact Factor