Ethiopia’s first neurointerventional & Stroke program

Dear Dr. Wondwossen Gebreamanuel Tekle, thank you for accepting the interview. You led a very inspiring initiative in Ethiopia by developing the first neuro-interventional/stroke program & 1st biplane cathlab there. Congratulations for this amazing accomplishment. We are curious to know more about it.

What is the current INR situation in Ethiopia?

We've just started the first neuro-interventional surgery (NIR) program in Ethiopia, a country of 120 million people (the second largest in Africa).
There is no trained NIR personnel in Ethiopia at the moment. The gap is HUGE!

Who initiated this project? How did you set up this project in addition to your other activities?

I did. I am originally from Ethiopia but trained in the United States. I have been practicing NIR in Texas for the last 10 years. I set up the project over a few years mainly by going back and forth between the USA and Ethiopia, and sometimes remotely. But once the program needed to start, I transitioned from being a full-time attending physician and associate professor in Texas to a part-time faculty so that I can spend at least 75-80% of my time in Ethiopia running the program and training fellows.

What are the main difficulties you had to face?

There are many challenges but to state just a few of them:

• Getting companies that produce thrombolytic drugs [actilyse (tpa), metalyse (TNK)] to come to Ethiopia as they repeatedly state they don't have enough stock of drugs to expand into more countries. We're buying these medications from other markets with much higher prices.
• Getting device companies to find distributors quick enough and bring their products to Ethiopia, with the exception of Medtronic and Terumo/Microvention who are making very good progress.
• Absence of trained nurses, techs, etc, in NIR.
• Creating adequate public awareness on the emergent nature of LVO strokes because most patients come late.
• Many people are unable to afford treatment for ruptured brain aneurysms, for example.

Which team did you create/manage for this purpose and which organization before/after the setup and launch of these center & program?

We first established an organization in the USA to support stroke care in Ethiopia. Then we looked for local partners in Ethiopia who owned well-run and good-quality hospitals and created a partnership with them in our NIR project. This approach helped us to focus on developing the program and launching it quickly instead of getting busy with the usually very long and frustrating task of finding a place and building our own facility which can be done at a later date.

What are the first cases that have been already treated on-site?

We already treated:

• Ruptured intracranial aneurysms
• posterior communicating and anterior communicating artery aneurysms;
• reversible cerebral vasoconstriction syndrome, etc.

 

What does this stroke program represent for the future of INR in Ethiopia?

I believe the program represents hope for the future of INR in Ethiopia as it has already started training fellows who will expand INR services to other parts of the country.

What advice would you give to your peers who would like to implement similar actions?

Be bold and courageous to expand such life-saving services to communities who have no access to NIR. There is always a way to get it started if you are willing to take on the challenge. It certainly is a fulfilling journey. You are much needed out there as stroke is becoming way too common in low- and very low-income countries. In fact, 2/3 of the stroke burden worldwide are in developing countries.

Do you have other projects/actions for this center & program or other initiatives in mind (such as launching other stroke centers in this country or elsewhere)?

Yes. Ethiopia is big and needs more centers. I started training fellows as soon as we opened the center anticipating that some large public and academic hospitals will want to start NIR services at some point, and when they are ready we will have some trained manpower to staff those institutions. For that reason, I plan to train fellows to handle stroke (LVO) emergencies early during their training.

Dear Dr. Wondwossen Gebreamanuel Tekle, I thank you very much for this very interesting interview and wish you and this first neuro-interventional center and stroke program in Ethiopia all the best for the future.      

Dr. Rodrigo Rivera,

Editor-in-chief
LINNC online

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