Journal of the International Association of Physicians in AIDS Care (JIAPAC) - Vol. 2, No. 1, January-March 2003
Carol A. Harris, MD, MSc
Associate Professor of Medicine and Director, Institute of Global HIV Medicine, Albert Einstein College of Medicine, Bronx, New York, USA

I thought that 20 years was a long time generally, and a very long time to be embattled in an epidemic. It is, however, a mere speck in time. For two weeks in November, 2002, I had the honor of teaching HIV medicine in Ethiopia. In return, Ethiopian physicians showed me a beautiful people, culture, and land that extends from the beginning of time.

Pestilence is not something new here. Ethiopians are not baffled that a new disease could engulf humanity, mocking our medical technology and antimicrobial wizardry. For millennia, they have known all manner of natural catastrophes, and have borne witness to the sinister machinations that only the human mind can conjure. Yet, throughout this tumultuous history, Ethiopians of all ethnic and cultural origins have remained resilient in the face of hardship, steadfastly dedicated to preservation of heritage, identity, and dignity.

From the moment of arrival in Addis Ababa, I felt that Ethiopia was a very special place, overwhelming with its unique combinations of sights and sensations. The changes that I experienced—in language, from English to Amharic; in distinct time, calendar year, and individual naming system; in exotic meals of "injera," fiercely-spiced meat dishes, and the richest of coffee; in haunting music—brought the people close to heart, and my own expectations and sensibilities quickly into question.

I was confronted with profound contradictions at every moment. Despite extreme poverty, there was exuberance for life and all its possibilities, best seen in the "mercato." This vast, vivid, and animated market overwhelmed me with the aromas of spices and peppers, and the sense that everything can somehow be recycled again. Despite lack of resources, the people were industrious and energetic. Women carried huge bundles of eucalyptus branches tied onto their backs, trudging from the surrounding hills to sell them as firewood in the city. Amidst the sophistication of the 21st century, millions lived in the countryside as in antiquity. Despite privation, the people glowed with warmth, pride, dignity, and generosity—characteristics that have been deeply embedded in their spirituality and tradition.

The terrain was majestic, glorious, and formidable. The highland plateau outside Addis was studded with mountain ranges. With a turn in the road, a pastoral village of neat "tukuls," or huts, and grain fields could plummet into a tortuous gorge or spiral upwards amongst crags and precipices. The natural wonders of the Gorge and Falls of the Blue Nile were matched by triumphs of mankind, such as the medieval castles of Gondar and the stone churches of Lalibela. I was constantly startled by unexpected beauty. A flock of black birds alighted from a tree, spreading their wings to become an unexpected and startling sea of iridescent blue. Being told they were starlings challenged my customary image of them as lackluster and raucous birds. "Those couldn’t be starlings," I mused in amazement. An Ethiopian colleague responded gently, "But Carol, those are Ethiopian starlings."

Over two weeks, workshops in HIV medicine were conducted in Addis Ababa, Gondar, and Bahar Dar, using several different forums. I worked with more than 200 Ethiopian physicians from all sectors of the healthcare system. These physicians had a deep and compassionate commitment to their profession and people, and expressed gratitude for the presentation of new medical information. Despite the absence of financial and human resources, they only desired the best for their patients.

In many of the sessions, I taught the principles of antiretroviral therapy, using two modules from the Global AIDS Learning and Evaluation Network (GALEN), a medical education curriculum created by the International Association of Physicians in AIDS Care (IAPAC); I taught the evolution of antiretroviral therapy in North America and Europe, and how we can apply this knowledge in other arenas. GALEN materials were invaluable for this purpose and the teaching sessions were well received. The copies of Modules 8 and 9, co-authored by John G. Bartlett, MD, of Johns Hopkins University, and Basil Vareldzis, MD, of the World Health Organization (WHO), were considered valuable gifts; I only wished that I had brought more than 200 copies for distribution.

After the sessions, I felt the GALEN training and reference materials empowered these dedicated physicians to effectively and appropriately deliver antiretroviral therapy within complex settings, and to expand their base of HIV clinical management knowledge, enabling them to act as agents of change in Ethiopia. It was comforting to know that the information provided in these brief sessions would carry forward long after my departure.

Although I did not know what level of medical expertise in HIV/AIDS to expect in Ethiopia, I was inspired by the careful reflection and independent evaluation of the information by the physicians throughout the sessions. Medical practice appeared hampered by limited infrastructure and personnel, but it was clear to me these physicians would know how to apply Western experience with HIV/AIDS to best fulfill their needs. They would benefit from scarce HIV medical education materials, such as the GALEN curriculum.

It was an honor to be invited as a "faranje," or foreigner into this country; it will be a privilege to be able to help these committed physicians care for those in need, and to lessen the suffering of those affected by AIDS in Ethiopia.

I do not know what path the AIDS epidemic will take in Ethiopia. However, I know that a major chapter in the history of this epidemic will be written here, and that it will be unique in the world. Despite adversity, there is a resilience, serenity, and indomitable spirit that must be the source of Ethiopian permanence. Ethiopians will prevail in this trial, as in all others they have confronted.

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