Written by Anisa Jafar, Consultant in Emergency & Paediatric Emergency Medicine

Edited by Silas Webb, ST4 Emergency Medicine, Kingston Hospital

Three days in the “Land of the Runners” and I find myself doing all sorts of mental gymnastics to marry up a dichotomy of fast and slow.  And of course, I’m not actually talking about running.

In 2025 The Ethiopian Society of Emergency and Critical Care Professionals (ESEP) was awarded a £200,000 grant from Global Health Partnerships as a part of the Global Health Workforce Programme which involved a partnership with the Royal College of Emergency Medicine (RCEM). But with only a 10-month timescale attached, speed was certainly of the essence.  If you have ever been involved in any sort of grant, for anything whatsoever, this simply does not compute – what can really be done in such a short timeframe? Well, it turns out, rather a lot – flying in the face of the relaxed notion and widely intellectualised “#African time”.  As an aside, on the subject of “time”, a handy fact which had entirely passed me by during my short visit, is that Ethiopia does actually run its own unique time system, If I try to explain it, you’ll be confused, however suffice to say, it may be wise to do a quick check of which time is being used when collaborating with Ethiopian colleagues.

The healthcare system in Ethiopia is tiered. At the Primary Level it comprises health posts, health centres and district hospitals. At a Secondary Level there are general hospitals. Finally at Tertiary Level there are specialised hospitals. Each type of provision serves an increasing number of people – with health posts covering a few thousand and specialised hospitals covering many million. Only basic emergency care can be expected at district level hospitals, and even general hospitals are limited in their emergency provision. More emphasis has been placed within tertiary hospitals in terms of Emergency Medicine (EM) development so far, but the provision remains variable.

Bespoke EM training was developed in 2010, at a single institution, and was closely aligned to the specialty of Critical Care.  However, the 2025 Marburg outbreak, COVID-19 pandemic and multiple natural disaster responses have really brought the speciality to prominence for the country’s Ministry of Health.  

The speciality training itself is currently 3 years long but those entering into it usually have significant experience in generalist areas of post-graduate medicine already.  There is much debate regarding the length of EM training, which  is an inevitable discussion as the speciality embeds more formally, because, very simply, there is so much for EM practitioners to learn how to do. Not unlike other LMICs with a young EM speciality, very quickly the question of where Paediatric EM training fits, is being asked. We have seen the same, for example, in Ghana and in Pakistan. This stands to reason given the high burden of child illness and injury which accompanies the health profile of LMICs.

So back to the whistlestop grant. The ESEP team had very much hit the ground running in terms of direction and precision in their strategy and planning – especially with the ear of the country’s healthcare leaders.  They are taking the lead as the first speciality in the country to develop national accreditation for individual sites’ training programmes which is a huge step in unifying the national EM training environment. The Ethiopian team have taken on advice and experience learned from African colleagues including those in Rwanda, Ghana, Uganda and South Africa during their summer meeting facilitated by the grant.

During the summer meeting, RCEM was able to connect the team with Prof Ellen Weber, who has since been providing mentorship to help Dr LemLem Beza grow their new Pan-African Journal of Emergency and Critical Care.  This meeting also sparked a strengthened partnership with The African Federation of Emergency Medicine and led to some preliminary discussions to develop a College of East African Emergency Physicians. This is an exciting development for the region as a vehicle for sharing best practice relevant to a not-dissimilar context, and if it really takes off, is likely to be a source of support and strength for the speciality of EM henceforth.

So whilst the old adage cautions not to run before you can walk, perhaps if you are as good at running as many are in Ethiopia, this rule simply does not apply! It is always very humbling and eye-opening to learn how systems work in other countries, and sometimes it feels surprising that as an outsider, you can be found to be even slightly useful. However the ESEP team were very keen to learn how we work in the UK so that they can take what will work for their system and adapt it, knowing that we’ve had a lot longer to both work things out, and indeed get things wrong – albeit in quite a different landscape. This is especially true as the ESEP team explore the best way to approach trainee engagement and accreditation of training centres and indeed sustaining and maintaining high standards.  Certainly some of their early challenges mirror many of our own UK concerns – for example: how should rotations be managed? How do we ensure adequate training in trauma? What is the best model to provide mentorship through training? How can we ensure less central and less popular training sites are staffed well enough to balance service provision?