Ethiopia, formerly Abyssinia and now officially designated the Federal Democratic Republic of Ethiopia, is located in the Horn of Africa, neighboured by Eritrea, Djibouti and Somalia to the north and east. Beyond the Horn, Kenya is south and the Sudans west.
It is the most populous landlocked country in the world with 92 million inhabitants. The capital and largest city is Addis Ababa, with unofficial reports of a population exceeding 5 million. The majority of the population lives in rural areas, often accessible only by foot.
This strikingly multi-cultural, multi-ethnic, multi-lingual society of more than 80 groups is exceptionally unique – the median age is only 16.9 years, it is majority Christian but one-third Muslim, with one of the oldest known alphabets, and uses the Ge’ez calendar which is 7 years, 3 months behind the Gregorian calendar (twelve months of 30 days, with a thirteenth month of 5 or 6 days).
The inhabitants are scattered throughout an unforgiving but diverse terrain of rugged mountainous plateaus, tropical forests and harsh deserts surrounding the Great Rift Valley. Almost 80% of the population has a rain dependent agrarian lifestyle. Major exports beyond coffee and livestock include khat, gold and leather. Ethiopia is home to 31 endemic species of mammals, including the nyala, Grevy’s zebra and the Ethiopian wolf.
And yet, this beautiful country is at the bottom of the Human Development Index due to a very low life expectancy, limited educational attainment and high percentage of people living in extreme poverty.
It is perhaps the most medically underserved nation in the world, with only 2,152 doctors for the entire population.
Maternal, newborn and child mortality are urgent concerns. Infectious diseases remain rampant, especially HIV/AIDS, tuberculosis, malaria and parasitic diseases. Many of these are associated with serious neurological complications. Non-communicable disorders including many neurological diseases are rapidly increasing. The result is a ‘double burden’ in one of the world’s most impoverished regions.
There is only one neurologist for every 4-5 million people, although the WHO recommends one for every 100,000 people. This number, albeit exceedingly disheartening, represents a significant improvement from the ratio of one neurologist for every 12 million people prior to commencement of the neurology training program.
Most are practicing in Addis Ababa, yet 85% of the population resides in rural areas scattered across an enormous land mass – larger than France and Spain combined; almost twice the size of the American state of Texas. Three graduates have relocated to start neurology services in the rural towns of Gondar, Hawassa and Nazareth. The remainder of the country is without any specialist neurological care.
The overwhelming majority of patients never have a chance to receive proper evaluation or treatment.
There are serious challenges beyond the shortage of neurologists in Ethiopia:
- Medical infrastructure is grossly inadequate
- Subspecialized services are non-existent
- Virtual absence of neurodiagnostic equipment
- Basic drugs limited or not available
- No meaningful rehabilitation services
- Stigma associated with epilepsy and other neurological diseases
These abysmal conditions are compounded by illiteracy, extreme poverty, food insecurity, underdeveloped or non-existent transportation services, neighbouring wars and a host of other problems, all in a setting of rampant tropical disease.