November 5, 2006

Dr. Shlomo Ma’ayan, Director of the Hadassah AIDS Center, with Ethiopian mothers during a recent visit there.A group of Ethiopian doctors and nurses were in Israel recently, learning AIDS treatment techniques to bring to the battle against HIV/AIDS they face at home.

The eight Ethiopian doctors and two nurses spent two weeks in Israel, working closely with medical teams from the Hadassah AIDS Center, the Central Virology Laboratory at Tel Hashomer and the Tel Aviv Medical Center, collectively known as the Israeli Consortium on AIDS Medicine (ICAM). They took part in the doctors’ clinical rounds, attended medical team meetings and, observed the advanced laboratory analysis that is part of the routine follow-up in the care of AIDS patients in Israel.

The program, funded by the US Government’s PEPFAR (President’s Emergency Plan for AIDS Relief) program, is aimed at training Ethiopian health care professionals in the techniques Israeli doctors have developed in more than a decade of treating AIDS in Israel.

According to Dr. Shlomo Ma’ayan, Director of the Hadassah AIDS Center and the head of the training program, the Israeli experience and methodology is particularly relevant to Ethiopia because so many of those suffering from AIDS in Israel are of Ethiopian origin.

“Ethiopian immigrants are by far the largest group of AIDS carriers in Israel. [We have] experience of a long period time in a very similar community to what they have in Ethiopia,” Ma’ayan told ISRAEL21c.

This experience can be of great value to Ethiopia because, while Israel and the West have had fifteen years to develop techniques to accompany the anti-retroviral drugs (ARVs) used to treat HIV/AIDS, Ethiopia, like other countries in sub-Saharan Africa, is only obtaining those medicines on a large scale now, as a result of huge global funding initiatives like PEPFAR.

PEPFAR, announced in 2003, is a five-year, $15 billion dollar program to reduce the spread of HIV/AIDS and improve access to treatment for the disease for the millions suffering in Africa, Asia and the Caribbean. Ethiopia, one of the plan’s 15 focus countries, was expected to receive more than $100 million dollars in 2006, much of this for the purchase and distribution of ARVs.

“You see the medicine came almost at once [to Ethiopia], once the cost issue was resolved,” explains Ma’ayan, who has been working in Ethiopia for the past ten years. “Then the question was, how do you build an infrastructure? In a country that has a quarter million AIDS patients eligible for treatment and four to five million HIV carriers, how do you get the infrastructure to start to treat those patients?”

The model that the Israeli doctors are teaching is what they call a ‘multi-disciplinary approach’. In this method, AIDS patients are treated by a team of doctors, nurses and care givers, all working together to ensure that patients are not only showing up for their periodic clinic visits, but also following their drug regimes at home.

This approach, Ma’ayan says, has emerged over years of experience with a large number of Ethiopian patients who do better with this type of team care.

“We are involving all medical professionals in treating AIDS,” he explains, “because we believe that AIDS is such a complex disease that it’s not a one shot [deal]. For this reason, doctors, nurses, case managers and psychological professionals work hand-in-hand on cases, learning about their patients and how best to treat them in the long-term.”

“We speak to each other and address both the medical aspects and the psychosocial aspects of AIDS, which are at least as important as giving the drugs.”

Ma’ayan elaborated: “There are difficulties that patients experience in taking these drugs for so long. After all, this is not aspirin, this is not antibiotics, it’s a treatment that has do be dealt with seriously because it’s a lifelong treatment. And lifelong, there’s issues of adherence, issues of understanding what the disease is, of side effects, of medicines and monitoring the medicines.”

Over the years, the Israeli medical community has learned critical lessons about the social aspects of the treatment – why people do or do not take the medicine, how to convince a person not to infect his/her spouse. “All these elements are extremely relevant to Ethiopia today,” says Ma’ayan.

Dr. Mekonnen Tadesse, a visiting doctor from the Afar region of Ethiopia, agrees. He believes that, of the things he’s learned in Israel, the most significant is the importance of case follow-up.

Case managers and social workers very much improve the level of treatment, he says, “because they know not only the medical aspects of the patients, but also the social aspects, which is very important. They’re inside what they are thinking, what are their problems beside the medical problems they have.”

Tadesse acknowledges that he and his colleagues face huge challenges in transferring what they’ve learned in Israel to Ethiopia where the AIDS prevalence rates can be as high as 12 percent in urban areas, and millions are believed to be infected by the virus.

“Here [in Israel] they have very small number of patients [and a large number of doctors] and in Ethiopia that’s our biggest problem,” Tadesse told ISRAEL21c “We have a shortage of health professionals, we have compromised laboratory treatment… so it’s a different setting.”

Estimates put the number of doctors in Ethiopia at 2500, in a country of more than 70 million. Nevertheless he says, this program is “very valuable, very important.”

“We have a lot to take to Ethiopia because we also have professionals, so how can these professionals be involved in the care? That’s the first question we ask ourselves,” says Tadesse. “With the limited resources we have, how can we give the best care to our patients?”

This is the fourth group of Ethiopian health care professionals to visit Israel. Those who train here will in turn train groups of doctors, nurses and case managers in Ethiopia.

Ma’ayan believes this training program will have significant impact on the future of AIDS care in Ethiopia. “The trainees learn that the team approach to management of AIDS is essential and indispensable if we want to achieve success in the ambitious American-Ethiopian program aiming at the distribution of ARVs to hundreds and thousands of AIDS sufferers in Ethiopia,” he says.

“[The doctors and nurses] come from all over Ethiopia, they are all involved in treating AIDS patients in huge clinics which have 1,000s of patients in one clinic for one doctor. So obviously, it’s impossible to treat such patients effectively.”

“But in our small example we basically show them how treatment should be organized for this chronic disease,” he explains. “And at least I can say that our example is good. I don’t know if it’s the best in the world, but, in our hands, it is working.”

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