Educational Sites for Resident Rotations

Since the late 1940s, the only site for civilian psychiatric care in the country has been Amanuel Hospital . Founded by the Italians, the hospital takes its name from the Amanuel Church, close by in the Mercato district of Addis Ababa. Amanuel Church is known for the healing powers of its holy waters, the traditional treatment for medical and psychiatric disorders. For many years, Amanuel housed mostly psychotic patients with forensic histories, who often stayed for decades in overpopulated rooms of  approximately 364 beds for 500 patients. 

Twenty years ago, the first psychiatric nurses were trained and took up positions at Amanuel Hospital. Sister Zewuditu on ward 2, one of  the first psychiatric nurses in Amanuel, describes the difficult conditions she found then and the gradual improvements she has assisted in making since that time.  In the last few years, the model at Amanuel has changed from custodial care to increasingly 21st century psychiatric care. There are now criteria for admission, and discharge planning is considered early in the hospitalization, although length of stay is longer than in most Canadian psychiatric wards. There are seven male wards and three female wards of about thirty patients each. With the inauguration of the residency program, two residents were assigned to each ward with a staff psychiatrist in charge—by the end of 2003, four residents had been assigned, so junior residents now take care of twenty patients each, and senior residents, ten patients each, leaving them time for their research project. The remaining patients are under the care of family doctors and nurse practitioners.

Ethiopian residents also work in the emergency department and in the outpatient clinics at Amanual.  There are morning rounds daily where the residents present any emergency or ward patient who required assistance after hours. The core curriculum lectures also take place at Amanual.

The second rotation site for residents in Addis Ababa is the St Paul’s Hospital , in the Yohanes area, next to the old Louis Pasteur Institute (too far to walk from Amanuel but about twenty minutes by car). As you enter the main doors, the psychiatry outpatient department is in the corridor to your left; here, in the mornings, many patients and their families wait to be seen. The psychiatry nurses organize the appointments, and the residents see up to two new patients each morning with several follow-ups. In general, these patients are less likely to be psychotic than are the patients seen and admitted at Amanuel Hospital. They present with very similar disorders to those of patients who visit psychiatric outpatient departments in North America. In most cases, patients at this site have mood and anxiety disorders, and medically undiagnosed symptoms are commonly seen.

A five bed addiction ward has now been organized by the psychiatry department at St Paul’s. Alcoholics Anonymous is not available in the country, although a group is being started for discharged patients. Substances of abuse in Addis include alcohol, marijuana, prescription medication (narcotics, barbiturates and benzodiazepines), and heroin. Khat, a leaf with amphetamine-like properties that is chewed, is commonly used and is legal; its role in the cause of psychiatric disorders in not clear.