A Pioneer for Plastic and Microsurgery in Ethiopia:

How Dr. Zenebe Teklu is leading his community towards improved access to surgery

by Miriam Gladstone

Dr. Zenebe Teklu remembers the moment when he decided to become a plastic and reconstructive surgeon. Years ago, while working as a general surgeon in Ethiopia, he encountered a young woman with a large chest wound through which many of her ribs were visible. As she had poor access to health care, a simple breast infection had gone untreated and had progressed to this critical condition. Teklu hoped to send her to a plastic surgeon in the capital city of Addis-Ababa to reconstruct her chest. The woman, unfortunately, did not have the means to access the lifesaving surgery.

“She said to me, ‘I am poor. I don't have anything. I can't afford to go to the capital, so please just do something for me here,” Teklu recalls. “I had no choice. I had to learn how to reconstruct the chest even though I had never done it before. I started going through plastic surgery textbooks and watching a lot of surgical videos.”

Remarkably, Dr. Teklu performed a successful Latissmus dorsi flap and the woman recovered well. It was then that Dr. Teklu realized how obtaining advanced surgical training would equip him to make an enormous impact on the health of his community. He went on to complete a fellowship in Plastic and Reconstructive Surgery at the College of Surgeons of East, Central and Southern Africa, and is in the process of completing additional training in Microsurgery. In this interview, Dr. Teklu describes the challenges of working as a surgeon within constrained resources and how he stays resilient, resourceful, and determined with the support of his family, friends, and colleagues.

A Shortage of Trained Surgical Health Care Workers

With only an estimated 20 plastic surgeons for the nearly 115 million people in Ethiopia, very few people in the country have reliable access to reconstructive surgical care. “Growing up in Ethiopia, everyone on my street wanted to be a doctor,” says Dr. Teklu. “But surgery to us was like some kind of legend.” A recent report even showed that in 2010 a lack of access to surgery killed nearly 17 million people per year, more than the total global deaths from HIV, tuberculosis and malaria combined.

A shortage of trained surgeons can result in incredibly long waiting times for patents. Dr. Teklu explains, “In my hospital there is around a 2-year waiting list for a simple plastic surgery procedure.”

Surgical camps or mission trips regularly visit the community and bring their own surgeons, anesthetists, and nurses. These programs can help to increase human resources in the short-term, however, may have unintended consequences on the community’s trust of their local health care:

“For more than 10 years, an NGO has come every 6 months to our hospital for two weeks to operate on cleft palate and cleft lip patients,” Teklu says. “But now there's this idea in the community that those kind of abnormalities can only be treated by foreigners. It has created an attitude that Ethiopian surgeons are not capable of treating it”.

Early surgical intervention is critical for preventing long-term, costly sequelae of injuries, accidents and burns. For example, in sub-Saharan Africa, over 1 million people per year are victims of burns. But without proper burn care soon after the injury, which often includes surgery, Dr. Teklu reports, “these simple burns will become complicated with different deformities that could have been prevented.”

Burn sequelae can have devastating effects not only on the individual, but also on the whole community. “[Without early burn care], the patient will become disabled for life. The whole family will be affected because that's the person who is supporting everybody else,” he adds.

A Shortage of Physical Supplies

Furthermore, Teklu says one of the other biggest barriers to improved access to surgical care is the allocation of limited resources in an already over-burdened health care system.

“[A lack of] consumables is a big problem in Ethiopia. For instance, an item needed in burn surgery is a graft blade, which is not on the national medicine list. It's not easily accessible or easily importable. We have to specially ask for it to be brought in,” he explained.

 Dr. Teklu points out, however, that simply providing new equipment may not suffice if the equipment is not integrated into the existing health care programs or staff not properly trained on its use. For instance, he reports, “We have a really advanced microscope that was bought by an NGO but now no one is trained to do anything with it.”

Partnerships for Capacity Building in Ethiopia 

Nowadays, the focus of development work is shifting to building capacity in hospitals and supporting the work of the local surgeons. Dr Teklu suggests the first step should be “to increase the capacity of training centers so that they can increase the number of surgery trainees.”

Once Dr. Teklu finishes his microsurgery training he plans to take his new skills with him back to Ethiopia, where he will be the first and only microsurgeon in the country. Of this new challenge, Dr. Teklu notes, “I know it is going to be stressful, but there’s also excitement that I’m going to start a new service and I'm going to help a lot of people. Being surrounded by different close friends, colleagues and family will help me.”

He’d also like to see more of a focus on mental health in his field. He says, “Wellbeing is what most people ignore in our culture, especially in Ethiopia. Whenever you talk about your wellbeing or your mental health, it's like it’s something extra, not like it’s something you need.” 

Teklu values having close collaboration with fellow surgeons and mentors through programs such as the SHARE program. He says partnership with others is a huge support to him in his training. One day, when the pandemic is in the past, Dr. Teklu dreams about working side-by-side with his mentors from oversees, “I hope that in the future to have to have some of the surgeons come to my hospital and do surgeries together. That's my plan.”

Dr. Zenebe Teklu is a reconstructive surgeon at the Jimma University Medical Center in Jimma, Ethiopia. He completed his microsurgery fellowship at the Ganga Medical Center and Hospital in India and his fellowship in Plastic and Reconstructive Surgery at the College of Surgeons of East, Central and Southern Africa.

Click here to read the interview with Dr. Teklu’s SHARE mentor, Dr. Johanna Riesel.