By Peter Goodspeed | National Post

In a land tormented by poverty, famine, drought, war and HIV/AIDS, Amanuel Hospital is Ethiopia's only psychiatric hospital.

Until recently, its 360 beds were the last and only refuge for the mentally ill in a country of 77 million people.

Not surprisingly, the hospital had a grim reputation, with more patients than beds, no dining room facilities, no specialty wards, few drugs and even fewer doctors.

Amanuel used to be regarded more as an asylum than a hospital. Just five years ago, Ethiopia, with more than double Canada's population, had only nine psychiatrists.

But a special relationship with the University of Toronto is beginning to change that, transforming the face of public health care in Ethiopia.

Dr. Clare Pain, a Global Health Scholar with Mount Sinai Hospital's Peter A. Silverman Centre for International Health, first volunteered in Ethiopia 24 years ago as a British physiotherapist working with children affected by polio. In the early 1990s, she returned as a Canadian psychiatrist and made friends with Ethiopia's few practising psychiatrists.

"It is a unique country," she said. "It is an ancient, mysterious, enormously stable place, culturally and socially. Materially they are quite compromised, but spiritually and socially they are rich. I'm absolutely in love with the place."

In late 2002, Dr. Atalay Alem of Amanuel e-mailed Dr. Pain seeking her help. He had a dream of expanding psychiatric care in Ethiopia by establishing a domestic training program for psychiatric residents.

Only, Addis Ababa University lacked enough qualified staff to establish a program by itself. Could Dr. Pain help?

His request came just as the University of Toronto was seeking to expand its educational relationships in other countries. When Dr. Pain approached her departmental chairman with a proposal to launch a voluntary teaching program in Ethiopia, the university jumped at the idea.

In a matter of months, Dr. Pain and Dr. Alem had established a program that would send three teaching teams a year to Ethiopia for a month each.

The teams, which consist of two psychiatry professors and one senior psychiatry resident from U of T, are voluntary and unpaid.

They instruct Ethiopian doctors in such specialties as forensic, child and geriatric psychiatry, and substance abuse. When they aren't lecturing, they provide clinical supervision as Ethiopian residents make their daily hospital rounds.

"It's great fun and a privilege to teach," said Dr. Pain.

"It's very rewarding because it is stimulating to work with smart residents, who ask smart questions. They come at your own stuff from a different angle.

"And there are hordes of bright, young, competent specialists at U of T who totally get it. It's as if they re-find their vocation through the eyes of the Ethiopian residents and doctors."

During the past five years, the visiting Toronto specialists have helped train and graduated 26 psychiatrists in Ethiopia.

But the impact on the country's health system is even more impressive. With a growing cadre of trained psychiatrists, Ethiopia has established four 20-bed psychiatric departments in regional hospitals, in addition to clinics staffed by psychiatric nurses in 26 district hospitals.

"Everyone who is a health professional [in Ethiopia] is now required to do some training in mental health," said Dr. Pain.

"There is an acknowledgment that there is no health without mental health. We've started to deliver better medicine."

In fact, the Toronto Addis Ababa Psychiatry Project has been so successful it is about to spawn a variety of similar programs in 10 other medical fields.

U of T is planning to launch an additional 10 small educational collaborations with the University of Addis Ababa in internal medicine, general surgery, pediatrics, family medicine, emergency medicine, laboratory medicine and rehabilitation medicine.

It will also help develop a PhD program in nursing, expand Ethiopia's pharmacy PhD program and help develop a master's program in library sciences.

"We seem to have stumbled on a model that works really well at building capacity and sustainability," Dr. Pain said.

"It is like having a kid: Once you sign on, you can't not fulfill your obligation."