Addis Ababa identity vs regional identity in Ethiopia :Role in the Conflict

My experience in Ethiopia has taught me that how the people of  Addis Ababa see Ethiopia is often from a much different perspective than how those in other ethnic groups living outside Addis Ababa especially those not Amhara see the country. This creation of a capital identity group versus a regional identity group plays a role in understanding the current Ethiopian conflict. The different perception of an Ethiopian identity creates an ideological conflict that is difficult to overcome. 

The modern city of Addis Ababa

I have lived in Ethiopia since 2012 functioning as an academic neurosurgeon training students, neurosurgical residents, fellows, acting as an advisor, as well as doing intense research on the scourge of neural tube defects. Initially I lived in Addis Ababa, the nations capital, then in Dessie in the Amhara region and then since 2015 in the capital of the Tigray region, Mekelle. When I moved away from Addis Ababa, still for many weekends I would travel to Addis Ababa to see patients and also do consulting for NGO development, business interests, and government health concerns. In both Amhara regions and the Tigray region I made trips to the countryside rural areas to meet with the rural people to try to understand how they live and what contributed to the incidence of neural tube defects for which I helped create research sites throughout Tigray and recently trying to establish in Oromia which was interrupted by the war.

The creation of monarchial command center
Addis Ababa is a relatively new city. Although there was some settlement there by the Oromia who called it Finfinne its urbanization began when the Ethiopian Amharic Emperor, Menelik II, moved there in the late 19th century to create a more centralized command post to control his domain that extended much farther south then northern Ethiopia. As has been well written about about the capitals of many developing countries, Addis which is the short term used by locals, became more cosmopolitan then other areas. A large influx of Amhara gradually moved into what had previously been Oromia. They encouraged the development of educational institutions, commerce, diplomatic interaction, and modernization of the city which rapidly outpaced that of the other areas of Ethiopia.

Immigration from many regional states to Addis Ababa blends into a city identity

Workers from many regional states seek opportunity and work in Addis Ababa

Immigrants from every region of Ethiopia came seeking work and opportunity they could not find in the countryside. Whereas in the countryside, which makes up the largest percentage of a rural population in the world among countries, lived a life less cosmopolitan and urban. While inter-ethnic marriage became very common in Addis it rarely happened and is often shunned in the countryside. The everyday language and identity in the countryside is the local one whereas in Addis those who were born and raised there identify themselves commonly as from Addis Ababa adopting Amharic as their main language and the Addis identity. They transform from their local ethnic culture to the Addis culture in one generation.

Rural Ethiopia is often one ethnic group following strong long standing cultural traditions

The current generation who was born in raised in Addis Ababa or went to university in Addis Ababa is more likely to accept the idea of a national identity to Ethiopia which makes a very small percentage of total Ethiopian population. Many have never been to the countryside and cannot relate to it other than it was where their ancestors grew up. This division of identity and experience no doubt plays a role in what is happening in Ethiopia today.

Those living in Addis Ababa have been raised with and most easily accept the idea of single Ethiopia identity predicted by such western social writers such as Levine. On the other hand researchers who spent time in the country side such as Young see Ethiopia as an empire of differing nations prone to recurring conflict.

The autonomy of the regional states and regional educational development empowers regional identity

Since the post Derg era began all the regional state capitals have had universities built. Although initially they were staffed by mostly Amhara faculty that is giving way to more regional ethnic faculty. Many of these faculty have had to chance to study abroad or least cooperate with international institutions.

Major universities now exist in all the major regionals states of Ethiopia

Over the past several decades thirty-three universities have been built in the many different regions of Ethiopia. Whereas the center of intellectual development was in Addis and primarily dominated by Amhara now there is a new spring of ideas and identity perceptions arising in each region. Thus new growth of regionalism is a strong counter to centralized Addis Ababa identity which promotes one national identity. Instead of all regional leaders going through a transformational experience of living in Addis Ababa for a time during their education that may alter their identity they are now being educated in regional universities by increasing regionally trained faculty and influenced by regionally experienced elders of the community.



The Path to Becoming a Neurosurgeon in Ethiopia

Neurosurgical fellow and resident repair an injured nerve in the arm of a man injured at work

The path to becoming a neurosurgeon in the developing country of Ethiopia  begins in primary education and progresses through a gauntlet of achievement challenges through early adulthood.  Ayder Comprehensive Specialized Hospital, the teaching hospital for Mekelle University,  is currently training 16 neurosurgeons for Ethiopia and surrounding countries.

As children they often grew up in a multi-generational house without electricity or running water. Time to travel to and from school everyday is measured not in minutes but in hours. Before and after school they have to help maintain the house and family income such as caring for livestock, farming, or doing labor.

When they go to primary school they initially speak the first language they learned from their family (Tigrinya, Oromifya, Sedamo, Afar, Grogi, etc.) but must then learn Amharic and English progressively in elementary and secondary school. If they are lucky enough to have a television set watching it can give an advantage to learning English. To get a chance at college they must show significant reading and writing skills in the three languages by the 10th grade.

At the end of their 12th year of secondary school they have to take a national competitive exam. Science and most studies in university are taught in English so competence is mandatory. The top scorers get a chance to attend medical school for a little over 2000 places currently.

For six years in medical school they are apart from their families for the first time. Living in crowded concrete dormitories with frequent water and electricity shortages, bedbugs, and a monotonous diet of little else but shir0 with enjera  are common experiences. The last year of medical school they function as an intern which is really on the job experience that is very demanding in terms of hours and responsibility.

To get into a residency program to become a specialist requires getting a sponsor, usually a university or regional health bureau, and then competing for the few hundred slots by interview, grade record, and more testing. For example in Neurosurgery last year there were 21 slots only for the whole country. If they get into specialty training, the pay is poor,  less than a hundred dollars a month and they have to find some kind of housing. Usually they end up renting a room in a house for sixty dollars a month. They will work 12+ hours a day and have to spend the night in the hospital about every third or fourth day working all night to care for patients. The training program lasts five years with one month of vacation per year.

The modern concept of physician training is that it is a triad of knowledge (basic science and clinical medicine), skill (examining patients, interpreting diagnostic tests, surgical skills, etc.), and professionalism. In the first year of training they have to learn how to care for trauma patients and critically ill patients. During this year they have to master the basic skills of general surgery before they can formally begin neurosurgery.

From the second year through the fifth year they have to learn the equivalent of a PhD in neuroscience, be able to save a critically ill patient, finely interpret magnetic resonance imaging and CT scans, master fine technical skills with eye hand coordination greater than the finest musicians, and demonstrate capable leadership skills to lead medical teams to save lives. They need to read about and comprehend about 500 to 800 pages of books and journals every three to four weeks.

Around the world, the British model of training surgeons has been adapted which is what we call competency based. Neurosurgical residents progress from watching how patients are cared for and undergoing surgery at first and then progressing to less and less supervision. Every day they are constantly challenged by not only the diseases they are treating but by a strong Socratic method of teaching requiring them to always explain and justify their every decision and action. Gradually they reach a point where they function with distant supervision which is the real measure of their capability. By the end of their training which has averaged evaluating a hundred or more patients in a week and participating in surgery on about 5 to 7 per week such that they have seen thousands of patients and participated in thousands of surgeries they will be competent neurosurgeons.