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Mulualem Gessesse Dr.


 
Key Achievements:  

First Ethiopian neonatologist, who has pioneered the opening of new neonatology units at four hospitals in Addis Ababa and a training course and curriculum for nurses and general practitioners to help reduce neonatal mortality, saving the lives of 10,000 newborns in just six years

Current Position: Neonatologist, Yekatit 12 Hospital, Addis Ababa
Birth Place: Addis Ababa, Ethiopia
Birth Date: 1964
Current Home: Addis Ababa, Ethiopia
 
       
  Secondary School  
  Teferi Mekonnen High School, Addis Ababa  
   
  MD, University of Havana, Havana, Cuba  
   
 

Pediatric specialization and neonatology sub-specialization, University of Havana, Havana, Cuba

 
   
  Medicine - Neonatology  
 
 
   
 

Dr. Mulualem Gessesse is a pioneering neonatologist who has spearheaded the establishment of four new neonatology centers in government hospitals in Addis Ababa over the last six years and developed training programs and curricula to train health professionals and nursing students in neonatal health promotion, saving over 10,000 newborn lives in the course of the last six years.

Born in 1964 in Addis Ababa in the Siddist Kilo neighborhood, Mulualem was the second of seven children, born to a father who was a military sergeant and a health officer and a mother who was a housewife.  Though her father died on duty in Bale when she was 14, he was a major influence on her life and watched her education closely, dreaming of building a hospital in Gondar, where he was from, one day.  When she was in the 10th grade, in 1978, shortly after his death, she, three sisters and a brother were given the opportunity to go to Cuba to study. Though her mother didn’t want her to leave, she eventually agreed because of Mulualem’s father’s strong desire for her to get the best possible education.

In Cuba, after spending six months learning Spanish, she joined the university in Havana, the country’s capital, to study medicine; though originally she was interested in studying engineering, her teachers helped her decide on medicine instead because of its importance for the country.  After studying for seven years, she became a general practitioner and returned to Ethiopia in 1986 to do her internship at various hospitals including Tikur Anbessa (Black Lion) and Yekatit 12.  Her graduation that year was a special occasion and attended by the minister of health.  She met her husband, Dr. Gemechis, while they were both working as interns.   

Immediately after graduation, she and her husband moved to Harar where she worked in the Army hospital in Bisidimo, Harar.  Because the specialists were Cuban, she also served as interpreter at board meetings.  After working there for five years, she returned to Addis and began to work at Yekatit 12 Hospital in 1990 where she continued to work for 10 years as a General Practitioner.  She had always been especially interested in working with children and jumped at the opportunity to study pediatrics in Cuba again.  Sub-specializing in neonatology, she has been working in that field at Yekatit 12 Hospital for the last six years.

After starting her pediatrics specialization training in Cuba, while in Addis visiting her family, she met a Cuban subspecialist in neonatology who worked at Tikur Anbessa Hospital (Black Lion Hospital) on Ward B6 and worked with her for about eight months.  Working with her, she saw how minimal the equipment and the trained personnel were and, heartbroken by the plight of the newborns, she was determined to help.  Tikur Anbessa, Ward B6, was the only center for at-risk newborns in Ethiopia at the time and the need was enormous.  Caring for struggling newborns was a greatly neglected issue in Ethiopia at the time, because of the lack of knowledge and facilities; the general practice was to let pre-term and asphyxiated newborns die by exposing them to the cold.  Exposure to cold and hypothermia aggravates any problem for newborns immediately, because they are not neurologically able to adjust their body temperature to cold.  Many newborns from within Addis as well as from the surrounding provinces were referred to the center at Tikur Anbessa and many of them died. 

She still had one more year to finish her pediatric specialization. By that time, she was married and had children and leaving her family was very difficult; she lost more than 20 kilograms in that first year.  But, offered another scholarship to study neonatology, the sub-specialization she knew was so vital, she stayed for another two years, with her husband’s support, working with extra energy and focus because she knew how difficult it would be to change attitudes and practices in what was virtually an undeveloped field in Ethiopia at the time. 

Returning to Ethiopia in 2006, she found the situation even more challenging than she had anticipated.  Tikur Anbessa was still the only hospital with any facilities to treat newborns; even in a major maternity hospital like Gandhi Hospital, there was no center for newborns.  Her first move was to focus on immediate post-delivery visits and refer at-risk children to Tikur Anbessa.  Her next move was to train four nurses and gather the most basic equipment available to be able to treat newborns at Yekatit 12 hospital instead of referring them out.  The conditions were miserable – no running water, no electricity, no incubators, no phototherapy, but her motto was “Improvise with what you have, improve and then standardize.”  She continued to train nurses and to develop a comprehensive training and operational program, designing appointment cards, admission and discharge protocols, management protocols, training manuals, and so on to be able to train competent professionals.  Eventually as people began to hear about her work, people from the diaspora and from other organizations began to help.  She established a a high risk clinic as well as an out patient department; she started isolating children with infections in a different room and increased the number of nurses monitoring them.   One of those who made a huge difference was Dr. Anteneh Roba from the international Fund of Africa who provide the equipment they needed within 6 months of his visit.  Admissions to the unit rose from 240 in the first year to over 1000 per year today; the number of child deaths dropped from about 16 percent in the first year to less than 5 percent today.

Realizing that just two centers in the country were not nearly enough, Dr. Mulualem began to focus on helping to start new centers in other hospitals where the number of deliveries was significant.  She trained nurses to help establish a unit at St. Paulos Hospital and handed the project over to Dr. Birzaf, who started providing services within six months.  Gandhi Hospital began to provide services in the same way.  With funds donated by the Indian Birla family, who had heard from colleagues about her work, Dr. Mulualem was able to build the Birla Pediatric Center at Yekatit 12;  she used the period during which they had to move out for nine months during the construction to help train personnel to start another unit at Zewditu Hospital.  Today there are five neonatology units in Addis, including the original one at Tikur Anbessa.  With continued support from Dr. Anteneh and from UNICEF, another dream, a new center of excellence for neonatology has been completed which will open soon.

Long-term, one of the solutions is to work on prevention of high-risk pregnancies, through expanding pre-natal care and reducing unwanted pregnancy.  Immunizations, preventive medications and prenatal testing can identify and prevent most of the problems currently afflicting newborns in this country.  But this kind of care is not currently accessible to most women, so the centers are dealing with the effects of problems faced by newborns.  Ethiopia is one of five African countries in which more than 50% of child deaths are caused by complications of pre-term births, infections and asphyxia.  Dr. Mulualem has been working to raise funds from donors to address these issues.  Even without significant funds, training to prevent infections and aggravations of newborn stress can be effective.  With the support of Minister of Health Dr. Teodros, Dr. Mulualem has been training university nursing students from Gondar, Jimma, Hawassa, Mekele, Haromaya and Bishoftu.  Along with the knowledge and skills, she and her colleagues try to impart the passion, dedication and commitment that is needed to work with newborns.

Dr. Mulualem has faced challenges in her work for a number of reasons.  First, she has found a lack of flexibility in making room for needed changes and a lack of integrity.  Second, she’s faced doubt because she is a woman and because she received her medical training in a socialist country, even though Cuba has one of the best medical programs in the world, with infant mortality at just 4 per 1000, lower than in the United States.  People often assume she works for personal gain, not realizing that at times she has used her own resources to achieve her goals.  And of course the bureaucracy, the lack of transparency, and the absence of a good system for work make progress complicated;  there is still a problem at the leadership level.

But the situation is improving.  With the willing collaboration of the Federal Ministry of Health, the International Fund for Africa, the Addis Ababa Health Bureau and the CEO’s and management teams of each hospital involved, Dr. Mulualem and her colleagues have been able to create four new neonatology units in Addis Ababa government hospitals, trained over 100 nurses, and saved the lives of more than 10,000 newborns in just six years.  Dr. Mulualem dreams of designing and starting a two and a half year BSC curriculum for nurses here in Ethiopia to become specialists in neonatal health.

Her advice for girls and young women today:  If you are passionate about your cause and believe in yourself, you can overcome whatever challenges come your way.  No path is ever smooth and comfortable.  To be successful, you must keep hammering away with persistence, commitment and passion.  We all have an obligation to work for our country.  If we understand that each of us has a calling and a legacy to leave, the burden will not be carried by just a few.  As we say in Amharic, “Hamsa lomi le and sew shekimu, le hamsa sew getu” (“Fifty lemons are a burden for one perons, but an ornament for fifty”).  If each of us does his or her part, the work can be completed easily.

 
 
 
  Key Sources  
  Interview with Dr. Mulualem Gessesse, June 2012  
  Other Sources  
        
  Researcher  
  Nahu Senait Girma, Hanna Arayaselassie  
       
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