I was recently at the European Society of Emergency Medicine meeting in Vienna where I met up with a great friend and colleague from Sweden. Katrin Hruska is an inspirational Swedish emergency physician who is leading the establishment of EM in her country as President of the Swedish Society of Emergency Medicine. When I meet people like Katrin I am reminded that there is an esprit de corps amongst emergency physicians around the world. I was therefore deeply moved by a story that she is sharing about a fellow physician caught in very difficult situation in Ethiopia. I invited Katrin to tell the story from her perspective. Please read and get in contact with Katrin if you can help.
Dr Fikru Maru
There is a joke in Ethiopia about how there are three kinds of Ethiopians: The ones who are in jail, the ones who have been in jail and the ones who are waiting to go to jail. I don’t think Dr Fikru Maru ever expected to be thrown in jail, but on the other hand he is no longer an Ethiopian citizen, but a Swedish one, having spent the last forty years of his life in Sweden.
It was in Sweden Fikru went to medical school and where he built a career as an interventional cardiologist. And it was with the support from Swedish investors and colleagues that he founded the Addis Cardiac Hospital ten years ago, with the hope of providing care that simply wasn’t available anywhere in Ethiopia. Dr Fikru implanted pacemakers and performed PCIs for patients who would otherwise have had to go abroad for treatment. The nurses and doctors at his hospital got training in Sweden and Swedish doctors would travel to Addis regularly to treat patients and help build local competence.
Swedish hospitals donated supplies and equipment that Fikru would bring one his trips to Addis. On one trip in 2010, when declaring the goods to customs, there was a disagreement on the value of the goods and Fikru found the custom fees asked for too high, so he decided to leave the bags at the airport. On his way home he paid the stipulated 5% tax on the goods he was taking back to Sweden. (Apologies for the lack of logic, but logic has very little to do with the fate of Dr Fikru.) But unfortunately he didn’t have enough cash to pay the fees for excess luggage and credit cards weren’t accepted. Running out of time to catch his flight, Fikru asked the airport staff to take the bags back to customs and bordered the plane. Before takeoff he was arrested by the police, accused of attempting to smuggle medical supplies into Ethiopia.
After being detained for eleven days, Fikru was released and travelled back to Sweden. He continued his work in Addis, but was naturally upset about the indictment hanging over him. After discussing the matter with the Minister of Health, the Director of Customs was contacted, who eventually talked to the prosecutor. The case was closed and the matter settled. At least that is what everyone thought.
Three years later, in the middle of the night, Fikru was pulled out of bed by police officers entering his house. He was arrested and spent four months sleeping on the floor together with other prisoners, awaiting a court hearing. His back is covered with scars from the bed bug bites he sustained there. He spent his time going through everything he had been doing in Ethiopia, trying to work out why he had been arrested. The charges came as a surprise. He was being accused of corruption. The prosecutor claimed that he had been using his connections and was aware of the fact that the Director of Customs was interfering with the judicial process when the smuggling case was closed three years earlier.
Another three and a half years later, Fikru is still detained in Ethiopia, waiting for his trial to finish. On 2 September he developed a spontaneous pneumothorax. His condition is deteriorating rapidly, since every attempt to remove the drainage has resulted in a relapse. Fikru needs thoracic surgery, that is not available in Ethiopia. To speed up his process, he has declined the right to defend himself and is willing to accept the verdict of the Ethiopian court. But there is no process to speed up, only a tormenting standstill. The last month has been filled with dates when a verdict would be given, but every time the judges have come up with a reason to postpone, a few days at a time. New obstacles are introduced randomly, one being that Fikru needs to be present in court for the verdict to be read, but on the day of the hearing the prison guards have not been given the order to take him there.
It is a desperate situation where a man is denied a life saving procedure, for incomprehensible reasons. The irony of a doctor’s desire to improve health care in a country in need, resulting in him risking to die from a simple pneumothorax is painful. The processes of the Ethiopian court are an insult to every health care provider who accepts the risk of working in a developing country. Fikru is losing and so are all the patients in need of better health care.