Joyce Murray speaks with Ato Alemayehu Galmessa, center, a psychiatric nurse and instructor from Alemaya University, and Ato Belete Shiferaw, a nursing instructor from Dilla College, during a rural health clinic visit.

Most of the year Joyce Murray, Ed.D., RN, FAAN, teaches psychiatric/mental health to graduate students at the Nell Hodgson Woodruff School of Nursing at Emory University. She is backed by libraries, computers and all of the educational resources of a major American post-secondary institution.

But at least two to three times a year, she travels to North Africa to train health care faculty at seven Ethiopian universities, here as recently as a few years ago, faculty were teaching clinicians from the handwritten notes they had taken as students.

For several years, Murray has been the director of The Carter Center’s Ethiopia Public Health Training Initiative. “I see it as the highlight of my career,” she said. “The idea was to strengthen the skills and knowledge of the faculty who teach the health care practitioners and health center workers around the country, thereby improving the health of all Ethiopians. It has been a quiet, ongoing effort and, we’re proud to say, it’s working.”

Savaged by war, drought and years of government corruption, Ethiopia’s health care system had greatly deteriorated. It’s a country where one-sixth of all children die before their fifth birthday and 50 percent are malnourished. Three-quarters of the population doesn’t have safe drinking water and two-fifths receive no health care.

Ethiopian Prime Minister Meles Zenawi invited President Jimmy Carter to help build and train his country’s health care work force in 1998, but the initiative didn’t really take off until USAID and the Packard Foundation provided major funding in 2000-2001.

Even with the funding, Murray had doubts at her first training workshop. Besides the language barrier, geographical constraints and cultural differences, the faculty had outdated texts, no journals and sparse lab equipment and teaching aids.

Murray soon found common ground in nursing, however. Nurses are a critical part of the interdisciplinary care team, she said. “They develop relationships with patients and families and they know the health issues they face.”

Some of the top concerns in Africa are infant diarrhea, malnutrition, malaria, tuberculosis, pneumonia and HIV/AIDS. With writing and teaching skills learned from their American initiative partners, Ethiopian nursing, sanitation, environmental and medical technology faculty are creating training modules to address those issues and others.

Modules on infectious diseases, maternal and child health, nutrition, water sanitation, mental health and behavioral problems include epidemiological and medical data, reference materials, case studies based on local experience, lecture notes and practice manuals.

“One university team writes the draft,” Murray said. “The other universities critique and review it, and then it goes to national and international experts on the subject. Then it’s bound and distributed.”

Professors use the materials to train health care students, who in turn, train community health care workers around the country. “We’ve helped them to increase their writing and teaching skills, and the initiative has added textbooks, journals, computers, printers and basic lab equipment to seven Ethiopian university programs, but the real beauty of this project is that it is their project and they own it,” Murray said. “They decide what topics to teach and what needs to be in the materials, because this is their country.”

Murray is encouraged by the stronger bonds between Ethiopian universities and the growth of the health care educational system in the country.

“Previously, the universities had one- and two-year nursing programs,” Murray said. “Now those programs will be taught by regional institutes and the universities will offer only degree programs. This September, Addis Ababa University is starting its first master’s degree program.”

Another measure of the project’s success was the EPHTI’s response to Ethiopia’s drought in 2002. The universities deployed more than 2,000 students to drought-affected communities to build wells and latrines, provide education and basic health care.

Dr. Hailu Yeneneh, a resident EPHITI technical adviser, wrote, “It was a remarkable display of dedication and compassion. Many of these students stayed on past their required time commitment to continue providing these essential services. We all learned a lot about ourselves and our country.”

Drought response training is being incorporated into university curricula to prepare health care workers to react to future disasters.

The initiative is also sponsoring a replication conference to demonstrate to other African countries how the project works.

“We provide resources, but we can’t do the work, because we don’t live there,” Murray said. “It’s essential that the project belongs to them. It has been wonderful to watch their growing confidence and the improvements they’re making to their health