Meet Dr. Zelleke
Tesfaye G Zelleke, MD is a child neurologist at Children’s National Hospital. Originally from Ethiopia, Dr. Zelleke completed his medical training in Addis Ababa University Faculty of Medicine. Dr. Zelleke started his early career as a general pediatrician in Jimma University, Ethiopia. He practiced pediatrics for six years before moving to the United States. Dr. Zelleke travels to Ethiopia frequently and teaches medical students and pediatric residents at the Addis Ababa University Faculty of Medicine, and Yekatit 12 Medical College in Addis Ababa, Ethiopia.
For Dr. Zelleke, global health is healthcare. “I come from Ethiopia with very limited resources,” says Dr. Zelleke, “there is a huge shortage of specialized medical providers.” Ethiopia has only four pediatric neurologists, Dr. Zelleke’s specialty, for a population of over 120 million. “There’s a lot of unmet need,” summarizes Dr. Zelleke, “I want to contribute to solving that problem.”
Two of Dr. Zelleke’s main projects aim to address this unmet need in Ethiopia. What started as Dr. Zelleke’s residency project at NYU, an intervention study on “The effect of high quality preschool program on language development in disadvantaged children in Addis Ababa, Ethiopia,” became a government funded program advancing preschool readiness. “At the time there was no preschool education for most children in Addis and Ethiopia generally,” recalls Dr. Zelleke, “preschool was accessible only for those who could afford it, but the mostly low income population cannot afford to send their children to these schools.” While 95% of children are enrolled in first grade by age seven in Ethiopia, only 75% remain enrolled the next year and merely 50% of children stay enrolled to fourth grade.
To understand and address this problem, Dr. Zelleke and his co-investigators started by comparing broader development milestones between preschool attendees and non attendees. The biggest factor by far? “Language development,” reports Dr. Zelleke, “an initial lack of preparation causes students to lag behind and impacts the rest of their lives.” The project then aimed to address this gap by founding the Ethiopian School Readiness Initiative (ESRI) and collaborating with the Education Bureau in Addis Ababa to launch a high quality program to help kids catch up, which they did after only a year. ESRI’s program now operates in 25 schools in five major regions of Ethiopia, Amhara, Oromia, Tigray, Somali, and Addis Ababa. By working in collaboration with regional education bureaus the program is able to operate in areas where 75% of the Ethiopian population is located. To date, ESRI has benefited over 56,000 children and trained over 2,600 teachers.
Since 2019, Dr. Zelleke has also been working on creating an epilepsy referral center in Yekatit 12 Medical College. Epilepsy is one of the most prevalent, and treatable, neurological disorders throughout the world. Epilepsy also disproportionately affects low and middle income countries, which house 80% of people with epilepsy worldwide. “Medications are available throughout the world for a very reasonable cost,” describes Dr. Zelleke, “treatment for a year would be about 5 USD.” Unfortunately, however, “75% of children and adults with epilepsy don’t get any treatment,” explains Dr. Zelleke. “There’s a huge treatment gap and yet it is one of the most cost effective interventions in neurology.”
Thanks to the generosity of the BAND Fondation, Dr. Zelleke has been able to work towards expanding access to epilepsy care in Ethiopia, launching a collaboration between the Comprehensive Pediatric Epilepsy Program (CPEP) and the Global Health Initiative (GHI) at Children’s National and the Yekatit 12 Hospital Medical College in Addis Ababa. Over three years, the project aims to expand access to epilepsy care to the majority of Ethiopians using task-shifting and building on the strength of the existing healthcare infrastructure.
The first stage of the recently funded project aims to improve care access by training local providers in skills specific to epilepsy care. Dr. Zelleke and his team will employ a task-shift model to train non-specialist health providers to diagnose, treat, and follow up with patients with epilepsy in primary care settings. In addition to training local providers in Ethiopia, the project will involve physician trainees in the Children’s National Global Health Residency Program.
A major part of the first stage of the project is strengthening the capacity of the Yekatit 12 Hospital Medical College in Addis Ababa as an epilepsy referral center in collaboration with the CPEP team. This will involve training pediatricians and general practitioners on epilepsy care and basic electroencephalogram (EEG) reading skills. This training will include familiarity with guidelines established nationally in Ethiopia and by the World Health Organization for the administration of first line anti-seizure medications. To ensure this educational effort is sustainable, a training manual will be developed and translated into Amharic, the local language, and initial trainees will be equipped with skills needed to teach peers in their field, expanding the network of providers with expertise on epilepsy care and treatment. “It’s an excellent approach to the problem given the very limited number of neurologists in Ethiopia,” explains Dr. Zelleke.
The end goal of the first phase of the project is a multidisciplinary epilepsy team including pediatricians, psychiatrists, social workers, epilepsy nurses, and pharmacists ready to provide care specifically for patients with epilepsy and trained to serve as educators for their peers, expanding the impact of the initial training effort. This stage of the project will also work with local Ethiopian epilepsy advocacy groups to develop and distribute educational materials for families and the public providing information on epilepsy in Amharic.
The second stage of the project aims to extend beyond Addis Ababa, replicating the task-shifting model to expand access to epilespy care to four other regions in Ethiopia. “This model is nothing new,” says Dr. Zelleke, “but it is something that can replicated in different regions. That’s what I am doing moving forward.” Following the successful development of an epilepsy center of excellence at Yekatit 12 Medical College, Dr. Zelleke and his fellow investigators will move 90 miles outside of Addis Ababa to a rural area of Ethiopia that still houses two million people. “The referral hospital there currently has no neurology provider or clinic, and anyone needing meurological care has to travel to Addis,” describes Dr. Zelleke. “We will train the local providers in epilepsy management and build up the referral hospital as a center of excellence and as a training site,” he adds. His team will also provide support through mobile clinics.
“In both phases, we are working closely with epilepsy advocacy groups in developing materials for families and the public,” describes Dr. Zelleke. This experience will help the research team create a sustainable system with the support of the Ethiopian Ministry of Health who will continue to provide training and support services after Dr. Zelleke’s team has left. Dr. Zelleke also envisions expanding the program to other countries in Africa. “It can be scaled on a bigger level and used for the treatment of other neurologic disorders and other healthcare issues,” describes Dr. Zelleke.
Expanding access to neurological care has been a personal and professional priority for Dr. Zelleke for many years. On a visit home during his fellowship in the US, Dr. Zelleke remembers riding the bus from Addis Ababa back to Debre Birhan where his family and extended family live. “On that trip,” explains Dr. Zelleke, “I met a mother and daughter returning from a clinic visit in Addis.” “The hospital they visited has one pediatric neurologist,”describes Dr. Zelleke, “they had been going back and forth, travelling 90 miles each way every month, and had still been seen by no neurology providers.” If there were pediatric specialists in her home city, there would be no need to travel back and forth, envisions Dr. Zelleke, “what if the family cannot afford this trip? It is not cheap to travel so much.” For the children who do not have the resources to make the trip to Addis, there is no care available. “This really made the case for me that I have to do something about this,” says Dr. Zelleke, “and sooner rather than later.”
Education is also a central part of the project. In addition to the focal point, educating Ethiopian clinical providers in skills needed for successful epilepsy care, the project aims to provide a global health elective for medical students, residents, and neurology fellows both in Ethiopia and from Children’s National. Educational outreach has always been important to Dr. Zelleke. Each time he travels to Ethiopia, he takes a few days to do rounds with medical students and residents and gives frequent talks on neurology and standards of care. Thanks to the launch of this new project, says Dr. Zelleke, “going forward I will have a more regular presence and will contribute to building up the epilepsy program and pediatric neurology program together.” Dr. Zelleke sees the epilepsy program as laying the ground work for educational collaboration and a sustainable partnership between Children’s National and Yekatit 12 Medical College.