Transforming Otolaryngology Care in Liberia
Tsion Sahle Gebre, MD, is one of the first trained ENT surgeons to practice in post-war Liberia.
Tsion Sahle Gebre, MD, is an otolaryngologist currently practicing in Liberia as a consultant ENT surgeon at the Gomez Institute of Medical Science. She recently shared insights into her background and work.
Tell us a little about yourself and your background.
I began my medical journey at Gondar University Hospital in Gondar, Ethiopia, followed by two years as a general practitioner at a rural hospital. I then entered residency training at St. Paul's Hospital Millennium Medical College, graduating in 2019. After completing my residency, I established the first ENT outpatient clinic in my hometown of Harar, Ethiopia, at Haramaya University’s Hiwot Fana Teaching Referral Hospital. This clinic significantly reduced the travel burden for patients in eastern Ethiopia, including those from Eastern Oromia, Dire Dawa, and the Somali region, who previously had to travel up to 500 km (around 310 miles) to receive ENT care.
Later, I assumed an academic role at St. Paul's Hospital Millennium Medical College, where I focused on training residents and medical students, primarily in otologic surgeries. I eventually relocated to Liberia, where I initially served as the country’s sole ENT surgeon before being joined by another fellow.
What led you to pursue a career as an ENT surgeon?
While working as a general practitioner in a rural hospital in Lalibela, Ethiopia, I used to see a lot of patients with ear discharge. Owing to the limitations in our medical training as well as the complexity of cases with long-standing ear drainage, successful treatment was often impossible. I felt helpless being unable to offer curative treatment to these patients. The nearest ENT specialist was in the capital city of Addis Ababa, which is 700 km (approximately 435 miles) away. The socioeconomic status of my patients, most of whom were farmers from surrounding areas, could not afford that journey, and it was almost impossible to provide proper care. This was one of the main reasons I chose ENT as my specialty.
Within otolaryngology, otology is my preferred area of interest. I was fortunate to train under an excellent otologic surgeon, Uta Fröschl, MBBS, PhD, who modeled her love for the specialty and helped me develop the skills necessary to perform otologic surgeries.
How did you decide to practice in Liberia?
When I arrived here, I saw that the Gomez Institute of Medical Science was a thriving hospital providing accessible care, including otolaryngology services, but there were no trained ENTs. My work here has been rewarding because I can help people who need my services and otherwise have no way to get treatment unless they travel to neighboring countries, which is impossible for many patients. Given the region’s general lack of ENT specialists, my practice includes general and emergency ENT care. Recognizing a critical service gap, I also established an audiology unit that offers comprehensive hearing and tympanometry tests, expanding ENT care in Liberia.
What are some of the challenges you encounter when providing otolaryngological care?
One of the most significant challenges I face is the lack of access to specialized instruments in Africa, which are essential for proper treatment in our surgical field. Additionally, ensuring safe anesthesia for patients with difficult airways is a major obstacle, as both the equipment and expertise required are often unavailable.
Despite these hurdles, the most rewarding aspect of my work is being able to offer much-needed care in a place where it is desperately sought. Being able to safely remove foreign bodies from the ear, nose, and airways and providing much-needed surgical care is rewarding. I feel a strong sense of fulfillment knowing that I am providing vital services and making a meaningful difference in people’s lives.
What are the most pressing otolaryngological healthcare needs that you see in your daily practice?
One of the most urgent healthcare needs in Liberia is addressing hearing health and providing treatment. Hearing aids, along with proper audiology and fitting services, are not available in the country. Furthermore, because of a lack of awareness and access to care, there is often a delay in diagnosing head and neck cancers. With no radiotherapy in Liberia, it can be very challenging to treat cancer patients, especially those who present with advanced stages of the disease.
What led you to join the Academy, and what do you hope to gain as a new member?
I joined the Academy to stay up to date with current treatment practices and guidelines, which will help me in my day-to-day practice. I have been attending the virtual Global Grand Rounds, which also help me keep aware of the current standards of care.
Is there anything else you would like to share with Bulletin readers?
ENT services in Africa are challenging to provide and largely ignored. As we know, our specialty requires specialized equipment, which can be inaccessible and quite expensive. In addition, knowledge about the specialty is lacking in many places and it is not given the attention that it deserves. Increased training in our healthcare institutions is crucial to improving service in many practice areas.
I look forward to connecting with other Academy members who are interested in addressing these critical issues to improve patient care in the region.