Global Scholar: Dr. Diriba Fufa Hordofa

Dr. Hordofa finds privilege in helping others in Ethiopia

There aren’t many quiet moments.

Not when you’re one of only nine pediatric oncologists in a country of almost 120 million people. Not when you’re also taking master’s classes in global child health and then trying to launch a Scholars Project at two facilities a thousand kilometers apart. Not when you have a family of your own — and are trying to keep that gym routine going through it all.

But sometimes, in those rare moments when he can catch his breath, Dr. Diriba Fufa Hordofa will allow himself a minute to look back and reflect on his story.

It still doesn’t quite compute.

“I feel very privileged,” he says, looking back on his journey from a childhood in remote Ethiopia, through medical school, all the way west to Baltimore, Maryland, and Memphis, Tennessee, east to Kolkata, India, and now back to Ethiopia, where he is taking on the critical issue of childhood cancer.

“What keeps me [going] to help these patients in such difficult conditions is just thinking, OK, who am I? … It’s only God’s grace that’s helping me to be privileged to help these people.”

One of 12 children, born into a farming family in the remote Gindeberet District of West Shao, Ethiopia, Dr. Hordofa would walk 7 kilometers each way to and from school, barefoot on a dusty, sandy road. Some days, he’d carry with him pouches of grain on his head or shoulders for grinding and mashing. At night, during his early childhood, he’d share one room with his siblings, plus the goats, sheep, and calves that were tied in the corners of the room. The young goats had free rein to wander around the room, and Dr. Hordofa laughs at the memory of their occasionally leaving an overnight surprise.

“Our families were very dedicated to our education,” he says. In fact, Dr. Hordofa remembers his father, a farmer who didn’t have a formal education, telling him one day, “Whatever the problem or challenges you encounter, even if I died, you shouldn’t be absent from your school.”

That moment has always stayed with him.

Perhaps it is fitting then, considering his humble, hard-working start, that Dr. Hordofa — now head of the pediatric oncology unit at Jimma University Medical Center, where he is also the lone pediatric hematologist-oncologist — has focused his Scholars Project on helping hospitals in Ethiopia better confront the challenges of operating in a limited-resource setting.

 Specifically, he is conducting an implementation study on integrating the ARIA Guide (short for Adapted Resource and Implementation Application) and hospital-based cancer registries into two cancer treatment centers.

 The ARIA tool provides resource-adapted guidance on the treatment of childhood and adolescent cancers. If a patient has been diagnosed with lymphoblastic leukemia, for example, the tool can provide guidelines on what to investigate before starting treatment, what to monitor during treatment, and how to assess the patient’s response. “This is very important in developing countries, where the trained human power is very limited,” he says. Along the way, those guidelines are adapted to the resources available to a particular institution.

 By implementing cancer registries in conjunction with the ARIA Guide, Dr. Hordofa hopes to better evaluate and measure outcomes, bolster planning, and support advocacy efforts with policymakers and stakeholders.

 He sees the two tools as intertwined — to truly measure the effectiveness of clinical guidelines, you need the data. “You cannot separate one from the other,” he says. “You cannot like just treat the patient and avoid the data.”

The field of pediatric oncology is relatively new in Ethiopia, where illnesses like HIV, tuberculosis, malaria, and pneumonia are also major challenges. And the field wasn’t initially an area of interest for Dr. Hordofa, who started off in pediatrics, becoming a medical director at Jimma.

 He shifted his focus to pediatric oncology, resigning his medical director position, when he saw that no one was taking advantage of a program to establish pediatric oncology through the Aslan Project.

 “I just decided, after thinking for a long time, I have to join this program,” he says. “How could we lack a person to join, to take the courage to join this very important program?” He notes that, previously, if a child was diagnosed with cancer at Jimma, they would have to travel to Addis Ababa, the capital of Ethiopia, for treatment. But more than 80% of the families confronting such a diagnosis would just head back home, he says.

 “[It was] because of the need on the ground,” he says of his decision. “I know many children were going back to their home, helpless. … I took this as a call from God, to me, to be in this field, to help these children. So that’s why I do not give up.”

 As part of a fellowship in 2017, Dr. Hordofa attended a one-month observership at St. Jude Children’s Research Hospital. Among his many takeaways from the fellowship was, first, that many people brought a public health perspective to their medical work.

 A second takeaway was just something he observed, again and again. Seemingly every time a department faced a challenge — whether that department was Critical Care, Infectious Diseases, … the list went on — it approached that challenge with the same perspective: This is an opportunity to change.

“Every one of them was thinking that challenges were an opportunity to change,” he says. “That was the first time I was really inspired with the public health. [I thought,] ‘I need to think like these people.’ ”

 The approach — and the interest in public health — stuck with him, eventually leading to the master’s program at St. Jude, the scholars project, and now work through a three-year grant from My Child Matters. With the latter, Dr. Hordofa will be working, with his colleagues, as a principal investigator to establish eight pediatric oncology satellite clinics in different parts of the country.

 These are all just the latest chapters in a journey that still leaves him humbled.

 “Though there are challenges and stress — and whatever the situations are there — I’m very grateful to God as well as to those people who have their blueprint in my life,” he says. “This will keep my energy to continue, to improve, to fight, to see pediatric cancer in Ethiopia being treated and cured as in other parts of the world.”

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