Early in my career, I worked as a mental health professional in Ethiopia, spending time with people living with schizophrenia and with their families. One thing stayed with me from this experience: the part of the illness that often shaped their lives went mostly unnoticed: cognitive difficulties. These difficulties influence whether they can go to school, hold a job, run a household, or simply keep up with a conversation. Yet they were rarely talked about, rarely measured, and almost never treated. This gap is what drew me into schizophrenia and psychosis research.
To me, one of the most important questions in our field is: how do we recognise and respond to cognitive difficulties in people with schizophrenia? Studies have shown that cognitive remediation therapies can improve these impairments. But before we can offer any treatment, we must be able to measure cognition. In a country like Ethiopia, where specialist clinicians are scarce and there are no validated tools, even this first step was a challenge.
This became the focus of my PhD at Addis Ababa University, supported by the African Mental Health Research Initiative (AMARI). My aim was to develop a measure of cognition that was not only valid, but feasible and acceptable for mental health professionals working in Ethiopian settings. Measuring cognition matters because it lets us track how an illness changes over time, judge whether a treatment is working, and match each person to the best rehabilitation pathway.
Building such a tool in a resource-limited setting is harder than it sounds. There are few clinicians, little time to administer long assessments, expensive, and limited awareness of cognitive difficulties in the first place. Tools developed in higher-income countries cannot simply be translated and reused, as language and culture pose barriers. When adapting a memory test that uses word lists, for instance, the words have to reflect things that are genuinely part of people’s daily lives. So, I reviewed the existing literature, identified the most promising tools, and then consulted at length with local clinicians, people with lived experience, research experts and family members. Those conversations let me to select, adapt and refine a set of measures, which became the Ethiopian Cognitive Assessment Battery in Schizophrenia (ECAS), a battery assessing six domains of cognition (verbal memory, working memory, verbal fluency, attention and processing speed, and executive function) that clinicians and researchers in Ethiopia can now use. With my supervisors’ support. I led the development and validation of this measure, which was published in six papers listed below.
Being part of the SIRS community has shaped this journey more than I expected. Presenting at the Congress and receiving a SIRS Early Career Award gave me the opportunity to connect with researchers from around the world working on the same questions and to give my work the visibility it could never have achieved from Ethiopia alone. For an early-career researcher from a low-income setting, that recognition is not just encouraging; it also opens doors, builds collaborations, and signals that this kind of work belongs in the global conversation about psychosis. SIRS matters for people with psychosis precisely because it keeps making that conversation more global and moving beyond the few well-resourced settings where most research is still done.
Where do I want to take this next? My current postdoctoral work, again supported by the Wellcome Trust–funded AMARI network, focuses on closing the literacy gap in cognitive assessment by adapting and norming versions of ECAS so they work even for people with little or no formal education, a reality for many in low-income settings. Looking further ahead, I think about a young person who develops psychosis a few years from now in rural Ethiopia. My hope is that, by then, recognising and addressing their cognitive difficulties will be a routine part of their care, not a privilege reserved for those who happen to live near a specialist centre.
It has been an incredible journey, and there is still a great deal to do across Africa and other low-income settings to improve the prospects of people living with a schizophrenia diagnosis. If you have an interest, skills or expertise to share, do get involved. There is much to give and much more to gain.
