Ebola a stark reminder of link between health of humans, animals, environment

By Emily Caldwell
Ohio State Research Communications

COLUMBUS, Ohio – For many, global public health seems like an abstract and distant problem – until the Ebola virus is diagnosed among people in our midst.

Though no one would call the Ebola pandemic a good thing, it has presented an opportunity for scientists to alert the public about the dire need to halt the spread of infectious diseases, especially in developing and densely populated areas of the world.

“What often seems like an abstract notion becomes very concrete when a deadly virus previously contained in Western Africa infects people on American soil,” said Wondwossen Gebreyes, professor of veterinary preventive medicine at The Ohio State University. “It does create a certain sense of urgency and awareness that this world is much smaller than we think.”

Gebreyes is the lead author of an article published in the Nov. 13, 2014, issue of PLOS Neglected Tropical Diseases that makes the case for accelerating efforts to put “One Health” into action. One Health refers to a strategy to more fully understand and address the links between animal health, human health and the environment.

Read more at Ohio State’s research news site >>

Greif neonatal program featured in news story


Earlier this year, clinical staff from Ohio State’s Greif Neonatal Survival Program brought their expertise to Ethiopia during our One Health Summer Institute.

The team was recently featured in a news story from the College of Medicine about the program’s growth since its founding in 2012.

You can also read their Ethiopia-based blog posts here and here.

Congrats to the Greif Neonatal Survival Program for its impact on saving lives!

Life-saving and life-sustaining: Maternal, newborn interventions at work


By Monica Terez, RN
Clinical Program Manager
The Ohio State University College of Medicine

The sixth floor of Black Lion Hospital in Addis Ababa is a bustling place.

One wing is dedicated to the care of laboring mothers, many of whom require complicated care provided by midwives and obstetrical residents.

Another wing houses approximately 45 infants, all requiring some degree of newborn intensive care. The infants are not arranged in rooms by chance, but rather by the level of care they require.


One large room is dedicated to the most fragile infants, often born weeks or months before the mother’s due date. Due to a lack of sufficient equipment, infants often share a bed or isolette. Babies are kept warm by space heaters positioned throughout the unit.

At any one time, each nurse may be assigned to care for as many as 10 sick neonates over the course of a 14-hour nightshift.

Considering how busy the unit is at any given moment, it would be easy to miss the most important care providers – the mothers of those infants – who desire to give their baby the best chance for survival.

With the support of the physicians and nurses in the neonatal intensive care unit, mothers provide Kangaroo Care for their babies for many hours. Kangaroo Care allows the mother to hold her baby, skin to skin on her chest, thereby regulating the infant’s temperature, calming the baby, enhancing growth and promoting maternal/infant attachment.

Three rooms of the neonatal unit are dedicated solely to mothers to rest, breast-feed, care for their infants, and just do what mothers do best – love their babies.

Black Lion has long realized the importance of maternal involvement in the health and growth of infants.

The unit’s equipment may be sparse and malfunctioning, nurses may be few and far between, the workflow may be less efficient than desired, but one thing is for sure. At Black Lion Hospital, the mother has taken her rightful place as an important care provider for her infant.  THIS is newborn care at its best!


Big audience for neonatal resuscitation training in Addis Ababa


By Diane Gorgas, MD
Associate Professor of Emergency Medicine
The Ohio State University

In four days at Addis Ababa University, we educated more than 50 health care providers on basic neonatal resuscitation. These individuals spanned the spectrum from new pediatric nurses and labor-and-delivery scrub nurses, to neonatal nurses with decades of experience, to midwives, to pediatric residents.

What we discovered was a commitment to excellence and a dedication to providing the best patient care possible, even in a resource-poor environment. The baseline fund of knowledge in addition to the intellectual curiosity of the group impressed us. There was a drive and a passion to learn that spoke for itself and was manifest in insightful questions, enthusiastic interaction, and a resistance to let us leave at the end of the day.


Diane Gorgas demonstrates advanced resuscitation techniques at the Black Lion Hospital in Addis Ababa.

The refresher training began by framing the need for this knowledge and skill set.  The Black Lion Hospital in Addis Ababa is the premier teaching and patient care site in this country of 92 million people. About 3,000 deliveries a year take place at the hospital. Being a tertiary care referral center, these are disproportionately more complicated and higher risk pregnancies than the general population.

Within an average, healthy population, 10% of babies will require some sort of support at delivery.  In this high-risk population, estimates can be as high as 30-40% of newborns who will require resuscitation.

Our training started with a definition of the scope of the challenge, and nurse-midwife Sharon Ryan, CNM, DNP, discussed both maternal and labor and delivery risk factors which may compromise a newborn and necessitate resuscitation efforts.

Monica Terez, RN and life-time neonatal nurse took over and outlined the equipment needs and basic resuscitation algorithm for a newborn, including ventilator support through bag valve mask and chest compressions.

I finished the training with a discussion of more advanced resuscitation techniques including intubation and vascular access. The training received high praise for its interactive nature, and for the hands-on experience it afforded all the learners.

Ethiopia is a book-rich culture.  They are an exceedingly motivated, bright, and industrious people who are struggling with the challenge of every developing country: how to educate and train its best yet retain them in country and not lose out to the developed world’s insatiable appetite for experienced health care workers.

The “brain drain” of trained physicians and nurses from Ethiopia to the U.S. and Europe is real. We have heard estimates that there are currently more Ethiopian-born physicians practicing in Chicago than there are in the entire country of Ethiopia. This creates a practitioner experience vacuum. Practical, clinical training is difficult to sustain as senior clinicians are wooed away to greener pastures, leaving the young to train the young.

The One Health Initiative is an excellent start towards bridging this gap, and the possibility of the three of us traveling to Ethiopia as supported by the Greif Foundation is making strides at providing these valuable experiences.

Maximum learning, for all partners

By Wondwossen Gebreyes, DVM, PhD 
Ohio State College of Veterinary Medicine

As I said in my previous post, we learned many things from each other during this successful Summer Institute. Here are a few of my thoughts on specific topics.

Maximum flexibility and minimum expectations: This became the motto for the team members a couple of days after we arrived. Considering the resource limitations of Ethiopia, the high economic growth and resulting traffic jams, and limitations in communications, one may not be able to plan things well in advance, or keep your lane consistently in driving on the highways, or be able to arrive for meetings on time.

Crowded streets of Addis Ababa.

At the end of the day, we always achieve all the goals, and everyone gets to be happy, though not in the most efficient way.

The situation also made me realize how much building capacity in the area of effective communication could improve all the activities we conduct in this partnership, be it neurosurgery, nursing, or environmental health.

Effective communication and filling the gap within our partner institutes in Ethiopia is critical.

However, life in the U.S. made us become very sensitive. We often try to be perfect. Ethiopia was a great venue for most to realize the sky does not fall. It is OK to be a bit late.

Relax, and still achieve our goals!

Equipment. Equipment, Equipment: As we all witnessed during our several meetings at the various health science colleges of the two universities and also read in blogs, one key ingredient missing very much in the hospitals, research, and teaching settings is equipment.

During this trip, I learned first-hand that 44% of the patient cases at the nation’s premier referral hospital, the AAU Black Lion Hospital, were cancer cases. It was sickening to also learn that among these cases, 65% were pediatric. Yes, indeed there is lack of manpower, and so we launched the institute.

The partner universities are also building the physical infrastructures. While these address part of the issue, the lack of equipment is a major impediment for capacity-building. How can one radiotherapy machine can handle such a large cancer case burden for 85 million-plus population?

Equipping laboratories and clinical units remains a major challenge that partners in Ethiopia and Ohio State will have to tackle.

Maximum motivation: I never realized so clearly until this trip what drives my passion in global work, particularly the teaching aspects. Never fully understood what drives me to lecture several hours with only a short tea break and still have the full steam.

I observed my colleague, Dr. Bisesi, give his lecture on environmental health, and I saw the wide open-eyed trainees and their interaction. I noticed the high level of motivation by the trainees. The same was true for my course.

Dr. Wondwossen Gebreyes with faculty at Addis Ababa University.

Students were so highly motivated that they even asked me to teach a full day on a Saturday. Some even suggested we keep going on Sunday, but that idea created a bit of a stir. “True,” I said in my heart, “that is a big NO in Ethiopia.”

You have to respect Sabbath day more than molecular epidemiology.

The Ferenji Effect: Ferenji is defined very loosely as “a foreigner,” particularly referring to a rich Caucasian. Its connotation is very positive. Ferenji is often considered as a nice, generous foreigner whose pocket carries endless amount of treasures … well, we all know the truth.

Typically Ferenjis are magnets to Ethiopian kids in urban and rural areas of Ethiopia; they often have chocolates, coins, and all kinds of fun things. At a minimum they have a digital camera to snap kids’ picture and show it back to them. The kids giggle seeing their own image in this small window. They followed Dr. Bisesi and Mr. Harrison as we traveled in a suburb of Addis.


During the Summer Institute, I witnessed the usual hospitality of the university security guards and others giving the due respect to our “guest Ferenjis” and I (the designated local chauffeur) also get a free ride.

Unlike what I stated above, about “Ferenji are magnets to local kids,” kids in the Woreta area acted differently. When we were collecting questionnaires for the rabies project, the kids would run away when they saw our giant, “tall-6-foot-some” great athlete and health science student, Korbin Smith. “They might have considered him as Goliath,” I thought to myself. I also hoped one of those little shepherd kids would not be like Dawit (David). Thankfully, we left the place with all fun and no fighting.

rabies workshop 13


Ohio State in Ethiopia: A great experience overall

By Wondwossen Gebreyes, DVM, PhD
Ohio State College of Veterinary Medicine

It has been wonderful working with all the Ohio State and Ethiopian faculty and students during the One Health Summer activity that run from June 7th to this week.

First off, I am very much proud to be a Buckeye. Everyone from the Buckeye nation (Ohio State) showed wonderful professionalism throughout the Summer Institute.

I heard all positive words from our partners in Ethiopia. Students and faculty from five of our seven health science colleges and also School of Environment and Natural Resources have all been great to work with.

I am also proud to be born Ethiopian. I am sure all my colleagues tasted the ultimate hospitality and motivation both in classrooms and social settings and learned a great deal of variations in traditions.

Lunch at Addis Ababa University.

The commitments from both student trainees and partner administrators has been unsurpassed. It gives me a great pleasure seeing the trainees’ eyes wide open in the various lectures, sharing the Ohio State students’ excitement for service learning (even some requested opportunities for next year before leaving Ethiopia), and reading all the blog posts from our students and faculty members.

Importantly, personally, I also learned few more things about Ethiopia and partnership along the way.

With respect to the scientific/ technical aspects of the Summer Institute, I am confident to say that we achieved the goals – in all aspects: coursework and trainings, pilot projects, and workshops. We were able to impact more than 200 professionals in these courses. And a number of scientific networks and new collaborative partnerships developed. Partner colleges were able to identify areas for further collaboration.

Both the Univeristy of Gondar (photo below) and Addis Ababa University partners as well as other institutes — such as the Ethiopian Health and Nutrition Research Institute (EHNRI) — were excited with the outcome.

U of G gate.

It was humbling to hear from the dean of AAU School of Medicine, Dr Mahlet, I quote: “We thought Ohio State would be similar to many, many universities we signed MoU with before and never heard from them again. You made us feel guilty by showing your commitment in a short period of time. Thank you and we are also determined to show our commitment.”

As we move forward, the Ohio State Health Sciences task force will resume its activity in full force. On behalf of the Ohio State Health Sciences One Health task force, thank you to all those who participated in the Summer institute! Some of the upcoming activities will include visits by the Ethiopia partner universities delegation; continued pilot projects on cervical cancer screen-and-treat, rabies intervention, electronic capacity-building, and service-learning clinical activities by neurosurgery and nursing teams. Please stay tuned and follow our blog.

In my next post, I will share some specific thoughts and observations on these activities.

Gondar hospital, present and future


Gondar will soon have a new hospital. This photo shows the construction in progress. Below are some scenes from the current facility.

Women walk into the Dean's Office at the University of Gondar Hospital.

Women walk into the Dean’s Office at the University of Gondar Hospital.


The hospital’s emergency room entrance.

A ward at the University of Gondar Hospital.

A ward at the University of Gondar Hospital.

Photos by Rick Harrison, Ohio State University Communications

Interviews and data collection


Ohio State student Korbin Smith helps interview a farmer in the South Gondar region of Ethiopia.

3nurse interview

Ohio State student Laura Binkley and University of Gondar faculty Dr. Reta Tasfay and Mr. Dagnachew Muluye interview a health care extension nurse about rabies.

Photos by Rick Harrison, Ohio State University Communications

One Health Summer Institute: Class is in session


Ohio State faculty arrive at Addis Ababa University’s Akaki campus. From left: Eric Sauvageau, MD, Andrew Shaw, MD, from the College of Medicine, Michael Bisesi, PhD, from the College of Public Health and Wondwossen Geybreyes, DVM, from the College of Veterinary Medicine.


Dr. Bisesi lectures at the Akaki campus.

A student walks through Addis Ababa University Akaki campus on July 8, 2013.

A student walks through Addis Ababa University’s Akaki campus.


Addis Ababa University students listen as Dr. Bisesi lectures.


Dr. Gebreyes teaching class.

2wondwossens class

Students listen during Dr. Gebreyes’ lecture on molecular epidemiology.

Photos by Rick Harrison, Ohio State University Communications

Images of Ohio State – Ethiopia hospital collaboration in neurosurgery

From left, Dr. Mersha, neurosurgery cheif, Dr. Ebenezer, Dr. Eric Sauvageau and Dr. Andrew Shaw enjoy coffee before making rounds at Tikur Anbessa (Black Lion) teaching medical center at Addis Ababa University.

From left, Tikur Anbessa’s Dr. Mersha, neurosurgery chief, and Dr. Ebenezer with Ohio State’s Dr. Eric Sauvageau and Dr. Andrew Shaw enjoy coffee before making rounds at Tikur Anbessa (Black Lion) teaching medical center at Addis Ababa University.

Eric Sauvageau, right, looks at a scan at Addis Ababa University hospital.

Eric Sauvageau, right, looks at a scan at Addis Ababa University hospital.


Drs. Azarias Kassahun and Eric Sauvageau examine a patient with myelopathy, a spinal cord constriction.


Signs reading “Good Luck” are posted all around the wards at the University of Gondar Hospital.

Photos by Rick Harrison, Ohio State University Communications