Patient patients in Gondar’s Vision Clinic

By Jeff Walline, Associate Professor
Ohio State College of Optometry

In Ethiopia, optometry is a bachelor’s degree, but I am here to teach six motivated students obtaining Master’s degrees in optometry. One purpose of their education is to expose them to optometry procedures that are practiced in the United States that are typically not practiced by optometrists in other parts of the world. Therefore, I teach them things that they cannot practice due to economic, social, and/or technologic constraints. However, the students are very interested in learning. Hopefully, they will also be able to practice these procedures in Ethiopia and teach future optometrists to practice them as well.

Below is a picture of patients waiting to have their eyes examined in the Vision Clinic. They wait in the courtyard of a three story building that appears old and decrepit in some areas and never completely finished in other areas.

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Patients waiting to have their eyes examined.

 

Ethiopian people are very patient, and waiting seems to be a natural part of their lives. They wait for eye examinations, they wait for cabs, they wait for something that never seems to appear. However, they never complain about waiting. It just seems to be a part of their lives.

What I teach optometry students in two semesters, I have squeezed into one week. I don’t know how much of it actually “sunk in,” but I know that the students will certainly have more information than when I arrived. They are anxious for a final, but I didn’t know that I was to give one. I will prepare a final when I return and send it to them, but first I will prepare them for the final on my last day here.

I want them to have a positive feeling about their experience, and I think a strong performance on the final would help to solidify that feeling.

I have one more day to lecture. On Monday, I thought this day would never arrive. Now that it has, I look forward to going home but not with as much fervor as before. The people of Ethiopia are very kind and I will miss them.

What I see when teaching optometry in Gondar

 

By Jeff Walline, Associate Professor
Ohio State College of Optometry

I am in Ethiopia to teach two courses at University of Gondar: advanced contact lenses; and children’s vision.

The students have a strong basis in pediatric care, and they ask very intelligent questions. They are very patient with me when I ask them to repeat their questions.

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My University of Gondar students

 

Traveling from the Gondar airport to my hotel, I went through an entire evolutionary cycle. Near the rural airport, several men tended their sheep and cattle grazing on the lush, green grass. No fences or borders exist, except those extended by men with canes and ever-watchful eyes. Soon, grass huts appeared, with little to adorn them or signify life nearby. I imagined that the same people tending the herds lived in these small, round huts, but I have no confirmation.

Shortly, the rural life began to intertwine with modern life, as the livestock grazed along the roads infrequently traversed by fueled automobiles. Although vehicles existed, it seemed as though most people of Gondar walk from place to place as they generally carried walking sticks to seemingly help them traverse the hills and sometimes rugged roadside.

As automobiles increased in frequency, so too did people. More people waited, as opposed to actively walked, alongside the road. They waited for one of the minivans or the three-wheeled motorized carts that would transport them to their location. Our bus continued to pass slower vehicles and be passed by faster ones on the hills, seemingly never concerned about the side of the road on which one drives.

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A woman preparing grain on the roadside.

 

I was dropped off at my hotel, located across the street from the Vision Care Training Center and Fistula Clinic, where I lecture to six Master’s students about pediatrics and specialty contact lenses. The electricity only went out for 5 minutes during the morning lecture, so we were able to use technology to project PowerPoint slides on the wall. However, the projector was very touchy.

So, I have witnessed everything from farmers to exceedingly bright, enthusiastic students, and every bit of the evolution connecting the two, and all of this within the small boundaries of Gondar, Ethiopia.

 

 

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.

bisesi_and_kids

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.

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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.

Watercolor inspirations in Gondar

By Karla Zadnik, OD, PhD
College of Optometry

Watercolor inspirations in Gondar!

Watercolor inspirations in Gondar!

Watercolored images of Four Sisters (restaurant) and the transportation van's dashboard chickens (by Karla Zadnik)

Watercolored images of Four Sisters (restaurant) and the transportation van’s dashboard chickens (by Karla Zadnik)

Dr. Karla Zadnik with the ethics course attendees at the University of Gondar

Dr. Karla Zadnik with the ethics course attendees at the University of Gondar

Ethics Engagement in Ethiopia

By Karla Zadnik, OD, PhD
College of Optometry

 

The Summer Institute’s research ethics course chugged along today. I started late, mostly because I didn’t realize most of my students were in the courtyard just outside the classroom in the bright morning sunshine, waiting for me to begin speaking. I lectured on the tenets of the Declaration of Helsinki (OSU faculty—you all remember those, right?) and the ethical use of animals in research (thanks Donna McCarthy!), but the highlight turned out to be the case study discussions.

I presented a case I’d heard at the 2008 Public Responsibility in Medicine & Research meeting. It weaves the tale of an imaginary city, Blovar, which is under siege such that its children are subsisting on an inadequate 400 calories. An entrepreneurial, mythical scientist who studies nutrition and brain function in children appears on the scene to conduct a purely observational study of the children. After carefully reading the case, the course attendees “went to town.” After their small group analysis of the case, I facilitated a discussion of the case. They didn’t need me. There were marked differences of opinion in the class. One attendee drew historical correlates, while another took the role of the Principal Investigator, cautioning the audience to assume that fellow scientists generally want to do a good job. The points made were lively, vehement even, yet collegial. All this before lunch!

The afternoon’s soundtrack was a thunderstorm of biblical proportions that hammered the roof of the classroom and lit up the sky. We all raised our voices in tune with the rain and created a chorus, celebrating the hard, thoughtful work of teaching and learning research-related ethics.

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Research ethics in Ethiopia

By Karla Zadnik, OD, PhD
College of Optometry

ImageI was hosted by Dr. Seleshe Nigatu of the University of Gondar as I opened the research ethics class in the Summer Institute with a discussion of the Tuskegee Study. The study is the U.S.’s 1978 Belmont Report with its basic principles of respect for persons, beneficence/nonmaleficence, and justice. The class of almost 60 people from the University of Gondar and Addis Ababa University, along with other Ethiopian institutions of higher learning, had expertise ranging across medicine, veterinary medicine, economics, and pharmacy. The photographs depict the engaged students. In the late afternoon, the participants tackled their first two case studies, one on Image

reporting of results to an industry sponsor and the other an accurate analysis of a case of subtle plagiarism but plagiarism nonetheless. Tomorrow, the class tackles animal care and use in research and biorepositories (thanks to Donna McCarthy and Mark Merrick and their lecture materials).

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The transition from Addis Ababa to Gondar was ably assisted by advice from Dr. Jodi Ford from the College of Nursing, who taught research methods at the University of Gondar earlier in July.