Public Health

Data collection in Debark

By Karissa Magnuson
Student, Ohio State College of Veterinary Medicine

For the past two days we have been in Debark, a town about 100 kilometers north of Gondar. Debark was our second data collection site for our rabies research project.

It is a common resting place for tourists who wish to visit the Simien Mountains. On our two-hour drive up to the city, we passed stunning scenery. The countryside is full of lush, rolling hills and looks like a patchwork quilt of rich coffee brown fields and vibrant green countryside.

We passed many farmers out plowing their fields with oxen and an old-fashioned plow. It was idyllic, and I felt like I had stepped back into a different time.  It was hard to go five minutes without seeing a shepherd out with his flock of goats or sheep, and there were always cows, goats, and sheep grazing in the distance. Our van had to stop or slow down a few times as wandering goats, sheep, and cattle crossed the road.

The people of Debark were very friendly and accommodating. For the project, my team was in charge of urban adults and children. It was truly a privilege to be able to walk their streets and be invited into their houses, especially since they knew nothing about me. Every house we went to, I was offered a chair or a place to sit, and a few times, they roasted a snack for me over their fire for me to eat. The hospitality here was truly amazing.

Our last day of data collection, we went up to a small neighborhood on a hill. Immediately we were surrounded by a huge group of children, all probably under the age of 10. They were all extremely friendly and asked me my name.

As my Ethiopian team members told them about the study and asked if they would like to participate, one of the little girls grabbed my hand.

All the children were eager to participate in the study. As we followed them back to their houses, my other hand was grabbed by a little boy, and I was led off down the dirt road to their homes.  Walking from one house to another, my hand was never empty. At one point, two of the children had a little disagreement about who actually got to hold my hand.

When we finished our data collection and were saying goodbye, all the children who had followed us around came over to me and shook my hand, and we touched shoulders. In Ethiopia, when you greet someone you shake hands and touch shoulders with the person. There must have been six or seven kids in line to say goodbye to me. It was truly a heartwarming and memorable experience that I will carry with me forever.

Whether Ethiopia or U.S., independence is a global value

imageBy Ally Sterman
Student, Ohio State College of Veterinary Medicine

Traditions and holidays are important wherever you are and know no boundaries. This holds true for the four of us students working here in Ethiopia. As July 4, neared we thought of the best ways to celebrate this holiday while abroad. Through Ethiopia was doesn’t officially have an Independence Day as we do in the states, they celebrate Adwa Victory in February. This is in memory of the Battle of Adwa, when they freed Ethiopia from Italian colonization.

We were in luck when we found our local convenient store ( a very small one room store with items on all the walls and one very small row of cookies, cereals and juices) at the end of our street had fireworks and sparklers. We purchased a few to celebrate and help make it feel like home.

We decided to try to find something very American for dinner and since our luck with cheeseburgers wasn’t going to well, and hot dogs aren’t common, we all agreed pizza was our best option. We celebrated our Fourth of July as best we could with pizza and fireworks. It wasn’t a traditional picnic cookout with the family and ending the evening with fireworks however it came pretty close.

We have all become close here like family, and our pizza and sparklers were just as much fun as a picnic and fireworks. All in all it was a successful Fourth of July celebration here halfway across the world.

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If generosity equaled power Ethiopia would control the world

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By Korbin Smith
Student, College of Medicine
School of Health and Rehabilitation Sciences

As we began our interviews with the locals I was amazed how easy it was to get people to volunteer. Everybody in this country wants to talk and help.

My group consisting of Dr. Atnaj Alebie and Tadele Atinafu have been more than helpful. They are brilliant professionals as well as very kind and humble people.

Together we were able to collect our first set of data in rural areas successfully and efficiently. Hearing what the rural adults and children believed caused rabies was truly incredible.

While many answers cause me to be concerned about their safety in an area where rabies is prevalent, it is inspiring to know that our work is needed.

Show and Tell: Our “First Kits” in Ethiopia’s Simien Mountains

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By: Tim Landers, RN, PhD
Ohio State College of Nursing

This past weekend, we had a chance to take a hiking tour of the Simien mountains in Ethiopia.  This has to be one of the most beautiful places on earth – the landscapes are gorgeous, the people are smiling and proud, and there is plenty of wildlife.

I have done quite a bit of hiking with my two sons and friends from Boy Scout Troop 33 in Columbus.  As we were hiking across the Simien mountain pass, our guide and I chatted about our experiences hiking and guiding groups.

Melese Beza (of www.outstandingsimienmountainstours.com) grew up tending livestock as a shepherd and works as a professional tour guide through the mountains as he completes his bachelor’s degree in tourism management.  He speaks English quite well and we began to talk about the types of health problems he encounters as a professional hiking guide.

We took a break as it began to rain and started a “show and tell” of our first aid kits.  He had a basic kit ready for the main emergencies from African trekking – including what he adoringly called “potions” such as acetaminophen, wound disinfectant, and diarrheal medications.

Simien Mountain tour guide Melese Beza of Outstanding Simien Mountains Tours and Tim Landers, RN, PhD do a show and tell of their first aid kits during a rain break while trekking through the Simien Mountains north of Gondar, Ethiopia.

Ohio State’s Tim Landers and Simien Mountain tour guide Melese Beza do a “show and tell” of their first aid kits during a rain break while trekking through the Simien Mountains north of Gondar, Ethiopia.

The two take turns with their "show and tell" on first aid.

The two take turns with their “show and tell” on first aid.

He used somewhat different terms, but described several conditions which would be expected – ankle “dislocations” (strains/sprains), altitude sickness, injuries from rock falls (abrasions and cuts), and blood sugar emergencies.  He also described unfortunate drowning victims he recalled from last summer and that they had attempted “breath blowing” with success in one victim.

In my training back home, we’ve prepared for emergency evacuation of wounded hikers by helicopter transport, extricating from deep woods by foot and by vehicle, and most of our Scouts have completed training in first aid and CPR.

In this region of Ethiopia, there is no such option.  There are no helicopter evacuations from the Simien Mountains.  Guides call for help and it will come as soon as word can reach the village by foot and a jeep, configured as an ambulance, can make it to the wounded person.

As we discussed how injured hikers are treated and our own experiences, I was impressed with his solid grasp on these conditions.  He has been working with several other guides trying to organize a more formal training in first aid and CPR for Simien Mountain guides.

Because our group is exploring the possibility of working with nurses and health extension workers to do health education, I was able to direct him to some excellent training resources developed by my friends at Columbia University School of Nursing. They have developed a fine first aid training curriculum in first aid for health extension workers.

I left him with some supplies from my kit and he reciprocated by sharing knowledge of local plants and remedies.

He left me with an appreciation for the training and preparation it takes to safely enjoy the outdoors – whether it is in Ohio or in Ethiopia.

Hand-in-hand on hygiene in a hospital setting

Tim Landers, RN, PhD, from Ohio State’s College of Nursing and Nora Mohammed, MSc, from University of Gondar -- an infection prevention hero!

Tim Landers, RN, PhD, from Ohio State’s College of Nursing and Nora Mohammed, MSc, from University of Gondar — an infection prevention hero!

By Tim Landers, RN, PhD
Ohio State College of Nursing

“Are you from Ohio? Will you talk to me?”

Nura stopped me in the courtyard of the University of Gondar hospital. She was waving my business card that had been given to her from a School of Nursing instructor who knew that my work centers on infection prevention.

She had just defended her Master’s thesis on hand hygiene at the University of Gondar in which she completed an audit of hand hygiene practices by nurses and other health care workers at a local hospital. When she told me about her project, I was very excited to learn more, so we met the next day to review her findings.

Improving hand hygiene saves lives. Reducing transmission of germs on the hands of health care workers is the most important means of preventing infections.  A recent article of mine on patient-centered hand hygiene is here. Another important article on the subject is here.

Effective hand hygiene programs use a multimodal approach, including strong administrative support, education, training, monitoring of hand-washing and feedback. A critical element of hand hygiene programs is providing products and supplies in the health care setting, and I’ve worked on the best approach for years.

But I had forgotten how critical the provision of products is in our hand hygiene efforts. Without a sink, running water, soap, or alcohol-based hand rubs, hand hygiene is simply not possible.

Quite frankly, I had come to take this for granted.

Until I met Nora.

In her study, Ms. Mohammed showed that in more than half of the “hand hygiene opportunities” – times when workers should perform hand hygiene – no soap, running water, or alcohol-based hand-rubs were available at this hospital. As a former nursing matron, or director of nursing, she saw the impact this had on patient outcomes.

By demonstrating the need to improve access, her study provides an important first step in improving hand hygiene practices.

I was really excited to meet someone who shares a passion for infection prevention and hand hygiene. She really is making a difference at her hospital and helping to save lives in Gondar. In the U.S., we call them “heroes!”

Yes, I am from Ohio, and I would love to talk to you!

O – H – I – O ! Ohio State students arrive in Ethiopia

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We were very excited to welcome four Ohio State students to Gondar yesterday.  They are beginning their work on the needs assessment for a rabies prevention/elimination project.

Last night over a traditional Ethiopian dinner, the group met with University of Gondar Veterinary Medicine Dean Dr. Mersha Chanie, Chair of Sociology Molalign Belay, guest Dr. Judd Walson from the University of Washington’s Department of Global Health, and Ohio Staters including Veterinary Medicine Professor Baye Molla, College of Nursing Vice Dean Usha Menon and other College of Nursing faculty.

One thing that struck me was the diversity and intensity of the group.  These four students represent the breadth of programs at Ohio State and how interdisciplinary work can bring creative and innovative perspectives to important problems.

Third-year veterinary student Karissa Magnuson is interested in wildlife veterinary medicine.  Ally Sterman is a third-year veterinary student with an interest in shelter medicine and public health approaches to veterinary problems.  Korbin Smith, BS ’13, was inspired by Dr. Randall Harris in the College of Public Health to consider opportunities in public health.  Heading up the team is graduate student Laura Binkley, who is working on a Master’s degrees in public health and wildlife ecology.

Absolutely striking was the passion that each student brought to their particular interests and the lively discussion about where interests overlap and intersect.  This is the kind of collaboration that we can build only at a major academic institution like Ohio State.

Go Bucks!

Meeting Our Partners

We have already met some amazing people as we get acclimated to Ethiopia. Here are some of our recent experiences:

We were welcomed to the University of Gondar by President Mengesha Admassu. With incence wafting through the room, we were served coffee and talked with senior leadership of the University. President Admassau expressed the great value that the University of Gondar placed on its collaboration with Ohio State.
We were welcomed to the University of Gondar by President Mengesha Admassu. With incense wafting through the room, we were served coffee and talked with senior leadership of the University. President Admassau expressed the great value that the University of Gondar placed on its collaboration with Ohio State.
Dr. Sisay Yifru, Dean of University of Gondar College of Medicine and Health Sciences demonstrates to me the use of a hand sanitizer dispenser on an inpatient unit at the University of Gondar Hospital. These dispensers are manufactured at a local plastics factory. The dispenser location and design demonstrate local adaptation of international “best practices” for hand hygiene in health care facilities, including placing hand sanitizer at the “point of care.” This technology was developed and deployed in cooperation with the Patient Safety Initiative, World Health Organization, but has been sustained by administrative support and leadership of the University of Gondar.
Dr. Sisay Yifru, Dean of University of Gondar College of Medicine and Health Sciences demonstrates to me the use of a hand sanitizer dispenser on an inpatient unit at the University of Gondar Hospital. These dispensers are manufactured at a local plastics factory. The dispenser location and design demonstrate local adaptation of international “best practices” for hand hygiene in health care facilities, including placing hand sanitizer at the “point of care.” This technology was developed and deployed in cooperation with the Patient Safety Initiative, World Health Organization, and has been sustained by administrative support and leadership of the University of Gondar.
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Drs. Jodi Ford and Usha Menon, College of Nursing, walk with the director of International Relations at the University of Gondar on a tour of the university’s new hospital under construction though a partnership with United States Centers for Disease Control and Prevention (CDC-Ethiopia), the Ministry of Health, and a private donor.