Day 1 in Ethiopia with #globalonehealth: He who learns, teaches

The headline above is an old Ethiopian proverb that seems to fairly well sum up my first day in this amazing country.

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Wondwossen Gebreyes

I have joined my incredibly talented Distance Education colleagues, Cory Tressler and Kevin Kula, as guests of the universities of Gondar and Addis Ababa. Our six-day mission:  to launch a Digital First iPad initiative with veterinary Prof. Wondwossen Gebreyes and work on developing health communication messaging for the nation’s out-of-control rabies epidemic.

The idea of going to Africa is almost as daunting as actually getting here. It’s easy to read about a place–eastern Africa, next to Somalia, one of the only countries on the continent not colonized, major coffee exporter–but any level of true appreciation takes an immersive experience, and a trial by fire of 12 hours on a plane solidifies the quest.

After watching eight hours worth of movies and sampling TV comedies, listening to one episode of the podcast Serial, and devoting four hours to syllabi construction, I landed in Addis aboard an Ethiopia Air flight at 7:30 a.m. local time (11:30 p.m. the night before in Columbus).

The first steps off the plane reveal how different life must be in this arid, high-altitude adventure: my first stop was an Ebola scanner to see if I had a temperature and questions about whether I had come from western Africa.

After 80 minutes in the passport control line, I claimed my luggage and found the hotel shuttle, happily ending up in the bed for my first two hours of sleep in 24.

The real differences in Ethiopian life were discovered when I ventured outside the hotel for a brief walk with my camera. Six shots into my journey, I was stopped by a pair of pimply-faced Addis police officers who asked why I was taking pictures. I tried to explain the idea of photo tourism and was feeling pretty cofident, until they requested my passport and began to walk around with it , speaking in  Amharic.

A Good Samaritan thankfully stopped to translate and after 15 minutes, they returned my passport, shook my hand and sent me on my way.

My photos, shown below, were pretty benign, but further research revealed no photos could be taken in Ethiopia of government offices or bridges, and shooting embassy photos can quickly get an SD card confiscated.

The day was rounded out by a terrific iTunes U afternoon with Dr. Gebreyes, Cory, Kevin and our local guardian angel Tigist Endashaw, followed by an authentic Ethiopian dinner. Tomorrow our work begins with a flight and full day of meetings at University of Gondar.

Next time someone flippantly says in America, “Well it’s a free country,” please take a second to think about that, and remember there are places in this world where rights are as fluid as jello.

With ever hour I will remember to be grateful for the fact I am a guest in this  incredible place and respect its ways and customs. I will also thank the Founding Fathers  for freedoms we enjoy and too often take for granted at home.

And although my camera rested for the remainder of today, I think he’s pretty likely to make it back out tomorrow.

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Do Something Great – Global One Health

By Kevin Kula
Instructional Designer (Learning Technology)
Office of Distance Education and eLearning
ODEE Project Lead for the “Global One Health” Digital First Impact Grant

It doesn’t take long for me to get another reminder at work of why I love Ohio State. A big focus of my next 3 weeks is preparing for us to take 40 iPad minis to Ethiopia as part of our “Global One Health” partnership with Wondwossen Gebreyes (Veterinary Medicine). Working with our Health Science colleagues, I am excited for the teaching, learning, and research impact we can have. I also look forward to the lasting impact this will have on me.

While I will gladly bring frisbees along on our trip to share with the children, I know futbol is the sport of choice (and subsequently contacted both Ohio State and the Columbus Crew for potential donations). With frisbees, soccer balls & iPads en route, Cory Tressler and I will be proud to represent ODEE and Buckeye Nation in our travels.

In the upcoming weeks we’ll be very busy & wearing smiles. Tasks include finalizing our research plan, iPad configurations, arm soreness from vaccines, and working on our set of five, Global One Health iTunes U courses. Thanks to all of our partner Instructors, Communications Teams, and everyone else who is playing a role in this tremendous project. We will truly have a memorable time in Ethiopia!

‘Do Something Great’

One Health Ethiopia featured in news article

Our One Health program was mentioned yesterday by The Columbus Dispatch in an article on Ohio State’s College of Veterinary Medicine.

Here’s an excerpt:

“About 75 percent of emerging diseases originate from animals,” said Dr. Wondwossen Gebreyes, the director of the infectious-diseases molecular epidemiology laboratory. “That’s why our work in veterinary medicine is crucial, not just to save animal life but also to save human lives.”

With growing interest in that link, Ohio State now offers a degree that can be completed in four years by combining a two-year master’s in public health with a four-year doctorate in veterinary medicine. Graduates can fill the demand for veterinary experts at agriculture companies and government health departments.

“They will be detectives of diseases, from the animal side,” said Dr. Armando Hoet, the coordinator of OSU’s veterinary public-health program.

Students learn how to wear protective gear to deal with Ebola, anthrax or other infectious diseases that can pass between humans and animals. They learn about bioterrorism and that 80 percent of agents that can be used as infectious weapons spread from animals.

“We train professionals to deal with those diseases both in the animal side and human side, and to prevent transmission from one population to the other,” Hoet said.

A summer program has started sending students to Ethiopia to look for ways to help prevent the spread of rabies. Other projects study whether salmonella bacteria strains from around the globe act differently and how influenza jumps from pigs to people at Ohio county fairs.

Read the full article on the Dispatch website >>

 

 

One health summer, in review

 

By Wondwossen Gebreyes
Professor, Ohio State College of Veterinary Medicine
Chair, Ohio State One Health Task Force

This summer we had another highly successful One Health Institute. There are a number of elements that made the 2014 Summer Institute unique and satisfying.

First, I would like to thank all the Ohio State, Ethiopian as well as East African (including Kenya and Tanzania) students, staff, faculty, researchers and administrators who took part on this wonderful and productive time. I highlight below the key events and activities.

1. The 2014 One Health Summer Institute engaged more partners than in any of the previous years. We had an unprecedented 26 faculty and 32 students from more than 10 Ohio State units. We delivered numerous courses, and several key networks have been established in several areas of clinical, research and service learning aspects.

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2. We conducted clinical training mainly with spay-neuter as part of our rabies pilot project.

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3. We launched the rabies elimination pilot project with the participation of 40 key officials from various Ethiopian institutes, including academic, research, legislative and regulatory. We conducted a thorough assessment of the plan prior to launch. Other collaborating U.S. institutes, mainly CDC, played a key role in this.

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4. We hosted trainees from Kenya and Tanzania in addition to the Ethiopian trainees. As part of our NIH-Fogarty program, we also hosted 12 trainees from the three nations for 45 days of intensive training in molecular epidemiology of food borne pathogens including laboratory sessions.

5. In addition, we also witnessed memorable learning moments for everyone:

  • The University of Gondar Diamond Jubilee is the key positive moment we all witnessed.

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  • The mass pooling of all vehicles by the UOG administration and scooter travel to dairy farms around the Gondar city areas were unforgettable.
  • Flexibility in action- the breakdown of our rental van with five people from Ohio State and CDC on board that had a domino effect of triggering so many phone calls and cancellation of a Skype call on cancer partnership.

Thank you all for all the hard work by our OSU-Ethiopia One Health Task Force on both sides as well as our NIH East Africa partners from Kenya and Tanzania. Look forward for continued and sustained partnership.

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‘Wild dogs cry out in the night,’ reminding me of our rabies project

By Armando Hoet
Associate Professor and Director of Ohio State’s Veterinary Public Health Program

Gondar, Ethiopia, Days 4 and 5

The last two days have been very intense and busy days trying to finish the program on time. Yesterday was especially interesting as I observed many “aha!!” moments for several of the participants. They have been working really hard the last two days:

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At the end, the training course was a success and they were really appreciative on the material and the course as a whole. And of course we all were smiles.

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There was a celebration on Thursday night to provide the certificates which were handled by the Dean of the Veterinary School and the vice-president of research, and of course more Ethiopian handshakes and hugs!!

 

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I bless the rains down in Africa … (if you do not recognize the quote, you are not a Toto fan!). It rained very hard yesterday, including with some small hail.

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Even though is great for the farmers, I could not avoid feeling sorry for the people in the streets wondering where to go in such weather (remember most people walk from point A to B).  It was really cold and even some sections of the street disappeared.

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I heard “The wild dogs cry out in the night”… (Yes, another Toto quote: http://www.youtube.com/watch?v=FTQbiNvZqaY.) Between a late World Cup game between Brazil and Croatia and a dog fight on the street at 1:00 a.m. that lasted 2 hours (a lot of barking and  howling), there was very little time to sleep.

There is a major problem of feral dogs in Gondar, which associated with the circulation of rabies is a big issue.

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It is estimated that 8,000-10,000 people die per year in Ethiopia of dog-associated rabies. This is one of the main reasons that Ohio State is leading the One Health program in Ethiopia, trying to curb such preventable deaths.

Yesterday two of our veterinary students arrived, Allie and Alexandra.

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They are in charge of a major project to determine the density of feral dogs in Gondar. They are also going to be involved in several spay-and-neuter clinics in the next four weeks.

From the first Capital of Ethiopia.

 

In Ethiopia, expect the unexpected – and coffee!

By Armando Hoet
Associate Professor and Director of Ohio State’s Veterinary Public Health Program

If Personal Space is big for you, then Gondar is not your place to be. Here it is customary to salute you with at least an extended handshake and a soft touch of shoulder to shoulder (you incline forward and gently touch your peer’s shoulder and stay there for a few seconds sharing pleasantries).

If the person greeting you already knows you, then you will get a full hug, which again last several seconds. And finally, if they have great respect for you, then the hug will be accompanied by three touches of the cheek , first right, then left and then right again. It is a big honor to receive such greetings, and I had several of those today. In conclusion, I received more hugs today that my wife has given me in a year. This heartfelt salutation definitively makes you feel welcome!!

Today we started the training, and the phrase “play by ear” perfectly describes the morning. I planned to start at 8:30, which in Ethiopian Time according to my hosts is around 9ish… Perfect, 9:00 it is. Then, the conference room was double-booked, not a problem.

The key in this type of extension and outreach training programs is to expect the unexpected and take it easy.

Finally, they gave us the Conference Room at the Dean’s suite reserved only for special occasions (which my courses always fit that description!!).

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The dean’s conference room.

 

Then after some housekeeping and preparation of the video, we were ready to go at 10:00 a.m.

A former dean and a chair are among the faculty attending the training program, which is a very different crowd from two years ago, as all of the people attending today are faculty.

Also very important to know is that no matter what happens to the schedule, never, never, never, never, ever skip the coffee break.

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Never, ever skip the coffee! Note the traditional coffee ceremony elements.

 

Ethiopia is claimed to be the birth place of coffee, so the coffee tradition is millenarian, and the “ceremony of coffee” is very important and a great opportunity to socialize. The process is very social and very beautiful because of the protocol that is followed: grass spread around for the green color that mean peace and calm, to the placement of flowers, to the accommodation of all the utensils in the short table, to the hot coals (see in the background) where the coffee is carefully reheat before serve, etc.

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Pouring the coffee during the traditional coffee ceremony.

 

However, even though it is very traditional, my infectious disease brain did not let me enjoy it to the fullest, if you do not understand what I mean you are not paying attention to this picture:

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This is it for today.

From the birthplace of humanity…!!

2014 One Health Summer Institute brochure posted online

 

By Christine O’Malley
Executive Director of Health Sciences

I’m happy to share that the brochure for the 2014 One Health Summer Institute is now online.

More info about the institute can be found here: http://u.osu.edu/onehealth/projects/education/summer-institute/

Or you can download the brochure by clicking on this photo:

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MBA students: Power outages don’t stop the One Health work in Addis Ababa

 

By Danielle Latman
Ohio State MBA student

On Monday morning 5/19, we woke up to no internet. The city was in the midst of a rolling blackout, which apparently happens quite frequently. Our hotel was powered by a back-up generator, so our lights and water were (for the most part) working, but the internet was out and the phones were also spotty. Ethiotel, the country’s only landline and cell phone provider, was also experiencing intermittent outages. Even so, we were luckier than most, since many people have no backup power supply.

We met with our Addis client, Dr. Hailu, at 11am to present a rough draft of our rabies elimination proposal. With water, coffee, tea and kollo, we shared our ideas and listened to his suggestions. Overall we are satisfied with the progress we’ve made and will make time to incorporate Dr. Hailu’s suggestions before we leave.

In the afternoon, some teammates stayed at the hotel to complete their section of the project, while the rest drove into the city center to do some shopping. We bought some roasted coffee at Tomoca and green coffee at the local supermarket chain Shoa. It was our first time inside a grocery store here and we were excited to see what people buy here on a daily basis. We were also excited to stock up on some essentials, like bottled water and Mars candy bars.

During the drive back, we hit rush hour traffic, which is unlike any other traffic I’ve ever experienced. Think LA-level gridlock, but with all cars spewing diesel exhaust, and streets without painted lanes, and huge potholes, and tons of people waiting in lines 2-3 people thick for the next bus or taxi van. Pedestrians are also quite bold and usually walk right in front of cars, while cars themselves drive quite closely to each other. It’s amazing we haven’t seen any accidents yet.

After dinner we did some more work and then got ready for bed. Somehow even in the midst of the blackout, the club across the street was still well-lit, with loud music blaring through the night.

Rabies project: MBA students meet faith healers, health workers in Gondar

 

By Danielle Latman
Ohio State MBA student

Wednesday, 5:30pm: Rain pelted the windows as I sat in the back of the van with seven men, interviewing a young woman about administering health information in the Gondar region.

We were pulled over on the side of the road on the outskirts of Gondar city, asking the woman about her role as a Health Extension Worker (HEW). This 8-year-old program trains and employs women to provide basic health education, information and supplies to each kebele (small municipality) throughout Ethiopia. The HEW program responds to the limited formal health care in the country, with very few doctors and nurses to meet the population’s needs.

We were meeting with the woman, whose name translates to “Love,” to learn more about the role of HEW and if/how they could be helpful to the rabies plan.

We (Danny, Javed, Niraj and myself, plus our three guides/translators from the University of Gondar, and our driver Amhara) were sitting in the van because of the rain outside, and because the HEW’s post was far away.

Surprisingly, this wasn’t our first van interview of the day. We started the afternoon by visiting the health station near Gondar city. The Ethiopian health system has a set structure operating from the kebele to the regional level.

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The Ethiopian health system has a structure operating from the kebele to the regional level.

The HEW operate from a local kebele post and visit families door-to-door. Above them is a health station, with nurses. Above that is a health center. And the highest level of care is provided at the hospital level, but only two main hospitals (in Addis and Gondar) can provide a wide range of health services.

At the health station we could meet with a HEW coordinator. Our van idled for a few minutes in front of the short cement building while the team members discussed with our hosts what we wanted to ask. A young woman approached our van to ask what we wanted. Our hosts spoke with her in Amharic, and then the young woman left and shortly returned carrying an umbrella over the head of another woman, wearing a white coat.

Sister Abanesh entered the van, sat in front and answered some of our questions about Ethiopia’s 17 health priorities which the HEW workers focus on. She was the coordinator and managed six HEW. But we didn’t get to talk to her long, since the director of this health center preferred that we speak with him formally in his office.

So we got out and walked to his office in the health station compound. On the walk we saw some cool posters promoting different positive health behaviors, which Danny and I (the marketing team) were very interested in for our part of the project.

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A health poster at a local clinic

We filed into the director’s office, sitting in chairs around his desk. He answered our questions about the training and reporting processes for HEW, and Sister Abanesh gave us some pamphlets that they use for family health education.

One important thing we have learned is that, while there is an overall 40 percent literacy rate in Ethiopia, almost all households have at least one child who can read, and so the child will read information for the whole family, leading to an almost 100% literacy rate at the household level. Then they showed us the storage area where they keep the vaccines cold.

We left with smiles, thank you’s and handshakes all around, then drove to our second van meeting of the day.

It is worth noting that the health station is located in a Jewish area just outside Gondar. We saw a house with a wooden Jewish star outside painted blue and white.

Our first meeting of the day had been no less surprising. We met with a group of faith healers who were having their association meeting at 9am. We all gathered behind their shack in downtown Gondar, which had posters for remedies like aloe vera curing HIV.

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Meeting with faith healers in downtown Gondar.

We had heard that a lot of people in Ethiopia use traditional or faith healing (bahawali hakeem in Amharic) instead of or in addition to modern medicine, especially the rural population. About 90 percent of Ethiopians live in rural areas. Thankfully, our university guides Akilew and Debasu had contacts with them and were able to set up a meeting.

Though we directed our questions to the group of about seven men and one woman faith healers, for the most part only the chairman responded. We asked about their motivation for becoming faith healers. For some it was a change from their strict religious backgrounds. For others it was passed down in their family. We also asked if they had or would ever collaborate with doctors or other medical scientists in their treatment. We were pleasantly surprised to learn that they are open to collaborations, especially with treating dogs that have rabies.

We then visited a vaccine storage facility, a health clinic, and a vet clinic (with a very sad-looking chicken outside). Rabies vaccines have to be kept cold – one of the challenges in warm climates like those in Africa. The veterinarian told us they had administered 500 rabies vaccines since March and showed us their cold storage and even a sample vaccine, which came from India.

After our morning meetings, our host Tamiru suggested we go to Hotel Taye for traditional Ethiopian coffee. In the second floor lounge area, a woman was roasting coffee beans and cooking ground coffee in a traditional pot over hot coals. Rose petals were strewn in front of her cooking area.

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Traditional coffee ceremony at the end of a long but productive day.

It was a very long, insightful and rich work day which lasted about 12 hours, and some of us retired early to be well-rested for what will surely be another full, surprising and enriching day.