#Ethiopia2015: When the heart overflows, it comes out through the mouth.

11784025_10207303807932931_86362059_oWe have satisfaction tinged with sadness today, as our short course came to a close.

I hope the students found it as much fun as I did, as we discussed communication messages and how to get them out into the world. We had a wonderful give and take with lots of questions and discussions.

Two days just did not feel like enough.

We capped off our afternoon with lunch at the Four Sisters–second time, it was so good!–and a shopping excursion across Gondar securing scarves, baskets, coffee and an Ethiopian soccer jersey.

We are making friends all over the place, as my student, Dan, is exchanging numbers with some local teens to meet up for a soccer match.

Tomorrow starts our focus group testing of rabies messages to see if we can come up wit a campaign that might help change behaviors toward vaccination of dogs against rabies, preventing bites and caring for a bite properly should it occur.

There are no words to describe how privileged we feel to be part of this One Health Task Force, and we are not sure how to repay all the kindness we have experienced, especially from our wonderful guide and host Mustafa. Our only hope is that he will join us at Ohio State soon, so we can return the hospitality.

It’s amazing that in such a short time, a place so far from home can feel like home.

Ameseginalehu (thank you) Ethiopia.

2015 @Ohio State #OneHealth Summer Institute: Better an egg this year than a chicken next year.

Day one of our two-day Communication short course is in the books, and I think went pretty well.

We had about 25 people who came from all areas of the university, they seemed both engaged in and enthusiastic about our topics—which included how and why we communicate, the different forms communication can take, and the ways in which communication can be impacted by external factors.

Our session lasted about 90 minutes before a tea and cake break, and we resumed anther 90 minutes before calling it a day with a “homework” assignment:

  • To report back what media our Ethiopian friends consume and how they consume it.

We are all fascinated to learn consumption habits in a city where Internet is scarce and smart phones are still rare.

Once clear example of that was during our course time, where everyone sat and listened—no fiddling on phones, checking email, surfing the web.

As much as I encourage tech in the class, it was refreshing to have an audience so engaged–not worried about something external, to watch the questions and realizations form on their faces, to make eye contact with each one.

View from the Goha Hotel (from TripAdvisor).

View from the Goha Hotel (from TripAdvisor).

After lunch at the Goha Hotel, where were treated to the loudest and most drenching rain we have ever seen—complimented by one-quarter inch balls of hail—we met with the veterinary students who will help us this week with our focus groups on rabies messages. We went over our posters and messages, and are excited to collect data on whether our messages work—or not.

When I was in Ethiopia last year, we spent just two days in Gondar, and I am overjoyed we are getting to immerse in the environment and culture here. Yesterday we walked the streets during the day and into the evening when we had dinner at a local pizza restaurant.

It is clear the people work hard, but they also know how to rest and relax in ways few Americans do. It’s amazing still to watch people just “be”—quietly sitting without a phone or device or even book in their hand.

They are present with their friends and family in a way few of us can imagine.

I hope to emulate it when I return home but fear my life treadmill will quickly ramp up to a sprinting pace. My goal when I return is to channel my Ethiopian friends and, at least for a little while, learn to just “be.”

2015 Summer Institute: When one is prepared, difficulties do not come

A beautiful Gonder morning has broken on our first full  day in Ethiopia. The initial night spent on  any international trip feels long, but in Gonder the night opens up in ways that assail all the western  senses.

ethiopia-day1Amharic prayers are called out in the darkness, as the scent of smoke curls in tendrils under every door frame,  around the head, into the nose. Jet lag prompted my collapse into sleep at 8 p.m. and to then jolted me awake at 2 a.m. An entire novel later, I put on the now much-appreciated Ethiopian Air sleep mask and drifted in an out of seep until 9:30 local time.

Today’s goal: Finalize the week’s goals.

Our Communication short course starts Tuesday with the Basic Tools of Writing, What is Communication and Messaging Types. We continue Wednesday with looking at different Media Types, PR and Developing Communication Plans.

Amid our course, we will conduct focus group testing on a sampling of rabies messages and posters we have developed to try and encourage behavior change , including:

  1. Avoiding dogs that may carrier rabies.
  2. Seeking treatment if exposed to rabies.
  3. Vaccinate dogs against rabies.

Culturally, we have some challenges. A 2013 study showed an estimated annual rabies incidence of 2.33 cases per 100,000 in humans and 412.83 cases per 100,000 in dogs, , with dog bite the source of infection for all fatal rabies cases. (Jemberu, Molla, Almaw and Alemu, 2013)

Although most people are familiar with rabies, animal vaccinations are not required like they are in the U.S. Dogs are not seen as part of the family as in the west, and vaccines are often not sought for them—even among veterinarians who own dogs. Those people exposed by a bite go to traditional healers, not doctors, and kids, especially boys, have a high risk of both exposure and death.

But knowledge is a call to action accepted by a community are key to addressing any health issue, and we hope we can make a difference in both areas with our study.

The chance to immerse in this community is a gift. There is purity in its spirit and energy in its people that I have never felt anywhere else.

On my last visit, I included an Ethiopian proverb to every post, and I will continue my own personal tradition this week. For our first day, let’s try this one:

When one is prepared, difficulties do not come.

As our adventure begins, I believe and hope we are prepared to contribute to his amazing community and, hopefully, make a difference.

Think Globally: Experiences Abroad Provide Perspective on Life

It is human nature to get used to the routines of life. Commuting to work, the morning coffee, walking the dog, and hundreds of other daily rituals create a level of comfort within our increasingly hectic lives. Being born in America provides an inherent level of comfort. While there is poverty in the United States, most Americans are born into a system of privilege that is not accessible in many areas of the world. Our daily rituals and comforts become second nature, while in other parts of the world these “minor” parts of our day are elaborate luxuries. For example, the United States has a health care system that provides a high level of care inside pristine facilities that contain the latest health technology available to treat and prevent diseases. We don’t think about this, we expect it. We get sick, we go to the doctor, and in most cases we get well. We have a growing culture of preventative health care that promotes healthy living and leads to early detection and a higher rate of successful treatment with many cancers and other diseases. While many countries also share a strong health care system, there are millions of people throughout the world that do not have this luxury. Again, we don’t think about that when we are taking advantage of the health care system, we take it for granted that the system is in place and it will always be there when we need it.

Working in higher education, I see students of all ages, ethnicities, and races expanding their knowledge each and every day. The facilities and resources available to faculty and students in the United States are the best in the world. If you can think it and dream it, you can probably get access to an expert that will help you learn to do it yourself. Similar to our American health system, students and faculty often take this infrastructure of knowledge for granted. There is amazing comfort in academia in the United States with freedom to study and be whatever you want to be, as long as you can financially afford the dream. While our college students are learning in the traditional sense within the confines of this comfortable system, many of them are not learning with a global perspective. The experience that comes from visiting a foreign country and getting outside the umbrella of comfort in the United States provides a valuable perspective that will make a person grown not only in knowledge, but humanity and compassion for others.

While visiting Ethiopia as part of the Global One Health initiative, I was surrounded by many opportunities to see, hear, smell, feel, and experience things that made me contemplate my own realities and expectations. While meeting with doctors I heard stories about the growing epidemic of pediatric cancer patients in Ethiopia, how many cases of cancers are not being detected until it is too late, how access to the needed treatment is not available when needed, and I saw medical facilities that were inadequate to meet the growing demand of the population. While meeting with veterinarians I heard and saw cases of animal diseases that aren’t being treated because of a lack of awareness & understanding and instances of diseases transferring from animals to humans because of contaminated contact.

At the same time I saw and heard a spirited population that is passionate about life, with a rich culture and heritage that is beautifully embraced and celebrated. I saw a level of appreciation for collaboration and the sharing of ideas that I don’t see on a daily basis in the United States. Ethiopia is a country of 96 million, with a median age of 16, who are living in an environment of rapid growth, where building and expansion is outpacing the capacity of the infrastructure, which in turn causes issues from traffic gridlock to water contamination from industrial runoff. In the past seven years, the number of colleges and universities in Ethiopia jumped from three to thirty-three! They live a reality that is vastly different than that of the average American.

As I climb back into my own daily routines in the USA and at OSU, I do so with a different perspective and a greater sense of love for my family, my job, my country, and my beloved alma mater, The Ohio State University. It is my wish for all OSU students to take the opportunity to study abroad and for OSU faculty and staff to engage in global projects. It will truly change your life and open pathways to be energized by collaborating with others in a way that will make a huge impact on the lives of others. Go Bucks, Be Global!

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Patience is a virtue that can be learned – in Africa

 

By Jacquelyn C.A. Meshelemiah
Associate Professor, Ohio State College of Social Work

“This is Africa!”

I have heard the expression, “This is Africa!” repeatedly over the last week while conducting research here in Gondar, Ethiopia.

I came here to collect data from Key Opinion Leaders (KOLs) on Tenofovir, a microbicide gel used to prevent HIV infection. It is in clinical trials in South Africa. The data collection is part of joint research project among Ohio State’s Colleges of Social Work and Nursing and the Department of Social Work at Gondar.

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Me (left) with Eden Begna, a 2014 social work graduate from the University of Gondar.

We most certainly hope to pilot Tenofovir in Ethiopia should the second trial in South Africa confirm the original results.  It will be a few years in coming, but we are conducting the research here to assess Ethiopia’s readiness for Tenofovir gel in the future.

The people I’ve interviewed include social workers, nurses, public health personnel, internists, HAPCO workers, OB/GYNs, health extension workers, and other relevant personnel. My colleague, Mr. Semalegne Kendie Mengesha, and I collected a lot of data!

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I’m interviewing Dr. Mengistu Mengesha

What I received was far more than rich data. I received an important lesson on time and patience.

Gathering rich data from 12 KOLs in Gondar took months of proposal writing/IRB prep work,  weeks of pre-scheduling semi-structured interviews, contacting more than 25 potential KOLs, double and triple confirmations of appointments to complete the interviews, and then bracing for the “Wait.”

Despite confirming appointments just hours or even sometimes just minutes before a confirmed appointment, Mr. Semalegne and I often found ourselves waiting, waiting, and even more waiting more than 50% of the time for participants to arrive at the agreed upon destination.

I found this pattern to be very surprising and initially very frustrating. My reference to the Biblical character Job became a daily ritual. (Job is known for his extreme patience.) Although the demands for my patience were nowhere nearly as intense as what was required for Job, I had to dig deep for my patience.

At the same time, my waiting resulted in numerous fruitful conversations about norms related to Ethiopian culture.  So, rather than perseverate over what I was repeatedly exclaiming as “Loss time!!!”   I decided to spend time trying to understand why time was relative and how waiting could be used constructively.

Eventually, I decided it was best to stay put  when a participant was running late, even if it meant waiting 20, 30, or 45 minutes for the participant to arrive.  Besides, it did not make sense to shuffle back and forth between the hospital and Taye Belay hotel in a bajaj.

Again, many participants were on time.  It was the other 50+% who showed up late or not at all that resulted in contact with more than 25 participants just to get the 12 I had intended to interview. All of the no-shows did eventually text or call within one to six hours after our appointments. That gave me some comfort and increased my patience, just a bit.

By the end of my research week, I was psychologically prepared to wait, and with patience.  I knew, based on the earlier interviews that we had completed, that we were going to get rich data and the undivided attention of the research participants once we were able to sit before them and start the tape -recording.

Now back to my point: “This is Africa!”

Yes, it is. Time is relative for most. It is not an attempt to be disrespectful or inconsiderate. It is what it is.

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From left, Solomon Getu, me, Ajanaw, and Semalegne Kendi Mengesha

I got the research done, formed some new relationships, developed some patience and learned what “This is Africa!” means.

I love Africa – all of it – even the part that makes me want me to scream and say, “Let’s start on time,” but then again, what is “on time” for me is not always the same thing for others.

“This is Africa!”

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From left, me with Addisu and Asmech.

Counting dogs, with Gondar’s children helping us

By Ally Sterman, 2015 DVM and
Alexandra Medley, 2017 DVM and 2018 MPH/VPH
The Ohio State University

Our dog survey project takes us through various areas and communities in Gondar. Many of these areas are homes or rural communities that are heavily populated with families who have many children. As we walk around the areas, we quickly attract children. It is not common in many of these areas for individuals with white skin to pass through. When I was in Ethiopia the previous summer, in very, very rural communities children used to run and hide from us. This summer they run straight for us.

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Often times we know they are coming for the screams of “you, you, you” or ” foreingee, foreingee.” Once they arrive, they begin to ask us our names, how we are and where we are from. Many will try to speak some English with us and others will suddenly become shy and run and hide. If you pull out a camera to take a picture, they also all hide but when we bring out the iPad to record data they become super interested in what we are doing. The brave ones come up and want to shake hands with us. Such a simple gesture brings a wide smile to their faces.

They have been very helpful, helping us identify what sex the dogs are, where they are and even bring them up to the front of the yards to help us see them better. In the suburban areas we had as many as 30 children following us and in the rural side entire small villages of children.

Interestingly, the local veterinarians have told us that the main breeding season is in the Ethiopian Spring (September by U.S. calendars), although we have seen many pregnant dogs and puppies. Despite our initial thought that each dog would be hard to tell apart, we have seen a variety of shapes, sizes, breeds and coat patterns. So far we have been able to casually determine that dogs are mostly found in the peri-urban, or housing, areas. Although dogs tend to remain in a small area, or territory, there are many friendly dogs that roam in groups.

 

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We have seen many different medical conditions in the dogs, such as lameness, ticks, fleas, fighting wounds, and malnutrition, but none of this was outside of what we expected. We have completed our two rural paths, that are high up in the mountains where there are less than 15 houses per path. We have seen many dogs there, but more incredibly, the stunning panoramas of Gondar from up high. This season heralds strong winds and rain, and sometimes we had to brace ourselves from falling over as we navigated hilly terrain. In a few more days, we will wrap up our dog survey.

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Building knowledge in Ethiopia as Gondar builds buildings

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

Gondar, Ethiopia, Day 3

We changed venue today to fit some late arriving participants, which is great to know that you are gaining people as you go instead of the other way around.  Because we changed venue, we started a little bit later than planned, just merely an hour. And as I mentioned before, you become a good jazz player in improvising and adjusting the timing and rhythm to be able to still produce a good melody.

The group is also starting to get more involved in the material, especially in the afternoon when we started the first group activities. They became really enthusiastic, and strong discussions and conversations occurred throughout the afternoon.

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Interestingly, I wanted to film such heated interactions in Amharic (the official language), but as soon as I pointed the camera, silence. Got it, no filming.

In any case, I believe they are enjoying the course, especially because at the end of the day I received several requests for pictures.

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I am not sure about you, but I do not have a lot of pictures requests from my students when I finish a class!

And of course, no matter what, do not forget the coffee break. During one of them we had the opportunity to enjoy Ethiopian donuts and learn more about our families and jobs (pay attention to the order of topics discussed).

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Finally, it is impossible not to be amazed by the amount of construction around. Hundreds and hundreds of buildings and houses all over the place.

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The city is rising around you as I type this. The interesting part is that they are using beautiful basaltic rock.

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The mountains surrounding the city are mainly composed of basalt volcanic rock, which are several millions of years old. Rocks that are incorporated in one way or another in their building and houses.

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As one of my hosts indicated to me, “When you see such rocks in a building, you know you are in Gondar!” In short the rock is a symbol of the Gondar region.

From the Home of Lucy, the world’s oldest!

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…!!

In Gondar, ‘dinner to go’ has a different meaning

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

Day 1

After a 36 hours total time of traveling, I am safe and sound in Gondar. This is a small town in the northwest corner of Ethiopia. It is in the mountains, 2,133 meters above sea level (almost 7,000 feet), a location that produces beautiful views of the city and surrounding areas as you travel through town.

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The lovely hills around Gondar

How do you move around? Well, the majority of the people walk from point A to point B. Those that have some income, can pay 2 to 3 Birr (the Ethiopian currency) for public transportation (basically small minivans similar to those in the 1960’s modified for public transportation), which is around 10 cents.

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The minivan taxis are in the background behind the Bajaj.

 

If you are ready to throw your money around, you can take a taxi for 80 Birr ($4).

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Inside a Bajaj taxi.

I tried to use the public transportation to go downtown, but every van was full with people and animals (mainly goats tied and place carefully under the seats), which more likely were the dinner for tonight.

You can conveniently buy your goat next to the bus stop for dinner to go, so you can process them as soon as you get home. Fresher and more organic is impossible!

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Dinner to go: Goats for sale next to a bus stop.

So, I got my taxi, and I went to the main square to have a short (touristic) walk after lunch. I will share those pictures down the road. Then, I got another taxi to go back to the hotel.

I will have 25 to 30 faculty tomorrow to teach about International Trade and Public Health, which is just a fancy name for Introduction to Risk Analysis, so I need to get ready. Let’s see how the week progresses.

From Gondar (Ethiopa), The Camelot of Africa.

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.