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 >>

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.

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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.

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:

brochure-cover

 

 

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.

The business of rabies elimination in Ethiopia

By Danielle Latman
Ohio State MBA student

Seven Master of Business Administration students from Ohio State’s Fisher College of Business will visit Ethiopia for three weeks in May as the in-country portion of our Global Applied Projects class. The class is taught by Kurt Roush and advised by Professor Scott Livengood.

We are: Javed Cheema, Katie Fornadel, Carla Garver, Alejandra Iberico Lozada, Daniel Meisterman, Niraj Patel, and me, Danielle Latman. Combined, we are from three different countries, have traveled to almost 70 countries, and have 65 years experience in sales, marketing, operations, financial services, nonprofit and military industries.

From left: Katie Fornadel, Alejandra Iberico Lozada, Daniel Meisterman, Danielle Latman, Niraj Patel and Carla Garver. Not pictured: Javed Cheema.

From left: Katie Fornadel, Alejandra Iberico Lozada, Daniel Meisterman, Danielle Latman, Niraj Patel and Carla Garver. Not pictured: Javed Cheema.

The Ohio State / Ethiopia One Health Partnership asked us to harness our business skills to help operationalize the partnership’s rabies elimination project, adding a layer of practical implementation to the research and training that veterinarians and scientists have already developed. We have split up into teams focusing on the finance, marketing, operations, logistics and data collection functions of the rabies elimination project. Our goal is to develop a proposed roadmap that will allow the U.S. And Ethiopian partners to implement the rabies elimination One Health model project on a targeted region in Ethiopia.

We will travel to Ethiopia from May 1-25 to work with officials in Addis Ababa and Gondar. For the past seven weeks, we have met with the CDC, Drs. Gebreyes and O’Quinn, cultural anthropologists and social service agencies to prepare for our trip. We have also eaten at the lovely Lalibela restaurant here in Columbus, received our travel visas, and gotten a lot of shots — and were dismayed to find a shortage of the yellow fever vaccine in the U.S.!

For all of us, this will be our first time visiting Ethiopia and sub-Saharan Africa in general, and we are excited for what are sure to be many new and rich experiences! We are looking forward to exploring the natural environment of the Blue Nile Falls and Simien Mountains, driving overland from Addis Ababa to Gondar, seeing the history of ancient castles and churches, visiting marketplaces and drinking delicious coffee with each other and our new colleagues and neighbors. We are thrilled for the opportunity to contribute our business skills and passion to build on the One Health Partnership’s success and help eliminate rabies in Ethiopia.

One Health web feature — inspirational Buckeyes

By Christine O’Malley
Executive Director of Health Sciences

Our university communications team just posted this great web feature on our One Health initiative in Ethiopia:

Here’s the link to the full story:

http://www.osu.edu/features/2014/destination-ethiopia.html

Things that struck me from the video:

Cervical cancer is the second-highest cause of death in Ethiopia, yet it’s very treatable if caught early. Our cervical cancer project is working to address that.

The student interviewed, Korbin Smith, went to Ethiopia as part of the rabies project. This was a fantastic student learning experience for him and our other students. This initiative benefits both our partners in Ethiopia by improving people’s lives and our community here at Ohio State by providing international learning opportunities.

I hope you are inspired as much as I am by our faculty, students, and One Health partners.

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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