Collecting samples from camels in the Awash Rift Valley

 

By Kelsey Gerbig
Veterinary Medicine student at Ohio State

Our summer research projects with Addis Ababa University took us to the Rift Valley in the Afar region of Ethiopia.

Kelsey and Giant Tortoise at Awash National Park

Kelsey Gerbig with a giant tortoise at the Awash National Park.

My focus is on Trypanosoma evansi and diagnostic techniques for practical and efficient identification of this blood parasite in camels.

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Used for meat, milk and transportation, camels play an important role in the lives of the pastoralists in the Awash Rift Valley, and results from this project will provide an idea of the prevalence of this disease in camels in the Afar region.

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Map credited to Kmusser, used under Creative Commons Attribution-Share Alike 3.0 Unported license

We left our hotel room early on Thursday to travel east to where the pastoralist tribe was currently living. The pastoralists are a nomadic people, who move with their animals to find grazing land and water throughout the year. On our way, we admired the gorgeous views.

Wildlife in Awash

The tribe that agreed to let us sample from their herd owned cattle, goats, and camels. We were quite taken aback at the size of their camel herd – close to 200!

Camels and Pastorals

We geared up to collect samples. Disposable gloves, shoe covers, and N95 respirators were donned. Even though we had limited contact with the camels, we wanted to take as many precautions as possible to avoid contracting zoonotic diseases.

Currently, it is fasting season for many in Ethiopia, and our helpers from the pastoralist tribe grew tired as the morning went on.

In the end, we were able to collect blood, feces, and respiratory secretions from 51 camels.

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Camel Fecal Sampling

At the end of our work, I couldn’t resist taking out my digital camera to document our experiences that morning. As soon as I began snapping pictures, the kids started posing so that they could see themselves on the digital screen. Even some of the men joined in, posing with their weapons and camels!

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We would like to say thank you to Dr. Nigatu Kebede and his laboratory technician, Nega Nigussie, for arranging our sampling trip and assisting with sample collection. Our summer research projects would not be possible without their help!

 

Flooding in the surgical suite during spay-neuter program in Gondar

By Maria Belu
Ohio State Veterinary Public Health student

Is that water coming in?

It was the first thought that popped into my head when I looked up after taking the heart rate of my recently extubated dog in recovery. It was the last of an amazing six days that I had spent taking part in a sterilization and rabies clinic in Gondar, Ethiopia.

We were there to serve the local community by offering spay/neuter surgeries at no cost to them as well as rabies vaccines. The second (and equally important) aspect of our mission was to educate recent veterinary graduates on how to perform spay/neuter surgeries through ventral approach from sedation to recovery.

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Maria Belu, center

I was overwhelmed every morning by the patience of people who brought their animals to us, waiting from early in the morning to late in the afternoon for when we could fit them in. Often the need of the community overwhelmed us, and at times we had to turn dogs away.

Despite this, I’m so proud of the small effort I played alongside my fellow students: Alexandra Medley, Kelsey Gerbig, Mal Kanwal, and Ally Sterman. It was an amazing clinical experience, being able to take care of a dog from the moment they were intubated and catheterized to when they recovered.

Most of the dogs we worked with were often scared of us; thus, they could be a little more difficult to handle. This observation is what made our last day so unbelievable.

As I said, I was recovering one of the last dogs we spayed that day, and when I looked up, water was coming in through the front door.

flooded-stairs

The rain for the past 15 minutes had been deafening, but I was used to rain, so we paid it little attention. In a heartbeat’s moment, more and more water kept coming in. People around me began scrambling, taking any supplies that were resting on the ground to place high on tables.

We were laying the dogs on a mat in the corner, and the few of us recovering dogs pulled up that mat to form a kind of comical island. One of the surgeons we worked with, Dr.Terefe, looked outside the window and called out that water was rising quickly.

Our other surgeon and head director of the project, Dr.O’Quin, quickly made the decision to evacuate the surgery suite since we were at the bottom of a hill.

I wrapped up my dog in a surgery gown and lifted her off the ground. She was one of the less aggressive dogs, so I was thankful that I was carrying her.

Alexandra, sadly, was helping recover one of the more aggressive dogs. Miraculously, as if she knew we were helping her, she let Alexandra lift her up and carry her without any fuss. That was the first miracle of the day.

The second miracle was that we had no dogs in surgery as the water rose. If we had to be flooded, it was a pretty good time for it happen.

flooded-surgical-suite

We picked up our dogs and moved toward the door. Some of the veterinary students helping us opened up the doors. The moment I stepped out, suddenly water was all the way up to my hip.

We walked out unable to see the ground under our feet, with water moving past us at a rapid pace. I gingerly stepped forward. We made it up the steps and joined some of the other university staff.

We placed the dogs on a nearby table and wrapped them up in window curtains that people brought us to keep the animals warm.

As we stood around looking like cats after an unwanted bath, with our patients wrapped in beautiful curtain, we began to laugh. It was not the end I had expected to our amazing week, but it was certainly a fitting one.

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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Thesis defenses and counting dogs in Gondar, the student perspective

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

After a 13-hour flight, we arrived in Addis Ababa, Ethiopia. A thought that kept crossing through both of our minds was whether or not our 140 pounds of veterinary medical supplies would make it to Ethiopia, through customs, and with us to Gondar. After locating the correct baggage claim lanes (this airport has 4), we waited patiently for our oversized and heavy baggage. Thankfully we made it with no difficulty through customs and to our airport.

Flights to Gondar leave early morning and we stayed overnight at the Jupiter hotel near the airport in Addis. The view from our room was of a large abandoned field. By day this field was a grazing zone for various sheep and goats, but by night it was a parking lot for local vehicles. After exploring around the area, we ended up calling it an early night.

We arrived to the airport early and upon arrival in Gondar were greeted by our partners from University of Gondar and taken to our hotel. Soon after settling in we headed to the vet school. We had the opportunity to listen to senior veterinary students defending their theses, which is the final project necessary to graduate. There are some striking differences between Ethiopia and U.S. vet school training. In Ethiopia the students defend a final thesis project instead of a cumulative boards exam (USA NAVLE), they attend school for 6 years (USA, 4), and primarily focus on large animal medicine because that is the primary need in the country.

After listening to the defenses we had a meeting with the faculty who helped us organize our dog survey. For the next week we are walking 15 different paths we have plotted through the city to count the roaming dog population and do a brief visual physical exam on each dog. Data we want to collect are the number of dogs seen along the path, sex, age, reproductive status, and any other clues to their health status.

Something we have learned already is how mountainous Gondar is, so although the paths are short, they take a while and we get a great workout. To get to destinations we take buses or taxis which are far more crowded than the average taxi in the US.

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Taxis and busy city streets

We have seen many types of dogs so far, from a small Papillon cross to a large Mastiff. Our favorite dog is the mixed breed brown dog who resides directly outside our hotel, affectionately named Kino.

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Kino, the dog

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.

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.

It’s all in the herbs: How traditional medicine shapes rabies treatment

By Karissa Magnuson
Student, Ohio State College of Veterinary Medicine

During our time here in Ethiopia, we have been surprised to find out how often people, especially in rural settings, believe and prefer a traditional healer instead of modern medical doctor. My curiosity on this subject led to me to do a little research online into the prevalence of traditional healers in Ethiopia as well as traditional treatments for rabies proposed by these healers.

Traditional medicine dates as far back as the 15th century in Ethiopia and consists not only of herbal remedies but also of animal and mineral-based concoctions as well as spiritualistic rituals and aromatherapy. Most traditional healers have learned their trade from a family member, and like doctors, these healers go through both a physical exam and history when they examine their patient.

Not surprisingly, many modern health care workers do not support traditional medicine; however, there are some that feel collaboration between traditional and modern healers could provide the best treatment for patients.

In my research I was shocked to discover that up to 80% of Ethiopians use traditional medicine as their primary source of health care. (A historical overview of traditional medicine practices and policy in Ethiopia.) Being from a country where modern medicine is viewed as infallible, with Chinese and other traditional medicine slowly gaining some credence in the U.S., an 80% preference rate is surprising.

So is there any stock in traditional medicine in the treatment of rabies? In my search, I found remedies which have included the use of skullcap on wounds (This herb tends to have astringent effects, antiseptic effects on wounds, and anti-anxiety effects.) Garlic was also frequently mentioned for treatment. I was shocked to discover that garlic has been found to have some effects on paralytic disorders. The bark of Alangium salviforium, a flowering plant, has also been indicated as a possible treatment and has been proven to have anti-epileptic effects. The main question that I am left with is: Are these treatments and herbs effective or is traditional medicine hindering rabies eradication in Ethiopia? Or perhaps, it warrants further research and possibly future collaborative efforts in the cure and eradication of rabies within this amazing country. Only more research will tell.

Data collection, shoulder dancing, and tailored suits

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

The initial data collection for the project has been finished.  Our group was unable to blog or access the internet over the last week due to traveling in small towns throughout Ethiopia that don’t have internet.  To catch up, we traveled from Gondar to Woreta where we conducted interviews before moving to Debre Tabor.  It is crazy how different the climate can change Imagehere with a 40 minute drive.  Woreta has a warm climate with temperatures probably averaging around 80 degrees.  A 40 minute drive to the highland in the mountains and Debre Tabor was probably around 55-60 degrees.

Luckily for me, this means I now have a cold.  I am beginning to think I have a weak immune system, as I am always the only one to get sick.  From Debre Tabor we met with Dr. Gebreyes, who brought a photographer and Dr. Sauvageau, a neurosurgeon from Ohio State. It was good to see others from Ohio.  We drove to Bahir Dar which is the city that borders Lake Tana, the biggest lake in Ethiopia.  Being a fishing connoisseur, it was very neat to see the traditional fishing methods.

We celebrated finishing the data by going to a traditional Ethiopian club in which we saw many styles of “shoulder dancing.”  I think I can dance better in Ethiopia than in the U.S.  As long as you can move your shoulders to the music you can be accepted as a dancer here.  People are less inclined to judge me on my overall lack of rhythm (or if they are judging me it is in Amharic and I can’t tell).

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Once we returned to Gondar I was happy to pick up the suit that I had ordered in the city aweek ago.  Since I am a rather tall, skinny, and lengthy individual, the suits already made did not fit me.  Dr. Tamiru, a partner we have been working with, took me to his tailor who agreed to make me a suit from the cloth of my choosing for 1,900 birr.  While that might seem like a lot in the U.S. that is equivalent to 100 USD.  This is extremely inexpensive for a customized tailored suit. The suit fits excellently.

In addition to completing the data collection, I have appreciated experiencing different aspects of the culture here in Ethiopia.

Dancing in Ethiopia

By Ally Sterman
Student, Ohio State College of Veterinary Medicine

After a week of traveling around the Gondar region, our travels brought us to a city named Bahar Dar. Here is where the Nile River begins, Lake Tana (the largest lake in Ethiopia) is located, and the Blue Nile Falls are located. Our partners wanted to show us what a traditional Ethiopian dance club looked like, so after dinner we headed out on what would be one of the most memorable nights of my life.

We arrived at the club and there was a small stage with four musicians. They were playing a few traditional Ethiopian instruments and a few modern ones like the electric keyboard. The more traditional instruments included a kraar, which is five- or six-stringed bowl-shaped lyre. There was also a masenqo which is a one-stringed lyre. The instruments supported the vocalists who came out and sang a variety of songs.

Ally Ethiopia pic

However, the highlight of the evening was the dancing. One set of dancers were two brothers who we had seen dance before in Gondar. During one of their songs they grabbed Laura (another student working on the rabies project) and took her up on stage to dance. After another few songs, a different dancer came out. We had the chance to watch him for a short period of time before he danced over to where we sitting. He again grabbed Laura and tied her to him, and then grabbed my hand. The two of us were pulled on stage to dance in front of everyone. Another gentlemen from Israel was also grabbed and brought ally dancingon stage. Laura and I soon found ourselves being tied together to have a dance-off (pictured left). This style of dancing is not quite what my years of dance had prepared me for but I tried anyways. After a few minutes it was over and we headed back to join the rest of the group. Our partners were proud of us going up there, though it was clear our dancing skills left something to be desired and more practice is definitely necessary. This was one of my most embarrassing experiences yet here in Ethiopia, but also my most memorable.