#OneHealth @OhioState 2015: He who conceals his disease cannot expect to be cured

It’s less than 48 hours before I head home from Ethiopia, and am spending my last day of work in Gondar fascinated and far from my comfort zone.

Dr. Shu-Hua Wang and Dr. Wondwossen Gebreyes.

Dr. Shu-Hua Wang and Dr. Wondwossen Gebreyes.

I have joined Dr. Shu-Hua Wang, tuberculosis expert from the Wexner Medical Center, as a guest in the Molecular Epidemiology class of One Health leader Dr. Wondwossen Gebreyes. I sit at the moderator table trying to appear professorial, even though the discussions of drug-resistant tuberculosis, HIV and rabies went pretty far over my head.

It is, however, fascinating to hear discussions of medical research and to be surrounded by such engaged and stimulating students who clearly want to make a difference in their community.

Equally fascinating, though slightly more overwhelming, was our visit last night to a slaughter plant just a short drive from our students’ hotel.

The goal had been to allow our vet students access to samples from the “specimens” at the plant for student research projects, but it ended up as more a field trip for our entire One Health crew.

Keeping our shoes free of blood.

Keeping our shoes free of blood.

We drove up a deeply rutted dirt road to the concrete facility, before piling out and donning plastic booties right outside the entrance.

It was dimly lit inside, but we had no trouble when we crossed the threshold immediately viewing the four steers that hung by their hind legs, as blood drained from their cut throats.

While workers skinned and dehooved the carcasses, preparing them for further butchering, we moved further into the facility toward the kill pen. There, a highly skilled knife wielder immobilized the animal with one stab and ended its life with another, in seconds.

Within a minute, it, too, was hanging and dripping, and headed for additional processing.

Our final stop was the veterinary office, where we examined the minimal, hand-written records kept on each animal, including notations of evident diseases like TB, necrosis and cirrhosis in the organs of many carcasses–organs that are removed and the meat moved along for consumption.

My veterinary friends were thoroughly engaged with their learning experience, but did repeatedly stop to ask if I, who has spent much of my life as the impartial journalistic observer, was OK.

I soon realize I was–and I was not.

It was not the carcasses overwhelming me–it was experiencing the moment that a living animal became a carcass that made my head pound and my heart ache.

Significant also was the fact this was one of few inspected slaughterhouses in the area, although certainly not the only place providing animals for human consumption. The others lack the sanitation and oversight we saw last night (even while we were there the vet refused to slaughter a steer who was sick).

That realization that made us all a little more quiet as we drove away.

I am more a chicken and fish eater than a beef consumer, but I recognize the importance of meat in the diet of many around the world–especially Ethiopia.

I believe, however, that everyone who eats any form of meat should be required to see from where it comes, to understand the contribution and sacrifice it takes to bring food to our tables.

Shu, Wondwossen and I ended our evening back at the Goha Hotel, sipping wine (and Fanta Orange), rehashing our experience, planning our remaining time in Gondar and preparing to head to Addis Ababa for more meetings. Rain washed away the day’s dirt and prepared the city and us for another dawn.

Laughter and good food among brilliant colleagues who have become good friends helped my heart and stomach to unclench.

We all ordered fish.

#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.

2015 Summer Institute: What happened to Saturday?

It seems like just a few hours ago that two students came to my house Friday for a sleepover so we could make our 6 am flight headed for Addis Ababa, Ethiopia.

Joslyn and Dan awaiting passport control in Addis Ababa.

Joslyn and Dan awaiting passport control in Addis Ababa.

As we now sit drinking much needed coffee, we realize it’s already Sunday, we have no idea what happened to Saturday, and we can barely remember what sleep feels like.

We are, however, extremely grateful for the chance to be part of the 2015 Ohio State One Health Summer Institute, where our job will be teaching communication and helping to craft messages that may help with the country’s rabies epidemic.

Since it’s been just eight months since my last visit to Ethiopia, it feels like a homecoming of sorts, but it is also a chance to see the country anew through the eyes of my students, Joslyn and Dan.

As I write, we have made a much-needed rest stop at the Jupiter Hotel in Addis Ababa before heading off to our final destination, the University of Gondar.

I will be here for a week. Dan and Joslyn for two weeks beyond that. We have already adopted the philosophy of the wise and wonderful Wondwossen Gebreyes, the leader of our venture: Maximum flexibility with minimum expectations.

So we celebrated when we found Wondwossen at baggage claim after we flew through  Washington D.C., and he came through Toronto. And we did not sweat when Dan missed his flight to Gondar.

One thing is sure: This will be another incredible adventure.


Day 6 in Ethiopia with @OhioState #globalonehealth: When spiders’ unite, they can tie up a lion

Night is falling on our incredible Global One Health trip to Ethiopia, but we are continuing our mission of outreach with every minute we have left.

2014-12-12 03.18.40 We spent our final full day at the veterinary campus of Addis Ababa University in Debrezeit, along with a contingent from North Carolina State University. There we learned of the work by SPANA, the Society for the Protection of Animals Abroad, to help the working animals of the world, across Africa and the Middle East.

Cart horses are an integral part of life in Ethiopia, but many of them suffer horribly with overwork, lameness and poor or insufficient nutrition. During our visit we came face-to-face with Epizootic Lymphanigitis, a horrifying infection of the skin and lymph system that means death if not treated.

1The work being done to care for these true beasts of burden was humbling indeed.

We were further inspired by Dr, Martha Yami of the National Veterinary Institute, who in just a 30 minute meeting gave us the best news of the day: NVI was nearing successful domestic production of a rabies vaccine, which they will provide for our Gondar pilot at virtually no cost.

We came here with plans to launch a technological initiative and, in my case, to help develop messaging that could bring greater success to a rabies initiative that will commence this summer.  We leave here with iPads in hands, courses launched and, with this news, access to the most powerful tool in our rabies arsenal.

In just a few hours we will board an Ethiopian Airliner and head back to the life we had, but we will not be the people we were. W

We have met so many amazing new friends and seen incredible sights that our cameras could barely contain.

We have worked long hours and never wanted to stop.

Kevin, Tigist and Cory

Kevin, Tigist and Cory

We offer a humble thank you to our friends at the University of Gondar and the University of Addis Ababa for their hospitality and inspiration. We thank our guardian angel Tigist Endashaw, who made sure we were always heading in the right direction.

We thank the incredible Dr. Wondwossen Gebreyes of Ohio State Veterinary Medicine, the godfather of Global One Health, who inspires us all to be better at what we do and, even more importantly, better people.

Our heartiest thank you, however, goes out to the people of Ethiopia, who could not have made us feel more welcome. We have walked your streets and eaten your food. We have felt your sun and breathed your air.

You are part of us and we of you. Together, we will accomplish much. This is just the beginning.


Day 4 of @OhioState #globalonehealth in Ethiopia: When the heart overflows, it comes out through the mouth

I very much wanted to come back and blog fully about our day “off” in Ethiopia, but I would really rather show you the most magical part of our day:

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These images come from Mary Joy Development Association, a healthcare center for low-income community members and orphaned children. Dr. Wondwossen Gebreyes has “family” members there–people he sponsors and cares for–and he was kind enough to bring us with to meet them and so many others.

Kevin Kula had been in touch with the Columbus Crew and Ohio State Women’s Soccer, which provided generous donations of jerseys and soccer balls. We had a wonderful time sharing with the children and watching them perform story-based dances:

It was a full day, despite no meetings scheduled. We flew from Gondar to Addis Ababa in the morning and after lunch visited a hospital in Addis.

After our Mary Joy visit, we dined at an Ethiopian cultural restaurant, complete with hours of native dance. Tomorrow, we finish our iPad mission with a training session at Addis Ababa University.

But the faces we met today will stay with us, long after our time in Ethiopia has passed.

Day 3 @OhioState #Globalonehealth: “If you can’t walk with your feet, walk with your hands”

I feel like today was a true representation of Ethiopia–incredible inspiration and incredible despair, and mixed in we experienced true beauty and spontaneous acts of friendship.

We immersed today at the University of Gondar where we embarked on the true purpose of our visit: launching our iPad initiative and beginning to develop our communication plan for curbing rabies.

The day began with a meeting on the collaboration to combat rabies and moved on to our One Health Summer Institute plans, before I was able to spin off with representatives of medicine, veterinary and communication to begin crafting our message and determining our medium.

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Cory Tressler prepares our iPads for launch.

After a poolside lunch, Cory Tressler of ODEE was his usual amazing self, as he introduced our hosts to iPad technology and the iTunes U courses developed for their training and use.

It’s impossible not to learn something new whenever Cory starts presenting, and we went over our allotted time with a spirited question and answer session.

It is also impossible not to be inspired by our hosts, who have fewer resources than we can even imagine, but possess enthusiasm that cannot be contained. Their challenges are many, but their spirits are so strong; there is no question they will achieve all that they set out.

Yet the reality of Ethiopian life was shown to us just a few hours later, when we visited the Gonder hospital.

One of our first stops was the under-renovation cancer ward, which resonated most with me because of my own husband’s struggle–and recovery from–non-Hodgkin’s lymphoma.  I automatically compare his chemotherapy experience in a state-of-the art oncology facility with the Gondar cancer patients, who will be treated in a single cinder-block room smaller than our average Ohio State classroom.

The chemotherapy mixing room at Gondar Hospital.

The chemotherapy mixing room at Gondar Hospital.

Survival in our cancer wards is expected, with all the tests and treatments modern medicine can provide. In Gondar, it is prayed for, as most diagnostics are only a guess and diagnosis come long after treatment is even an option–especially for cervical cancer.

While we were there, a nurse from the hospital died because testing that might have diagnosed and saved her was not available. We passed neonatal wards where cribs were considered a luxury, and saw the sick and crippled waiting outside for attention.

Cory and I were both overwhelmed and virtually silent as we rode away—struck mute in part by what we saw, but also with the realization of how random life must be to provide our loved ones with so many gifts and opportunities, while others struggle to survive–and even thrive.

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The Castle.

We gratefully ended our day on the most beautiful note–with a tour of city’s royal castles, built by a succession of Ethiopian Kings beginning in the early 17th century. The historical significance paled only when compared with the will-not-say no tenacity of our host, Dr. Wondwossen Gebreyes, who managed to talk–and encourage with a few Birr (Ethiopian money) for the castle to stay open long enough for our tour.

It is from Dr. Gebreyes that today’s headline saying comes–an Ethiopian trait that signifies there is more to any quest than simple desire. Sometimes you need to try a new angle to achieve your goals.

Lesson learned.


Day 2 in Ethiopia with #globalonehealth: Anticipate the good so that you may enjoy it

Before we came to Ethiopia, our friend and leader Dr. Wondwossen Gebreyes encouraged us to temper expectations and be flexible. We did both of those things, but we also inadvertently followed the Ethiopian adage in our headline: “Anticipate the good so that you may enjoy it.”

Today began with a flight from Addis Ababa to Gondar, where we were slated to meet with our many friends at the University of Gondar about Dr. Gebreyes’ iPad launch and messaging related to rabies. Our 10 a.m. meeting soon turned into a 2 p.m. meeting, since my 8 a.m. flight became a 12:30 p.m. flight.

(After five hours on the Addis airport, I know it like the back of my hand–and you can’t beat the reclining chairs!)


Welcome to Gonder!

One of the most striking parts of the day was the arrival at the Gondar airport, which looked like a small-town auditorium in the middle of the old west.

The drive to the university continued to overwhelm our senses, as we saw wagons as plentiful as Toyotas in America, each drawn by a scrawny-necked pony-sized equine. There were market stalls lining the roads, as dozens of people walked hither and yon. And when they were not walking, we saw something we almost never see in America: people sitting still, not working a phone, not reading, and just being.

Once we made it to the university, we met for about an hour to introduce ourselves and get our plan in motion before embarking on a campus tour that showed incredible technological advancements that existed amid the economic challenges that are Ethiopia.

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Our Data Center visit.

Our first stop was to see the data center that handle the university’s computer infrastructure, and it was truly impressive scope and forethought. They have 172 terabytes of storage being backed up every night. They are challenged, however, by the nationwide infrastructure, which can slow their Internet to a crawl outside the campus.

We next toured the campus, complete with a visit to an overcrowded computer lab, the library and a tech-centered classroom that featured state-of-the-art lecture capture.

Distance education is a goal, but everyone acknowledged that greater Internet capacity would be needed to expand course offerings beyond campus boundaries.

But what amazing boundaries the campus had–breathtaking mountain views, with students milling on every street and throughout every building.

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224 steps and we walked every one!

Like any good member of the University of Gondar, we walked the 224 steps to the area called Maraki, which means “charming” in the Ethiopian language of Amharic. We even engaged in a quick game of Frisbee, but short when our flying disk flew down the side of the hill.

We capped of with dinner at Goha, offering a magnificent hilltop view of Gondar–uncluttered by high rise or any light noise–before the time difference found us all closing out the night in our hotel lobby, glued to our computers as email flooded in during U.S. work hours.

Tomorrow, we are all business–rabies education and messaging, iPad instruction, course launching, before we dine with the university’s vice president. So much to do, so little time.

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.


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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