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 >>

One Health Ethiopia featured in news article

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

Here’s an excerpt:

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

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

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

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

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

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

Read the full article on the Dispatch website >>

 

 

One health summer, in review

 

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

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

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

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

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

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

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

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

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

UOG-graduation

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

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

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Greif neonatal program featured in news story

 

Earlier this year, clinical staff from Ohio State’s Greif Neonatal Survival Program brought their expertise to Ethiopia during our One Health Summer Institute.

The team was recently featured in a news story from the College of Medicine about the program’s growth since its founding in 2012.

You can also read their Ethiopia-based blog posts here and here.

Congrats to the Greif Neonatal Survival Program for its impact on saving lives!

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.

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.

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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.

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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.

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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.

Q&A on animal care and vet students in Gondar, Ethiopia

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Dr. Sintayehu on the far left, Christine second from right, during Christine’s visit to Ethiopia earlier this year.

Introduction: Christine O’Malley and Dr. Sintayehu Mulugeta are friends who work on collaboration between Ohio State and the University of Gondar (UOG), Ethiopia. This summer, Ohio State sent a team of students and faculty to partner with UOG on a spay/neuter program and dog inventory as part of a rabies elimination pilot project. Below is a transcript of a Skype conversation between the two friends. Sintayehu, a veterinary medicine faculty member, describes the field training UOG provides its vet students.

Christine: Now that the Diamond Jubilee is over, what’s going on at the University of Gondar? Is it summer break?

Sintayehu: Well, I am out of office for field work with students on their clinical field experience. Most of the schools are on summer vacation now, but students in Medicine and Health College, Vet Faculty and freshmen in various departments are still in campus.

Christine: What kind of field work do the vet students do?

Sintayehu: To support clinical medicine course and help them develop confidence and get acquainted with the real picture at clinics out there in working place, students take a course called off-campus training. The students will have about two weeks’ time exposure to different districts’ government vet clinics where they work as clinical vet students with close supervision by one faculty staff from UoG, and the district’s vet.

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Sintayehu: They also engage in community services and help the clinics in every capacity they are capable of, like cleaning the clinic compound, providing recommendations on potential shortcomings, etc. After completion of off-campus training, they are supposed to present a field practice report about their stay and will be evaluated based on that.

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Christine: Do they provide direct care to animal patients?

Sintayehu: Yes, with supervision. That is why I am currently with them here in field.

Christine: I bet they learn a lot from that.

Sintayehu: Sure. That is the best way of learning from practical courses. And this is witnessed by them. However, because of small amount of budget they sometimes come back to campus earlier than planned. This is really a continuous challenge to the faculty and to them.

Christine: What are the most common illnesses or conditions that you see at the district clinics?

Sintayehu: Well, I can say we have all sorts of diseases. For instance, in the place we are now working are Infectious (Pasteurellosis, Black leg, Anthrax, Lumpy Skin Disease, Sheep pox, Rabies, Newcastle Disease), Parasitic (helminthes, arthropods: ticks, lice, mange mites; protozoans: Trypanosomes, Coccidia), Metabolic and nutritional, and reproductive disorders in cattle, sheep, goats, donkeys and chicken. I was surprised to see dogs as well in the clinic.

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Sintayehu: However, to be honest with you, there are no laboratory facilities for confirmation of cases, so the diagnosis is almost always relied on history and clinical findings. No single laboratory diagnostic aid and there are only few drugs available.

Sintayehu: I saw a new building for the clinic and I was told that it has been built from the World Bank fund. Mr Nigussie, the vet technician working here, told me that it is now completed and will be furnished with basic clinic facilities from the same fund. Then it can have better veterinary service.

Christine: Why were you surprised to see dogs?

Sintayehu: I mean not to see them, but the awareness of the community, most of which are poor farmers, to get medical care for their dogs.

Christine: That seems like a good thing.

Sintayehu: Definitely! I was told by Mr Nigussie that the community has good awareness about the importance of bringing their animals to clinics whenever there is ill-health to their animals. That shows there is a big demand for vet service.

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Christine: Also a good thing for the rabies project, perhaps? Showing awareness of needing to take care of their dogs?

Sintayehu: Yes. You know, I also asked about the status of rabies in the area. It is terrible to hear that there is high prevalence of rabies in the countryside. This is worsening by strongly rooted perception of the community that traditional healers can cure the disease. It is challenging human/animal health care.  There is no rabies vaccination at the clinics. The only thing the vets in such districts doing are advise farmers to be careful of suspected dogs.

Christine O’Malley: Yikes! What areas will you visit next?

Sintayehu: This is the last field work for this academic year.  Koladdiba, the place we are now working in, is not that much far from Gondar, about 35kms, but the road is rugged and may take you about an hour or so. I love having seen the countryside. I wish I could visit such places more often.

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Group of students with Dr. Sintayehu, their mentor, in the middle wearing the blue jacket.

Life-saving and life-sustaining: Maternal, newborn interventions at work

 

By Monica Terez, RN
Clinical Program Manager
The Ohio State University College of Medicine

The sixth floor of Black Lion Hospital in Addis Ababa is a bustling place.

One wing is dedicated to the care of laboring mothers, many of whom require complicated care provided by midwives and obstetrical residents.

Another wing houses approximately 45 infants, all requiring some degree of newborn intensive care. The infants are not arranged in rooms by chance, but rather by the level of care they require.

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One large room is dedicated to the most fragile infants, often born weeks or months before the mother’s due date. Due to a lack of sufficient equipment, infants often share a bed or isolette. Babies are kept warm by space heaters positioned throughout the unit.

At any one time, each nurse may be assigned to care for as many as 10 sick neonates over the course of a 14-hour nightshift.

Considering how busy the unit is at any given moment, it would be easy to miss the most important care providers – the mothers of those infants – who desire to give their baby the best chance for survival.

With the support of the physicians and nurses in the neonatal intensive care unit, mothers provide Kangaroo Care for their babies for many hours. Kangaroo Care allows the mother to hold her baby, skin to skin on her chest, thereby regulating the infant’s temperature, calming the baby, enhancing growth and promoting maternal/infant attachment.

Three rooms of the neonatal unit are dedicated solely to mothers to rest, breast-feed, care for their infants, and just do what mothers do best – love their babies.

Black Lion has long realized the importance of maternal involvement in the health and growth of infants.

The unit’s equipment may be sparse and malfunctioning, nurses may be few and far between, the workflow may be less efficient than desired, but one thing is for sure. At Black Lion Hospital, the mother has taken her rightful place as an important care provider for her infant.  THIS is newborn care at its best!

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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.