#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.


Think Globally: Experiences Abroad Provide Perspective on Life

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

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

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

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

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



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.


Discovering Discovery Themes 7,500 Miles Away

By Kevin Kula
Instructional Designer (Learning Technology)
Office of Distance Education and eLearning
ODEE Project Lead for the “Global One Health” Digital First Impact Grant

I have a confession to make:  prior to last night I had never read Ohio State’s Discovery Themes.  You might be in the same boat, I won’t tell.  Here’s your chance to brush up.  Don’t worry, there won’t be a quiz.

Cory Tressler demonstrates a video lecture

Cory Tressler demonstrates a video lecture

Thursday’s visit to the Addis Ababa campus provided me with the opportunity to reflect on Ohio State and its role in global health and education.  Our team’s major goal for the day was to conduct our second iPad rollout:  distribute seven iPad minis to our partners and conduct a training session on relevant features/applications.   Although we were here to teach, we were by no means the experts in the room.

Joining us were authorities on tuberculosis and human papillomavirus (HPV) research, as well as officials from the Ethiopian Public Health Institute.  Experts renowned in their respective fields, these colleagues gave us their full attention for more than two hours to learn how a device only 9×6 inches in size could revolutionize their work.  Yes, there is a need here, but more importantly there is the passion to learn and grow.

Kevin Kula addresses a group question

Kevin Kula addresses a group question

We took time to review the five, iTunes U courses that will be developed for Phase 1 of this grant work.  Spanning across four Colleges at Ohio State, these five courses supplement one another and share the interwoven, OSU Discovery Themes of Food Production and Security and Health and Wellness.  Since I was ingrained in the course development process these past three months, the interconnections and partnerships gradually became clearer to me.  I began to see how our Digital First Impact Grant initiative is truly about Global One Health.

Our iPad training session was followed by a campus tour.  It didn’t take me long to take note of my surroundings:  students walking to class with their eyes focused on a smartphone.  A walk through a large, social science classroom reminded me of the view from Independence Hall.  And while the Addis Ababa campus did not have a Mirror Lake, per se, they did have their “kissing pond.”  But we’re Ohio State.  Aren’t we supposed to be different?  If not, why did we travel 7,500 miles to be here this past week?

Classroom seating in Addis Ababa lecture hall

Classroom seating in Addis Ababa lecture hall

Look familiar?  A snapshot of Independence Hall.

Look familiar? OSU’s Independence Hall







I began this blog by reflecting on Ohio State and its role in global health and education.  A few paragraphs later, I’ve been led back to a mere thirteen letters in our Discovery Themes:

Collaboration (taken from OSU Discovery Theme Guiding Principles)

  1. The Discovery Themes Initiative must be a model of interdisciplinarity and transinstitutionality that promotes and enhances broad university collaboration.
  2. The Discovery Themes Initiative will build on existing strengths and/or develop new programmatic excellence that will achieve a substantial comparative and competitive advantage.
  3. The Discovery Themes Initiative will support existing faculty excellence, building current faculty work into a collaborative experience.

Sitting around the table this week with colleagues from our Ethiopian partner universities, I realize that Ohio State is not intrinsically different.  We have the same questions and concerns.  We have the same experts asking questions of how to better health and education for humanity.  So how can we best exemplify this as Buckeyes?  We can step up on our cross-disciplinary, cross-institutional, and cross-cultural collaboration.  Dr. Gebreyes likes the word synergy.  After this trip, I do, too.

Synergy [sin-er-jee] noun – the interaction of elements that when combined produce a total effect that is greater than the sum of the individual elements

Session pic 1

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:

1 6
14 9
10 15

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.

2014-12-09 06.17.56

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.

2014-12-09 10.21.15

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.