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!)

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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.

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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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Do Something Great – Global One Health

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

It doesn’t take long for me to get another reminder at work of why I love Ohio State. A big focus of my next 3 weeks is preparing for us to take 40 iPad minis to Ethiopia as part of our “Global One Health” partnership with Wondwossen Gebreyes (Veterinary Medicine). Working with our Health Science colleagues, I am excited for the teaching, learning, and research impact we can have. I also look forward to the lasting impact this will have on me.

While I will gladly bring frisbees along on our trip to share with the children, I know futbol is the sport of choice (and subsequently contacted both Ohio State and the Columbus Crew for potential donations). With frisbees, soccer balls & iPads en route, Cory Tressler and I will be proud to represent ODEE and Buckeye Nation in our travels.

In the upcoming weeks we’ll be very busy & wearing smiles. Tasks include finalizing our research plan, iPad configurations, arm soreness from vaccines, and working on our set of five, Global One Health iTunes U courses. Thanks to all of our partner Instructors, Communications Teams, and everyone else who is playing a role in this tremendous project. We will truly have a memorable time in Ethiopia!

‘Do Something Great’

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.

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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.