One Health

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

July 18 2014

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.

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.

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.

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.

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.

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

July 8 2014

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.

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!

Big audience for neonatal resuscitation training in Addis Ababa

July 7 2014July 7, 2014

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.

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.

Counting dogs, with Gondar’s children helping us

June 20 2014June 19, 2014

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

Our dog survey project takes us through various areas and communities in Gondar. Many of these areas are homes or rural communities that are heavily populated with families who have many children. As we walk around the areas, we quickly attract children. It is not common in many of these areas for individuals with white skin to pass through. When I was in Ethiopia the previous summer, in very, very rural communities children used to run and hide from us. This summer they run straight for us.

Often times we know they are coming for the screams of “you, you, you” or ” foreingee, foreingee.” Once they arrive, they begin to ask us our names, how we are and where we are from. Many will try to speak some English with us and others will suddenly become shy and run and hide. If you pull out a camera to take a picture, they also all hide but when we bring out the iPad to record data they become super interested in what we are doing. The brave ones come up and want to shake hands with us. Such a simple gesture brings a wide smile to their faces.

They have been very helpful, helping us identify what sex the dogs are, where they are and even bring them up to the front of the yards to help us see them better. In the suburban areas we had as many as 30 children following us and in the rural side entire small villages of children.

Interestingly, the local veterinarians have told us that the main breeding season is in the Ethiopian Spring (September by U.S. calendars), although we have seen many pregnant dogs and puppies. Despite our initial thought that each dog would be hard to tell apart, we have seen a variety of shapes, sizes, breeds and coat patterns. So far we have been able to casually determine that dogs are mostly found in the peri-urban, or housing, areas. Although dogs tend to remain in a small area, or territory, there are many friendly dogs that roam in groups.

We have seen many different medical conditions in the dogs, such as lameness, ticks, fleas, fighting wounds, and malnutrition, but none of this was outside of what we expected. We have completed our two rural paths, that are high up in the mountains where there are less than 15 houses per path. We have seen many dogs there, but more incredibly, the stunning panoramas of Gondar from up high. This season heralds strong winds and rain, and sometimes we had to brace ourselves from falling over as we navigated hilly terrain. In a few more days, we will wrap up our dog survey.

Public health course ends with a conference lecture in Gondar

June 19 2014June 19, 2014

By Armando Hoet
Associate Professor and Director of Ohio State’s Veterinary Public Health Program

Gondar Ethiopia, day 6

I am still not sure what happen, but I blinked, and there I was in the front row of the largest conference center in Gondar at the Medical School, seated between the president and vice-president of Gondar University , as one of the main keynote speaker for the 24^th Annual Research Conference of Gondar University.

This year the conference was even more special, which explain the large number of journalists and cameras, as it was the 60^th anniversary of the university (Diamond Jubilee).

Before the conference started the President shared with me his career path, starting as a sanitarian doing pre- and post-slaughter inspections, later becoming a Public Health official, studying part-time to become a physician and in the last 8 years he has been the president of the University of Gondar; leading a 30,000-student institution of higher education. He is in his own words “one of the strongest advocates of One Health.”

I believe the presentation went well based on the amount of interesting questions and post-conference trading of business cards.

As I am leaving tomorrow, I would like to thank my guide in Gondar, Professor Tamiru, who showed me the best of the city in this and my previous visit in 2012. And who took me today to the best view in town: The Goha Hotel.

Everything ended well, except for the Spanish team (5-1 to the Netherlands in the world cup) …

Finally, one of the best ideas I am taking back this trip is the unisex open bathrooms. I am sure they will pick up really fast at OSU.

Why misuse valuable space in duplicating men and women bathrooms, when we can share one? I am sure that we can use the extra space for additional offices. Right?

From the city of the Emperors of Africa

Thesis defenses and counting dogs in Gondar, the student perspective

June 16 2014June 16, 2014

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

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

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

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

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

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

Taxis and busy city streets

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

Kino, the dog

‘Wild dogs cry out in the night,’ reminding me of our rabies project

June 16 2014June 16, 2014

By Armando Hoet
Associate Professor and Director of Ohio State’s Veterinary Public Health Program

Gondar, Ethiopia, Days 4 and 5

The last two days have been very intense and busy days trying to finish the program on time. Yesterday was especially interesting as I observed many “aha!!” moments for several of the participants. They have been working really hard the last two days:

At the end, the training course was a success and they were really appreciative on the material and the course as a whole. And of course we all were smiles.

There was a celebration on Thursday night to provide the certificates which were handled by the Dean of the Veterinary School and the vice-president of research, and of course more Ethiopian handshakes and hugs!!

I bless the rains down in Africa … (if you do not recognize the quote, you are not a Toto fan!). It rained very hard yesterday, including with some small hail.

Even though is great for the farmers, I could not avoid feeling sorry for the people in the streets wondering where to go in such weather (remember most people walk from point A to B). It was really cold and even some sections of the street disappeared.

I heard “The wild dogs cry out in the night”… (Yes, another Toto quote: http://www.youtube.com/watch?v=FTQbiNvZqaY.) Between a late World Cup game between Brazil and Croatia and a dog fight on the street at 1:00 a.m. that lasted 2 hours (a lot of barking and howling), there was very little time to sleep.

There is a major problem of feral dogs in Gondar, which associated with the circulation of rabies is a big issue.

It is estimated that 8,000-10,000 people die per year in Ethiopia of dog-associated rabies. This is one of the main reasons that Ohio State is leading the One Health program in Ethiopia, trying to curb such preventable deaths.

Yesterday two of our veterinary students arrived, Allie and Alexandra.

They are in charge of a major project to determine the density of feral dogs in Gondar. They are also going to be involved in several spay-and-neuter clinics in the next four weeks.

From the first Capital of Ethiopia.

Building knowledge in Ethiopia as Gondar builds buildings

June 11 2014

By Armando Hoet
Associate Professor and Director of Ohio State’s Veterinary Public Health Program

Gondar, Ethiopia, Day 3

We changed venue today to fit some late arriving participants, which is great to know that you are gaining people as you go instead of the other way around. Because we changed venue, we started a little bit later than planned, just merely an hour. And as I mentioned before, you become a good jazz player in improvising and adjusting the timing and rhythm to be able to still produce a good melody.

The group is also starting to get more involved in the material, especially in the afternoon when we started the first group activities. They became really enthusiastic, and strong discussions and conversations occurred throughout the afternoon.

Interestingly, I wanted to film such heated interactions in Amharic (the official language), but as soon as I pointed the camera, silence. Got it, no filming.

In any case, I believe they are enjoying the course, especially because at the end of the day I received several requests for pictures.

I am not sure about you, but I do not have a lot of pictures requests from my students when I finish a class!

And of course, no matter what, do not forget the coffee break. During one of them we had the opportunity to enjoy Ethiopian donuts and learn more about our families and jobs (pay attention to the order of topics discussed).

Finally, it is impossible not to be amazed by the amount of construction around. Hundreds and hundreds of buildings and houses all over the place.

The city is rising around you as I type this. The interesting part is that they are using beautiful basaltic rock.

The mountains surrounding the city are mainly composed of basalt volcanic rock, which are several millions of years old. Rocks that are incorporated in one way or another in their building and houses.

As one of my hosts indicated to me, “When you see such rocks in a building, you know you are in Gondar!” In short the rock is a symbol of the Gondar region.

From the Home of Lucy, the world’s oldest!

In Ethiopia, expect the unexpected – and coffee!

June 10 2014

By Armando Hoet
Associate Professor and Director of Ohio State’s Veterinary Public Health Program

If Personal Space is big for you, then Gondar is not your place to be. Here it is customary to salute you with at least an extended handshake and a soft touch of shoulder to shoulder (you incline forward and gently touch your peer’s shoulder and stay there for a few seconds sharing pleasantries).

If the person greeting you already knows you, then you will get a full hug, which again last several seconds. And finally, if they have great respect for you, then the hug will be accompanied by three touches of the cheek , first right, then left and then right again. It is a big honor to receive such greetings, and I had several of those today. In conclusion, I received more hugs today that my wife has given me in a year. This heartfelt salutation definitively makes you feel welcome!!

Today we started the training, and the phrase “play by ear” perfectly describes the morning. I planned to start at 8:30, which in Ethiopian Time according to my hosts is around 9ish… Perfect, 9:00 it is. Then, the conference room was double-booked, not a problem.

The key in this type of extension and outreach training programs is to expect the unexpected and take it easy.

Finally, they gave us the Conference Room at the Dean’s suite reserved only for special occasions (which my courses always fit that description!!).

The dean’s conference room.

Then after some housekeeping and preparation of the video, we were ready to go at 10:00 a.m.

A former dean and a chair are among the faculty attending the training program, which is a very different crowd from two years ago, as all of the people attending today are faculty.

Also very important to know is that no matter what happens to the schedule, never, never, never, never, ever skip the coffee break.

Never, ever skip the coffee! Note the traditional coffee ceremony elements.

Ethiopia is claimed to be the birth place of coffee, so the coffee tradition is millenarian, and the “ceremony of coffee” is very important and a great opportunity to socialize. The process is very social and very beautiful because of the protocol that is followed: grass spread around for the green color that mean peace and calm, to the placement of flowers, to the accommodation of all the utensils in the short table, to the hot coals (see in the background) where the coffee is carefully reheat before serve, etc.

Pouring the coffee during the traditional coffee ceremony.

However, even though it is very traditional, my infectious disease brain did not let me enjoy it to the fullest, if you do not understand what I mean you are not paying attention to this picture:

This is it for today.

From the birthplace of humanity…!!

In Gondar, ‘dinner to go’ has a different meaning

June 9 2014June 10, 2014

By Armando Hoet
Associate Professor and Director of Ohio State’s Veterinary Public Health Program

Day 1

After a 36 hours total time of traveling, I am safe and sound in Gondar. This is a small town in the northwest corner of Ethiopia. It is in the mountains, 2,133 meters above sea level (almost 7,000 feet), a location that produces beautiful views of the city and surrounding areas as you travel through town.

The lovely hills around Gondar

How do you move around? Well, the majority of the people walk from point A to point B. Those that have some income, can pay 2 to 3 Birr (the Ethiopian currency) for public transportation (basically small minivans similar to those in the 1960’s modified for public transportation), which is around 10 cents.

The minivan taxis are in the background behind the Bajaj.

If you are ready to throw your money around, you can take a taxi for 80 Birr ($4).

Inside a Bajaj taxi.

I tried to use the public transportation to go downtown, but every van was full with people and animals (mainly goats tied and place carefully under the seats), which more likely were the dinner for tonight.

You can conveniently buy your goat next to the bus stop for dinner to go, so you can process them as soon as you get home. Fresher and more organic is impossible!

Dinner to go: Goats for sale next to a bus stop.

So, I got my taxi, and I went to the main square to have a short (touristic) walk after lunch. I will share those pictures down the road. Then, I got another taxi to go back to the hotel.

I will have 25 to 30 faculty tomorrow to teach about International Trade and Public Health, which is just a fancy name for Introduction to Risk Analysis, so I need to get ready. Let’s see how the week progresses.

From Gondar (Ethiopa), The Camelot of Africa.