One Health Summer Institute: Class is in session

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Ohio State faculty arrive at Addis Ababa University’s Akaki campus. From left: Eric Sauvageau, MD, Andrew Shaw, MD, from the College of Medicine, Michael Bisesi, PhD, from the College of Public Health and Wondwossen Geybreyes, DVM, from the College of Veterinary Medicine.

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Dr. Bisesi lectures at the Akaki campus.

A student walks through Addis Ababa University Akaki campus on July 8, 2013.

A student walks through Addis Ababa University’s Akaki campus.

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Addis Ababa University students listen as Dr. Bisesi lectures.

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Dr. Gebreyes teaching class.

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Students listen during Dr. Gebreyes’ lecture on molecular epidemiology.

Photos by Rick Harrison, Ohio State University Communications

Images of Ohio State – Ethiopia hospital collaboration in neurosurgery

From left, Dr. Mersha, neurosurgery cheif, Dr. Ebenezer, Dr. Eric Sauvageau and Dr. Andrew Shaw enjoy coffee before making rounds at Tikur Anbessa (Black Lion) teaching medical center at Addis Ababa University.

From left, Tikur Anbessa’s Dr. Mersha, neurosurgery chief, and Dr. Ebenezer with Ohio State’s Dr. Eric Sauvageau and Dr. Andrew Shaw enjoy coffee before making rounds at Tikur Anbessa (Black Lion) teaching medical center at Addis Ababa University.

Eric Sauvageau, right, looks at a scan at Addis Ababa University hospital.

Eric Sauvageau, right, looks at a scan at Addis Ababa University hospital.

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Drs. Azarias Kassahun and Eric Sauvageau examine a patient with myelopathy, a spinal cord constriction.

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Signs reading “Good Luck” are posted all around the wards at the University of Gondar Hospital.

Photos by Rick Harrison, Ohio State University Communications

Learning from Ethiopia’s ‘MacGyver’ doctors

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From left, Tikur Anbessa’s Dr. Mersha, neurosurgery chief, and Dr. Ebenezer with Ohio State’s Dr. Eric Sauvageau and Dr. Andrew Shaw as they enjoy coffee before making rounds at Tikur Anbessa (Black Lion) teaching medical center at Addis Ababa University. (Photo by Rick Harrison, Ohio State University Communications)

By Andrew Shaw
 Clinical House Instructor at Wexner Medical Center, Ohio State

Since returning from Ethiopia I am filled with excitement. The people there are incredibly welcoming, warm, and giving. They invited us to see their patients, wards, and hospitals. The doctors there exhibit such passion for medicine, learning, and are always wanting a lecture.

Establishing a long term relationship with the Neurosurgery Department at Black Lion hospital will be mutually beneficial.

Upon our arrival, I believed we would be the teachers, but I often found myself on the learning end. The pathology they see is often advanced and requires much skill to treat.

You might recall the show MacGyver. As Wikipedia says, “Resourceful and possessed of an encyclopedic knowledge of the physical sciences, [MacGyver] solves complex problems with everyday materials he finds at hand, along with his ever-present duct tape and Swiss Army knife.”

Our Ethiopian partners are the “MacGyvers” of medicine doing amazing things with limited resources.

It’s all in the herbs: How traditional medicine shapes rabies treatment

By Karissa Magnuson
 Student, Ohio State College of Veterinary Medicine

During our time here in Ethiopia, we have been surprised to find out how often people, especially in rural settings, believe and prefer a traditional healer instead of modern medical doctor. My curiosity on this subject led to me to do a little research online into the prevalence of traditional healers in Ethiopia as well as traditional treatments for rabies proposed by these healers.

Traditional medicine dates as far back as the 15th century in Ethiopia and consists not only of herbal remedies but also of animal and mineral-based concoctions as well as spiritualistic rituals and aromatherapy. Most traditional healers have learned their trade from a family member, and like doctors, these healers go through both a physical exam and history when they examine their patient.

Not surprisingly, many modern health care workers do not support traditional medicine; however, there are some that feel collaboration between traditional and modern healers could provide the best treatment for patients.

In my research I was shocked to discover that up to 80% of Ethiopians use traditional medicine as their primary source of health care. (A historical overview of traditional medicine practices and policy in Ethiopia.) Being from a country where modern medicine is viewed as infallible, with Chinese and other traditional medicine slowly gaining some credence in the U.S., an 80% preference rate is surprising.

So is there any stock in traditional medicine in the treatment of rabies? In my search, I found remedies which have included the use of skullcap on wounds (This herb tends to have astringent effects, antiseptic effects on wounds, and anti-anxiety effects.) Garlic was also frequently mentioned for treatment. I was shocked to discover that garlic has been found to have some effects on paralytic disorders. The bark of Alangium salviforium, a flowering plant, has also been indicated as a possible treatment and has been proven to have anti-epileptic effects. The main question that I am left with is: Are these treatments and herbs effective or is traditional medicine hindering rabies eradication in Ethiopia? Or perhaps, it warrants further research and possibly future collaborative efforts in the cure and eradication of rabies within this amazing country. Only more research will tell.

Data collection, shoulder dancing, and tailored suits

By Korbin Smith
Student, Ohio State College of Medicine
School of Health and Rehabilitation Sciences

The initial data collection for the project has been finished.  Our group was unable to blog or access the internet over the last week due to traveling in small towns throughout Ethiopia that don’t have internet.  To catch up, we traveled from Gondar to Woreta where we conducted interviews before moving to Debre Tabor.  It is crazy how different the climate can change Imagehere with a 40 minute drive.  Woreta has a warm climate with temperatures probably averaging around 80 degrees.  A 40 minute drive to the highland in the mountains and Debre Tabor was probably around 55-60 degrees.

Luckily for me, this means I now have a cold.  I am beginning to think I have a weak immune system, as I am always the only one to get sick.  From Debre Tabor we met with Dr. Gebreyes, who brought a photographer and Dr. Sauvageau, a neurosurgeon from Ohio State. It was good to see others from Ohio.  We drove to Bahir Dar which is the city that borders Lake Tana, the biggest lake in Ethiopia.  Being a fishing connoisseur, it was very neat to see the traditional fishing methods.

We celebrated finishing the data by going to a traditional Ethiopian club in which we saw many styles of “shoulder dancing.”  I think I can dance better in Ethiopia than in the U.S.  As long as you can move your shoulders to the music you can be accepted as a dancer here.  People are less inclined to judge me on my overall lack of rhythm (or if they are judging me it is in Amharic and I can’t tell).

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Once we returned to Gondar I was happy to pick up the suit that I had ordered in the city aweek ago.  Since I am a rather tall, skinny, and lengthy individual, the suits already made did not fit me.  Dr. Tamiru, a partner we have been working with, took me to his tailor who agreed to make me a suit from the cloth of my choosing for 1,900 birr.  While that might seem like a lot in the U.S. that is equivalent to 100 USD.  This is extremely inexpensive for a customized tailored suit. The suit fits excellently.

In addition to completing the data collection, I have appreciated experiencing different aspects of the culture here in Ethiopia.

Dancing in Ethiopia

By Ally Sterman
Student, Ohio State College of Veterinary Medicine

After a week of traveling around the Gondar region, our travels brought us to a city named Bahar Dar. Here is where the Nile River begins, Lake Tana (the largest lake in Ethiopia) is located, and the Blue Nile Falls are located. Our partners wanted to show us what a traditional Ethiopian dance club looked like, so after dinner we headed out on what would be one of the most memorable nights of my life.

We arrived at the club and there was a small stage with four musicians. They were playing a few traditional Ethiopian instruments and a few modern ones like the electric keyboard. The more traditional instruments included a kraar, which is five- or six-stringed bowl-shaped lyre. There was also a masenqo which is a one-stringed lyre. The instruments supported the vocalists who came out and sang a variety of songs.

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However, the highlight of the evening was the dancing. One set of dancers were two brothers who we had seen dance before in Gondar. During one of their songs they grabbed Laura (another student working on the rabies project) and took her up on stage to dance. After another few songs, a different dancer came out. We had the chance to watch him for a short period of time before he danced over to where we sitting. He again grabbed Laura and tied her to him, and then grabbed my hand. The two of us were pulled on stage to dance in front of everyone. Another gentlemen from Israel was also grabbed and brought ally dancingon stage. Laura and I soon found ourselves being tied together to have a dance-off (pictured left). This style of dancing is not quite what my years of dance had prepared me for but I tried anyways. After a few minutes it was over and we headed back to join the rest of the group. Our partners were proud of us going up there, though it was clear our dancing skills left something to be desired and more practice is definitely necessary. This was one of my most embarrassing experiences yet here in Ethiopia, but also my most memorable.

Things I have not missed

By Timothy Landers, RN, PhD
Ohio State College of Nursing

I was on Skype with my Mom during our last week in Gondar. Back in Columbus, she was telling me about the new washer and dryer that arrived while I was in Ethiopia. The two were installed six inches apart. They are finding that this is just enough space for things to fall down and get lodged perfectly. It sounds like a hassle.

Then, they asked me what I thought it would feel like to go back home to Columbus.

I said I didn’t think I could go completely back home.

Of course, I have missed my wife and my sons Joey and Brian. I am looking forward to seeing my friends and sleeping in my own bed. I have missed our cat and dog.

But there are plenty of other things I have not missed. I have not missed how I let my day get off to a bad start because it took three extra minutes to park. I am not looking forward to returning home and obsessing about the invasive thistle plant messing up our lawn. I have not missed the conversations about washers and dryers in our air-conditioned homes that are six inches too far apart.

These things seem important to us – but I can see now, they are not.

I have no right to complain about a three minute parking spot hunt to the woman I saw in the asthma clinic who had wheezed and walked for three hours to get to her 9 a.m. appointment.

I promise not to complain about the thistle growing in my back yard. I’ve learned that because it grows so well in almost any condition, it is an ideal forage food for work animals in the Ethiopian mountains.

Finally, I pledge to think of my new friend and colleague, Charles Turner, who told me about mango fly larvae burrowing under the skin when clothes are hung out to dry.  I will think about his stories from his adventures teaching nurses all over Africa the next time I agonize over whether to pick “Whites – hot” or “permanent press – cold” on the washing machine. 

And if that fails, I’ve asked my friends to give me a good smack upside the head.

Or, I’ll think of my friends in Ethiopia.

Endemenachu?

By Timothy Landers, RN, PhD
Ohio State College of Nursing

One of the things that has been most impressive in my visit to Gondar is the respect for people and for relationships that is present in every interaction.  Every conversation begins with a greeting, ሰላም, “Selam!”  Followed by some greeting such as “how are you”, “how is your day going”, or “how are you feeling?”  Or more often, all three.

In a typical conversation, each person in the group is acknowledged and receives a handshake.  The president of the university greets the department chair, the student, and the housekeeper.

There is a nonverbal conversation among Ethiopian men – what we’ve come to call the “ah-ha.”  It is a brief gasp taken with force which is usually uttered when another is speaking.  It says, “I am listening, I am interested, I am here.”

When I arrive at my office in the morning, I make it a point to say hello to the co-workers I meet – something I picked up from an airline pilot who told me he ALWAYS greets his flight attendants and co-pilot first thing.

However, it’s not the same kind of recognition and appreciation for the other person that I have seen in our visit to Ethiopia.

In the past two weeks in Ethiopia with each “Selam,” “good morning,”  “how are you feeling?” and “how was your day?,” I’ve learned more about my co-workers than I could have in six months in Columbus.

But, I’d like to change.

When I leave Gondar, I am going to be more aware of how I greet those around me – everyone.  It’s worth the time to let them know that I am interested in how they are doing.  I am hoping to let them know that I value them and am interested in them.

How are you doing today?  How are you feeling?  Did you have a good night?

After that, I will unlock my door and get to work.

And there is lots of work to do.

Risk perceptions

By Kristina Slagle

Student, Ohio State College of Food, Agricultural, and Environmental Sciences; School of Environmental and Natural Resources 

Soon after arriving in Addis Ababa, I had the opportunity to give a lecture on risk perceptions to students attending the summer institute. As my driver took me from my hotel to the university, I realized that traffic laws are merely a suggestion here, and pedestrians cross anywhere they can find a break in the traffic. My driver explained that the road we were on went from Addis to Djibouti, so it was constantly busy. Trucks full of construction materials, minibuses used for public transport, and small passenger cars jostled for position, while rickshaws led by mules stayed largely to the side and out of the fray. Needless to say, I was thankful for a driver who knew the unwritten rules of the road!

Once I arrived at the university, I had a bit of lunch, and then I was off to lecture. Throughout the lecture, I asked the students for examples of risk perceptions from Ethiopia, and one student mentioned traffic deaths. At the end of the lecture, we spent some time discussing strategies that had failed and what future efforts to reduce traffic deaths might look like. It was a very rewarding experience having engaged students interested in applying knowledge, and learning about applications within their culture. It’s always wonderful when the learning goes both ways in a classroom!

Now I’m off to Gondar to meet up with our team working on rabies!

Second team of Ohio State faculty arrive in Ethiopia

Eric Sauvageau is all smiles at baggage services.

Eric Sauvageau is all smiles at baggage services.

By Wondwossen Gebreyes, DVM
Ohio State College of Veterinary Medicine

The second team of Ohio State faculty arrived in Addis Ababa yesterday after 18+ hours of flight and airport transfers. While our travel was overall smooth, some flight glitches occurred. One of our team members, Mike Bisesi, had his first and last name switched on his ticket, and TSA and United made it a big deal worth a thousand USD to correct his ticket. Two team members, Eric and I, did not get our luggage on arrival. Despite the long flight and the mishaps, there are still lots of smiling faces. This morning, we are at the Akaki satellite campus of Addis Ababa University, gearing up to begin the environmental health course module led by Bisesi. We will keep you all posted with more updates.