Public Health | One Health

#Ethiopia2015: When the heart overflows, it comes out through the mouth.

July 22 2015

We 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.

July 21 2015

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).

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

July 20 2015July 20, 2015

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.

Amharic 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:

Avoiding dogs that may carrier rabies.
Seeking treatment if exposed to rabies.
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.

Ebola a stark reminder of link between health of humans, animals, environment

November 14 2014November 14, 2014

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.

Collecting samples from camels in the Awash Rift Valley

August 8 2014August 8, 2014

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.

Kelsey and Giant Tortoise at Awash National Park

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.

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.

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.

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!

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.

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!

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

August 6 2014

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.

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.

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.

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.

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

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!