Addis Ababa | One Health

Think Globally: Experiences Abroad Provide Perspective on Life

December 30 2014

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!

One health summer, in review

September 22 2014

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.

2. We conducted clinical training mainly with spay-neuter as part of our rabies pilot project.

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.

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.

The flooding of the surgical suite in the middle of spaying of dogs was a great challenge for our team.

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.

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.

2014 One Health Summer Institute brochure posted online

May 28 2014

By Christine O’Malley
Executive Director of Health Sciences

I’m happy to share that the brochure for the 2014 One Health Summer Institute is now online.

More info about the institute can be found here: https://u.osu.edu/onehealth/projects/education/summer-institute/

Or you can download the brochure by clicking on this photo:

MBA students: Power outages don’t stop the One Health work in Addis Ababa

May 23 2014

By Danielle Latman
Ohio State MBA student

On Monday morning 5/19, we woke up to no internet. The city was in the midst of a rolling blackout, which apparently happens quite frequently. Our hotel was powered by a back-up generator, so our lights and water were (for the most part) working, but the internet was out and the phones were also spotty. Ethiotel, the country’s only landline and cell phone provider, was also experiencing intermittent outages. Even so, we were luckier than most, since many people have no backup power supply.

We met with our Addis client, Dr. Hailu, at 11am to present a rough draft of our rabies elimination proposal. With water, coffee, tea and kollo, we shared our ideas and listened to his suggestions. Overall we are satisfied with the progress we’ve made and will make time to incorporate Dr. Hailu’s suggestions before we leave.

In the afternoon, some teammates stayed at the hotel to complete their section of the project, while the rest drove into the city center to do some shopping. We bought some roasted coffee at Tomoca and green coffee at the local supermarket chain Shoa. It was our first time inside a grocery store here and we were excited to see what people buy here on a daily basis. We were also excited to stock up on some essentials, like bottled water and Mars candy bars.

During the drive back, we hit rush hour traffic, which is unlike any other traffic I’ve ever experienced. Think LA-level gridlock, but with all cars spewing diesel exhaust, and streets without painted lanes, and huge potholes, and tons of people waiting in lines 2-3 people thick for the next bus or taxi van. Pedestrians are also quite bold and usually walk right in front of cars, while cars themselves drive quite closely to each other. It’s amazing we haven’t seen any accidents yet.

After dinner we did some more work and then got ready for bed. Somehow even in the midst of the blackout, the club across the street was still well-lit, with loud music blaring through the night.

Town-gown partners showcase Columbus-OSU ties with Addis VIPs

April 24 2014April 24, 2014

By Christine O’Malley
Ohio State University
Executive Director of Health Sciences

Last week, we had a tremendous visit by 11 delegates from Addis Ababa University. The delegates met with Ohio State’s university and health sciences leaders. Many potential collaborations were discussed as we explore ways to broaden our One Health initiative.

Some of the delegates were able to visit with City of Columbus representatives. Greater Columbus sister Cities International Inc. posted this on its Facebook page:

Post by Greater Columbus Sister Cities International, Inc.

It’s so great to have a strong town-gown partnership when Ohio State brings international guests to Columbus!

The business of rabies elimination in Ethiopia

April 24 2014April 24, 2014

By Danielle Latman
Ohio State MBA student

Seven Master of Business Administration students from Ohio State’s Fisher College of Business will visit Ethiopia for three weeks in May as the in-country portion of our Global Applied Projects class. The class is taught by Kurt Roush and advised by Professor Scott Livengood.

We are: Javed Cheema, Katie Fornadel, Carla Garver, Alejandra Iberico Lozada, Daniel Meisterman, Niraj Patel, and me, Danielle Latman. Combined, we are from three different countries, have traveled to almost 70 countries, and have 65 years experience in sales, marketing, operations, financial services, nonprofit and military industries.

From left: Katie Fornadel, Alejandra Iberico Lozada, Daniel Meisterman, Danielle Latman, Niraj Patel and Carla Garver. Not pictured: Javed Cheema.

The Ohio State / Ethiopia One Health Partnership asked us to harness our business skills to help operationalize the partnership’s rabies elimination project, adding a layer of practical implementation to the research and training that veterinarians and scientists have already developed. We have split up into teams focusing on the finance, marketing, operations, logistics and data collection functions of the rabies elimination project. Our goal is to develop a proposed roadmap that will allow the U.S. And Ethiopian partners to implement the rabies elimination One Health model project on a targeted region in Ethiopia.

We will travel to Ethiopia from May 1-25 to work with officials in Addis Ababa and Gondar. For the past seven weeks, we have met with the CDC, Drs. Gebreyes and O’Quinn, cultural anthropologists and social service agencies to prepare for our trip. We have also eaten at the lovely Lalibela restaurant here in Columbus, received our travel visas, and gotten a lot of shots — and were dismayed to find a shortage of the yellow fever vaccine in the U.S.!

For all of us, this will be our first time visiting Ethiopia and sub-Saharan Africa in general, and we are excited for what are sure to be many new and rich experiences! We are looking forward to exploring the natural environment of the Blue Nile Falls and Simien Mountains, driving overland from Addis Ababa to Gondar, seeing the history of ancient castles and churches, visiting marketplaces and drinking delicious coffee with each other and our new colleagues and neighbors. We are thrilled for the opportunity to contribute our business skills and passion to build on the One Health Partnership’s success and help eliminate rabies in Ethiopia.

One Health web feature — inspirational Buckeyes

April 4 2014

By Christine O’Malley
Executive Director of Health Sciences

Our university communications team just posted this great web feature on our One Health initiative in Ethiopia:

Here’s the link to the full story:

http://www.osu.edu/features/2014/destination-ethiopia.html

Things that struck me from the video:

Cervical cancer is the second-highest cause of death in Ethiopia, yet it’s very treatable if caught early. Our cervical cancer project is working to address that.

The student interviewed, Korbin Smith, went to Ethiopia as part of the rabies project. This was a fantastic student learning experience for him and our other students. This initiative benefits both our partners in Ethiopia by improving people’s lives and our community here at Ohio State by providing international learning opportunities.

I hope you are inspired as much as I am by our faculty, students, and One Health partners.

Maximum learning, for all partners

August 8 2013

By Wondwossen Gebreyes, DVM, PhD
Ohio State College of Veterinary Medicine

As I said in my previous post, we learned many things from each other during this successful Summer Institute. Here are a few of my thoughts on specific topics.

Maximum flexibility and minimum expectations: This became the motto for the team members a couple of days after we arrived. Considering the resource limitations of Ethiopia, the high economic growth and resulting traffic jams, and limitations in communications, one may not be able to plan things well in advance, or keep your lane consistently in driving on the highways, or be able to arrive for meetings on time.

At the end of the day, we always achieve all the goals, and everyone gets to be happy, though not in the most efficient way.

The situation also made me realize how much building capacity in the area of effective communication could improve all the activities we conduct in this partnership, be it neurosurgery, nursing, or environmental health.

Effective communication and filling the gap within our partner institutes in Ethiopia is critical.

However, life in the U.S. made us become very sensitive. We often try to be perfect. Ethiopia was a great venue for most to realize the sky does not fall. It is OK to be a bit late.

Relax, and still achieve our goals!

Equipment. Equipment, Equipment: As we all witnessed during our several meetings at the various health science colleges of the two universities and also read in blogs, one key ingredient missing very much in the hospitals, research, and teaching settings is equipment.

During this trip, I learned first-hand that 44% of the patient cases at the nation’s premier referral hospital, the AAU Black Lion Hospital, were cancer cases. It was sickening to also learn that among these cases, 65% were pediatric. Yes, indeed there is lack of manpower, and so we launched the institute.

The partner universities are also building the physical infrastructures. While these address part of the issue, the lack of equipment is a major impediment for capacity-building. How can one radiotherapy machine can handle such a large cancer case burden for 85 million-plus population?

Equipping laboratories and clinical units remains a major challenge that partners in Ethiopia and Ohio State will have to tackle.

Maximum motivation: I never realized so clearly until this trip what drives my passion in global work, particularly the teaching aspects. Never fully understood what drives me to lecture several hours with only a short tea break and still have the full steam.

I observed my colleague, Dr. Bisesi, give his lecture on environmental health, and I saw the wide open-eyed trainees and their interaction. I noticed the high level of motivation by the trainees. The same was true for my course.

Students were so highly motivated that they even asked me to teach a full day on a Saturday. Some even suggested we keep going on Sunday, but that idea created a bit of a stir. “True,” I said in my heart, “that is a big NO in Ethiopia.”

You have to respect Sabbath day more than molecular epidemiology.

The Ferenji Effect: Ferenji is defined very loosely as “a foreigner,” particularly referring to a rich Caucasian. Its connotation is very positive. Ferenji is often considered as a nice, generous foreigner whose pocket carries endless amount of treasures … well, we all know the truth.

Typically Ferenjis are magnets to Ethiopian kids in urban and rural areas of Ethiopia; they often have chocolates, coins, and all kinds of fun things. At a minimum they have a digital camera to snap kids’ picture and show it back to them. The kids giggle seeing their own image in this small window. They followed Dr. Bisesi and Mr. Harrison as we traveled in a suburb of Addis.

During the Summer Institute, I witnessed the usual hospitality of the university security guards and others giving the due respect to our “guest Ferenjis” and I (the designated local chauffeur) also get a free ride.

Unlike what I stated above, about “Ferenji are magnets to local kids,” kids in the Woreta area acted differently. When we were collecting questionnaires for the rabies project, the kids would run away when they saw our giant, “tall-6-foot-some” great athlete and health science student, Korbin Smith. “They might have considered him as Goliath,” I thought to myself. I also hoped one of those little shepherd kids would not be like Dawit (David). Thankfully, we left the place with all fun and no fighting.

Research ethics in Ethiopia

July 24 2013

By Karla Zadnik, OD, PhD
College of Optometry

I was hosted by Dr. Seleshe Nigatu of the University of Gondar as I opened the research ethics class in the Summer Institute with a discussion of the Tuskegee Study. The study is the U.S.’s 1978 Belmont Report with its basic principles of respect for persons, beneficence/nonmaleficence, and justice. The class of almost 60 people from the University of Gondar and Addis Ababa University, along with other Ethiopian institutions of higher learning, had expertise ranging across medicine, veterinary medicine, economics, and pharmacy. The photographs depict the engaged students. In the late afternoon, the participants tackled their first two case studies, one on

reporting of results to an industry sponsor and the other an accurate analysis of a case of subtle plagiarism but plagiarism nonetheless. Tomorrow, the class tackles animal care and use in research and biorepositories (thanks to Donna McCarthy and Mark Merrick and their lecture materials).

The transition from Addis Ababa to Gondar was ably assisted by advice from Dr. Jodi Ford from the College of Nursing, who taught research methods at the University of Gondar earlier in July.