Gondar | 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.

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.

Patience is a virtue that can be learned – in Africa

August 12 2014

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.

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!

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.

SolomonGetu-JM-Ajanaw-SemalegneKendieMengesha

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!”

From left, me with Addisu and Asmech.

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.

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.

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