One Health Summer Institute

#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.”

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 Ethiopia featured in news article

October 20 2014October 20, 2014

Our One Health program was mentioned yesterday by The Columbus Dispatch in an article on Ohio State’s College of Veterinary Medicine.

Here’s an excerpt:

“About 75 percent of emerging diseases originate from animals,” said Dr. Wondwossen Gebreyes, the director of the infectious-diseases molecular epidemiology laboratory. “That’s why our work in veterinary medicine is crucial, not just to save animal life but also to save human lives.”

With growing interest in that link, Ohio State now offers a degree that can be completed in four years by combining a two-year master’s in public health with a four-year doctorate in veterinary medicine. Graduates can fill the demand for veterinary experts at agriculture companies and government health departments.

“They will be detectives of diseases, from the animal side,” said Dr. Armando Hoet, the coordinator of OSU’s veterinary public-health program.

Students learn how to wear protective gear to deal with Ebola, anthrax or other infectious diseases that can pass between humans and animals. They learn about bioterrorism and that 80 percent of agents that can be used as infectious weapons spread from animals.

“We train professionals to deal with those diseases both in the animal side and human side, and to prevent transmission from one population to the other,” Hoet said.

A summer program has started sending students to Ethiopia to look for ways to help prevent the spread of rabies. Other projects study whether salmonella bacteria strains from around the globe act differently and how influenza jumps from pigs to people at Ohio county fairs.

Read the full article on the Dispatch website >>

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.

Greif neonatal program featured in news story

September 10 2014

Earlier this year, clinical staff from Ohio State’s Greif Neonatal Survival Program brought their expertise to Ethiopia during our One Health Summer Institute.

The team was recently featured in a news story from the College of Medicine about the program’s growth since its founding in 2012.

You can also read their Ethiopia-based blog posts here and here.

Congrats to the Greif Neonatal Survival Program for its impact on saving lives!

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.

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

July 18 2014

Dr. Sintayehu on the far left, Christine second from right, during Christine’s visit to Ethiopia earlier this year.

Introduction: Christine O’Malley and Dr. Sintayehu Mulugeta are friends who work on collaboration between Ohio State and the University of Gondar (UOG), Ethiopia. This summer, Ohio State sent a team of students and faculty to partner with UOG on a spay/neuter program and dog inventory as part of a rabies elimination pilot project. Below is a transcript of a Skype conversation between the two friends. Sintayehu, a veterinary medicine faculty member, describes the field training UOG provides its vet students.

Christine: Now that the Diamond Jubilee is over, what’s going on at the University of Gondar? Is it summer break?

Sintayehu: Well, I am out of office for field work with students on their clinical field experience. Most of the schools are on summer vacation now, but students in Medicine and Health College, Vet Faculty and freshmen in various departments are still in campus.

Christine: What kind of field work do the vet students do?

Sintayehu: To support clinical medicine course and help them develop confidence and get acquainted with the real picture at clinics out there in working place, students take a course called off-campus training. The students will have about two weeks’ time exposure to different districts’ government vet clinics where they work as clinical vet students with close supervision by one faculty staff from UoG, and the district’s vet.

Sintayehu: They also engage in community services and help the clinics in every capacity they are capable of, like cleaning the clinic compound, providing recommendations on potential shortcomings, etc. After completion of off-campus training, they are supposed to present a field practice report about their stay and will be evaluated based on that.

Christine: Do they provide direct care to animal patients?

Sintayehu: Yes, with supervision. That is why I am currently with them here in field.

Christine: I bet they learn a lot from that.

Sintayehu: Sure. That is the best way of learning from practical courses. And this is witnessed by them. However, because of small amount of budget they sometimes come back to campus earlier than planned. This is really a continuous challenge to the faculty and to them.

Christine: What are the most common illnesses or conditions that you see at the district clinics?

Sintayehu: Well, I can say we have all sorts of diseases. For instance, in the place we are now working are Infectious (Pasteurellosis, Black leg, Anthrax, Lumpy Skin Disease, Sheep pox, Rabies, Newcastle Disease), Parasitic (helminthes, arthropods: ticks, lice, mange mites; protozoans: Trypanosomes, Coccidia), Metabolic and nutritional, and reproductive disorders in cattle, sheep, goats, donkeys and chicken. I was surprised to see dogs as well in the clinic.

Sintayehu: However, to be honest with you, there are no laboratory facilities for confirmation of cases, so the diagnosis is almost always relied on history and clinical findings. No single laboratory diagnostic aid and there are only few drugs available.

Sintayehu: I saw a new building for the clinic and I was told that it has been built from the World Bank fund. Mr Nigussie, the vet technician working here, told me that it is now completed and will be furnished with basic clinic facilities from the same fund. Then it can have better veterinary service.

Christine: Why were you surprised to see dogs?

Sintayehu: I mean not to see them, but the awareness of the community, most of which are poor farmers, to get medical care for their dogs.

Christine: That seems like a good thing.

Sintayehu: Definitely! I was told by Mr Nigussie that the community has good awareness about the importance of bringing their animals to clinics whenever there is ill-health to their animals. That shows there is a big demand for vet service.

Christine: Also a good thing for the rabies project, perhaps? Showing awareness of needing to take care of their dogs?

Sintayehu: Yes. You know, I also asked about the status of rabies in the area. It is terrible to hear that there is high prevalence of rabies in the countryside. This is worsening by strongly rooted perception of the community that traditional healers can cure the disease. It is challenging human/animal health care. There is no rabies vaccination at the clinics. The only thing the vets in such districts doing are advise farmers to be careful of suspected dogs.

Christine O’Malley: Yikes! What areas will you visit next?

Sintayehu: This is the last field work for this academic year. Koladdiba, the place we are now working in, is not that much far from Gondar, about 35kms, but the road is rugged and may take you about an hour or so. I love having seen the countryside. I wish I could visit such places more often.

Group of students with Dr. Sintayehu, their mentor, in the middle wearing the blue jacket.

Life-saving and life-sustaining: Maternal, newborn interventions at work

July 8 2014

By Monica Terez, RN
Clinical Program Manager
The Ohio State University College of Medicine

The sixth floor of Black Lion Hospital in Addis Ababa is a bustling place.

One wing is dedicated to the care of laboring mothers, many of whom require complicated care provided by midwives and obstetrical residents.

Another wing houses approximately 45 infants, all requiring some degree of newborn intensive care. The infants are not arranged in rooms by chance, but rather by the level of care they require.

One large room is dedicated to the most fragile infants, often born weeks or months before the mother’s due date. Due to a lack of sufficient equipment, infants often share a bed or isolette. Babies are kept warm by space heaters positioned throughout the unit.

At any one time, each nurse may be assigned to care for as many as 10 sick neonates over the course of a 14-hour nightshift.

Considering how busy the unit is at any given moment, it would be easy to miss the most important care providers – the mothers of those infants – who desire to give their baby the best chance for survival.

With the support of the physicians and nurses in the neonatal intensive care unit, mothers provide Kangaroo Care for their babies for many hours. Kangaroo Care allows the mother to hold her baby, skin to skin on her chest, thereby regulating the infant’s temperature, calming the baby, enhancing growth and promoting maternal/infant attachment.

Three rooms of the neonatal unit are dedicated solely to mothers to rest, breast-feed, care for their infants, and just do what mothers do best – love their babies.

Black Lion has long realized the importance of maternal involvement in the health and growth of infants.

The unit’s equipment may be sparse and malfunctioning, nurses may be few and far between, the workflow may be less efficient than desired, but one thing is for sure. At Black Lion Hospital, the mother has taken her rightful place as an important care provider for her infant. THIS is newborn care at its best!