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

 

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.

Rabies project: MBA students meet faith healers, health workers in Gondar

 

By Danielle Latman
Ohio State MBA student

Wednesday, 5:30pm: Rain pelted the windows as I sat in the back of the van with seven men, interviewing a young woman about administering health information in the Gondar region.

We were pulled over on the side of the road on the outskirts of Gondar city, asking the woman about her role as a Health Extension Worker (HEW). This 8-year-old program trains and employs women to provide basic health education, information and supplies to each kebele (small municipality) throughout Ethiopia. The HEW program responds to the limited formal health care in the country, with very few doctors and nurses to meet the population’s needs.

We were meeting with the woman, whose name translates to “Love,” to learn more about the role of HEW and if/how they could be helpful to the rabies plan.

We (Danny, Javed, Niraj and myself, plus our three guides/translators from the University of Gondar, and our driver Amhara) were sitting in the van because of the rain outside, and because the HEW’s post was far away.

Surprisingly, this wasn’t our first van interview of the day. We started the afternoon by visiting the health station near Gondar city. The Ethiopian health system has a set structure operating from the kebele to the regional level.

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The Ethiopian health system has a structure operating from the kebele to the regional level.

The HEW operate from a local kebele post and visit families door-to-door. Above them is a health station, with nurses. Above that is a health center. And the highest level of care is provided at the hospital level, but only two main hospitals (in Addis and Gondar) can provide a wide range of health services.

At the health station we could meet with a HEW coordinator. Our van idled for a few minutes in front of the short cement building while the team members discussed with our hosts what we wanted to ask. A young woman approached our van to ask what we wanted. Our hosts spoke with her in Amharic, and then the young woman left and shortly returned carrying an umbrella over the head of another woman, wearing a white coat.

Sister Abanesh entered the van, sat in front and answered some of our questions about Ethiopia’s 17 health priorities which the HEW workers focus on. She was the coordinator and managed six HEW. But we didn’t get to talk to her long, since the director of this health center preferred that we speak with him formally in his office.

So we got out and walked to his office in the health station compound. On the walk we saw some cool posters promoting different positive health behaviors, which Danny and I (the marketing team) were very interested in for our part of the project.

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A health poster at a local clinic

We filed into the director’s office, sitting in chairs around his desk. He answered our questions about the training and reporting processes for HEW, and Sister Abanesh gave us some pamphlets that they use for family health education.

One important thing we have learned is that, while there is an overall 40 percent literacy rate in Ethiopia, almost all households have at least one child who can read, and so the child will read information for the whole family, leading to an almost 100% literacy rate at the household level. Then they showed us the storage area where they keep the vaccines cold.

We left with smiles, thank you’s and handshakes all around, then drove to our second van meeting of the day.

It is worth noting that the health station is located in a Jewish area just outside Gondar. We saw a house with a wooden Jewish star outside painted blue and white.

Our first meeting of the day had been no less surprising. We met with a group of faith healers who were having their association meeting at 9am. We all gathered behind their shack in downtown Gondar, which had posters for remedies like aloe vera curing HIV.

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Meeting with faith healers in downtown Gondar.

We had heard that a lot of people in Ethiopia use traditional or faith healing (bahawali hakeem in Amharic) instead of or in addition to modern medicine, especially the rural population. About 90 percent of Ethiopians live in rural areas. Thankfully, our university guides Akilew and Debasu had contacts with them and were able to set up a meeting.

Though we directed our questions to the group of about seven men and one woman faith healers, for the most part only the chairman responded. We asked about their motivation for becoming faith healers. For some it was a change from their strict religious backgrounds. For others it was passed down in their family. We also asked if they had or would ever collaborate with doctors or other medical scientists in their treatment. We were pleasantly surprised to learn that they are open to collaborations, especially with treating dogs that have rabies.

We then visited a vaccine storage facility, a health clinic, and a vet clinic (with a very sad-looking chicken outside). Rabies vaccines have to be kept cold – one of the challenges in warm climates like those in Africa. The veterinarian told us they had administered 500 rabies vaccines since March and showed us their cold storage and even a sample vaccine, which came from India.

After our morning meetings, our host Tamiru suggested we go to Hotel Taye for traditional Ethiopian coffee. In the second floor lounge area, a woman was roasting coffee beans and cooking ground coffee in a traditional pot over hot coals. Rose petals were strewn in front of her cooking area.

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Traditional coffee ceremony at the end of a long but productive day.

It was a very long, insightful and rich work day which lasted about 12 hours, and some of us retired early to be well-rested for what will surely be another full, surprising and enriching day.

The business of rabies elimination in Ethiopia

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.

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

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.

The initial journey of the University of Gondar-Ohio State rabies project: my perspective

By Tamiru Berhanu Denka, DVM
University of Gondar, Faculty of Veterinary Medicine

I was voluntary and happy when requested to be part of the Rabies Knowledge Attitudes and Practice assessment in and around Gondar. The University of Gondar team was established ahead of the arrival of Ohio State teams, and was made up of lecturers and assistant professors from College of Medicine and Health Sciences (CMHS) and the Faculty of Veterinary Medicine (FVM).

Tdele Atnafu form the School of Pharmacy, and myself form FVM went to two districts: Debark and Woreta, 105 km and 120 km respectively away from Gondar.  Dr. Reta Tesfaye (FVM) and Debasu Damtie (CMHS) went to different places in Gondar. The mission of our team in these different places was to contact responsible government bodies and to discuss and debrief the rabies project objective in Gondar particularly, as well as Ethiopia at large, before beginning work.

The Faculty of Veterinary Medicine, UOG, Welcoming Ohio State students at Hotel Lamergeyer.

The Faculty of Veterinary Medicine, UOG, Welcoming Ohio State students at Hotel Lamergeyer.

After the arrival of the Ohio State team, Dr. Wassie Molla, coordinator of the project from UOG, held a meeting to allow the teams from Ohio State and UOG to meet and discuss the interview questions, recording on the ipad, and consent of interviewees at the meeting hall of FVM.

The next step was to start the job– interviewing various individuals and professionals as per the project proposal. Interviewing individuals is not an easy thing to do. However, our prior communication and discussion helped us to interview efficiently. Everyone was welcoming and eager to participate in these interviews. As we continued on, I began to see how important the issue of rabies is, and how much it affects my country. Everywhere we went people stopped their daily activities to meet with us, allowing our groups to finish interviews more quickly than originally anticipated. Due to our efficiency, our teams were asked to take on the challenge of an additional city and we did so in stride. In total we surveyed four cities and conducted approximately 280 interviews in eight days.

Because, it is cultivation season, the periurban community leaders and communities were super busy plowing. At this critical time, it was necessary for us to meet this group of people for the interview. Then we decided to participate in plowing! (Ally, Ohio State 3rd year Vet Med student).

Because, it is cultivation season, the periurban community leaders and communities were super busy plowing. At this critical time, it was necessary for us to meet this group of people for the interview. Then we decided to participate in plowing! (Ally, Ohio State 3rd year Vet Med student).

We then went to Addis Ababa to attend the rabies stakeholders workshop, held July 18-19. I am having an immense experience working in a team, appreciate  learning about a different culture, and developing more friendships among the Ohio State team and from the University of Gondar as well.

Mr. Berihun (lecturer, Department of Nursing) did well plowing. The farmers were surprised when he started pushing the oxen.

Mr. Berihun (lecturer, Department of Nursing) did well plowing. The farmers were surprised when he started pushing the oxen.

Dr. Tamiru Berhanu (lecturer, University of Gondar, Faculty of Veterinary Medicine)

Dr. Tamiru Berhanu (lecturer, University of Gondar, Faculty of Veterinary Medicine)

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The UOG–OSU rabies project team members after successful interviews of various target groups of the study at Debark, 105 km from Gondar, where UOG is located.

The UOG–OSU rabies project team members after successful interviews of various target groups of the study at Debark, 105 km from Gondar, where UOG is located.

Dr.Baye Molla and the OSU students (Laura Binkely, Karissa Magnuson, Korbin Smith and Allyson Sterman) before getting to attend the graduation ceremony of the UoG  on July 6, 2013.

Dr.Baye Molla and the OSU students (Laura Binkely, Karissa Magnuson, Korbin Smith and Allyson Sterman) before getting to attend the graduation ceremony of the UoG on July 6, 2013.

The MPH-VPH program started admitting students in 2012. The program was made successful due to the significant contribution of Ohio State professors. From Left to Right: Dr.Achenef Melaku- Dean of FVM, UOG. Dr.  Sileshi Nigatu- Head Department of Veterinary Public Health and Epidemiology.

The MPH-VPH program started admitting students in 2012. The program was made successful due to the significant contribution of Ohio State professors. Dr.Molla (Ohio State professor) with two of the first batch of MPH-VPH graduates on June 6, 2013. The MPH-VPH students have green striped graduation gowns.From Left to Right: Dr.Achenef Melaku- Dean of FVM, UOG. Dr. Sileshi Nigatu- Head Department of Veterinary Public Health and Epidemiology. 

University of Gondar graduation ceremony

University of Gondar graduation ceremony

Rabies In Ethiopia And The Way Forward – Stakeholders Workshop

By Mary Jo Burkhard, DVM, PhD
Ohio State College of Veterinary Medicine

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I had the privilege of facilitating a 1.5 day workshop for stakeholders committed to the control and eradication of rabies in Ethiopia. We had approximately 70 registrants including representatives from a number of agencies such as the Ethiopian Health and National Research Institute (EHNRI), Federal Ministries, Center for Disease Control (CDC); partners including conservation, environmental, research and vaccine development groups, as well as a host of faculty and students from the University of Gondor, Addis Ababa University, and The Ohio State University.

Mamo Gebreyes

Dr. Hailu Mamo, Research Coordinator from ENHRI and Dr. Wondwossen Gebreyes from OSU, two of the meeting organizers working on details before the start of the session.

While not everyone could make it for all of the sessions on both days, we had 45-60 participants in each session which demonstrated the importance of rabies control in Ethiopia. Particularly when you consider that the session was held on a regional campus approximately 23 km outside of downtown Addis Ababa that required navigation through substantial traffic!

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We utilized a very powerful workshop format that we at the College of Veterinary Medicine like to call “Focus Forward.” This format included overview presentations, facilitated small group discussions, identification of common recommendations by a “theme team,” and prioritized voting through participant clickers. Dr. Tamiru Berhanu, a veterinarian and lecturer at the University of Gondor (UOG), served as one of our small group facilitators. Dr. Tamiru Berhanu is one of the partners for the rabies collaborations between the University of Gondar and Ohio State. I learned that in Ethiopia, it is common to refer to doctors by their first name, so Dr. Berhanu rapidly became known to me as Dr. Tamiru. Once I figured out the Ethiopian way of addressing people, it became a lot less confusing to sort through our excel spreadsheets of the participant list!

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Tamiru Berhanu, a partner for the rabies collaborations between the University of Gondar and Ohio State, and Mary Jo Burkhard.

We had four main topics to cover in the workshop: surveillance and reporting, how to identify people exposed to rabies and develop standards for immediate care of bite wounds, controlling rabies in the dogs and other animals, and education for both urban and rural areas. During the breakout sessions, diverse teams of experts discussed these critical topics. One of the strongest themes that arose in all of the sessions was the need to include traditional Ethiopian healers in the process by combining culturally-accepted, traditional methods of treatment and training of traditional healers with rabies vaccination programs and current medical treatments for bite wound care.

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Here, Dr. Debasue Damtie (at right, taking notes on participant responses), a professor from the University of Gondor, leads one of the breakout sessions.

Even though I spent nearly all of my time in the workshop rooms, I learned a lot about Ethiopian culture just from listening to the discussions and hearing the recommendations. However, I am also looking forward to seeing more of Addis Ababa over the next couple of days now that the conference is over and personally experiencing more of the Ethiopian culture!

Interviews and data collection

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Ohio State student Korbin Smith helps interview a farmer in the South Gondar region of Ethiopia.

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Ohio State student Laura Binkley and University of Gondar faculty Dr. Reta Tasfay and Mr. Dagnachew Muluye interview a health care extension nurse about rabies.

Photos by Rick Harrison, Ohio State University Communications

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

By Karissa Magnuson
Student, Ohio State College of Veterinary Medicine

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

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

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

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

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

Dancing in Ethiopia

By Ally Sterman
Student, Ohio State College of Veterinary Medicine

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

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

Ally Ethiopia pic

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

Data collection in Debark

By Karissa Magnuson
Student, Ohio State College of Veterinary Medicine

For the past two days we have been in Debark, a town about 100 kilometers north of Gondar. Debark was our second data collection site for our rabies research project.

It is a common resting place for tourists who wish to visit the Simien Mountains. On our two-hour drive up to the city, we passed stunning scenery. The countryside is full of lush, rolling hills and looks like a patchwork quilt of rich coffee brown fields and vibrant green countryside.

We passed many farmers out plowing their fields with oxen and an old-fashioned plow. It was idyllic, and I felt like I had stepped back into a different time.  It was hard to go five minutes without seeing a shepherd out with his flock of goats or sheep, and there were always cows, goats, and sheep grazing in the distance. Our van had to stop or slow down a few times as wandering goats, sheep, and cattle crossed the road.

The people of Debark were very friendly and accommodating. For the project, my team was in charge of urban adults and children. It was truly a privilege to be able to walk their streets and be invited into their houses, especially since they knew nothing about me. Every house we went to, I was offered a chair or a place to sit, and a few times, they roasted a snack for me over their fire for me to eat. The hospitality here was truly amazing.

Our last day of data collection, we went up to a small neighborhood on a hill. Immediately we were surrounded by a huge group of children, all probably under the age of 10. They were all extremely friendly and asked me my name.

As my Ethiopian team members told them about the study and asked if they would like to participate, one of the little girls grabbed my hand.

All the children were eager to participate in the study. As we followed them back to their houses, my other hand was grabbed by a little boy, and I was led off down the dirt road to their homes.  Walking from one house to another, my hand was never empty. At one point, two of the children had a little disagreement about who actually got to hold my hand.

When we finished our data collection and were saying goodbye, all the children who had followed us around came over to me and shook my hand, and we touched shoulders. In Ethiopia, when you greet someone you shake hands and touch shoulders with the person. There must have been six or seven kids in line to say goodbye to me. It was truly a heartwarming and memorable experience that I will carry with me forever.