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Dear readers,

Thank you for your attention to our insights from Ohio State’s 2013 activities in Ethiopia. This site has now moved.

Please join us at u.osu.edu/onehealth. We have more information about our partners and projects on the new site.

You can continue to follow our personal insights on the blog section of u.osu.edu/onehealth.

Sincerely,

The Ohio State One Health Task Force

Maximum learning, for all partners

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.

Ohio State in Ethiopia: A great experience overall

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

It has been wonderful working with all the Ohio State and Ethiopian faculty and students during the One Health Summer activity that run from June 7th to this week.

First off, I am very much proud to be a Buckeye. Everyone from the Buckeye nation (Ohio State) showed wonderful professionalism throughout the Summer Institute.

I heard all positive words from our partners in Ethiopia. Students and faculty from five of our seven health science colleges and also School of Environment and Natural Resources have all been great to work with.

I am also proud to be born Ethiopian. I am sure all my colleagues tasted the ultimate hospitality and motivation both in classrooms and social settings and learned a great deal of variations in traditions.

The commitments from both student trainees and partner administrators has been unsurpassed. It gives me a great pleasure seeing the trainees’ eyes wide open in the various lectures, sharing the Ohio State students’ excitement for service learning (even some requested opportunities for next year before leaving Ethiopia), and reading all the blog posts from our students and faculty members.

Importantly, personally, I also learned few more things about Ethiopia and partnership along the way.

With respect to the scientific/ technical aspects of the Summer Institute, I am confident to say that we achieved the goals – in all aspects: coursework and trainings, pilot projects, and workshops. We were able to impact more than 200 professionals in these courses. And a number of scientific networks and new collaborative partnerships developed. Partner colleges were able to identify areas for further collaboration.

Both the Univeristy of Gondar (photo below) and Addis Ababa University partners as well as other institutes — such as the Ethiopian Health and Nutrition Research Institute (EHNRI) — were excited with the outcome.

It was humbling to hear from the dean of AAU School of Medicine, Dr Mahlet, I quote: “We thought Ohio State would be similar to many, many universities we signed MoU with before and never heard from them again. You made us feel guilty by showing your commitment in a short period of time. Thank you and we are also determined to show our commitment.”

As we move forward, the Ohio State Health Sciences task force will resume its activity in full force. On behalf of the Ohio State Health Sciences One Health task force, thank you to all those who participated in the Summer institute! Some of the upcoming activities will include visits by the Ethiopia partner universities delegation; continued pilot projects on cervical cancer screen-and-treat, rabies intervention, electronic capacity-building, and service-learning clinical activities by neurosurgery and nursing teams. Please stay tuned and follow our blog.

In my next post, I will share some specific thoughts and observations on these activities.

An island monastery in Lake Tana

By Laura Binkley, student
Ohio State College of Public Health and
School of Environment and Natural Resources

During a quick visit to Bahar Dar, we were able to venture into Lake Tana. Lake Tana is the widest lake in Ethiopia and one of the largest lakes in all of Africa. Emptying into the Nile River, it contains several islands. Many of these islands possess ancient monasteries that have been well preserved by the monks. We decided to take a boat tour that would take us out to one of the islands.

Traveling across the lake provided us with fascinating views of the landscape and a strong sense of calm after an intense week of data collection. As we moved through the lake we passed giant pelicans, townspeople cleaning their clothes in the lake, and fisherman fishing in hand-made papyrus boats that seemed impossible to balance in. On our way to the island we crossed paths with the Nile River itself which was a pretty incredible experience.

When we stepped off of the boat onto the island we were surrounded by green. A vast field included papyrus plants and a variety of trees and plants from coffee to mango and banana. We walked down a small mud path towards the monastery where we were greeted by villagers selling fresh fruits and tiny handmade papyrus boat souvenirs among other things.

Once we arrived at the monastery we paid our fee to enter and were then led by an elderly monk to a small stand that he called a museum. He explained that the monastery had been around since the 12th century and then proceeded to show us the contents of the museum which consisted of ancient books, an emperor’s robe, elaborate crosses, and other priceless valuables of the church.

Once our tour of the museum stand was complete the monk lead us to the monastery itself. The monasteries on all of the islands are circular in shape with three main parts. We started at the outer part which consisted of a small wall left open to the outside that surrounded the monastery. Here was where we were to take off our shoes before entering the sacred place.

We were then lead inside to the second part. This section was dark except for the little light that illuminated the walls which  were covered in beautiful Christian art pieces. There were also ancient worship drums that were made of clay and covered in hide. We were not allowed to enter the third section where a sacred arc in honor of Mary was hidden. I can only imagine how fascinating it must look.

Once we had a chance to look around for a bit we grabbed our shoes and exited the monastery. We thanked the monk and then headed back down the trail to the boat that had been waiting for us. The boat then headed back towards the mainland again. It was all a very surreal experience that can only be found here in Ethiopia.

Haggling for souvenirs

By Korbin Smith
Student, Ohio State College of Medicine
School of Health and Rehabilitation Sciences

After the conference in Addis finished, we were about to do some touring throughout the capital of Ethiopia.  Downtown Addis has the biggest market in all of Africa.  This market is essentially hundreds of small stores all selling a mixture of food, clothes, and souvenirs. Growing up in a family in which going to garage sales was a regular family activity, I was prepared for the price negotiations.  In other words, “this wasn’t my first rodeo.”

While I did have a decent amount of birr to spend on souvenirs, I wasn’t giving up my money without a price battle.

After feeling out the atmosphere of many different shops, I began the negotiations. I am not going to name the specific things I was purchasing to avoid ruining the surprise for people back home, but I can describe my negotiation strategy.

I picked two items I liked in one store, and the owner told me 300 birr.  I decided that it would be a good strategy to offer half the asking price.  After being shocked that I was haggling, the owner said 250. I followed up with 200.  Ultimately I said 215 as my final offer, and they took it saving me 75 birr. (That one is for you Dad.)

Touring the UoG campus

By Karla Zadnik, OD, PhD
College of Optometry

Today started with a tour of the University of Gondar main campus.

Dr. Zadnik, Dr. Emch, and Dr. Seleshe Nigatu

Dr. Emch, Dr. Zadnik, and Dr. VanNasdale at the foot of a long stairway on campus.

Watercolor inspirations in Gondar

By Karla Zadnik, OD, PhD
College of Optometry

Watercolor inspirations in Gondar!

Watercolored images of Four Sisters (restaurant) and the transportation van’s dashboard chickens (by Karla Zadnik)

Dr. Karla Zadnik with the ethics course attendees at the University of Gondar

Ethics Engagement in Ethiopia

By Karla Zadnik, OD, PhD
College of Optometry

 

The Summer Institute’s research ethics course chugged along today. I started late, mostly because I didn’t realize most of my students were in the courtyard just outside the classroom in the bright morning sunshine, waiting for me to begin speaking. I lectured on the tenets of the Declaration of Helsinki (OSU faculty—you all remember those, right?) and the ethical use of animals in research (thanks Donna McCarthy!), but the highlight turned out to be the case study discussions.

I presented a case I’d heard at the 2008 Public Responsibility in Medicine & Research meeting. It weaves the tale of an imaginary city, Blovar, which is under siege such that its children are subsisting on an inadequate 400 calories. An entrepreneurial, mythical scientist who studies nutrition and brain function in children appears on the scene to conduct a purely observational study of the children. After carefully reading the case, the course attendees “went to town.” After their small group analysis of the case, I facilitated a discussion of the case. They didn’t need me. There were marked differences of opinion in the class. One attendee drew historical correlates, while another took the role of the Principal Investigator, cautioning the audience to assume that fellow scientists generally want to do a good job. The points made were lively, vehement even, yet collegial. All this before lunch!

The afternoon’s soundtrack was a thunderstorm of biblical proportions that hammered the roof of the classroom and lit up the sky. We all raised our voices in tune with the rain and created a chorus, celebrating the hard, thoughtful work of teaching and learning research-related ethics.

Power Up!

By Karla Zadnik, OD, PhD; DeanVannasdale, OD, PhD; and Andrew Emch, OD, MS
College of Optometry

Dr. Dean inspiring Optometry faculty at the University of Gondar

Dr. Andrew and Dr. Dean spent their second full day at the Department of Optometry, University of Gondar. At the Gondar faculty’s request, they taught a crash course on keratoconus, irregular corneas, and specialty contact lens fitting. The faculty was clearly eager to learn and are well-educated. They asked complex questions, almost stumping Ohio State’s favorite sons with evidence-based questions that required detailed knowledge of disease epidemiology.

Glasses donated for hands-on student learning at the Department of Optometry

After a jet-lag antidote lunch that included Coke and strong coffee, they went back to tour the Department’s clinic. The facility is adequately sized to educate the enrolled students.

Unfortunately, frequent, rolling power outages regularly limit patient care, on average two days a week. Equipment is a limitation as well. The clinical equipment, shared between Optometry and Ophthalmology, is a rate-limiting step for both education and eye care delivery.

Power outage = keratoconus story time with Dr. Andrew!

In spite of these challenges, the young faculty (average age 27 years old), all products of the initial years of the program, are dedicated to building educational capacity, departmental independence, and high standards for the provision of comprehensive eye examinations.