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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.

Crowded streets of Addis Ababa.

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.

Dr. Wondwossen Gebreyes with faculty at Addis Ababa University.

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.

bisesi_and_kids

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.

rabies workshop 13

3interview

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.

Lunch at Addis Ababa University.

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.

U of G gate.

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.

Endemenachu?

By Timothy Landers, RN, PhD
Ohio State College of Nursing

One of the things that has been most impressive in my visit to Gondar is the respect for people and for relationships that is present in every interaction.  Every conversation begins with a greeting, ሰላም, “Selam!”  Followed by some greeting such as “how are you”, “how is your day going”, or “how are you feeling?”  Or more often, all three.

In a typical conversation, each person in the group is acknowledged and receives a handshake.  The president of the university greets the department chair, the student, and the housekeeper.

There is a nonverbal conversation among Ethiopian men – what we’ve come to call the “ah-ha.”  It is a brief gasp taken with force which is usually uttered when another is speaking.  It says, “I am listening, I am interested, I am here.”

When I arrive at my office in the morning, I make it a point to say hello to the co-workers I meet – something I picked up from an airline pilot who told me he ALWAYS greets his flight attendants and co-pilot first thing.

However, it’s not the same kind of recognition and appreciation for the other person that I have seen in our visit to Ethiopia.

In the past two weeks in Ethiopia with each “Selam,” “good morning,”  “how are you feeling?” and “how was your day?,” I’ve learned more about my co-workers than I could have in six months in Columbus.

But, I’d like to change.

When I leave Gondar, I am going to be more aware of how I greet those around me – everyone.  It’s worth the time to let them know that I am interested in how they are doing.  I am hoping to let them know that I value them and am interested in them.

How are you doing today?  How are you feeling?  Did you have a good night?

After that, I will unlock my door and get to work.

And there is lots of work to do.

Landers: Nurses are awesome, say it loud and proud!

By Timothy Landers, RN, PhD
Ohio State College of Nursing
and Gennit*, 9th grader from Atlanta, Ga.

*Gennit is not her real name but the story is true.  Her mom gave us permission (from the row behind us) to use this story and photo.  Hopefully, this counts as her “What I did over summer vacation” essay when school starts.

I’m sitting on the plane with Gennit, a 13-year old girl who was born in Ethiopia, but now lives in Atlanta with her brother and parents.  Gennit is a nice and articulate 13-year girl, and we chatted during the 13-hour flight about our experiences in Ethiopia.

photo-2She had a lot of things to say, and I noticed that she was somewhat soft-spoken making it difficult to hear her at times.  I asked her about my observation that many Ethiopian girls and women speak softly and what she thought about that.

Gennit told me she thought is was more “ladylike” to speak softly and, in Ethiopia, children are taught that it is wrong for a girl to talk loudly.

She spoke in her own dialect – the American southern teenager — and said, “Like, it’s like wrong for a girl to speak like that.  Ok, like, it’s just like, everyone has, like, their own traditions and, like, it’s just how a girl is raised.”

At the same time, she had some very interesting and important opinions to share.  It’s, like, totally cool that a 13-year-old gets this linguistics lesson.

I started thinking about what this means for nurses and for nursing.  It is often difficult for us to articulate our contribution to health and health care.  We are trained to be reserved and deferent.  It’s considered respectful, but it means that our voices are not heard.  This can be especially true at the table of health care decision-making.

As we work with our colleagues from the University of Gondar, we need to encourage them to represent nurses in a way that is culturally acceptable and to advocate for nursing’s contribution to patient outcomes — to speak up for what nurses mean to patient care.

This is true for us in Ohio, too.  We should learn to make our voices heard.

REPRESENT!

What nurses do is, like, totally awesome!

The Sounds of Ethiopia

Tim Landers of Ohio State’s College of Nursing shares this clip of what 5 a.m. sounds like in Gondar, Ethiopia, as he prepares for another day with the One Health Summer Institute.

A lesson in the art of craftsmanship

By Tim Landers, RN, PhD
Ohio State College of Nursingflower_napkin

I’ve noticed some really excellent craftsmanship in Gondar.

Craftsmanship is evident in the way a napkin is carefully folded that turns an evening meal in to a “dinner.”  And craftsmanship is the patience of our waitress giving me a lesson in napkin folding.

Craftsmanship is the way that the pharmacist carefully wrapped up a packet of medication she prescribed for me because of the cold I’ve acquired in my last days in Gondar. It says, “I hope you feel better” before you open it.

folded_medicine_packet

Craftsmanship is the certain way a bundle of straw is tied to the back of a donkey on the way to market or the way a cup of coffee is poured when the person actually cares. It’s the expert skill and flair a microbiologist uses to streak an agar plate or a nurse uses to comfort an ailing patient.

One of the great craftsmen I have met is Mr. Abebe Demise. Abebe has a small shoe-shine bench outside our hotel. What makes him a craftsman is not that he does a good job cleaning and shining shoes; he does a great job on shoes from the dusty streets of Gondar. abebe_working

What makes him a craftsman is that when Mr. Abebe is at work shining shoes, he is in the zone. His full attention is on the task at hand. He uses the tools of his trade – he uses all of his attention – to shine shoes. To watch him in action is to see a master craftsman at work.

Craftsmanship is a difficult concept to teach to students in our “Research Methods Course.” There is just a way that a carefully constructed title of a scientific paper can grab your attention. A well-written set of specific aims can explain the purpose of a research project in a way that extends beyond the words printed on the page.  A well-organized literature review can make reviewers beg you to do your experiments.

This skill of craftsmanship in writing grants takes years to develop — and I am no pro.  But I know good grants craftsmanship when I read it—and when I see it.

On my last day in Gondar, Abebe Demise called to me from his shoe-shine bench across the street.  He had a small envelope for me with “For: Tim Landers, From: Abebe” written on the outside.  Inside were two picture postcards of Gondar.

I’d like to think that maybe – just maybe – this was one craftsman’s way of acknowledging a fellow craftsman.

tim_and_abebe

Professor Tim Landers and Mr. Abebe Demise, one of the great craftsman of Ethiopia.

Show and Tell: Our “First Kits” in Ethiopia’s Simien Mountains

tim landers 3

By: Tim Landers, RN, PhD
Ohio State College of Nursing

This past weekend, we had a chance to take a hiking tour of the Simien mountains in Ethiopia.  This has to be one of the most beautiful places on earth – the landscapes are gorgeous, the people are smiling and proud, and there is plenty of wildlife.

I have done quite a bit of hiking with my two sons and friends from Boy Scout Troop 33 in Columbus.  As we were hiking across the Simien mountain pass, our guide and I chatted about our experiences hiking and guiding groups.

Melese Beza (of www.outstandingsimienmountainstours.com) grew up tending livestock as a shepherd and works as a professional tour guide through the mountains as he completes his bachelor’s degree in tourism management.  He speaks English quite well and we began to talk about the types of health problems he encounters as a professional hiking guide.

We took a break as it began to rain and started a “show and tell” of our first aid kits.  He had a basic kit ready for the main emergencies from African trekking – including what he adoringly called “potions” such as acetaminophen, wound disinfectant, and diarrheal medications.

Simien Mountain tour guide Melese Beza of Outstanding Simien Mountains Tours and Tim Landers, RN, PhD do a show and tell of their first aid kits during a rain break while trekking through the Simien Mountains north of Gondar, Ethiopia.

Ohio State’s Tim Landers and Simien Mountain tour guide Melese Beza do a “show and tell” of their first aid kits during a rain break while trekking through the Simien Mountains north of Gondar, Ethiopia.

The two take turns with their "show and tell" on first aid.

The two take turns with their “show and tell” on first aid.

He used somewhat different terms, but described several conditions which would be expected – ankle “dislocations” (strains/sprains), altitude sickness, injuries from rock falls (abrasions and cuts), and blood sugar emergencies.  He also described unfortunate drowning victims he recalled from last summer and that they had attempted “breath blowing” with success in one victim.

In my training back home, we’ve prepared for emergency evacuation of wounded hikers by helicopter transport, extricating from deep woods by foot and by vehicle, and most of our Scouts have completed training in first aid and CPR.

In this region of Ethiopia, there is no such option.  There are no helicopter evacuations from the Simien Mountains.  Guides call for help and it will come as soon as word can reach the village by foot and a jeep, configured as an ambulance, can make it to the wounded person.

As we discussed how injured hikers are treated and our own experiences, I was impressed with his solid grasp on these conditions.  He has been working with several other guides trying to organize a more formal training in first aid and CPR for Simien Mountain guides.

Because our group is exploring the possibility of working with nurses and health extension workers to do health education, I was able to direct him to some excellent training resources developed by my friends at Columbia University School of Nursing. They have developed a fine first aid training curriculum in first aid for health extension workers.

I left him with some supplies from my kit and he reciprocated by sharing knowledge of local plants and remedies.

He left me with an appreciation for the training and preparation it takes to safely enjoy the outdoors – whether it is in Ohio or in Ethiopia.

Hand-in-hand on hygiene in a hospital setting

Tim Landers, RN, PhD, from Ohio State’s College of Nursing and Nora Mohammed, MSc, from University of Gondar -- an infection prevention hero!

Tim Landers, RN, PhD, from Ohio State’s College of Nursing and Nora Mohammed, MSc, from University of Gondar — an infection prevention hero!

By Tim Landers, RN, PhD
Ohio State College of Nursing

“Are you from Ohio? Will you talk to me?”

Nura stopped me in the courtyard of the University of Gondar hospital. She was waving my business card that had been given to her from a School of Nursing instructor who knew that my work centers on infection prevention.

She had just defended her Master’s thesis on hand hygiene at the University of Gondar in which she completed an audit of hand hygiene practices by nurses and other health care workers at a local hospital. When she told me about her project, I was very excited to learn more, so we met the next day to review her findings.

Improving hand hygiene saves lives. Reducing transmission of germs on the hands of health care workers is the most important means of preventing infections.  A recent article of mine on patient-centered hand hygiene is here. Another important article on the subject is here.

Effective hand hygiene programs use a multimodal approach, including strong administrative support, education, training, monitoring of hand-washing and feedback. A critical element of hand hygiene programs is providing products and supplies in the health care setting, and I’ve worked on the best approach for years.

But I had forgotten how critical the provision of products is in our hand hygiene efforts. Without a sink, running water, soap, or alcohol-based hand rubs, hand hygiene is simply not possible.

Quite frankly, I had come to take this for granted.

Until I met Nora.

In her study, Ms. Mohammed showed that in more than half of the “hand hygiene opportunities” – times when workers should perform hand hygiene – no soap, running water, or alcohol-based hand-rubs were available at this hospital. As a former nursing matron, or director of nursing, she saw the impact this had on patient outcomes.

By demonstrating the need to improve access, her study provides an important first step in improving hand hygiene practices.

I was really excited to meet someone who shares a passion for infection prevention and hand hygiene. She really is making a difference at her hospital and helping to save lives in Gondar. In the U.S., we call them “heroes!”

Yes, I am from Ohio, and I would love to talk to you!

O – H – I – O ! Ohio State students arrive in Ethiopia

Image

We were very excited to welcome four Ohio State students to Gondar yesterday.  They are beginning their work on the needs assessment for a rabies prevention/elimination project.

Last night over a traditional Ethiopian dinner, the group met with University of Gondar Veterinary Medicine Dean Dr. Mersha Chanie, Chair of Sociology Molalign Belay, guest Dr. Judd Walson from the University of Washington’s Department of Global Health, and Ohio Staters including Veterinary Medicine Professor Baye Molla, College of Nursing Vice Dean Usha Menon and other College of Nursing faculty.

One thing that struck me was the diversity and intensity of the group.  These four students represent the breadth of programs at Ohio State and how interdisciplinary work can bring creative and innovative perspectives to important problems.

Third-year veterinary student Karissa Magnuson is interested in wildlife veterinary medicine.  Ally Sterman is a third-year veterinary student with an interest in shelter medicine and public health approaches to veterinary problems.  Korbin Smith, BS ’13, was inspired by Dr. Randall Harris in the College of Public Health to consider opportunities in public health.  Heading up the team is graduate student Laura Binkley, who is working on a Master’s degrees in public health and wildlife ecology.

Absolutely striking was the passion that each student brought to their particular interests and the lively discussion about where interests overlap and intersect.  This is the kind of collaboration that we can build only at a major academic institution like Ohio State.

Go Bucks!

Making Animal Inquiries in Addis Ababa

I took this picture outside of the Jupiter Hotel in Addis Ababa. This is kind of how I felt trying to navigate  a busy street with an unfamiliar language.

I took this picture of a stray dog outside the Jupiter Hotel in Addis Ababa. This is kind of how I felt trying to navigate a busy street with unfamiliar language and surroundings.

By Tim Landers
Ohio State College of Nursing

One of the first people we met when we arrived in Addis Ababa was Daniel, our driver who took us around some of the sights.

Traffic is very bad, with pedestrians, loaded mules, stray animals and vehicles trying to share the same road.

Most of the dogs we saw were roaming the street, but as we wove through traffic, I asked Daniel if he had a dog.  He was happy to show us photos of “Jack.” We know that dogs are important parts of many peoples’ families, and this was true for Daniel as well.

We asked more about Jack – where did he find him, when did he go to the doctor, and what type of dog he was.  Expecting that he would tell us about Jack’s pedigree, Daniel seemed very puzzled by the this question.  “He’s a small dog, a nice dog.”

Daniel was concerned because Jack had some sort of infestation, and he did not know how to treat it.  Unfortunately, we had two nurses in the car and no veterinarians.  We did stop at a local pharmacy to see what treatments they might have.

While we were able to buy fairly high-end human antibiotics, but they did not carry veterinary medications.

During our tour of Gondar, we encountered this donkey, which in Ethiopia are seen as work animals.

I asked one of the veterinarians with our group about an ulcer on the back of this donkey.  He actually pointed me to a paper he had written about these “pack ulcers” –erosions caused by loading of the animal for transport of goods to the market.  They are generally non-infectious, but they look uncomfortable!