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.
By Karla Zadnik, OD, PhD
College of Optometry
I was hosted by Dr. Seleshe Nigatu of the University of Gondar as I opened the research ethics class in the Summer Institute with a discussion of the Tuskegee Study. The study is the U.S.’s 1978 Belmont Report with its basic principles of respect for persons, beneficence/nonmaleficence, and justice. The class of almost 60 people from the University of Gondar and Addis Ababa University, along with other Ethiopian institutions of higher learning, had expertise ranging across medicine, veterinary medicine, economics, and pharmacy. The photographs depict the engaged students. In the late afternoon, the participants tackled their first two case studies, one on
reporting of results to an industry sponsor and the other an accurate analysis of a case of subtle plagiarism but plagiarism nonetheless. Tomorrow, the class tackles animal care and use in research and biorepositories (thanks to Donna McCarthy and Mark Merrick and their lecture materials).
The transition from Addis Ababa to Gondar was ably assisted by advice from Dr. Jodi Ford from the College of Nursing, who taught research methods at the University of Gondar earlier in July.
By Michael Bisesi, PhD
Ohio State College of Public Health
Since my arrival on July 7, we have accomplished several activities. As an environmental health scientist, I was able to teach applicable modules to a wonderful group of grad students, clinicians (veterinarians, physicians, nurses) and scientists.
The modules included lectures and discussions regarding the properties of various environmental matrices (air, water, soil) and the fate of microbial and chemical contaminants that can adversely affect plants, animals, and humans.
An extension from the classroom included a field trip and qualitative assessment of the waste water treatment facility for the city of Addis Ababa. This was very enlightening since it demonstrated a system that has insufficient capacity for the volume of polluted waste water originating from municipal, industrial, hospital and runoff sources. The surrounding adjacent areas had fields growing crops, animals drinking and feeding, and humans using this area as a resource.
I also visited the slaughterhouse and tannery which have some pollution control technologies and practices in place. Observation of the river and surrounding land confirms suspicions that multiple sources are contributing to environmental pollution that impacts animal and human health. Our integrated approach to address this will bring results, but much work lies ahead. Our Ethiopian partners are wise to have included this work as a priority for our partnership.
Photos by Rick Harrison, Ohio State University Communications
By Andrew Shaw
Clinical House Instructor at Wexner Medical Center, Ohio State
Since returning from Ethiopia I am filled with excitement. The people there are incredibly welcoming, warm, and giving. They invited us to see their patients, wards, and hospitals. The doctors there exhibit such passion for medicine, learning, and are always wanting a lecture.
Establishing a long term relationship with the Neurosurgery Department at Black Lion hospital will be mutually beneficial.
Upon our arrival, I believed we would be the teachers, but I often found myself on the learning end. The pathology they see is often advanced and requires much skill to treat.
You might recall the show MacGyver. As Wikipedia says, “Resourceful and possessed of an encyclopedic knowledge of the physical sciences, [MacGyver] solves complex problems with everyday materials he finds at hand, along with his ever-present duct tape and Swiss Army knife.”
Our Ethiopian partners are the “MacGyvers” of medicine doing amazing things with limited resources.
By Kristina Slagle
Student, Ohio State College of Food, Agricultural, and Environmental Sciences; School of Environmental and Natural Resources
Soon after arriving in Addis Ababa, I had the opportunity to give a lecture on risk perceptions to students attending the summer institute. As my driver took me from my hotel to the university, I realized that traffic laws are merely a suggestion here, and pedestrians cross anywhere they can find a break in the traffic. My driver explained that the road we were on went from Addis to Djibouti, so it was constantly busy. Trucks full of construction materials, minibuses used for public transport, and small passenger cars jostled for position, while rickshaws led by mules stayed largely to the side and out of the fray. Needless to say, I was thankful for a driver who knew the unwritten rules of the road!
Once I arrived at the university, I had a bit of lunch, and then I was off to lecture. Throughout the lecture, I asked the students for examples of risk perceptions from Ethiopia, and one student mentioned traffic deaths. At the end of the lecture, we spent some time discussing strategies that had failed and what future efforts to reduce traffic deaths might look like. It was a very rewarding experience having engaged students interested in applying knowledge, and learning about applications within their culture. It’s always wonderful when the learning goes both ways in a classroom!
Now I’m off to Gondar to meet up with our team working on rabies!
By Wondwossen Gebreyes, DVM
Ohio State College of Veterinary Medicine
The second team of Ohio State faculty arrived in Addis Ababa yesterday after 18+ hours of flight and airport transfers. While our travel was overall smooth, some flight glitches occurred. One of our team members, Mike Bisesi, had his first and last name switched on his ticket, and TSA and United made it a big deal worth a thousand USD to correct his ticket. Two team members, Eric and I, did not get our luggage on arrival. Despite the long flight and the mishaps, there are still lots of smiling faces. This morning, we are at the Akaki satellite campus of Addis Ababa University, gearing up to begin the environmental health course module led by Bisesi. We will keep you all posted with more updates.
By Ally Sterman
Student, Ohio State College of Veterinary Medicine
With the start of the both the new week and new month our Ethiopia summer project really begins. Though we four students from various colleges at Ohio State arrived near the end of last week in Ethiopia, we did not begin our field work until July 1.
Our project takes us into both the rural and urban communities interviewing local adults, children, policy makers, community and faith leaders, as well as health care workers about rabies and dogs. We are set to travel around to three different areas before a workshop is held in Addis Ababa to discuss rabies further in mid-July.
However we do not go out alone. Each Ohio State student has two wonderful Ethiopian University of Gondar partners. These individuals are primarily faculty and staff at the university from a variety of fields/disciplines. They not only serve as interpreters for our project but tour guides of the city and historians for Ethiopia’s culture/traditions/history. They are quickly becoming lifelong and treasured friends. I know I can speak for all of the students about how grateful and appreciative we are for their help and how much fun/enjoyable they are making this experience.
The picture below was taken before one of the interviews conducted by my group. My group’s main focus is community leaders which include teachers, faith leaders, elders, and other various leaders in both the rural and urban settings. This picture was taken of one of the churches we travelled to in the city of Gondar where we had the opportunity to meet and talk to the priests about rabies and the dog population here in the city.
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!
By Tim Landers
Ohio State College of Nursing
We’ve arrived in Gondar!
Our traveling group from the College of Nursing arrived this morning and were greeted by officials from the University of Gondar and Baye Molla, PhD, clinical assistant professor in Ohio State’s College of Veterinary Medicine.
Dr. Molla is a native of Gondar and has been a wonderful guide and adviser as we have planned our trip to Ethiopia for the One Health Summer Institute.
Over the summer, we will be joined by 20 faculty and students from Ohio State, representing the colleges of Nursing, Veterinary Medicine, Medicine, Public Health, Optometry, and Food, Agricultural and Environmental Sciences, as well as faculty from Addis Ababa University and University of Gondar.
In addition, Robert Agunga, director of Ohio State’s Center for African Studies, will join us in presenting a series of short courses using the One Health framework.
The College of Nursing’s faculty contingent will begin the institute by offering a week-long course in research methods to students and faculty from the University of Gondar.
The Ohio State University Health Science Colleges established the One Health Ethiopia Task Force in August 2012. Our goal is to develop a sustainable and mutually beneficial partnership with Ethiopian academic and affiliate partners, especially the University of Gondar and Addis Ababa University.
Because Ohio State has seven health science colleges on one campus, unlike any other American university, we are able to offer our Ethiopian partners unprecedented interdisciplinary collaboration that results in healthier, happier, more productive lives for Ethiopia’s citizens. The work we do is also intended to be replicated elsewhere, amplifying the impact of our collaboration.
This blog features the activities of our faculty and students involved in:
- One Health Summer Institute courses taught by faculty from Ohio State’s Colleges of Veterinary Medicine, Nursing, Public Health, Optometry, and Medicine;
- Ongoing research initiatives on rabies, cervical cancer and food security, including the Ohio State health sciences colleges above and the School of Environment and Natural Resources; and
- Workshops on rabies eradication, One Health partnerships, molecular epidemiology, and neurosurgery.
Our faculty and students are in Ethiopia to collaborate, educate, and inspire.
We hope you enjoy our offerings!