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.
Photos by Rick Harrison, Ohio State University Communications
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 Bayleyegn Molla, DVM, PhD
College of Veterinary Medicine, The Ohio State University
This week, I had a chance to tour the microbiology at the University of Gondar Hospital.
The lab processes hundreds of samples from patients every month. Patient samples are accepted, labeled and sent on to the microbiology lab where they are placed in different agars and broths to check for the growth of bacteria in patient samples.
I was surprised when the staff showed us a large book where the date, source, and patient information are recorded. This can be a time consuming task and makes it difficult to transmit results efficiently to clinicians. Papers can be torn, lost, or burned.
It is a less than ideal system.
When I asked to see the computer, they happily showed us the new electronic system to track individual results including results, name of the organism recovered, and information about antibiotic resistance for each organism. Having this system allows more rapid feedback to clinic staff and can be used to research problems in microbiology.
I was relieved and encouraged that they were using this technology.
This made me reflect on how I still rely on older systems in my old work. They are comfortable for us to use. In order to really harness technology to address important health and food safety problems, I also need to help develop effective technology, trust it to perform, and use it to its maximum.
That is what I learned in the microbiology lab.
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!