Laura Binkley, a graduate student in the School of Environment and Natural Resources, took part in a research mission to Ethiopia this past summer as a part of the One Health Initiative. Laura and her collegues worked with professionals at the University of Gondar to measure public perception on rabies transmission in order to discover alternative modes of transmission. Here is Laura's firsthand account of her experience:
"This summer I was fortunate enough to participate in the One Health Summer Institute which is a partnership that was recently created between the Ohio State University and a number of Ethiopian government agencies, service organizations, and academic institutions. I was on the rabies elimination team and our goal was to use a mental models approach in order to determine public perception of rabies transmission in the area. In order to do this we conducted in depth interviews in multiple problem areas throughout Ethiopia including places like Gondar, Debark, Woreda, and Bahir Dar. We interviewed policy makers, human health professionals, animal health professionals, rural citizens, urban citizens, and religious leaders. Through analysis we will be able to identify gaps in knowledge in the community as well as to discover alternative routes of transmission.
The whole experience was fascinating and I am very grateful that I was able to participate. I think one of the most memorable things about my experience was the incredible hospitality and generosity of not just our partners at the University of Gondar but the people as a whole. One of the most important words that we learned was “Amasaganalo” which means thank you. Even in the poorer areas people were so positive and happy. Gondar was where we spent most of our time. This is a rural town in the highlands where farming practices used hundreds of years ago are still the norm yet new buildings and businesses are blossoming on the outskirts of the city. Upon arrival I was amazed by the brilliant colors of the clothing and houses. Traditionally the clothes are made of white cloth that is embroidered with beautiful intricate and colorful designs. The number of people walking around effortlessly carrying giant baskets on their heads along with countless donkeys roaming the streets carrying all kinds of things from wood to straw was astounding to me. We immediately made friends with our new partners at the University of Gondar who went to extremes to make sure that we were comfortable and well taken care of. I was able to learn so much from them and I truly miss them now that I am back home. The food took some getting used to for me because I have a sensitive stomach and most of the food is very spicy but very good. Almost everything is served on injera which is a spongy flatbread made out of teff flour. Food is either served on the injera or dipped into the injera and then eaten by hand. My favorite dish by far was “Shiro” which is a combination of bean powder, spices, and other wonderful things poured onto injera. Coffee originated in Ethiopia and is a huge part of the culture. Coffee ceremonies are usually held three times a day and we were invited to our fair share. This is an elaborate ceremony where the coffee beans are roasted in a pan over a small charcoal stove and delicately prepared. Incense is traditionally burned during the ceremony as well so the smells are intoxicating. The coffee itself is nothing like the coffee we serve here but it is sensational. It is extremely rich, thick, and bitter but is served with a lot of sugar to sweeten it up. I was amazed by the giant spoonfuls of sugar that I saw people repeatedly dumping into their coffee.
Several things stood out to me as major hazards as well. I saw people cleaning their clothes and bathing in the rivers not far from donkeys and other livestock drinking and standing in the water. In the market area flocks of goats scurried in every direction among vendors selling produce and raw meet. Some of the jugs that people used to carry water even looked like they may have been reused chemical containers. Most significant to our research project was the fact that dogs were everywhere! The dog, or “Woosha,” in Ethiopia is a considered to be a member of the community. There are community dogs, family dogs, and wild dogs running around in the streets. The potential for zoonotic disease transmission and environmental health contamination was everywhere.
Though interviewing was a rigorous process it was also very enlightening in many ways. I was amazed by the number of people that knew someone that had died of rabies or was attacked by a dog. Even many of the people we interviewed had suffered dog attacks themselves. Several of the health professionals that we interviewed mentioned that transmission between wildlife such as hyenas and the domestic community dogs was a significant challenge when it comes to controlling rabies. There seemed to be quite a range of understanding about rabies transmission among groups from a very good understanding among health professionals to traditional healer beliefs and practices in the rural areas. Another major issue is that the old and very dangerous Fermi-type phenolized sheep brain tissue vaccine is still being used to treat rabies in Ethiopia. Though it is less expensive, it has severe potential side effects including allergic reactions, partial paralysis, encephalitis, and death among other risks. The treatment itself also consists of numerous painful shots in the stomach. While conducting interviews at one of the health clinics a family approached us and asked whether or not they should get their child, who looked like she was about 3 years old, vaccinated because she had been scratched and exposed to saliva by the family dog that had started acting strange and then died a few days later of unknown cause. We did not know what to tell them other than to listen to what the health professional told them because if we recommended the vaccine then the girl could suffer effects almost as severe as the disease itself. However, if we advised them not to get the vaccine then the girl could develop symptoms and die if she truly was exposed to the virus. Had the post-exposure prophylaxis that is used in the U.S. been available we would have recommended the vaccine without question and would know that we were making the right decision however this was not an option. Rabies elimination has a long way to go in Ethiopia and is going to require new policy, population control, access to modern vaccines, and education among other things. I am honored to have been able to participate in the first step of the process and I think that we got a good start at a stakeholders workshop that we held in Addis Ababa. Over the next few years the Ohio State University will continue to work with Ethiopia to make these changes.
There are so many memorable experiences that I will forever cherish from learning how to do traditional Ethiopian shoulder dancing to exploring the surreal castles and monasteries scattered across the landscape. The children running up to us in packs screaming “you, you, you” to get our attention just to say hi to us. I am truly grateful for this experience and look forward to seeing how things progress."
- Laura Binkley, MS/MPH student in the School of Environment and Natural Resources and the College of Public Health