Harmony at the Grand Abay Fall (Tis Abay)
By Zergabachew Asfaw M.D. FACP
I arrived at beautiful Bahirdar city on August 25,2022 to attend Bahirdar
University students’ graduation ceremony and deliver Prof Edemariam Tsega’s
award from Hakim Workneh and Melaku Beyan Society to an outstanding
student. My visit was culminated with an amazing visit to the Grand Abay fall. The
whole experience was impactful and sobering.
I was accompanied by my best friend captain Kebede Woldetsadik, as we always
do whenever I visit Ethiopia. One day before the graduation I had to visit the
teaching hospital and new support facilities built that can transform the medical
institute to a state-of-the-art medical center in the country. The graduation
ceremony that took at the university sport stadium on August 27,2022 was
glamorous. A large number of students were graduated in different areas. Some
of them graduated at PHD level. A total of 127 students completed the
requirements to become medical doctors and took Hippocratic oath at the
ceremony. The oath is traditional and reminds young doctors that they should
threat everybody equal without any discrimination. Awards were given to
graduates with outstanding performances.
The next day August 28, 2022, we visited Grand Abay Fall. We started the trip at 8
AM from Sky resort and hotel on a minibus. The ride to the cliffs of Abay gorge
took about forty-five minutes. Then we had to walk downhill on a rocky steep
path towards the historic bridge- 17 th century Portuguese Bridge, the first bridge
to span the Abay River near the fall. Local people told us that it was bult during
the reign of emperor Fasillades and the stones were glued together by ostrich egg
and wheat flour. It is fascinating to look down to the river and adjacent gorge and
appreciate the natural beauty of the land. I felt that I am united with nature, and I
became part of it. It is the wilderness that existed before current civilization. One
can see the natural biodiversity and beauty spreading along the gorge. The
tranquility that I experienced was deep and absorbing. We had to cross a metal
rope bridge across gorge near Hydro-electric plant, Tis Abay (smoke of Abay). The
next phase is an upward journey towards a plateau where one can see the Grand
Abay Fall at a close range. This part was the most challenging walk especially for
me. I had experienced shortness of breath on several occasions because of
change of altitude and extreme exertion. My friend Captain Kebede had a walking
stick, and he had a better balance and stability, and he was able to manage
uneven terrain treks over loose rocks. He was able to advance faster ahead of
many of us while I had struggle not to fall.
When we arrived at the plateau things were different. There was a large tent
filled with people dressed in beautiful national dresses. Festivity has started and
there was music, food and drink. I was told that there were celebrities including
mayor of Bahir Dar in the crowd. There were motivational speeches and others
demanding the regional authorities to help build road that leads to the Grand
Abay Fall. Many individuals, including the mayor, participated in the in-group
dance “eskista”. Then it was announced that anybody who is confident can walk
downhill from the plateau towards the Grand Abay Fall to see it at proximity. I
tried to walk halfway, and I found it very risky and gave up. The mayor Bahir Dar
who is very much younger than me returned gasping after going halfway too. This
observation helped to decide rather than fighting with my ego. Then we had to go
on swamp path towards the river so that we can cross on a motorboat.
There were four motorboats transporting people along the bank of Tana River.
The service was not organized and the crowed waiting for the boat ride was huge.
There was an incidence when a gentle man nearly drawn while attempting to get
on one of the boats as a result of pull and push to get ahead. I noticed that
waiting in a queue is not customary. We managed to get on a boat and crossed
Abay River to the other side where the car was waiting for us. One of our team
members wanted to have tella, local beer. We all endorsed his idea and gathered
in a small hut where tella is sold. We all enjoyed the drink and hospitality of the
local people. They are cheerful and friendly. They were very grateful for the
generous payment that we made, and it seems customary to say blessing for their
customers and thus we received their blessings. We then traveled back on the
minibus to Bahur Dar to a boat waiting for us so that we can visit monasteries
located on islands over lake Tana.
There are thirty islands on lake Tana and several monasteries are located here.
The boat trip was arranged by Bahir Dar University as curtesy for Hakim Workneh
and Melaku Beyan Society. The boat trip took half an hour to the nearest
monastery. This is monastery resided by female only. At the entrance we were
welcomed by a female monk, and we proceeded to the church. We were directed
to the church entrance, and we all entered the church after removing our shoes.
The monk explained the history of the monastery. It was established in the 14 th
century by a monk Ezayesus and it was designated after him. The monastery has
centuries old trees and numerous birds. One can feel eternal tranquility at this
place. Because it was getting dark, we proceeded to the next island which is male
monastery. However, since it was closed, we were given a brief description of the
monastery and we visited its museum.
The harmony that we started at The Great Abay Fall culminated at monastery
whose inhabitants, the monks, are content with their lives and live devotional life.
They said they pray for Ethiopia and the whole world. We were told that there are
numerous invisible monks in the monasteries that pray for Ethiopia. What I
observed during my visit to Bahir Dar is emergence of state-of-the-art medical
center that will come into existence within a few years to replace medical tourism
to Bangkok, Thailand. Ethiopia is stretching her hands to God. The nation needs
peace, harmony, love and prosperity. May harmony prevail!
By: Zergabachew Asfaw MD, FACP
Diabetes is a common metabolic problem that affects millions of people all over the world. More than three million cases are identified each year. More than 30 million Americans live with diabetes. It is the most common cause of non-communicable illness that leads to morbidity and mortality. It affects almost every organ in the body.
Diabetes is caused by relative deficiency or absence of insulin secretion by the pancreas. There are two types of diabetes. Type I is an early onset of diabetes and type II is adult-onset diabetes. The type one has genetic preponderance. The change in lifestyle has resulted in an epidemic of diabetes mellitus.
The diagnosis of diabetes is based on identifying the symptoms and checking laboratory tests. The symptoms include polydipsia- drinking water excessively and polyuria (excessive urination). Other manifestations may include fatigue, weight loss, or weight gain and generalized weakness. Morbidity from diabetes involve both macrovascular (atherosclerosis) and microvascular (retinopathy, nephropathy, and neuropathy) diseases. Intervention can limit end-organ damage, and therefore, patients with diabetes require initial and ongoing evaluation of diabetes-related complications.
Diabetes, if not treated, can affect every organ of the body. It can lead to blindness, renal failure, and a variety of cardiovascular disorders. There is not a single organ that is spared from the complications of diabetes. Therefore, early diagnosis and management are very essential to prevent those complications. The effect on the vision is called diabetic retinopathy. In addition, it can result in early cataract formation. The effect on the kidney is called diabetic nephropathy and when it progresses, it would lead to renal failure and the affected individual ends on hemodialysis. The impact of diabetes on the nervous system is multiple. It can cause peripheral diabetic neuropathy and damage to the central nervous system. The other impact is diabetic foot ulcers, which is also a major challenge to treatment.
Type I diabetes require insulin administration for treatment. We perform a history and physical examination two or four times a year to obtain information on nutrition, physical activity, reductions of cardiovascular risk factors, current management, and diabetic-related complications.
Initial treatment of patients with type II diabetes includes lifestyle change focusing on diet, increased physical activity, and exercises, and weight reductions, reinforced by consultation with a registered dictation and diabetic self-management education.
Glycemic control can minimize the risk of retinopathy, nephropathy, and neuropathy in both type I and type II diabetes. The goal of management is to reduce HA1C to less than 7% and maintain fasting blood glucose 80 to 130 mg/dl. To live the best life with diabetes, a comprehensive plan of diabetic care is necessary. Quality evidence-based diabetes self-management education and support service are fundamental parts of the treatment plan. To take control of your diabetes, you need to educate, empower, and motivate yourself.
The honoree was Dr. Widad Kidane Mariam.
Dr. Widad Kidane Mariam was born in 1931 and belonged to a free-will Ethiopian émigré family in Palestine. She received her medical degree in 1959 and post-graduate health sciences concentration in maternal and child health from the American University of Beirut [AUB]. She died in 1989 after few years of voluntary community service during her retirement from the Division of Medical Services of the Ministry of Public, Ethiopia.
Dr. Widad was one of the youngest trail blazers associated with the meaningful equal opportunity for all Ethiopians regardless of their genders, ethnic and socio-economic backgrounds during her lifetime tenure as Director General of the Division of the National Medical Service in the Ministry of Public Health. Given her pioneering spirit in bridge building coupled with her persistent and persuasive lifetime goals, Dr. Widad has fulfilled her unique dream by marching back from her temporary exodus status in Palestine and Lebanon to live forever in her eternally promised Ethiopian ancestral land sixty years ago. Very few pioneers recognize that the newly founded status for the first Ethiopian female medical graduate was a calculated success story on how overcome the historical odds for a woman facing the gradual but sure upward mobility to topmost health policy making position in Ethiopia.
The capstone of her professional life was when she mobilized and spent her precious free time to serve as uncompensated member of advisory boards of several interdisciplinary grassroots charity and non-governmental organizations. Beside her demanding position in the Ministry of Public Health, she served as a volunteer to organize the first Ethiopian Family Planning Association and aim of which was to promote and support Maternal Health and Child Survival health care services. Her vision was to leverage her liaison roles to collaborate with the wives of the Rotary and Toastmaster Clubs of Ethiopia to plan organize private maternal and child health clinics for homeless pregnant and indigent women to improve the quality of life of residents of Addis Ababa Municipality with ultimate up scaling into national policy. As a Good Samaritan, she was able to collect and distribute free drugs not only from non-for-profit international humanitarian grants and donations but also fund raising from wives of foreign diplomats and grassroots societies. She used her influence to negotiate public assistance to nongovernmental organization to claim reimbursement for not for profit health care services as part of the allocated Ministry of Public Health’s budgets for humanitarian women’s health and child survival projects in addition to funded partnerships supported by the Swedish Save the Children Fund [RADARN], as well other international humanitarian technical assistance such as USAID.
In the final analysis, Dr. Widad has dedicated her time and energy as the most honorable pioneer advocate of equal opportunity, equity and justice throughout holistic human span of life. Hakim Workineh and Melaku Beyan society honors Dr Widad for her dedicated life time contributions to promote health in Ethiopia.
WHO IS WHO BIOGRAPHY OF THE FIRST ETHIOPIAN FEMALE IN MEDICINE AND PUBLIC HEALTH: WIDAD KIDANE MARIAM, MD, MHS
Dr. Widad Kidane Mariam was born in 1931 and belonged to common Ethiopian émigré family in Palestine. Indeed their free-will destiny was determined by the superior values given to secure better education for their offspring who grew up in exodus but with final dream that someday they shall contribute to Ethiopia as their first promised land. She was one of five children who invariably excelled in their professions whether in health, public services or private entrepreneurship. Dr. Wadad Kidane Mariam became a valedictorian of Ramallah Girls Elementary and Highs School in Palestine. Subsequently, she attended the first Beirut College for Women [BCW] where she received her baccalaureate degree and in 1959 she graduated from the School of Medicine of the American University of Beirut [AUB]. AUB was also known for producing the highest number of the first generation of Ethiopian physicians until 1960s. She also received postgraduate degree in maternal and child health at the American University of Beirut [AUB]. Dr. Widad seized the unique opportunity from where she was in exodus to excel and has never forgotten Ethiopia as her land of origin. By the same token, her older brother, Yohannes Kidane Mariam, a graduate of the American University of Beirut [AUB] has his maiden career in public service when he finally held the multiple portfolio as Minister and Private Secretary of Emperor Haile Sillassie until his untimely execution in captivity at the outset of the Socialist Revolution Regime in 1974.
Dr. Widad was a private medical practitioner before she was offered permanent public service position leading to her appointment as the “first female” National Director General of the Division of Medical Services in the Ministry of Health. During her tenure as Director General during her maiden public health career[ 1960s-1970s] she served as Ethiopian the first female member of the National Medical Board of Advisers in the Ministry of Public Health, as well as the Ethiopian Medical Association. Her new status empowered her to surround herself with key associates such as Dr. Arnt Myer-Lee of the Swedish International Development [SIDA] and Dr. Ahmed A. Moen, Associate Director of Medical Services who was among other associate manager and all of whom were US trained health care managers in charge of the Offices of National Health Planning and Statistics and accreditation and licensing non-governmental hospitals and rural clinics and Office of Nursing and Gondar Graduate Health Officers, Community Nursing and Environment Health and Laboratory Technicians. The diverse team managers graduated from various universities such as AUB, the University of Michigan School of Public Health , University California School of Public Health in Los Angeles, Saint Louis School Health Administration Program Graduate and Yale School of Public Health. Dr. Ahmed Moen was transferred from his first position as the Associate Administrator of the Malaria Eradication Program in order to merge the autonomous vertical communicable diseases projects supported by expatriate advisers seconded by WHO, USAID, SIDA AND British Overseas Development Agency [BODA] under Vice Minister of Health Affairs and Medical Service Division in the Ministry of Public Health effective in 1960.
The appointment of qualified Ethiopian leadership team has ushered unprecedented restructured of referral services and coordination of primary care, hospitals and vertical programs which occurred as run-up to the establishment of the first Medical School in Addis Ababa University in collaboration with the American University of Beirut that admitted 4 premedical students two study in AUB while the medical students are expected to complete the bridging curriculum that lead to continuity of transferring their medical degree prerequisites to newly established School of Medicine of Addis Ababa University during in the 1960s. Some of the home-grown holders of the accredited first degree in medicine from the Ethiopian Medical also pursued post-graduate medical specialty programs overseas and when returned they assumed leadership positions such as Chairpersons and Deans of Addis Ababa University School of Medicine, Gondar University an affiliated of Addis Ababa University and the first Medical Degree in Community Medicine in Jimma. [Kidane Mariam and Moen, Ahmed, PP 111-139, JEM and National Five-Year Public Health Plan of Action 1965-1970]
The Medical Service Division was actively engaged to supersede the expatriate health advisers, managers of vertical programs such as malaria control and smallpox eradiation that involved joint expatriate full-time advisers, as well as American, Japanese and Austrian Peace Corps Volunteers. The new Ethiopian leadership team initiated the formal integration of multiple technical assistance's such as the World Health Organization [WHO], Swedish Development Agency [SIDA] and US Agency for International Development [USAID]. The young and enthusiastic policy makers including and not limited to the equal opportunity given to male and female graduates of the Gondar College of Public Health Officers, Community Nurses, and Environmental Health Technicians including the first Ethiopian Red Cross Nursing School that graduated the highest number of hospital registered diploma nurses and certified Medical Assistants and Licensed Practical Nurses and Nurse Mangers. All of these integrative human resource development policy making culminated with writing and managing two consecutive Fifth Five-year Strategic Plan of Ethiopia in 1960s-1970s.
Dr. Widad as a Director General of the Medical, as well as her associates worked as centralized and decentralized teams in charge of the first development of urban and provincial hospitals and public health centers staffing patterns for more than more than one small and midsize umber of hospital beds, community health centers, maternal and child health primary care stations. The Ethiopian leadership initiated sustainable human resource development plan to provide access and referral services from primary up to secondary district and tertiary regional and provincial healthcare delivery services. The plan included collaborative memorandum of understanding to formally institute partnership with the First Addis Ababa University Medical School and also the Ethiopian Medical Association and Gondar College of Public Health that formerly under the Ministry of Public Health in the newly founded Addis Ababa University regional baccalaureate colleges and schools on one the one hand and the Medical Service Division and the Department of National Public Health Planning of the Ministry of Health. [Kidane Mariam and Moen, Ahmed, PP 111-139, JEM and Admasu, Mengesha and Moen, Ahmed A. PP 23-29. P2P Publication 2013].
Given the leadership status of being the first female Ethiopian Medical Service Director, Dr. Widad with assistance of her associates of public health and nursing graduates, she was successful style of management included her in the new role of advisers of the Minister of Health, Ato Ketema Abebe and aim of which was to supersede WHO and bilateral appointed expatriates not only in the Ministry of Public Health but also coordinate reorientation of human resources development in collaboration with Addis Ababa University Medical School to implement policy priority of rural medical and health service national staffing patterns. Given the leadership status of being the first female Ethiopian Medical Service Director, Dr. Widad with assistance of her associates of public health and nursing graduates, she was successful style of management included her in the new role of advisers of the Late Non-Medical Minister of Health, Ato Ketema Abebe and aim of which was to supersede WHO and bilateral appointed expatriates not only in the Ministry of Public Health but also coordinate reorientation of human resources development in collaboration with Addis Ababa University Medical School to implement policy priority of rural medical and health service national staffing patterns.
The Medical Services Division under the leadership of its new home-grown and international medical and public health graduates collaborated to restructure, update and design modified curriculum and admissions standards for prospective graduates of Gondar public health and future applicants of medical school at the Addis Ababa University. The transfer of the joint ownership of Gondar School of Public Health from the Ministry of Health resulted in continuation of the Bachelor of Science Degree in public health and medicine with privileges and rights given to all students enrolled in colleges and schools in Addis Ababa University systems then. In so doing, several of Gondar Public Health Officers who completed a minimum of 4 years of rural and national services were granted advanced credits for premedical courses and practicum that waived the conventional admission of medical students. In so doing, the first merged curriculum graduates received Medical Degree in 1968 and also became the first time Ethiopian Medical and Health Provincial Officers eligible to be the seed of the first home-grown Ethiopians with Medical degrees. A new policy of requirement of obligatory and equitable minimum two years of field service for all graduates of the medical schools and public health was officially proclaimed and placed under the watch of the first Medical Director of the Ministry of Public Health.
[Kidane Mariam and Moen, Ahmed, PP 111-137, JEM and National Five-Year Public Health Plan of Action 1965-1970, Admasu, Mengesha and Moen, Ahmed, P2P Publication PP 23-29]
The 1960s witnessed the unprecedented self-reliance and pioneering investment return. The precedents set new standards for effective agenda of nation building when expatriate medical advisers and mangers were superseded by home-grown medical and public health graduates in charge of central and district levels. A new approach to constructive engagement in policy-making that refrained from exclusive privilege to serve in urban areas instead of under serviced rural areas. By all measures of success no one should avoid the obligatory integrative experience coupled with a minimum of two years of rotation at all levels of medical and allied health rank and file positions in Ethiopia. The policy involved service contract signed by all fresh medical and allied health sciences degrees holders regardless of obtaining their degree origin from national or international colleges and universities. The pioneers have already sacrificed to institute self-reliance as mandated national priority to achieve the ultimate vision of securing a fair share of the little Ethiopians can give back and also help in curtailing excess that favor the privileges of the fortunate class and the purposed enunciated in the health tax for health centers building in Ethiopia. [Mehari, Enawgaw et. al: Triangular Partnership to Support Medical Education in Ethiopia. P2P Publication, 2013]
THE GOOD SAMARITAN LEADERSHIP MODEL
In the final analysis, as a civil servant, Dr. Widad mobilized and spent her free time to work as uncompensated member of advisory boards of several interdisciplinary grassroots non-governmental organizations. She became an uncompensated volunteer to organize the first Ethiopian Family Planning Association and aim of which was to promote and support Maternal Health and Child Survival health care services. As one of her vision was to collaborate with the wives of the Rotary and Toastmaster Clubs of Ethiopia to plan organize private maternal and child health clinics for homeless pregnant and indigent women to improve the quality of life of residents of Addis Ababa Municipality. With ultimate upscaling into national policy. As a good Samaritan, she was able to collect and distribute free drugs not only from non-for-profit international humanitarian grants and donations from wives of foreign diplomats and grassroots societies. She used her influence to negotiate reallocation of public assistance to nongovernmental organization to claim reimbursement from the annual Ministry of Public Health’s budgets for women’s health and child survival projects as a partners of the Swedish Save the Children Fund [RADARN], as well other international humanitarian technical assistance such as USAID.
All of these Samaritan up-bringing fostered her pioneering spirit to turn back the clock to her favorite social experiment that allowed humanitarian assistance to bond with a group of women and children care givers and thereby focusing on the new phenomena of homeless and broken families in need of voluntary leadership to operate free-clinics for women and children. This could not have occurred without the partnership of the Ministry of Public Medical and Health Services Division and Addis Ababa Municipality Health Division. When Dr. Widad Kidane Mariam retired from the Ministry of Public Health and partly because of the mass attrition of qualified civil servants, she resorted to her basic humanitarian instinct of pioneers to engage in real health profession-based constructive leadership to practice ob-gyn in not-for-profit organization as an uncompensated volunteer to promote family health planning organizations and access for all as evidence-based lifetime achievement of her 30 years of public health service when she died in 1989.
What Dr. Widad achieved is complemented by her siblings and parents. Her oldest sister, the late Helen Kidane Mariam was employed in an executive position at the Economic Commission of Africa, Addis Ababa. Her father Kidane Mariam Wolde Mariam and mother Bekeletch Workneh, produced three college graduate Tekle Mariam, George and Diana. However, she was survived by her younger brother, George who graduated with MA from Eratmus University in Rotterdam, Netherland and retired there, as well as her younger sister Diana Kidane Mariam, BA, who graduated from Sweet Briar Women College, Briar, Virginia and Mt. Saint Mary University, Los Angeles, CA and finally her adopted daughter, Herut Kidane Mariam is an entrepreneur in the arts and works in Amsterdam, Netherlands.
St Mary of Zion Ethiopian Orthodox Tewahdo Church
by Dr Getachew Feleke
Millions of people travel globally every day. Travel from resource rich to resource limited countries can be associated with travel related illnesses. Most at risk are those who travel to their country of birth as they are more likely to socialize, stay with family and share food and drinks. These diaspora don’t necessarily feel they are at risk and are less likely to take precautions.
Risk of travel associated illnesses is related to where one is going, the length of stay, the time (month) of travel, activities during travel and the underlying health status of the traveler.
Travel associated illnesses can be prevented or reduced if appropriate precautions are taken. The goal of this presentation is to increase awareness of common travel related illnesses. Travel to Ethiopia is the focus of the presentation, but the information may be relevant to other destinations too.
Tips to all travelers
In long distance flights, getting up, walking or stretching every couple of hours to avoid blood clots is advised. Prolonged sitting may result in blood clot (deep venous thrombosis: DVT) which is a serious health hazard.
Travelers taking medication must carry enough supply of the medicines for the duration of the trip.
Mapping out available health service at the destination is advised. .Travelers may also consider buying travel insurance.
Getting pre-travel advice and immunization from an experienced clinician is advisable
Common travel associated illnesses
-Fever/chills: many infectious causes
-Other (bites, traffic accident, sexually transmitted infections, skin rash)
Causes of travel associated illnesses
-Contaminated Food and water: Poor sanitary conditions lead to contamination of the food and water with human excreta (feces). Human excreta contain germs .Eating and drinking germ contaminated food and drinks cause illnesses such as traveler's diarrhea, hepatitis, typhoid, amoeba and cholera
- Ingesting raw foods such as eggs, milk and salad may lead to traveler’s diarrhea.
-Not washing hands and using contaminated utensils are risk factors for upset stomach/diarrhea
Poor sanitary conditions and poor hygiene can result from lack of knowledge, lack of clean water, crowding, lack of bathrooms/latrines (open defecation), or other environmental and cultural factors
Vector (Mosquito) bites: Infectious diseases such as malaria, yellow fever and dengue fever are transmitted by mosquitoes.
Malaria, a most serious infection that affects millions of people is transmitted by the bite of an infected female anopheles mosquito. Yellow fever and Dengue is transmitted by a different mosquito.
Contact with contaminated hands, utensils, environment: Infectious diseases can be transmitted from person to person through contact. Unclean hands, utensils, environment, etc play an important role in this regard. Diarrhea, vomiting, influenza are examples.
Airborne (Breathing contaminated air): Infectious agents(germs) maybe floating in the air we breathe. For the most part, these bugs come from infected persons nearby who cough and sneeze without covering mouth and nose; Measles and tuberculosis are spread this way.
The germ causing meningitis is spread similarly but requires close person to person contact
Blood/body fluids exposure: Serious infections such as HIV, Hepatitis B. and hepatitis C are acquired from blood or body fluids of an infected person. This occurs via contaminated needles, sharps (blades, surgical instrument), unprotected sexual contact and rarely transfusion. It is important to note that these infections are not transmitted through hugs, handshakes, eating together, etc.
Bites; scratches; cuts, puncture wounds Rabies is a deadly disease that results from the bite or scratch of a rabid animal, mainly dogs. Bats and raccoons are important carriers in the US
Accidents that result in open wound can predispose to tetanus, a serious preventable infection
Traffic accidents can present serious health risks to travelers
Prevention of travel associated illnesses.
Many travel associated diseases are preventable! Preventive measures include:
1) Vaccination: vaccines are available against: Hepatitis A. Hepatitis B, Yellow fever, Influenza,
Rabies, Typhoid fever, meningococcal meningitis and cholera. Pre-travel consultation regarding vaccination is advised. It is important to be up to date with routine childhood and adult vaccines. (Measles, mumps, rubella, polio, tetanus, diphtheria, pertussis, hepatitis B, influenza.)
2) Mosquito avoidance: These important measures include
-Staying indoors at dusk and dawn. Malaria transmitting Mosquitoes bite early evening (dusk) and early morning (dawn).
-Cover as much of the exposed skin as possible,
-apply insect repellents to exposed skin
-use bed nets preferably impregnated with insecticide
3) Chemoprophylaxis (Using drugs to prevent infections) .
-This mostly applies to malaria. There are effective drugs that can protect from malaria.
-Taking the pills start before the travel date and continued during and for few days after travel.
General behavioral precautions
-Wash hands after using the toilet and before eating or use hand sanitizer.
-Eat well cooked food while hot. Avoid cold foods. Food can be contaminated after it is cooked.
-Drink boiled water, bottled water or chemically treated water
-Fruits that you can peel are safe. Rinsing/ washing fruits, salads with water may not be safe as the water may be contaminated
-Avoid ice from tap water
-Avoid crowded places
-Avoid contact with animals
-Avoid unprotected sexual contact, unsafe body piercing, tattoos
-If dog bite occurs, wash wound with clean water immediately
What can be done if one gets sick while travelling?
Travelers’ diarrhea. This is the most common condition a traveler encounters. Travelers’ diarrhea may be mild, moderate or severe. Fluid replacement is important.
Mild diarrhea: Usually self-limited. It can be self-managed with fluids and anti-diarrheal drugs such as Bismuth sub salicylate or loperamide (lomotil).
Moderate to severe diarrhea is best managed by health care provider. Self-treatment with antidiarrheal drugs is acceptable. If there is no improvement in 2 to 3 days, a clinic visit is warranted,
Some travelers carry antibiotics ( ciprofloxacin ; azithromycin). In situations where no medical care is available, taking antibiotics as a temporary measure may be acceptable.
Fever: this may be caused by infectious diseases, that Include malaria typhoid and meningitis. Fever lasting over 24-48 hours must be taken seriously, and must be evaluated by a healthcare provider.
Being vaccinated or being on preventive drugs may not be fully protective. Serious infection such as malaria, typhoid, and meningitis can be deadly unless treatment is started early.
Fever in the returning traveler:
Fever may be caused by many infectious diseases, Including malaria typhoid and meningitis. Fever lasting over 24-48 hours must be taken seriously, and must be evaluated by a healthcare provider.
It is important to remember that being vaccinated or being on preventive drugs may not be fully protective.
Fever in the returning traveler could be a sign of a serious infection. Malaria and typhoid are two infections that can present in a returning traveler. If these infections are not treated early they can be deadly. The returning traveler who has fever must seek medical treatment immediately.
It is important to inform the doctor all the travel details (itinerary) including vaccinations and medications taken. It is preferable to consult with a doctor experienced in travel medicine.
Travel associated illnesses are common. Diaspora visiting friends and relatives are most affected. Traveler's diarrhea, hepatitis, typhoid and malaria make up the majority of travel related illnesses.
These infections can be prevented with pre-travel immunization (hepatitis A; hepatitis B; Typhoid) or taking preventive drugs (malaria).
Behavioral precautions are important in avoiding travel associated illnesses.
-Eating well cooked food while hot, avoiding raw foods and drinking boiled or bottled water.
-avoiding mosquito bites (staying indoors, covering skin, using insect repellent and bed nets.
Mild to moderate traveler's diarrhea can be self-managed by taking fluids and anti-diarrhea drugs
Fever can be a sign of serious infection .Consulting a health care provider is advisable.
Fever in the returning traveler must be taken seriously and warrants seeking medical help.
Selected vaccines for travelers
Hepatitis A –Transmission is via the fecal-oral route (by contaminated food or water)
--The vaccine is protective; two doses are required given 6 month apart
-- Vaccination is recommended for individuals who are not already immune
-- The vaccine may be taken any time before travel.
Hepatitis B: Transmission is via blood and body fluid exposure.
-The vaccine is protective; three doses are required at 0, 1 and 6 months
-Vaccination is recommended for individuals who are not immune
-Hepatitis B vaccine is currently included in as one of the routinely given childhood vaccines
Meningitis: -Transmission is from person to person (close contact)
-The vaccine is single dose.
-Vaccination is recommended for travel during the dry season (December to June)
-The vaccine is best given 10 days or earlier before travel.
-Booster doses are required in 3-5 years.
Typhoid Fever: Transmission is via contaminated food and or water
-The vaccine is moderately protective
-Vaccination recommended especially for those travelling rural areas,
-These vaccine comes in an oral and injection form. The oral vaccine comes in 4 doses
The injection form is a single dose. Protection may last for 3 to 5 years.
Rabies: -Transmission is by bite or scratch of a rabid animal primarily dogs
-The vaccine is protective.it is not routinely available.
- The vaccine is recommended for travelers at risk of coming in contact with animals
-If a bite/scratch occurs immediate medical attention is warranted
Yellow fever:-Transmission is via a mosquito bite
-The vaccine is protective. It is a one-time injection with lifelong protection.
-Vaccination is recommended if travelling to endemic countries.
-Yellow fever vaccination is a requirement to enter some countries
Tetanus: The tetanus causing spore (germ) is commonly found in the soil.
-wound (cut, lacerations) contaminated with soil may cause tetanus.
-The vaccine is protective .It comes as a combined vaccine against tetanus, diphtheria, pertussis (Whooping cough); it is one of the routinely given childhood vaccines
-Repeat vaccination (booster) every 10 years is recommended.
Written by Richard Pankhurst
Adapted from An Introduction to the Medical History of Ethiopia
While diplomats, doctors, and other foreigners had been introducing modern medicine to ever-wider sections of the public, the first Ethiopian doctor, quite unknown to Menilek or anyone else in the country, had been obtaining his training abroad.
The story of this physician, variously known as Dr. Martin and Hakim Workneh, is most romantic. Born in October 1865 of a good family, he was not yet 3 years of age when his parents, along with other prominent people of Gondar, were seized by Emperor Tewdros andÂ taken with their families to his fortress at Magdala. On the arrival of the Napier expedition notÂ long afterwards, the child was found wandering away from his parents and was assumed by theÂ British to be lost. He was therefore annexed by Colonel Charles Chamberlain, of the 23rd IndianÂ Pioneer Regiment, who took him back with him to India and kept him at his home inÂ Rawalpindi. The colonel died in 1871, after which the boy was dispatched to the mission schoolÂ at Amritsar, the expense of his education being met by one of their number, Colonel Martin. TheÂ missionaries christened the boy Charles after the colonel who had brought him to India andÂ Martin after the one who paid for his education.
Written by Dr. Girma Abebe
Born in Wollo Province, Ethiopia, on April 27, 1900, Melaku Beyan was the son of Grazmatch (Lieutenant) Beyan and Woizero (Mrs) Desta. After his parents had transferred to Harar, their son, only a little boy, came to serve Ras Makonnen, the father of Crown Prince Tafari, who was then the Governor of Harar Province. Then young Melaku served the Crown Prince as his personal assistant in Harar and later in Addis Ababa for well over a decade. Palace life, which was competitive and terrifying, led Melaku to become disciplined and meticulous in his work. Wasting no time at the palace in Harar and Addis Ababa, Melaku immediately joined the elite priest school that attracted the cream of tutors famous for their cultural and historic knowledge of Ethiopia.
Written by Efrem Alemayehu M.D
After graduating from the Addis Ababa University Medical School, we (the present members of Hakim Workeneh and Melaku Bayan Society) left Ethiopia for North America in the late 70s and early 80s. We left our beloved Ethiopia to further our education because of political unrest and other personal reasons. We left Ethiopia during the rainy winter, or in the summer time, a season filled with plenty of sunshine and comfort. Global warming and environmental degradation have changed the climate of Ethiopia from what it was then. Many are dealing with harsh and extreme weather conditions. But I digress. We landed in various parts of the U.S. and Canada, in the scorching heat of the summer or in the bone-piercing cold winter. Because of the newness of the season, we accepted winter with excitement. Many of us who settled in areas with snow have winter stories to tell. Let me tell you mine, as it will give you a glimpse of my early life in Canada.
Written by Abebe Haregewoin, MD, Ph. D.
Every society deserves a character that is at the center of this story. Even the most conservative societies need someone who thumbs his nose at what is considered sacrosanct and sacred and out of limits to either derision or negative commentary from the vast majority. This is always a sign of a healthy society â€“ magnanimous toward eccentricity and tolerance toward members of society who sing to a different tune and march out of sync with the most common beliefs of most members of their society. In some societies such acts can have severe consequences, which may include stoning, or some such unpleasant acts by the conventional hordes in the belief that this will ensure the favor of God or the King or even other members of their society who are inclined to nod in approval at their outrage against the unlucky ones who end up being the individuals on whom society has to prove its point of, â€œThou shalt notâ€¦â€ In the modern age in the so-called enlightened societies the media may take its pound of flesh if such a personality is worth their time and ultimately their economic interest.
Written by Dr. Zergabachew Asfaw
This is a short introduction to the history of Ethiopian surgeons, those who developed the practice of surgery in a war-torn and fragmented nation. Documentation is sparse, but I hope this short depiction will motivate younger Ethiopian doctors to do more research and write about the early Ethiopian doctors, the trail blazers of this profession. After the Italian invasion of Ethiopia, the country embarked in a rapid growth of educational opportunities. Schools were opened and teachers imported; several young students were sent abroad for higher education.
It is a great pleasure to present Professor Edemariam Tsega as a pioneer in Ethiopian medical education. He single handedly introduced post graduate program in Internal medicine in Ethiopia and served his nation with great distinction for over forty years. He completed his primary education at Haile Sellssie I school in Gondar and his secondary education at Haile selassie I secondary school in Addis Ababa. He graduated from university college of Addis Ababa with bachelors degree in science in 1961 and then he joined McGill University where he got medical degree in 1965. He studied at London school of hygiene and tropical medicine in 1968. He did not want to stop there and even after becoming professor of medicine he eared PhD from Lund university, Malmo, Sweden. His qualifications are immense.
Written by Zergabachew Asfaw and Yohannes Endeshaw
Normal aging is associated with changes in all organ systems, and the following questions are intendedÂ to whet your appetite in the area of sleep and aging.
Written by Fassil Teffera
Many moons ago, I was assigned to work at Jijiga hospital. As it was customary at the time one GP is assigned to a hospital of whatever size, with some nurses and several Health assistants. I did the outpatient clinic daily and in patient rounds and minor surgery as well. I also did difficult deliveries though most of the deliveries were made by the competent Health Assistants who must have done thousands before I came to the scene.
I had a wonderful staff of Nurses, Health assistants, Lab and X-ray techs. We were supported by dedicated ancillary services and administrative staff. Of course, we had our dose of Political Cadres who carried their weekly indoctrination of the superiority of the Socialist mode of production over the Capitalist one.
One Friday, a giggling Health Assistant came and told me that a bride is coming to be seen by me, prior to her wedding night. I did not understand what it meant. She told me the Somali men bring their bride to the hospital prior to the anticipated wedding night. I still did not understand the whole idea. The Health Assistant noted my confusion and re assured me that everything will be fine and she will help me handle the issue as she had done with many others before.
Sure enough, there walked in a very handsome bridegroom and his beautiful bride with beaming smile in their beautiful weeding dresses. They got registered and the bride was brought to the OR by the nurses and Health Assistant, and undressed and put on an OR gown.
They all giggled saying that I will be the first man to see the bride even before the bridegroom. The lady was put on the table and the staff explained to me what to do. As it was customary in Somali culture all girls had sutures placed over their vulva thereby completely blocking the vagina except for a small whole for the urine to dribble thru. This was a protection from in inadvertent or deliberate pre marriage sexual performance.
After the lady was put on lithotomic position we figured out where the small hole was located, which was at the distal aspect of the vaginal opening which allowed only a small finger to be passed. The local lady sureon had done a good job of suturing the labia majora of a baby girl around the age of three and completly blocked and entrance or exit from the vagina.This was done to protect the girl and the family from future embarassment.
Written by Abebe Haregewoin
Ethiopians share with the rest of humanity that propensity for excessive preoccupation with oneâ€™s health.Â This condition is often referred to as hypochondria.Â The person who exhibits this syndrome is referred to as a hypochondriac.Â Â People with this condition are excessively worried about getting a disease, even after there is no supportive medical evidence.Â Such people often misinterpret minor health problems or even normal body functions as symptoms of serious illness. Since the sufferer does not have total control of their understanding perceived disease, it is usually difficult to dissuade them that their illness has no physical basis. An abdominal cramp for such a person is the beginning of a cancer in the belly, and a headache, the start of a brain tumor.Â It is a major feat of accomplishment for a medical person to convince the sufferer that they are in no immediate danger from any kind of illness.Â As a matter of fact the patient might lose confidence in their medical care giver, and as is often the case go shopping for a more sympathetic ear elsewhere or go to the witch doctor or other non-medical healer.
The symptoms a hypochondriac describes can range from general complaints, such as ill defined pain or excessive tiredness, to concerns about normal body functions such as breathing, change in eating pattern, bowel motion or urination.Â The affected person is obsessed with the selected symptom and really believes that it is the manifestation of a dire illness.
Written by Abebe Haregewoin
A very pretty teen age girl was brought to the emergency room at Fenote Selam Hospital in the middle of the night in a state of apparent uncontrolled shrieking alternating with strange gesticulations, shivering and writhing. Her hapless father with his eyes filled with terror was holding his daughterâ€™s waist and trying to restrain her restless hands and fists from self inflicted injury. The poor man looked totally exhausted from his struggle from this sylph of a girl, who seemed to have endless and uncontrollable power of an angry lioness. There was also a rope tied to her waist and gripped by her fatherâ€™s gnarled peasant fists, apparently to prevent her from running away and do herself grievous harm. It was apparent from the red and bleeding welts on her face and exposed chest that she has been scratching and beating her face and chest uncontrollably. A couple of scratches on the fatherâ€™s cheeks and nose revealed that he has also been a victim of her tireless nails and fists. Her poor mother, a scrawny little thing herself, was weeping uncontrollably from blood shot eyes. She was also making her own scene, by wailing for her daughter as if she was already dead. Her heart rending funereal tunes which were only interrupted whenever she frequently blew her profusely runny nose was the only respite from the impromptu mother and child tragic opera and drama.The trio was surrounded by bedraggled, younger and older siblings of the sick child, uncles, aunts and villagers of all sizes and shapes. Some were weeping and all looked miserable. From the bags of supplies they were holding it was apparent that they had travelled from a long and harrowing distance to come to the hospital.
Ethiopian Medical History
Photo: Dr. Melaku Beyan. Dr. Melaku Beyan became the first Ethiopian medical doctor to complete his education in the United states in 1935 (Dr. Workneh Eshete became the first Ethiopian doctor to obtain a modern medical education in 1882)
The non-governmental organization, People to People, has just released The Manual of Ethiopian Medical History by Enawgaw Mehari, Kinfe Gebeyehu and Zergabachew Asfaw. The purpose of the publication is to teach the future generation of Ethiopian medical students and health care professionals about Ethiopiaâ€™s medical history.
Mekele University and Bahir Dar University have reportedly agreed to incorporate the study into their medical education curriculum.
Enawgaw Mehari, MD
Kinfe Gebeyehu, MD
Zergabachew Asfaw, MD
Senior Graphic Editor: Matthew I. Watt