Diary of a CEO: Highlights from Ethiopia

After a brief break from my travels to India in March, I headed off to Ethiopia and Vietnam in May. Both Orbis country offices had major events scheduled and I was delighted to be asked to join in their respective celebrations.

For this visit, Ethiopia Country Director, Dr. Alemayehu Sisay, created a full agenda that took me to: training hospitals in Addis Abba and Hawassa, eye care units to observe cataract and trichiasis surgeries, a meeting with U.S. Ambassador Tracey Jacobson, meetings with our incredibly talented Orbis Ethiopia team, and the main highlights of the trip – the dispensing of the 100 millionth dose of Zithromax and the 25-year anniversary of Orbis working in Ethiopia.

All this made for an incredibly memorable, busy, and fast-paced visit.

Menelik II Hospital

My visit started at Menelik II Hospital which has been serving the people of Ethiopia for over 100 years. This hospital is known for providing tertiary eye care services across the country. In 2022, the hospital moved to a new dedicated and specialized eye care unit and added 120 beds to the previous 40 beds serving people with eye problems. This new eye care unit is equipped to provide different specialty services in ophthalmology while boosting the current eye care service of the hospital.

While at Menelik II Hospital, I had the opportunity to tour the new eye care unit and meet with ophthalmologists and residents who expressed their gratitude for Orbis’s partnership and commitment to training and skills development. I asked them, “what do you need most?” They replied more training opportunities, such as HBTs (hospital-based trainings), fellowships, and other skills development support.

100 Millionth Dose of Azithromycin

This remarkable milestone was celebrated at a special ceremony in the Gacho Baba District in the Gamo Zone, which is part of Ethiopia's Southern Nations, Nationalities, and Peoples' Region (SNNPR). Orbis Ethiopia, an organization which most of Gacho Baba’s residents know very well, was coming to celebrate our 25 years of service and mark the 100 millionth dose of azithromycin administration.

As we got closer to our destination, I saw something I wasn’t expecting – men on horses. Dr. Alemayehu saw it too and smiled. He explained to me that this is very rare for the community leaders to welcome guests in this way – it means this is something very special. As the line of cars drove down into the valley, we saw children lining up on the road and waving to us.

Men on horses in Gamo Zone, Ethiopia, wait to take guests to a special milestone ceremony — We were honored with a horseback escort to the celebration

Once we parked our vehicle, we were led down a pathway. In front of us were a group of elders holding plant fronds. Greetings and handshakes were exchanged, fonds accepted by the visitors and then we made our way to seating under a tent. Then the elders officially kicked off the day’s festivities.

Many dignitaries from inside and outside Ethiopia were invited to give remarks on this special day. On behalf of Orbis, Dr. Alemayehu and I were both invited to speak. It was a very proud moment for Alemayehu, Orbis, and all of us working to eliminate trachoma.

A special ceremony to celebrate 100 million doses of trachoma-fighting antibiotics.

Then members of the community danced in celebration of our shared accomplishment and a group of children put on a play about the importance of taking azithromycin and following the SAFE guidance. Now it was time for a 6-year-old boy named Hizkiel to receive the 100 millionth dose of azithromycin. First, we need to measure Hizkiel’s height to determine the amount of drug he should receive. Then Mr. Lelisa Amanuel, Senior Advisor to the State Minister in the Ethiopian Ministry of Health, gave Hizkiel the azithromycin. Our Orbis Ethiopia team members working the event deserve so much credit for everything going so well on this momentous day. And the day was still not done yet - two more activities still to go. As shown in the pictures, next up was a vision screening that had been set up in the community school.

Before the day was over, we held a panel discussion at a nearby hotel to discuss the issues that lay ahead for achieving trachoma elimination, as well as other community eye health needs. The panel also took the opportunity to discuss community and pediatric eye health across Ethiopia and how groups such as the Ophthalmological Society of Ethiopia and national and international partners can identify and advance actions in response to Ethiopia’s vision care needs.

Members of the Ethiopian eye health community and Orbis CEO Derek Hodkey discuss trachoma elimination efforts — Panelists include left to right: Dr. Tsedeke Asaminew, President Ophthalmological society of Ethiopia; Dr. Menbere Alemu, ITI Country Representative; Mr. Fikre Seife, MOH, NTD National NTD Program team leader; Derek and Dr. Alemayehu from Orbis

Rural Eye Care Units

Gurage Zone is one of 13 administrative zones in the SNNP region. Orbis is conducting a comprehensive rural eye care project in the West Gurage Zone for the reduction of avoidable blindness and visual impairment due to cataract, trachoma, and uncorrected refractive error.

After a few hours drive from Addis Abbba and we arrived at the Wokitie Secondary Eye Care Unit (SECU) which is staffed with one cataract surgeon, two optometrists, two ophthalmic officers, and one Integrated Eye Care Worker. On this day, the cataract surgeon, Dereje Hailu, invited me to stand next to him while he removed a cataract from an elderly woman and then inserted a new intraocular lens (IOL) to restore the woman’s vision. The woman was given an injection of local anesthesia and after a few minutes, the surgeon began his incision work and removed the cloudy lens and just as quickly inserted the new IOL.

The whole procedure took 10 maybe 15 minutes at most. He placed a patch over her eye and was cleaning up and preparing for the next patient. It was remarkable to see it all done in person and know that this woman’s vision in that eye is now going to be better than my own vision.

After greeting some of the waiting patients, we were shown a small optical shop where spectacles are prepared for folks. That day, a few young girls were there picking out frames for new glasses and speaking with an optometrist. In the same room I saw stacks of IOLs and noticed they all had come from Aurolab, which is the manufacturing facility at Aravind Eye Care Systems in India I toured when I was in India in March.

An Orbis-trained Integrated Eye Health Worker performs trachomatous trichiasis surgery on a patient in Ethiopia — Tsehay, an Ethiopian healthcare worker prepares a patient for trachomatous trichiasis surgery in 2018.

After thanking the teams for their dedication and good work, we got back in the car and headed about 12 miles down the road to the Were Ber Health Center. We had come here to observe a TT surgery. The Center is staffed with an Orbis trained mid-level eye care worker. He treats patients with active trachoma and operates on those suffering from trachomatous trichiasis (TT). He is also involved in the training of Health Extension Workers who refer patients for eye care. Dr. Alemayehu and I were invited by Mr. Abdulwahid Nuredin to join him in the surgery room where he had already administered local anesthesia to his patient. Dr. Alemayehu explained to me that given the degree of scar tissue under the eye lid, this patient most likely had repeated trachoma infection, and this was not her first time receiving this procedure. Because the eye lid has a lot of small blood vessels, unlike the cataract procedure, this was a bit bloody.

Dr. Alemayehu described each step, and this procedure took about 20-25 minutes. Having watched videos of this type of surgery and read about the impacts of TT on people’s lives, it was immensely important for me to see this up close and to have the chance to connect with patients.

Hawassa University

My final visit before departing back home was to Hawassa University. Orbis Ethiopia has been working with Hawassa University for almost 20 years. Today, Hawassa University is a tertiary eye care and training center. We were welcomed by Dr. Argaw Abera, Ophthalmology & Optometry Department Head, along with members of his team. There is a real commitment to success between Hawassa University and Orbis.

New ophthalmologists, optometrists, and cataract surgeons have exited the training programs, there have been 12 rounds of HBTs (hospital-based trainings), and terrific use of the Orbis Cybersight platform. As a result of the trainings Orbis has helped support, the number of sub-specialty referrals sent to Addis Abba have decreased with more being done in Hawassa. Public awareness around Hawassa has grown which is driving demand for more services

Insufficient numbers of trained sub-specialists, lack of ophthalmic medical equipment, and supply-chain interruptions are some of the challenges the team at Hawassa University are now facing. I was escorted around the hospital and into the surgical theaters. I was impressed that the Hawassa team can safely and effectively deliver the surgical care that is needed given the state of some of their equipment. Some pieces of equipment are either very outdated or in the outer room because they stopped working or in need of parts. The team at Hawassa University is doing good considering some of the obstacles they are managing. I was extremely grateful and honored to meet such a dedicated team of professionals.

Orbis Ethiopia Team

My trip would not have been possible without the tremendous support of the wonderful Orbis Ethiopia Team and the Country Director, Dr. Alemayehu Sisay. I found a team that works very well together, supports each other, and is committed to our mission & values. Both Jennifer Colletti and I felt so welcomed and fortunate to spend time with the team. Plus, while we were there, we joined the team in celebrating 25 years of impacts and operations in country. We had a cake and everything :)

Members of the Orbis Addis Ababa team unite for a team photo — Out to dinner with some members of the Orbis Addis Abba team - I’m taking the photo :)

I was pleased to join Dr. Alemayehu in presenting service awards to some members of the team in recognition of their continued dedication to Orbis.

Recognizing Saba Giorgis, Finance Manager for her 19 years of service.

Twenty-five years of service and engagement with communities is a long time for any organization to make a commitment and I can confidently report that our work has made and continues to make significant improvements to eye care needs across Ethiopia’s SNNP region. Our efforts to tackle the scourge of trachoma continue.

Mass Drug Administration (MDA) is a highly complex scope of work. Coordination and planning are essential success factors and I’m delighted to say that our team is proficient at being both flexible and adaptable to any number of complexities. They understand how important it is to stay on the MDA dosing schedule so that progress made is progress kept.

In addition, we continue our work to grow eye health human resources and deliver trainings and training modalities [HBTs, Cybersight, fellowships, etc.] to expand the skills and expertise of local professionals. However, there is still more to work required to address the growing needs of the pediatric population and training professionals with comprehensive eye care skills to better serve their communities. I firmly believe we have the network of partners and the leadership in Ethiopia to make meaningful progress in these areas. It was an incredibly rewarding visit for me, and I look forward to more positive impacts to come from the Orbis Ethiopia team.

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