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UNC Ethiopia Alliance


Vision

Through a mutually beneficial collaboration, the vision of UNC Ethiopia Alliance is to establish a sustainable cancer program in Ethiopia while creating a global health learning opportunity for our students.

Background

While no country is immune to the burden of cancer, developing nations are estimated to bear the majority of new cancer diagnoses. It was estimated that 65% of new cancer diagnoses occurred in developing countries in 2012.1 In Ethiopia, a developing country with roughly 100 million people, cancer accounts for about 5.8% of total national mortality, and it is estimated that the annual incidence of cancer is around 60,960 cases, with the annual mortality over 44,000.1 Unfortunately, this figure is thought to be a drastic underestimation of Ethiopian cancer cases. Based on extrapolations from the country’s largest cancer center, Tikur Anbessa Specialty Hospital (TASH) in Addis Ababa, the incidence of cancer in Ethiopia may be as high as 150,000 new cases per year; however, less than 1% of this population is likely to receive specialist care based off this estimate. While the survival rate for pediatric malignancies is greater than 85% in the United States, it is estimated that the survival rates are below 20% in Ethiopia.

Three critical challenges make it difficult to provide comprehensive cancer care in Ethiopia: 1) a suboptimal drug supply chain leading to substandard and falsified medical products;  2) a shortage of adequately trained workforce (physicians, pharmacists, nurses) to meet the demands of a rising number of people with cancer; 3) a lack of accurate data on incidence and outcomes of cancer in Ethiopia to advocate for changes in practice and policy.

Mission

To address these challenges, our UNC team will carry out our mission with the following three domains:

  1. Medication Safety
  2. Workforce Development
  3. Evidence-based Practice
“This international rotation has helped me form a different perspective on healthcare and opened my eyes to just how different pharmacy practice is compared to the United States. This experience has definitely pushed me to take initiative, and re-emphasized the significance of adaptability (expecting the unexpected), prioritization (modifying goals/plans to meet current needs), and teamwork (working together on an interdisciplinary team with different ideas, backgrounds, and expertise to make various small impacts), which are all skills that I have taken with me and plan on continuing to apply to pharmacy, my career, and beyond. I feel humbled and grateful to have been a part of such a dynamic team, learn from oncology residents, and meet and learn from some amazing people in Ethiopia.”

-Bem Agegnehu, PharmD (Former UNC PY4 Student, ’20; Traveled to Ethiopia in January 2020 as part of the GPS rotation)
Domain 1

Medication Safety

Goal: Develop a transparent supply chain system focused on chemotherapy and supportive care,with the goals of reducing unnecessary drug shortages and falsified/substandard medications.

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  • Conduct focused interviews of pharmacists, health ministry, and pharmaceutical agencies to map out current chemotherapy supply chain process in Ethiopia.
  • Perform comparative analysis of Ethiopia’s chemotherapy supply chain to similar countries in the region (i.e. Tanzania, Kenya).
  • Partner with supply chain experts to propose a chemotherapy supply chain process to reduce substandard/falsified medical products.
  • Establish a working group consisting of the UNC team and representatives from our Ethiopian Partners, with the goals of developing a drug formulary management process.
Domain 2

Workforce Development

Goal: Train physicians, pharmacists, and nurses to deliver world-class cancer care in Ethiopia. A specific focus of our UNC team is to train clinical pharmacists with proficiency in oncology care to meet the demands of patients in Ethiopia.

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  • Continue annual trips by UNC Pharmacy faculty and students to Ethiopia to teach pharmacy students in the oncology module of the MSc in Clinical Pharmacy.
  • Continue involvement in the established fellowship training program for pediatric oncologists funded by an NGO, The Aslan Project. UNC Medical Faculty participate in teaching medical fellows.
  • Establish a training program for safe handling and preparation of chemotherapy (audience: pharmacists, nurses).
  • Provide access to an online-based curriculum led by UNC faculty on various topics related to cancer treatment and supportive care (through the UNC Cancer Network).
Domain 3

Evidence-based Practice

Goal: Establish a comprehensive national cancer registry with a focus in pediatric oncology to better characterize the burden of cancer, current treatment outcomes, and gaps in care (including medication shortages).

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  • Design and validate chemotherapy documentation forms for pharmacists and physicians to use and for data clerks to include into the registry.
  • Develop and pilot both Excel-based and Red Cap based registries with existing data clerks in multiple institutions in coordination with the Ministry of Health.
  • Use the existing data to identify gaps for quality improvement initiatives and for future research endeavors.
“Honestly speaking, when I think about UNC team, I have become overwhelmed. Team helped me to become someone that will put the footprints to change the landscape of pediatric oncology/hematology patients’ management and subsequently improves outcome and quality of life of the patients. Thanks to UNC team, now we have started the cancer registry. In addition, I got a lot of experiences from the team and the team teaches me a lot of things which all hugely impacted my career. Now, I am confident enough that good things are coming that will change our patients’ quality of care and treatment outcomes as long as the UNC team is working with us.”

-Atalay Mulu Fentie, BPharm, MS (Lecturer at School of Pharmacy, College of Health Sciences, Addis Ababa University)

Team members of UNC Ethiopia Alliance

Benyam Muluneh, PharmD, BCOP, CPP

Clinical Assistant Professor, Eshelman School of Pharmacy
Co-Director, UNC-Ethiopia Alliance

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Dr. Benyam Muluneh is a Clinical Assistant Professor here at the Eshelman School of Pharmacy. Dr. Muluneh spearheads the UNC Ethiopia Alliance where he oversees the execution of various projects and maintains strategic partnerships in Ethiopia to further advance the missions of UNC Ethiopia Alliance.

Thomas Alexander, MD, MPH

Pediatric Hematologist-Oncologist
Assistant Professor, UNC School of Medicine
Co-Director, UNC-Ethiopia Alliance

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Given his clinical and research expertise, Dr. Thomas Alexander ensures high quality, data-driven, patient-centered execution of our mission and vision. Dr. Alexander spearheads numerous initiatives within UNC Ethiopia Alliance including physician education (in partnership with Aslan), exploring novel diagnostic methods, and serving as clinical lead for the registry initiative.

Yasmin Abdella

UNC Undergraduate student ; Neuroscience B.S, Chemistry minor
Project Manager, UNC-Ethiopia Alliance

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Yasmin Abdella is an undergraduate premed student studying Neuroscience with a minor in Chemistry at UNC. She serves as the Project Manager of UNC Ethiopia Alliance where she coordinates and organizes meetings between all members, takes minutes throughout meetings, organizes files and documents and implements new online platforms such as “Trello” for better efficient management and organization of projects for UNC Ethiopia Alliance.

Kaitlyn Buhlinger, PharmD, CPP

Clinical Pharmacist Practitioner, UNC Health

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Kaitlyn Buhlinger is clinical pharmacist practitioner at UNC Health. She was the team lead on the national pediatric oncology registry initiative in Ethiopia in March 2019 where she partnered with stakeholders in Ethiopia to design and implement a registry process and accompanying tools. She continues to use her expertise in UNC Ethiopia Alliance in order to assist with the educational aspect of UNC Ethiopia Alliance and to implement new strategies to improve chemotherapy use in Ethiopia.

Vanessa Ayer-Miller, DrPH

Pediatric Oncology Coordinator, Lineberger Comprehensive Cancer Center

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Dr. Vanessa Ayer-Miller oversees the technical aspects of the registry project initiative in UNC Ethiopia Alliance where her main goal is to improve the data collection practices currently in place in Ethiopia hospital sites. She has been working to identify a secure server and implement a sustainable database for data collection in hospitals to better characterize the epidemiology of pediatric malignancies in Ethiopia.

Megan Roberts, Ph.D.

Assistant Professor, UNC Eshelman School of Pharmacy

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Dr. Roberts is an Assistant Professor at the Eshelman School of Pharmacy. As an implementation scientist she uses her expertise to ensure our approach to implementing interventions is evidence-based, thoughtful, and collaborative with stakeholder input.

Michael Chargualaf, PharmD

Adjunct Clinical Professor, UNC Eshleman School of Pharmacy
Medical Science Liaison, Daiichi Sankyo

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Dr. Chargualaf is an adjunct faculty at UNC’s Eshleman School of Pharmacy and a Medical Science Liaison with Daiichi Sankyo. He uses his clinical and industry expertise, to lead the registry initiative within UNC Ethiopia Alliance. He also uses his expertise to help draft various policies for chemotherapy use in the Ethiopian context, most recently for use of HD-MTX administration for patients in Ethiopia.

Jaime Richardson, BA, RN, BSN, OCN, CCRP

Nurse Navigator, Precision Medicine
UNC Health

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Jaime Richardson uses her expertise in oncology Nursing and background in global health to set guidelines for chemotherapy administration for hospitals in Ethiopia involved in UNC Ethiopia Alliance. With our nurse colleagues in Ethiopia, Jamie collaborates to establish guidelines for safe handling procedures and explores training that can be given to healthcare workers.

Catherine Habashy, MD, MPH

Fellow, Pediatric Hematology and Oncology, UNC

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Catherine Habashy is a fellow at UNC where she specialists in Pediatric Hematology and Oncology. In UNC Ethiopia Alliance, she is currently studying the cost effectiveness and diagnostics of chemotherapy in Ethiopia, to understand of the impact of drug shortages and how to optimize supply chain of chemotherapy drugs currently in place within various hospital sites in Ethiopia.

Sachiko Ozawa, Ph.D., M.H.S

Associate Professor, UNC School of Pharmacy

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Sachi Ozawa is an associate professor in the Division of practice Advancement and clinical Education at the UNC Eshelman School of Pharmacy. In UNC Ethiopia Alliance she uses her public health and economics expertise to model the cost effectiveness of improved diagnostic capacity and chemotherapy drugs in Ethiopia.

Hendrik van Deventer, MD

Adult Hematologist
Associate Professor, UNC School of Medicine

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Dr. Van Deventer is an adult hematologist/oncologist who oversees our future expansion to improve the care of adult cancer patients in Ethiopia.

David Steeb, PharmD, MPH

Director of Global Engagement, UNC Eshelman School of Pharmacy

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Dr. Van Deventer is an adult hematologist/oncologist who oversees our future expansion to improve the care of adult cancer patients in Ethiopia.

Stephen Clark, PharmD, BCOP

Assistant Professor of Clinical Education, UNC Eshleman School of Pharmacy
Clinical Pharmacy Specialist, UNC Health

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Dr. Clark lends his expertise in clinical pharmacy, quality, safe handling, and operations to ensure proper planning and execution of our various initiatives within UNC Ethiopia Alliance.

Lidia Mohammed

UNC Undergraduate student ; Computer Science B.S, Cognitive Science minor
IT assistant, UNC-Ethiopia Alliance

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Lidia Alemayehu is an undergraduate student studying Computer Science with a minor in Cognitive Science at UNC. She uses her IT expertise in UNC Ethiopia Alliance where she manages our website and supports any technological and marketing needs for our initiatives.

Befikadu Mekonnen

University of Rochester Undergraduate student ; Biomedical Engineering B.S

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Bef is an Undergraduate Student studying Biomedical Engineering on a premed track at University of Rochester in New York. Bef is a former TASH patient and worked on coding the Supply Chain Data for the UNC Ethiopia Alliance during the summer.

Research & Publications

  1. Chargualaf MJ, Giao TT, Abrahamson AC, et al. Layered learning pharmacy practice model in Ethiopia. J Oncol Pharm Pract. 2019;25(7):1699‐ doi:10.1177/1078155218820105 Link: https://pubmed.ncbi.nlm.nih.gov/30616470/?from_single_result=benyam+muluneh+chargualaf
  2. Mulu Fentie A, Buhlinger K, Borlagdan J, et al. Pre-implementation assessment of a national Ethiopian pediatric cancer registry. Blood Adv. 2019;3(Suppl 1):16‐ doi:10.1182/bloodadvances.2019GS121614 Link: https://pubmed.ncbi.nlm.nih.gov/31809541/?from_term=benyam+muluneh+ethiopia&from_sort=date&from_pos=1
  3. Hailu D, Adamu H, Fufa D, et al. Training Pediatric Hematologists / Oncologists for Capacity Building in Ethiopia. Blood (2019) 134 (Supplement_1): 3423. Link: https://ashpublications.org/blood/article/134/Supplement_1/3423/428351/Training-Pediatric-Hematologists-Oncologists-for
  4. Aslan Newsletter: https://files.constantcontact.com/4e6407de201/6e751c93-1043-4875-b8aa-95c65a9fa298.pdf
  5. UNC GPS program: https://pharmacy.unc.edu/2018/11/students-make-international-impact-through-gps-ethiopia-program/
  6. UNC Media Hub. UNC pharmacists are helping cancer patients in Ethiopia. http://mediahub.unc.edu/unc-pharmacists-are-helping-cancer-patients-in-ethiopia/
  7. UNC Media Hub. Katie Buhlinger “is going to change the field of pharmacy”. http://mediahub.unc.edu/katie-buhlinger-is-going-to-change-the-field-of-pharmacy/

In the News

UNC pharmacists are helping cancer patients in Ethiopia

MAY 6, 2019 by MEDIAHUB

Story by: Cailyn Derickson

ADDIS ABABA, Ethiopia — The 3-year-old boy sat cross-legged on his hospital bed. He was all skin and bones, except for his stomach, which was bloated and protruded from the bottom of his dingy, off-white shirt.

A blood transfusion IV line was stuck into his right hand. His face was blank.

He has leukemia.

Two jugs of water stood in the corner of his room at Tikur Anbessa Specialized Hospital, the first pediatric oncology hospital in Ethiopia. The boy’s father used them to bathe his son and quench his thirst because the pediatric oncology unit did not have running water. A copper pipe had eroded, and no contractor would take the job to fix it.

“Daddy,” the boy said in Amharic. “Can you lay me down? I’m tired.”

The five University of North Carolina at Chapel Hill pharmacists watching the boy were shocked by the conditions of the hospital. They were there to implement the first-ever national pediatric center registry, which would identify patient cancers, track therapies and subsequent complications, and document outcomes. read more

“Thinking about my time in Ethiopia, it was nothing short of eye-opening, humbling, and inspiring. I loved being able to work on the unit around the pediatric hem/onc patients and staff, while also diving into some great conversations at the school of pharmacy. Seeing everyone at the hospital and school’s willingness to engage and collaborate gave me so much hope for this project and made me that much more excited to be a part of it. Additionally, I was fortunate to learn about and experience Ethiopia’s vast and beautiful history, culture, food, and people and I am eager to return in the near future to serve this project and maintain this partnership.”

-Katie Buhlinger, PharmD (Former UNC student ’17, Traveled to Ethiopia as a PGY2 Resident in March 2019)

External Partners

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