Our last day in country began with our final presentation to IGAD. We discussed how our business plan has pivoted based on the experiences and meetings in the past week. Working with IGAD and Dr. Girum this week has been wonderful and the entire team was appreciative of the time and effort spend on their behalf.  

​Once the presentation concluded, the team split to visit the local museums and to Merkato, Africa’s largest market, for some final souvenirs. Street after street revealed more shops filled with trinkets, clothes, shoes, jewelry and happy, smiling vendors. While bustling and busy, the market was a fun adventure and provided a unique, authentic taste of Addis before we left. 

​After our final meal at one of our favourite restaurants, the team crammed all our business suits, scarves and souvenirs into our suitcases and made our way to the airport. After many, many, many security checks and endless lines, the team loaded onto the airplane for a full 24 hours of travel back to chilly Edmonton. What an unbelievable experience and an enormous challenge!!

​For our second day of the weekend, we were treated to an adventure 40 minutes out of the city to see Maars, huge craters caused by volcanic explosions. The craters have become lakes filled with bright green water. The team explored the area and were treated to a scenic lunch by the waters edge. 

After lunch, the team returned to the city to pick up other team members and were off again through the bustling city to Entoto, a palace built by Emperor Minilik. We drove up sharp switchback roads to the highest peak overlooking Addis Ababa and explored the palace grounds and quaint museum. 

​Further down we stopped again to shop at a traditional clothing market. As the Ethiopian Epiphany (celebrating the Baptism of Christ) were days away, it seemed like the whole city was out buying new clothes for the celebrations.  After the market, the team hurried back to the hotel to polish up the final presentation for IGAD the next morning. 

​The weekend has arrived!  Today, Tim and I (Sarah) had the incredible luck to be invited to a golf tournament on Addis’s only golf course by Abraham Abegaz.  Since my (and probably Tim’s) life priorities typically revolve around the opportunities to swing a golf club, to do so in Ethiopia was an experience that is exceptionally noteworthy.  The course in Addis is 30 years old, but only recently has been converted back from a military housing area to a public course.   We had clubs arranged for us and we were fit into a tournament sponsored by the local Coca Cola representative at the last minute.  My foursome was made up of Abraham, a leading gynaecologist in the country, and the chairman of the Addis golf club.  The experience of golf here was unique.  The chips had to be of marksman quality and the greens were fast and furious.  The OB stakes were everywhere you looked, and while the course was relatively wide open, the OB across fairways meant precision was key.  The contenders were furiously passionate about their play, and regularly had asides in Amharic to debate a ruling.  There was no room for a foot wedge or a mulligan; these guys are hawks!  In this season, the grass is very dry, and we had a pick and place rule on the fairway. I shot a disappointing net score of 85, with Tim sweeping in for the win at 84.  After the game we shook off the sun and tough game with a delicious BBQ and great conversation.  The awards presentation saw Abraham grab bronze.  During the ceremony, it was neat to witness the similarity of the love of golf in the room as there is at home.  The golf club is in a fledgling state so it was also interesting to hear the conversations of an evolving etiquette, pace of play, and scoring. The great game of golf seems to transcend boundaries as we learned playing here in Addis.

​The rest of the team was lucky enough to experience horse back riding at the Italian Embassy and a local wedding.  Tim and I were jealous that we could not be in two places at once.  The team was treated like royalty at the wedding and given a beautiful feast.  Doran underwent a tiger-like transformation after experimenting with some of the local cuisine.  We reunited with the team in the early evening for a debrief planning session for Monday’s presentation to IGAD.

​Our main events for today included a visit to the Pharmaceuticals Fund and Supply Agency (PFSA) in the morning. In the afternoon, we split into two groups with half of the group visiting the African Union (AU) and the other half visiting Novartis.

Meeting 1 - PFSA:
The PFSA is responsible for ensuring an “uninterrupted supply of pharmaceuticals” for Ethiopia. They were able to provide much insight into the importation and process. Nearby there was some serious construction of new buildings as you can see in the above pictures. The hospitality shown by the PFSA was exemplary. Some challenges were identified including that there is a lack of foreign currency at times within the banking system in Ethiopia. 

Meeting 2 - AU:
The team that visited the AU included Beatrice, Hicki, Jodi-Ann and Nevill, along with Dr. Maeir and Dr. Girum. We were able to visit with Dr. Johan Strijdom, Head of the Social Welfare Division at the African Union. Dr. Strijdom, aka Uncle Johnnie, was quite helpful in answering the many questions the team had for him regarding establishing and maintaining relationships across the IGAD region. He also offered advice as to some things to be considered to ensure the success of the RCCE. He even stated that the AU would love to support an initiative such as this as its success would lead to the betterment of the IGAD region and Africa by extension. All in all, the meeting was quite productive and we all left feeling quite excited about the promised support from the AU.

Meeting 3 – Novartis:
The meeting with Novartis faced some technical difficulties off of the start. It was apparent fairly quickly that they had a deep desire to help with helping patients to access effective medications. There were many awards and certificates of appreciation on their wall from different initiatives within Ethiopia. There were representatives for the region from Kenya as well as local associates responsible for Ethiopia overall pharmaceuticals and as well an associate responsible specifically for Cancer specific medications. Many of the issues raised by the PFSA were also raised by Novartis. There will have to be some innovations regarding supply chain. Financing due to the low amount of foreign currency available within Ethiopia and the costing of expensive chemotherapies. Novartis did mention that they currently have programs providing first line and second line chemotherapies for leukemia patients at Black Lion. Novartis is definitely interested in furthering partnerships and agreements with the RCCE as well. It will be interesting to see the agreements that occur through further communication as the business plan is developed.

It’s day # 7 of our trip and we have reached the middle of our marathon schedule in Addis. We are little sad with the departure of Emily for Nicaragua but more excited with the arrival of Dr. Mike Maier. His presence and time definitely conveys a lot of inspiration for our cause. Together, or in groups, our team had previously collected a lot of pieces of vital information building into our assumptions and thought processes. Today would be the day for further affirmation of some of our ideas and a happy run through with some potential partners.  
 
In the morning, Doran and Diane along with Dr. Maier visited the Black Lion hospital for a walking tour of the oncology department. The hospital conducts chemotherapy sessions on Tuesdays and Thursdays. So we thought it would be a good idea to have a feel of the chemo sessions and take points on the service standards, conditions of patients, and the challenges faced in local cancer treatment.  The hospital and its staff showed unbelievable dedication to every single one of its patients, despite its very tight resources constraints. 

​Other members of the team spent the morning meeting with the Ethiopian Institute of Architecture, Building Construction and City Development (EiABC).  The meeting centered around urban development and renewal plans for Addis Ababa, along with discussions about construction timing, costing, and complexities.

​The afternoon had some team members meeting with GE’s regional office.  The discussions centered around potential partnerships, as well as possible relevant equipment and services as they relate to the Regional Cancer Centre of Excellence.  As seems to be the norm for our meetings in Ethiopia, GE was very generous in their information and willingness to help the Regional Cancer Centre of Excellence succeed.  Another great meeting with another great partner. 
 
After completing most of our day’s agenda, we went on to see Mrs Sharon Ashton and get her views about doing business in Canada. Sharon is originally from Canada and has had a distinguished career in asset management with UBS, Toronto. Se moved to Ethiopia with her husband in 2003. Since then Sharon has devoted her time to the field of health in Ethiopia. Sharon initially worked in close conjunction with Black Lion hospital and then with St. Paul hospital before setting up her own eye clinic called WGGA Eye Centre. During the last 10 years, she along with Dr. Melaku Game has poineered various training programs in the health sector. The talk with Sharon was pretty insightful and we learned several ground facts about the border customs, regulatory agencies, work culture, and the lifestyle of Ethiopians. The talk concluded with a tour of her eye clinic which is aided with the latest opthalmic equipments, and whose walls are decorated with some great artwork by a local student. 

​The short tour of the eye clinic was followed by a nice dinner where we all de-stressed after a long eventful day. It was the most satisfying of the meals we had. Most of our meetings were done by now, and we had obtained all the information and insights we needed at the beginning of this trip. Later we returned back to the hotel and had our customary debrief session before calling it a day.      

​Today, we started our day early by having our pre-meeting at 7 am while having our breakfast in our one and only Kaleb Hotel. The first meeting we had this morning was with the Black Lion Hospital oncologists to get first-hand perspectives about cancer patients and their needs. The limited resources of drugs and low retention of trained staff have been big barriers in delivering proper diagnosis and treatments to the patients.
 
As the only hospital with cancer clinic, it is struggling to access medicines for patients, who are able and willing to pay, and affordable medicines for the underprivileged patients. On top of that, the wait time between the drugs’ supplies is about 6 to 7 months, which means patients are left hanging unless they have the means to go abroad and get treated in another country.

​Furthermore, Black Lion Hospital is serving approximately 10,000 new cancer patients annually and only 7 oncologists are currently serving these patients. These oncologists were trained internationally (including the U.S., the U.K., India, Australia, Germany, South Africa) and they decided to stay in Addis Ababa, even though they are making less than USD$1,000 monthly, because it is their intention to serve the people.

​This was the waiting room of the oncology clinic at Black Lion Hospital. People stood in line outside of the building to get registered and waited in the waiting room until it was their turn to see the oncologists. The exceedingly high demands of cancer care and the low supplies cause an overcapacity in the oncology clinic. Ethiopia health service really needs improvement to serve the patients better (including access to equipment, medicines and trained supporting staff) because Ethiopia has capable and internationally trained doctors. After our meeting with the oncologists and tour in Black Lion Hospital, we moved on to our afternoon meeting.
 
Later in the afternoon, we had two meetings scheduled. Since we could not be at two places at once, we had to split up the team. Team A (Doran, Sean, Tim and Sarah) met with an Ethiopian architect to discuss the building of the actual cancer center. Engineer Zeleke was kind enough to meet them at our hotel. They had a very informative meeting and were able to gather information regarding building and materials cost. This information will be very useful in determining how much the IGAD Regional Cancer Center of Excellence will cost, which is an important piece of our business plan.
 
Team B (Prof. Emily, Dr. Maier, Beatrice, Nevil, Jodi-Ann and Hicki) went for the other meeting at the African Union (AU). The African Union plays a key role in conflict resolution, continent-wide interventions in health and other areas. Therefore, gaining their input, support and advice is key to the success of the cancer center. Team B met with two doctors who work at the AU Clinic to discuss the project and the role AU can play. Despite the meeting not being exactly what we expected, some very useful insights were gained. We learned that in order to gain the brand and reputation required of a world class facility, we need to build a facility that the AU would be comfortable to refer their clients to. This gave us a benchmark to measure the quality of service needed to make the IGAD regional cancer center a success. After the meeting, we got to take pictures in the beautiful African Union compound.

​We ended the day by having a team dinner with the wonderful Dr. Girum. Dinner was at a local Ethiopian restaurant called Yod Abyssinia. Of course dinner included injera, tibs, shiro and doro wat. We also said goodbye to Prof. Emily as she embarks on a research project in Nicaragua. 

​Thanks (Ameseginalehu in Amharic) to Dr. Girum Hailu Maheteme’s connections and efforts, we were surprised and excited to learn that we had a meeting planned with Ethiopia’s newly appointed Minister of Health, Professor Yifru Berhan. With the help of our expert driver, we navigated through the city streets of Addis Ababa and arrived at the Ministry of Health very quickly. We were ushered up to a board room where we could set up the A/V for our presentation and see the cityscape. Dr. Girum and Mr. Abraham Abegaz joined us and shortly after, his excellency, the Minister of Health joined us. Dr. Block, Sean and Doran expertly presented our team’s experience, our initial research findings and our plans for our time in country. Following this, the Minister asked some thoughtful questions, then stated his support for the project and encouraged our team to consider the unique opportunities available for this type of initiative. The Minister was wonderful and the team was very grateful for the face-to-face meeting on such short notice. The prospect of horseback riding and golf with some important local influencers was also offered to the team and if possible with our schedule, we may be able to squeeze these activities in! Very exciting!!

​With the support of the Minister, our team was even more charged to tackle this enormous challenge of setting up a Regional Cancer Center of Excellence in Ethiopia to serve the IGAD region. After a ‘quick’ lunch, the team de-briefed and was off again, this time to Zewditu Hospital, an inner city general hospital. Here we met with Dr. Adamu Addissie who is the director of the School of Public Health. As well, Dr. Adamu also is an expert in ethics and is heavily involved in training and research in the area of public health in Ethiopia.  The team was hosted with kolu and delicious coffee and tea, while we discussed the intricacies of health care, informed consent, palliative care and human resources in developing countries. This meeting lasted into the early evening, and the team debriefed quickly at the hotel before heading out for a bite to eat close to the hotel. 

​All in all, an exciting, grounding day that put into perspective the challenges and realities of our developing plan. Based on today’s developments, I am eager to see how our trip and business plan evolves as we collect information and first-hand experiences! 

​Hello everyone, Tim writing his first blog entry here. Today just so happened to be my first full day in Addis and I have to admit that I was inspired by our meetings and presentations. This morning, we had the opportunity to visit Mr. Wondu Bekele Woldemariam, the General Manager of Mathiwos Wondu-YeEthiopia Cancer Society. Mr. Wondu created this organization in honor of his son Mathiwos who passed away from leukemia. He sacrificed financial stability in order to create this legacy organization in his son’s honor. Due to hard work and his passion to help others, Wondu has made the Mathiwos Wondu-YeEthiopia Cancer Society (MWYECS) into something special. This organization provides financial, clothing, housing, transportation, and psychosocial support to cancer patients being treated at the Black Lion Hospital in Addis Ababa. The focus is on pediatric cancer while they are starting to branch out into women’s cancers (breast and cervical) which also happen to be the most prevalent in Ethiopia.
As you can imagine, we had a lot of questions and were provided an incredible amount of information. Mr. Wondu also sits in a number of key positions including the Global Cancer Ambassador for Ethiopia with the American Cancer Society. He was a wealth of knowledge and an inspiration to the efforts we are putting forward. We also had the pleasure of touring his facility and meeting some of the patients and family members who utilize their services. The facility is currently supporting 24 patients and their families. Capping off the trip, MWYECS fed us wat and injera which has been by far the best meal I have had upon coming here.
Once we completed this meeting, we traveled back through the city of Addis and were able to see for the first time other parts of the city. Construction here is booming in much of the downtown core; however, many of the buildings seem to be half constructed. We traveled down a number of major routes and saw some things you wouldn’t in downtown Edmonton. Some of the most well behaved goats live in packs on the side of the road and don’t seem to be bothered by the Canadian tourists taking their pictures. All-in-all it was an amazing trip and really opened my eyes to the different challenges cancer patients and the business problem face in Ethiopia. Here is Doran for a recount of the afternoon.

​Hello everyone, Doran here. This afternoon was a meet and greet/introduction between teams for the Frontiers of Business Class and IGAD. I had the privilege of being part of the team to present our project to Dr. Girum from IGAD and we followed up with a question period between ourselves and Dr. Girum. I was pleased to find out that he was arranging meetings with us and the Deputy Prime Minister as well as a meeting  with the Ethiopian Health Minister tomorrow. We also met with a World Health Organization representative who was responsible for Non-communicable diseases for Ethiopia. We talked about many different initiatives as well as different channels that information is delivered throughout Ethiopia. Many of the different pieces and meetings appear to be falling into place.  As well there appears to be Ethiopian coffee served at each meeting. As a lover of all things coffee these meetings are going to be a breeze. 

​After our meeting, we all took a 10 minute stroll through the streets of Addis to get to MK’s, the lunch spot of the day. The food offering included a mix of Ethiopian food, Italian food, and some Western foods as well. We all enjoyed our meals.

​The team is finally getting the hang of the device charging situation in Ethiopia...

​A late night dinner was unable to resolve the eternal debate between Walia and St. George beer.  More testing will have to be done.

​Late night brought a dinner adventure for part of the team that included unordered dishes, a missing waiter, and the elusive 1 hour bill.  Finally getting to pay and go to bed was worthy of a celebratory photo.

​Melkam Gena!! That’s Merry Christmas in Amharic, and today was the celebration of the Christmas day in Ethiopia. Our team started the day on a healthy note after a good night’s rest and overcoming the jet-lag. A nice heavy breakfast in the morning and we all were pumped up to take on the in-country agenda.      

​After finishing our breakfast, we decided to do a group review of the business plan template that we have been working on in Edmonton. Diane led our discussions and helped us get the complete picture of what we have achieved so far, capture the missing information, and formulate questions for our contact persons of our upcoming meetings. This session was very beneficial for each member of the team because now we know where we stand and what information we are trying to look for while in Addis Ababa. Since we only have 10 days here, we need to maximize our time to get reliable information to base our business plan on.  After working together for 4 hours straight, we decided to have a lunch a Roomi Burger, which was about 15 minutes walk from our hotel. This restaurant serves burgers, sandwiches, pizzas and assortment of beverages (fruit juices, fruit smoothies, coffee, teas, etc) but I will recommend to try Roomi’s avocado juice because it is very tasty and avocado is not typically served as a juice in Canada, definitely worth a try.

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The lunch was very filling and the walk back to hotel under the warm sun served the perfect anecdote. On returning back to our workspaces, we had our task cut out. Jodi-Ann was assigned leadership to take us through the remainder of the business plan. Jodi has this amazing zeal of a focus leader. So much that I strategically sat little behind her to avoid getting caught half asleep. Jodi ran us through a nice 3 hour session of intense brainstorming and in the end we had our work target covered. By the time it got dark, we knew where we are in terms of our business plan, what our information gaps are, and what clarifications we need to proceed ahead. It’s indeed a great feeling to have such clarity and know everyone’s role. While we retreated to our respective dens, we had our minds clear and our respective tasks set out for the rest of the trip.