Goodbye and thank you to Dr Sam Ghebrehewet

The Collaborative would like to thank Dr Sam Ghebrehewet, Regional Deputy Director, UKHSA North West for his outstanding work across Cheshire and Merseyside over the past 23 years and wish him well in his new position with Public Health Scotland as Head of Vaccination and Immunisation Division. His wonderful leadership during the pandemic was greatly valued by the Champs Directors and the whole system.

We sat down with Dr Ghebrehewet to learn about how he started his career in public health, challenges he’s faced, what he’s most passionate about and more.

Read the feature below.

Dr Ghebrehewet has worked in the North West for around 23 years and first started his career following graduation from medical school in 1988. His first job was a Medical Doctor for a health centre in a remote part of Ethiopia. He was the first doctor to ever be assigned to the health centre.

Dr Ghebrehewet explained: “I was doing if you like everything. I was on call 24/7 and they would say ‘we have got a doctor now so I’ll call him in the middle of the night’ at 2am and 3am so there was no 9-5 working. You just worked all day and you could work the night as well. It was interesting because as a new medical doctor, you just wanted to see more patients and do what you can but a lot of the challenges were things that you can’t really solve immediately.”

Dr Ghebrehewet said there were many challenges in the role. One example was treating a young child for scabies. Dr Ghebrehewet said he spoke with the child’s father and offered to treat him too so that the child did not catch scabies again but the child’s father declined.

In conversation with the child’s father, Dr Ghebrehewet explained “So what happens if we don’t treat you is we treat the child and he’ll catch it again. Then not only catching it again, if it is infected, for example a bacterial infection because the skin is broken everywhere, it could go into his blood stream and it could cause kidney infections, it could cause pneumonia, it could cause everything.”

His father said he didn’t want to be treated and just wanted “some respite for the child so he could have some painless / itching free days”. He went on to say “why are you interested in treating me? My wife has got the same. His older brothers have got the same. The school he goes to has got the same. What difference is it going to make treating me?”

Dr Ghebrehewet said that his father had a point because treating him on his own would not change anything. He explained: “He was right. I said to him ‘if you are also infected with the bacteria, you could also have a kidney infection and you could also die from infection’. He said back to me ‘I wish that happens to me because it’s not a life that we are living. There’s nothing to eat, we don’t have clean water, there’s no light, we’re suffering’.

Dr Ghebrehewet said he was really taken back by that “it hit me like something and I couldn’t sleep that night because what he had said to me thinking they do have so many other issues and treating the child will solve nothing. I thought I am not helping them as a medical doctor and what I’m doing as a doctor is not making any difference.”

After a year and a half, Dr Ghebrehewet transferred to the main hospital in the region but said that “it hit me hard that I’m really not doing anything. You treat people and they come back with the same issue day in, day out. Some of them have got big leg ulcers and you treat them and they come back again, then again. It really makes no difference because there’s no clean water. Sanitation is poor and there are no toilets.”

After starting his new role at the hospital, Dr Ghebrehewet explained: “The same thing started to happen. Six intestinal parasites, seven intestinal parasites, hookworm, tapeworm – you name them. And you don’t know which one to treat because it’s a breeding place for parasites. And I was thinking what is happening here, what can we do here.”

He said that second hand shoes were bought to stop the hookworm and toilets were built but nothing changed. He said the residents did not use the toilets for their intended purpose and instead they found grain stored in five of them as it was the safest place to store grains away from the rats. Two of the toilets visited had also not been used at all.

“We went to see the toilets and out of seven, five of them were blocked and used to put grains in. I asked what had happened and was told ‘because we have so many rats, it was the safest place to keep the seeds and grains. We don’t use the toilet. We can’t be defecating inside our house’. There was a culture of defecating outside which was very difficult to change.”

Dr Ghebrehewet said he submitted a report on the situation to the Department of Health in Ethiopia and they asked him to come to the capital city of Ethiopia (Addis Ababa) and do public health.

He said: “I thought this is interesting. I didn’t know much about public health and I told them about the scabies issue and they said ‘we need people like you do the public health. It’s about population health, not individual treatment for individuals, because that’s what we are lacking’. So I attended a three-month course on public health in primary care, and then came to Liverpool to do Masters in Public Health (MPH) in 1993/1994.”

Public health graduation

Dr Ghebrehewet said that after he graduated, in 1997, he was asked to apply for the training programme in public health with Mersey Deanery, and successfully completed his training in early 2001. He was then appointed as a Consultant in Communicable Disease Control (CCDC) in Cheshire. His career led him to work for the Health Protection Agency from 2003 onwards as the lead for health protection in Cheshire and Merseyside. In 2009, he became Cheshire & Merseyside Health Protection Unit Director before moving to Public Health England in 2013.

Dr Ghebrehewet then became the Deputy Director for Health Protection in Cheshire and Merseyside in 2015. He moved on to the UK Health Security Agency in 2021 and was appointed as the Regional Deputy Director for Health Protection North West in March 2023.

Talking about his time at the Health Protection Agency (HPA) in 2010, as lead for Vaccination and Immunisation in the North West, Dr Ghebrehewet explained one of his most memorable achievements was winning HPA Vaccination and Immunisation team of the year.

His second most memorable achievement was during a large measles outbreak in Liverpool and Merseyside in 2012 and 2013. Dr Ghebrehewet said: “It was the biggest outbreak of measles in England for over many years. We had 685 confirmed cases and in collaboration with colleagues, I feel like I led the health protection response successfully and I’m very proud of that.”

Dr Ghebrehewet said his third most memorable achievement was being nominated for an award in 2016 for undertaking research. He said he was the first person to be awarded the Public Health England Science and Research award. Following that, in 2017, he also won the North West Coast Research and Innovation Award in 2017.

In addition, in 2016, he wrote the first textbook in Health Protection called ‘Health Protection Principles and Practice.’  He said “that was a proud moment for me. The textbook contains a huge amount of information and defines what Health Protection is, what the practice is and what the skills are.” Dr Ghebrehewet explained he is currently writing the 2nd edition of the book.

Leading work on antimicrobial resistance in Ghana

As well as his work in the UK, Dr Ghebrehewet also leads a partnership on antimicrobial resistance in Ghana, West Africa. He explained: “It’s a big team including microbiologists, infection control nurses, pharmacists and managers from the UK and we work with the Faculty of Public Health in the UK.”

In 2021, Dr Ghebrehewet won the Faculty of Public Health Presidential Medal for leading the commonwealth partnership for antimicrobial stewardship in Ghana.

Talking about his passion for work, Dr Ghebrehewet said: “I am passionate about vaccination and immunisation. I think immunisation in the UK is taken for granted.
Having a vaccine doesn’t protect itself. People have to be injected with the vaccine. People say ‘oh we have a vaccine for it’. If people are not taking it, it’s the same like you don’t have it.

“So it’s an important area I’m really passionate about and it has made a huge difference in people’s lives. I think it is the second most successful intervention that we have in public health, only second to clean water. Therefore, vaccination is a really important public health intervention. We protect all the nasty infections because we have these wonderful vaccines. Many infections are now almost non-existent or eradicated because we have a vaccination programme that is successful in the UK.”

COVID-19 pandemic challenges

In the UK, one of the biggest challenges Dr Ghebrehewet faced was the COVID-19 pandemic.

He explained: “We were receiving UK residents from Wuhan, China because they were in the area where there was an epidemic of SARS-CoV-2 (COVID-19). I remember being told vividly on a Wednesday that UK Citizens from China were coming to Arrowe Park Hospital and we needed to host 90 families in one day, and basically “quarantine” them. It was a mammoth task and the most unforgettable experience, as there were so many challenges, not least we had very little / limited knowledge about SARS-CoV-2 at the time.”

He added: “The second biggest challenge was when the COVID-19 pandemic hit us. It was huge. It was relentless. It was day and night. It was being reported all day, all night and we were on call, all day, all night, not sleeping. It was the most stressful time.

“I must say the Champs Public Health Collaborative and the Directors of Public Health were fantastic. They were really supportive and understanding of the challenge we had. I think in Cheshire and Merseyside, because of the Champs Collaborative we came out of it in the best possible form. So I would like to take this opportunity to put it on the record my sincere gratitude and thanks to the Champs Collaborative, the DsPH and their teams for what they have done. We in health protection will never forget the professional commitment and dedication they have shown throughout the pandemic.”

Talking about his new role, Dr Ghebrehewet said: “I’m moving as Head of Vaccination and Immunisation Division for Public Health Scotland – the equivalent to the UK Health Security Agency in England. It’s a new division, bringing all vaccination into one and they have a different system in Scotland and this is a new post. I’ll be leading the Scottish vaccination and immunisation programme for Scotland.

“With the experience I have on health protection, and understanding and knowledge on vaccination, practice and science, I’ll be expected to represent Scotland at national vaccination and immunisation forums including Joint Committee on Vaccination and Immunisation (JCVI) meetings.”

Dr Ghebrehewet explained he’ll lead a team of consultants in public health, scientists, practitioners and vaccinators. He’ll be strategically leading the programme and engagement with stakeholders, including the Scottish Government, NHS Scotland, Health Boards, clinicians and academia.

As well as this, he’ll be expected to provide expert advice on vaccination and immunisation, lead and contribute to public health management of incidents related to vaccine preventable diseases and deliver education and training.