Saturday, March 21, 2015

Disaster Flood Relief - helping animals to help people

In January Malawi and northern Mozambique were struck by the largest floods in a generation. This caused almost 200,000 people to become homeless. Now there is a cholera outbreak further worsening conditions. This was in largely rural regions were people are farmers and depend on their livestock for their income. They don't have bank accounts so often their “money in the bank” is in the form of cattle and goats. Little veterinary care reaches these areas normally and none has occurred since the floods. Recently LSPCA (Lilongwe Society for the Protection and Care of Animals) in conjunction with HSI (Humane Society International) and WTG (Welttierschutz Gesselschaft) went south to figure out what they could do to help those affected by the floods. Some districts were being helped but no relief had gone to Balaka, Zomba, or Machinga agriculture districts so this is where our attention was focused.

Kathleen and I went down to Zomba on a Monday afternoon via minibus. Public transportation is always an adventure in Africa. The bus does not leave until every seat has been sold and by that I mean there are 5 people for every 4 seats. The drive takes about 4 hours in a car but it was closer to 7 hours in the bus and that was without any breakdowns. We talked to someone else a few days later that went the same route and it took them 14 hours with 2 breakdowns. We met Jender in Zomba. Jender is the project coordinator at LSPCA for the Disaster Relief and he had already been down in the Balaka and Zomba districts for a week. We ended up working in Zomba for one day and in Machinga district for 3 days.

Kathleen and I have always been interested in and talked about doing some sort of relief work in Africa. This turned out to be out first chance where we were able to actually do this. The plan was that LSPCA and its partners would supply the drugs and the Malawi government through their agriculture field offices would supply some manpower and get the farmers and villages organized. The diseases mainly effecting the animals were the sorts of things that occur after too much rain. Foot Rot, Lumpy Skin Disease, and especially intestinal parasites were at high levels. The poultry in this area is also periodically effected by New Castles Disease which tends to kill most of them. The plan was to deworm as many animals as possible, treat the ones that needed it with antibiotics, manage any wounds, and vaccinate the poultry against New Castles Disease. Each district is broken down into different EPAs (Extension Planning Areas). We would visit a different EPA each day. Some people would go through the villages door to door on bicycles or motorcycles to vaccinate the chickens. This is done by placing a drop of I-2 vaccine in their eye.
Vaccinating a chicken                     
While they did this Jender, Kathleen, and I would go to the local dip tank where there would be a cattle chute where we could treat the cattle. Large herds of goats would also be gathered there to be treated. Goats and sheep were given oral dewormer.
Deworming a goat                    
The cattle were injected with ivermectin and if they had other problems then I would figure out what needed to be given. When we would first arrive we would often meet the local chief (often a woman) and the head of the herders association.
Village chief thanking us                      
Some of the herders were very organized and worked together as a team. The cows were moved through the chute efficiently and we were able to treat all the animals. Other EPAs were each herder to himself and it was harder to treat as many animals.  We didn't like the way they would hit them with sticks at times and would occasionally make suggestions on how to move them in a less violent way.
Herders making a plan on how to treat
Examining the cows in the chute         
Too much hitting going on                    
Loading the cows into the chute           
Jabbing cows                                    
Over the course of the 10 day intervention we managed to treat 2172 cattle, 37963 goats, 1453 sheep, 1871 pigs, and 34513 chickens. Our goal beyond treating as many animals as possible was to also help the local AVOs (Assistant Veterinary Officers) and AHSAs (Animal Health Surveillance Assistants) improve their techniques and skills. It was also to start more regular veterinary care by starting treatment now but then leaving additional drugs for future use.

To get to these areas would involve driving 2 hours down a “road”. It would start as a dirt road, become a dirt track, and by the end of the road we would be jeeping the car down a path the width of a bicycle.
View out the windshield of "the road"
The bottom of the car would scrape along some of the ruts and there were several streams and big puddles we had to cross.
One of the "puddles"                          
When it rained the road became a muddy quagmire that we would easily get stuck in. The car we had was not ever designed for this type of terrain.
20 minutes of rain was a problem                
Carrying supplies in past washed out bridge
Along the way we would pass multiple tiny villages and scattered farmhouses. Corn fields were everywhere but we also saw rice paddies, beans, zucchini, and tobacco being grown. Some of the villages were near big lakes where people fished for a living.
Typical farm dwelling                     
Drying fish at Lake Chilwa             
Along these roads we would pass refuge camps for the displaced people. Most were living at the local schools so the children have not been able to learn since the rains began. Many of these families lost everything they owned and now have only one blanket and some food relief provided by the government and NGOs. Rotary International and an organization called Shelter Box were setting up large tents for people to move into so that they could have some privacy. Once the rainy season ends in the end of April/beginning of May then the people will go rebuild their houses.
Shelter Box tents at a refuge camp
In one tiny village we passed through there were three funerals that day. A cholera death where the person had gone from healthy to dead in just over 24 hours and 2 malaria deaths. We passed some houses of natural healers or “witch doctors” who are often the only type of medical care in some of these areas.
A natural healer we met
There was one school that we passed that was still in session. We saw that there were children outside sitting under a tree with a blackboard. I had seen this sort of thing in National Geographic before so we stopped to take a look in real life. This had the effect of pretty much disrupting the entire school.
Outdoor classroom                     
The headmaster came out to see what the commotion was and ended up giving us a guided tour of several classrooms. The school was horribly overcrowded which is why 3 of the classrooms are outdoors. If it rains then there is no class. The indoor classes had up to 160 children in each class. The would sit on the floor and there was pretty much no way to get any more kids into the room.
Typical overcrowded classroom
Jender was able to translate for us so we were able to have some fascinating conversations with people. Jender always liked to ask people if they had seen Mzungu (white people) before. Often the answer was that they had seen one once or twice but had never spoken with one. They would ask if there were poor people in America and we were asked if a person in America makes more money does it mean that someone else makes less? Children would scream, point, and chase after us. The adults were more subdued but would still come out of their houses to stare and wave. Herders would want to shake our hands and thank us for coming so far to their country.
Kids chasing the car              
The living conditions were rough. It was good that we had been traveling through many developing countries by this point because it did not faze us. Our hotel had no toilet seat, no running water (you poured water from a bucket into the toilet), and to turn the light on/off you had to screw the light bulb in and out of the socket. The mosquito nets had holes the size of a head. Not a mosquito head. A human head. There was only one restaurant in town that would have had most westerners skipping food. We would often have to go buy the food in the market and bring it to the restaurant to be cooked. It was better if you didn't look in the kitchen to see where the food was being prepared. Kathleen and I must have pretty strong gastrointestinal systems at this point because we haven't gotten sick despite questionable water and cleanliness conditions.  We still plan on deworming myself when I get back though.
The local eatery
The week flew by. I almost felt guilty that I was having so much fun since the situation that these people were in was not a lighthearted scene. It did feel like we made a positive impact to the people we were able to help. We were thanked by everyone (herders, local agriculture staff, village chiefs, etc) and we could see that by helping their animals that we were helping the people since there is such a close connection between the two. Kathleen and I hope that at some point we will get another chance to help like this again. It was quite the powerful experience.

Sunday, March 8, 2015

World Spay Day - Malawi

For the last month Kathleen and I have been residing in the capital of Malawi, a sleepy town called Lilongwe where we have been volunteering at the LSPCA – the Lilongwe Society for the Protection and Care of Animals, an organization that is working on multiple levels within Malawi. Some are at the national level: They are currently working on an EU initiative on tightening guidelines for Animal Welfare at slaughterhouses and Better Training For Safer Food. They have helped the Malawi government start enforcing the animal cruelty laws and now the first convictions are trying to stop the roadside puppy mill trade. They are helping with fighting the poaching and ivory trade in the region. This organization also helps on the local level: There is community outreach done where LSPCA education officer(s) visit primary schools to teach children about animal welfare. They run a clinic where clients can come with their animals for veterinary care and vaccinations. There is a charge for this service. They also perform free spay/neuter and vaccination clinics in the poor parts of the city. They also do a monthly large animal clinic and are hoping to soon start a program for donkeys to teach people how to take better and more humane care of them.

Malawi has really stoked Kathleen's fire. She has on numerous occasions claimed this is her “happy place”. She is involved in many of the projects going on at LSPCA and has fallen in love with her typical “day at work”. In the mornings she has been teaching at the primary schools how to provide the basic needs of animals and the 5 Freedoms of animal welfare: Freedom from Fear, Freedom to express natural behavior, Freedom from discomfort, Freedom from hunger and thirst, and Freedom from pain, injury, and disease. She also teaches a bit on animal behavior, rabies awareness, signs and symptoms, and tips on prevention. In the afternoons, she often visits the Animal Kindness Clubs at the schools, encouraging the children to continue learning and practicing compassion towards animals. There they use dance, poetry and debate as medium to celebrate and teach animal welfare objectives. Kathleen has also been briefed on the animal welfare slaughterhouse legislation and plans on visiting slaughterhouses later this month. Most recently, Kathleen has joined the Triathlon Committee and is taking the lead on behalf of LSPCA on fundraising for the event which will take place in April.
Kathleen teaching Animal Welfare
My role is more simple. I am here as a veterinarian. I help run the hospital along with the resident South African vet Robyn McCann. Since we are staying at the accommodation on the shelter grounds I also am the after hours emergency vet. Every Tuesday and Wednesday the vets go out into the communities around Lilongwe and do a free spay/neuter clinic. Rabies vaccination and some basic veterinary care is also provided. These are very poor areas and the conditions are primitive. Basically we are doing surgery on folding tables under some trees in a dirt square. People will be lined up with their dogs on chains, wires, and ropes hoping to get them neutered or spayed. The majority of the dogs are medium size short hair brown dogs – the generic Malawi mutt. They are pretty adorable but many of them are not socialized and they often get into fights amongst each other as they wait.
Publicity banner
This last week was World Spay Day which the LSPCA stretched into 3 days to maximize the effect. Our good friend and vet colleague Amanda McNabb heard about what was going on and with less then 2 weeks notice managed to completely change her work and bike race schedule, gather up 2 suitcases of donated medical supplies and donations for an orphanage Kathleen has visited, and through a GoFundMe campaign raised a bunch of money for supplies toward stocking the shelter. We were incredibly impressed with the generosity of our friends and veterinary community that helped out. Drugs from multiple clinics as far away as Wisconsin helped give what they could. Amanda showed up on Monday, did a ton of surgeries for 3 days, held the hospital down for a day while Kathleen and I went to renew our visas, and then went and enjoyed the spectacle of the first Malawi Veterinary Association meeting since 2013 before leaving the next day. It was fun having a friend come visit again so now Amanda is tied with Dan Sears and Seth Wolpin for meeting up with us twice during World Tour (though Seth still has the lead since he spent a grueling 3 months with us hiking across the Himalaya). Over the course of the three days 221 animals were spayed and neutered. Each day there would be a couple of hundred dogs waiting as we pulled in. Many people stood in the hot sun for a full day or more hoping to get the surgery performed.  The recovery building was piled up with dogs waking up from anesthesia.
Standing in line all day                                     
Recovery - this building actually collapsed the next week
Dogs recovering from anesthesia                    
There were also vets from Uganda (the head of LSPCA Richard Ssuna), South Africa (Robyn), England, Zambia, and a Finnish vet that lives and works in India. On the first day we even had two Dutch vet students drop by and we rapidly put them to work. A large group of Malawi veterinary para-proffesionals (vet techs and assistant equivalents) helped us out by monitoring patients during surgery and recovery, inducing and prepping for surgery, and in helping with the registration and crowd control.  Kathleen used her old human clinical medicine skills and found that dogs aren't that much different to monitor.  Dozens and dozens of children would gather and watch. At the end of the days they would get very excited when cameras were taken out wanting to get their picture taken. They always loved to look at the screen to see themselves. High fives were also popular and Amanda taught some of them how to do exploding fist bumps.
Elona and Amanda doing surgery      
Me yelling at Amanda to work faster
The children were fascinated            
The team                                           
There were some sad moments and some great moments. I had to put down a suspected rabies dog that was hypersalivating, neurologic, and acting strange according to the owner. In the afternoon of the third day I saw two elderly men sitting on a wall with their dogs. They had been waiting for a long time. At least all day if not since the previous day. I found that they were number 2 and 3 on the waiting list for females to be spayed. I promised them that I would get their animals done next. I injected the next 3 females with xylazine to sedate them. After I did this I would place a piece of tape on their head with their estimated weight. One of the grandpa's dogs did not want the tape, freaked out, slipped out of its leash, and took off running. The dog ducked under a fence and disappeared with the poor man chasing after her in the hot sun. I was really bummed. I had wanted to help him and now his drugged dog was loose in the town. Fortunately after about 20 minutes he came back with his dog reattached to the rope. The dog was still able to walk but just barely. 40 minutes later he had a spayed dog and everyone was happy.
Sedating dogs with xylazine
We want to give a HUGE thanks to all our friends and colleagues who helped out with supporting World Spay Day. This type of activity has a real impact on peoples lives here. Rabies kills a scary number of people here. A regional hospital where Kathleen and I were at for flood relief had 10 confirmed rabies deaths last year and they thought that there were many more in the villages where people did not seek health care. In Lilongwe 2 weeks ago a woman and 4 month old baby were attacked by stray dogs and the mother was killed. This also is not an uncommon occurrence. Vaccinating and trying to control the dog population helps save human lives also. Many Malawi at spay day thanked me profusely and that thanks goes back to the sponsors that helped make it happen. As they say here, Zikomo!