Equine practitioners Imogen Burrows and Claire Hodgson went to the Gambia as part of an XLEquine initiative to provide CPD for local vets through the country's Department of Livestock Services
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WE had been invited to the Gambia to help improve veterinary knowledge and care for working equids as part of an XLEquine initiative. We were to support local vets and Department of Livestock Services (DLS) officers by providing a three-day practical programme of CPD focusing on core clinical examination skills, infectious disease and biosecurity, and wound care and parasitology.
XLEquine had developed the idea with Heather Armstrong, a director of the Gambia Horse and Donkey Trust (GHDT), to offer biannual CPD meetings. Having agreed the topics that should be covered, we were given free rein to write our lectures and design practical workshops.
Once we arrived in West Africa, we fine-tuned our plans to suit the facilities and equipment that were available. Not only had we not been to the Gambia before, but it was the first trip of this type that either of us had made; it was quite an adventure and we have already discussed the possibility of making another trip.
Initially we stayed at the GHDT's property in Banjul to finalise our plans with Dr Duffeh of the DLS. From Banjul we headed about 160 miles inland to the GHDT's hospital at Sambel Kunda in the central river region, breaking the journey with a visit to the charity's new hospital complex at Makasutu. Despite using the new Gambian highways, the journey took nearly five hours.
Although we had spoken to colleagues who had been to the Gambia, we only had a limited idea of what to expect and soon discovered that Sambel Kunda is definitely real Africa. However, we were amazed at some of the facilities that were available to us – solar power provided electricity to charge our mobile phones and laptop, and running water was available (once the yard had been cleaned), although bucket showers were the norm. These were not heated, but when daytime temperatures are measurable on a rectal thermometer, this was not much of a concern.
Nowhere in the Gambia is further than 20 km from the country's River Gambia, so water is not in short supply, and this surprised us. Although we visited during the dry season when the pastures were sparse, we were pleased to find many of the animals in good condition, with some that would be classed as obese.
Presenting our CPD course was a great experience. The DLS officers and vets were enthusiastic, and there was no shortage of discussion and exchange of knowledge and advice. We found out as much as we could about the hospital's caseload and the common problems. It was a tough challenge to deliver authentic lectures and practical workshops to people who knew far more about Gambian diseases than we did. However, we decided to begin with first principles and then take a logical step-by-step approach, which was well received. We reinforced knowledge by focusing on adopting thorough clinical examination skills that can provide a wealth of information but are often overlooked.
The feedback from the course was excellent. The delegates were enthusiastic and had an insatiable appetite to improve their knowledge and practical skills. We found that the key was to leave enough time free for discussion, as the Gambian way is to share experiences, from which discussion follows naturally. This meant that we had to be flexible with timings and topics. We also ended up delivering short lectures on, for example, the diagnostic approach to the colicking equid, the neurological patient, fracture management, euthanasia, etc – and the delegates were keen to suggest a list of topics for the next meeting, making future planning easier.
We also provided veterinary care in the village. We weren't sure what equipment or drugs would be available, but we were pleased to find a good range of both, including bandages and suture materials. We were told that stock levels can fluctuate widely according to donations and the availability in the markets.
Solar power at the hospital even allowed us to carry out abdominal ultrasonography on a patient that was urinating blood. Although people had generously donated items such as an endoscope, obtaining the necessary disinfectant cleaning solutions could be tricky.
We took it in turns to work with hospitalised patients, or to head out to the towns and villages to run field clinics. We were astounded at the number of people who brought their animals along, and were consistently impressed by the number of animals that were presented purely for health checks and routine care such as tick removal, dental care and deworming, as well as returning for follow-up appointments.
The vast majority of patients were donkeys and horses; however, we also had our fair share of calvings and sheep and goat cases. We were even asked to provide medical attention for some people.
One of the highlights of the course, and the only thing to start precisely on time, was the ‘delegates v GHDT’ football match. The delegates had a larger squad with greater stamina, which meant a DLS triumph, but GHDT team training is under way for the rematch.
Practising veterinary medicine in one of the poorest countries in Africa is a challenge. There are no luxuries, and it is amazing how inventive you can become. That said, it is a hugely grounding experience and brings you back to working from first principles. Focusing on the information gained from the clinical examination of the animal in front of you is critical, as the history is often poor at best. We came away with a new found respect for the toughness of working equids and their ability to heal and survive in some of the harshest environments.⇓
The experience also reinforced just how much animals benefit from nursing care, especially where medicines are limited. Many of the UK's horses are kept as a luxury – a wonderful hobby – whereas in many countries they are integral to people's survival. Owning a working equid in the Gambia can increase a family's income by up to 500 per cent. As a consequence, euthanasia is a rare treatment, and working with cases that we would have felt were hopeless at home reinforced that there may be other options where long-term care and rehabilitation could result in a positive outcome.
The evolution of veterinary practice is something we take for granted. The availability of simple luxuries in veterinary practice, such as the ability to run blood samples, unrestricted analgesia and next-day drug deliveries, make our case management smoother, give us the ability to make rapid and often definitive diagnoses, provide appropriate treatments and improve not only individual outcomes, but the duration and, most importantly, the quality of life for the animals under our care. Grounding ourselves within our professional field, and reminding owners of the global situation equids face, is no bad thing.