WVS Trip to The Gambia, 2-9th July 2004
The Team
Robert Christley
Gina Pinchbeck
Nick Bell
Aims of the project
- Training of staff at the Gambian Horse and Donkey Trust (GHDT)
- To assist with basic veterinary care and advise the staff of the GHDT about cases seen on the trip.
- To supply some drugs but also to help source drugs in the Gambia
Summary of the week’s itinerary
Fri – arrived, meal with Chrissy Foley (manager of GHDT) and Stella Marsden (co-founder of GHDT)
Sat - Travel up river to base camp at Sambel Kunda
Sun – Visit Mamoud Fana Lumo and treat presented animals. Stopping at numerous villages (Brickamaba, Madina, Patteh Sam, Njie Kunda) on the journey to and from the Lumo. Using clinical cases to train staff.
PM. Training at GHDT base.
Mon – Visit Wassu Lumo and treat presented animals. Meet with Marabou bone healer to discuss case and help persuade owner to euthanase a filly with a fractured tibia.
PM – training at GHDT base.
Tues - Training at GHDT base. Revisit a couple of horses.
Wed – Travel down from Sambel Kunda to Komos. Stop at the Presidents compound at Kanali and treat horses.
Thurs- Visit Gambian Veterinary Council and give a lecture. Visit pharmacies and 5 horses currently owned by the Tourist Board at Kaloli. It is likely that the ownership of these horses will be transferred to the GHDT very soon.
Fri – Visit president’s stables at State House Banjul
Training Sessions
Staff attending the training sessions included:
GHDT staff: Cherno, Bubakah, Satala, Mbalow, Gibby, Abdulie, Chrissy Livestock assistant: Saloum attended some of the training and came on Lumo visits with us.
Government soldiers: Joof, Mussa Ba, Bojang
The following training sessions were given at Sambel Kunda:
- Clinical examination of the horse (and donkey). Including, heart rate, respiratory rate, normal respiratory sounds, examining mucous membranes and capillary refill times, gut sounds etc
- Dehydration and fluids. Explanation of how fluids are lost in the horse and how much and how often horses should drink. Detection of dehydration by clinical examination. Discussion of oral rehydration therapy. Discussed the need to inform owners regarding provision of adequate water.
- Anatomy of the fore and hind limb, with reference to wounds, tendon lacerations, fractures etc.
- Basic hygiene and animal care. Including Zoonosis and infectious diseases
- Wound management of the fresh wound, including; identification of structures that may be involved, cleaning and lavage fluids that may be used, and bandaging techniques.
- Treatment of proud flesh.
- Endoparasites. The basic life cycle of gastrointestinal worms and their treatment. Mention of some other non-gastrointestinal parasites, such as lungworm and Habronemiasis.
In addition to the above training for all staff of the GHDT and the 3 army soldiers we were also able to demonstrate to Chrissy how to pass a stomach tube for use in oral rehydration and how to trim proud flesh.
It is worth mentioning that Chrissy obviously has a lot more knowledge (both veterinary and husbandry) than the other staff. Hence, future training sessions should probably be geared to the other GHDT staff with individual short sessions for Chrissy on any subjects or skills she feels she needs. On this trip we had numerous discussions on fractures due to tethering or other injuries with Chrissy. We were unable to demonstrate Robert Jones bandaging and splinting due to a lack of bandage material at GHDT. We left notes regarding this, but this should be covered again in a future workshop when materials are available.
Neurological cases
We were also able to demonstrate neurological examination and localising a lesion on a neurological case seen at Wassu Lomo. This case had fore and hind limb ataxia but normal cranial nerve function. However, whilst we were able to localise the lesion, we were unable to make a specific diagnosis.
We heard from Chrissy, Saloum and attendees of our talk at the Veterinary Council about a neurological disease of horses that appears to have emerged in recent times. The neuro-anatomical location and cause of this condition is unknown. Generally reported signs include progressive hind leg paresis leading to paralysis (often rapidly, over a few days) in usually fit and well-conditioned horses. The horses continue to be bright and to eat. Typically there is no obvious evidence of forelimb or cranial nerve signs. Fever is not reported. Some people reported that the horses become “tucked-up” in the abdomen, due to tensing of the abdominal muscles. Other signs reported by some people in some cases include circlingand muscle stiffness of fore and hind limbs.
One reported case occurred a day after treatment for Trypanosomiasis. However, no other cases were associated with such treatment. It seems likely that at least some of the reported cases may be due to more than one condition. Clearly this problem needs further investigation. Ideally, a case may be available for examination during one of the planned veterinary visits to GHDT. However, if possible, a video recording of a neurological examination of a case should be collected. Furthermore, arrangements for a post mortem examination (including examination of the neurological system) should be a priority. We are unsure where such an examination could be performed – perhaps at the ITC or Agriculture department.
Ophthalmology Cases
We saw numerous ophthalmology cases many involving corneal ulceration, both in adults and foals. Most cases were associated with old injuries, although some acute ulcers were identified.
The proper kit for examination of eyes was not available (for example no ophthalmoscope, flourescin or atropine). The next trip should included a training session on ophthalmology with staining of ulcers, how to treat them etc. It would very useful if an ophthalmoscope could be taken on the trip to allow more in depth examination of these conditions. We believe the majority of eye cases are likely traumatic (e.g. from inappropriately made blinkers or rough fibre) and that priority should be given to training regarding the recognition and treatment of such conditions.
Trypanosomosis
This is definitely a problem around the area of GHDT as Chrissy has taken samples to Bansang for definitive diagnosis and had positive cases. However, the GHDT are sometimes treating horses for Trypanosomosis, which don’t have obvious clinical signs, other than weight loss (the owners often present their horse reporting it has Trypanosomosis as it is a disease they know of). As the ITC laboratory is several hours away, it is impractical to sample every horse prior to initiating therapy. This is an area that will benefit hugely form the provision of an in-house lab. Testing horses presented for treatment of Trypanosomosis in order to estimate the proportion of animals treated that actually have trypanosomosis would be useful, as would a proper prevalence study in the regions around GHDT. This is possibly something that an MSc student or a veterinary undergraduate student on a “summer studentship” could do as their research project. Liverpool University has a number of such posts funded over the next few years. It may be possible for one of these to be provided for such as project. In the mean time, gaining access to unpublished data from the ITC would be of great benefit.
Dehydration
We saw a number of horses (dramatically fewer donkeys) that had clinical signs of mild to moderate dehydration. Although often thin, no other abnormalities were detected in the majority of cases. It seems common practice to only give water twice daily and problems associated with infrequent provision of water were covered in a training session. However we felt the provision of water troughs or buckets of water at the Lumo sessions would set a good example and would also give the animals a midday drink. This would be a good place to display posters (see below) and for GHDT staff to discuss water access with owners.
De-worming
In regard to the ILPH recommendation that “routine de-worming of clinically normal animals in the dry season should be ceased until a proper sustainable worming policy has been agreed” we found no evidence of routine de-worming of clinically normal animals by the GHDT. Currently Chrissy and her team are de-worming on the basis of poor body condition and those horses that according to the owners have never been de-wormed in their life. We think this is entirely appropriate until parasitological surveys are conducted that may inform alternative parasite control. There is also some limited evidence (reports of seeing voided worms after GHDT de-worming but not after previous de-worming treatments of the same horses by others) that the de-wormers used by livestock assistants may be ineffective, possibly due to inappropiate dosing.
Sourcing of drugs
We were able to visit a couple of pharmacies in the Kombos. The veterinary pharmacy was very poorly stocked. However Chrissy had located an extremely useful and helpful human pharmacy, which allowed us to wander around and examine products. We were able to source appropriate bandage materials and cotton wool, povidone iodine for use as a disinfectant and as a treatment for various skin conditions, and a supply of tablet form of potentiated sulphonamide which would cost approximately 12 pence per dose. This pharmacy also indicated it would be willing to order drugs (including veterinary drugs) directly for GHDT. A list of all currently stocked human drugs, and their price, has been brought back to UK for future use.
Staff at the GHDT are also growing their own Aloe plants. Sourcing a cheap recipe for making this into wound ointment would be useful.
We recommend that the GHDT, with our help, develops a list of essential drugs and supplies that should be kept as stock by the GHDT. Local sources of these should be sort and, where not available, priority given to importation of these supplies by visiting WVS and other people.
Visit to the President’s horses
The 3 stallions at Kanali were in good condition. However the mares and foals, and donkeys, were in poor condition. Several had severe skin problems, possibly ringworm with overlying bacterial folliculitis in a couple of horses. A donkey had a severe wound that had been left untreated. It seems there is a real need for a knowledgeable horse manager here who can take advice from Chrissy. Kanali is several hours away from GHDT base and can be visited by Chrissy only on an intermittent basis. Chrissy had visited a few weeks previously and left treatment which appears to have been wrongly administered.
There was some discussion of a scheme the president wished to set up which involved purchasing 200-300 donkeys then loaning, or giving, these to local people to work. Whilst this is a generous gesture by the president we felt it would be inadvisable at present until a proper, knowledgeable horse manager could be employed.
We were also asked to advise on some wildlife they have here (specifically a Puma and a leopard). We advised that we would seek assistance from someone in WVS who had more knowledge of these species.
The horses at State house in Banjul were in very good condition and it seems dramatic improvement, following Chrissy’s advice and the provision of a budget for these horses, has been made here since February.
Lecture to the Gambian Veterinary Council
We were asked to give a lecture (on any topic) to the Gambian Veterinary Council.
We each chose speak for a short period
Rob Christley spoke about veterinary training in the UK
Gina Pinchbeck spoke about research at Liverpool University
Nick Bell spoke about the role of WVS and other UK equine charities
The lecture appeared to be well received. The vets highlighted the neurological problem that Chrissy had already mentioned.
They also highlighted their concern about lack of funding for training Veterinary surgeons from the Gambia. Unfortunately we did not know of any charities that will fund UK training of undergraduate veterinary surgeons from overseas. The introduction of equine training on the Livestock assistant’s (LA) course was discussed and will improve knowledge, however the lack of appropriately trained Vets and LA’s is obviously a problem.
We also discussed research projects and the possibility of forming links with Gambian vets to obtain funds for PhD training or research projects.
A researcher also brought to our attention some prevalence studies on equine Trypanosomosis and internal parasites, which are unpublished but are in an ITC working document.
Future
In terms of training courses for the future we would recommend that a curriculum for training be developed. This should outline all the topics to be taught, preferably with learning objectives for each. This curriculum (which may need updating from time to time) could then be used by all visiting trainers (with records kept by Chrissy) in order to avoid duplication and omission. This should also help GHDT staff identify key skills and knowledge and facilitate reinforcement of these between training visits.
In the mean time, recommended areas for future training include:
- Restraint of horses
- General horse care
- Body condition scoring
- Examination and treatment of eye conditions. (Take a kit)
- Ageing of horses and donkeys
- Splinting and bandaging
- Dermatology and skin care
- How to suture wounds (selected participants only)
- Trypanosomosis and other diseases.
- Training in lab techniques if lab in place
Posters
We felt the teaching of some of the above subjects would be helped by the use of posters (preferably laminated) that can be left at GHDT. These may need to be purchased, but may be sort as donations from drug companies, feed companies and so on. Examples may include posters illustrating the anatomy of the limbs, head, eye or gastro-intestinal tract, or which illustrate ageing horses and donkeys using dentition.
The livestock assistant Saloum and ourselves briefly discussed the possibility of using pictorial posters (preferably purely based on illustrations, or if not, in the local languages) at the Lumos and villages in order to educate owners on simple husbandry such as water provision, tethering, harness etc.
Database
Currently paper records are kept of each case seen. Chrissy has a laptop and wants to start a database of records. We have a few suggested minor revisions to the clinical examination form, which we will discuss with Chrissy. Gina and Rob will design a database (probably using Microsoft access) to record this data and any additional data collected in the future (for example laboratory data). Such a database can be used to quickly generate reports, such as monthly reports of the number and type of cases seen, the drugs used and so on.
Laboratory
This should be a priority. We understand that a microscope has already been acquired. Other needs include a centrifuge (preferably hand cranked?) and refractometer.
If this equipment can be acquired for the next visit then a training session in lab techniques should be organised for the next trip. This should include techniques for staining and recognising Trypanosomosis and Babesia, how to estimate packed cell volumes and total protein, Diff-quick stain for differential white cell counts and faecal worm egg counts.
We feel it might be best to train 2 or 3 GHDT staff in these techniques rather than all staff, although we leave this to the discretion of the GHDT. One member of the staff, Mbalow, already has lab experience from his work at the ITC centre in the Gambia.
Vaccinations
We did not see any African Horse Sickness whilst there but this obviously remains a potential problem.
Further enquiries should be made regarding the incidence of tetanus in horses and donkeys in the Gambia. Vaccination against tetanus is rare, and given the worldwide occurrence of tetanus in horses, it seems likely that sporadic cases do occur. We thought that the army and president’s horses should receive tetanus vaccination and that consideration be given to instituting a wider vaccination campaign (particularly once the planned horse and donkey identification programme is up and running). It is possible that some of the neurological cases mentioned could be tetanus.
General
Chrissy and the team at the GHDT are doing a fantastic job and have undoubtedly already made a difference to the health of horses and donkeys in the area. They were very well received in all of the villages we visited and appear to have already gained the respect and trust of the local people. The local people have a real willingness to learn and take advice, which hopefully means that this project and any future education programs should have long-term success.
We would like to thank all at the GHDT for the kind hospitality shown to us throughout the time we were in the Gambia. We thoroughly enjoyed our stay and very much hope we get an opportunity to build on the work done so far.
