Global Health Vet – A One Health approach to public health

It’s nice to get back out there and do some more international work. After all, this is globalhealthvet and I was looking forward to gain new experiences promoting veterinary public health abroad. I got exactly what I wanted a few weeks ago when I went to Nicaragua, on a student-led initiative to promote veterinary care on Ometepe Island.

This trip was organized by veterinary students from the International Veterinary Student Association (IVSA) chapter at Oregon State University for the 5^th consecutive time and this year, the group included 30 veterinary students and 8 veterinarians.

Ometepe Island, which is on Lake Nicaragua, is home to 35 000 inhabitants who rely heavily on agriculture for survival. In this rural environment, there can be limited access to veterinary care and a large part of the animal population has not received basic treatments. After taking a ferry to the island, the group was driven in small buses to Hacienda Mérida, which is where the clinic was set up. It was obvious from the ride through the island that people of Ometepe were living in remote conditions and that they did not always benefit from amenities such as telephone or paved roads. This is has a strong impact on health of both the people and their animals as medical care may not be readily available.

Ometepe Island, with its 2 volcanoes: Concepción (left) and Maderas (right)

The trip lasted for 7 days and the clinic was set up in a shed on the hacienda’s premises. Students were responsible for bringing supplies such as medications, centrifuges and microscopes. Fortunately, a lot of the supplies from previous trips was stored at the hacienda.

During the 7-day trip, a total of 774 patients were treated: 272 small animals for wellness exams/90 surgeries; 159 large animal patients/17 surgeries; 343 animals seen on farm calls by the mobile unit

Once up and running, the clinic consisted of several different stations. Personnel at intake was responsible for triage of patients as well as basic history. Small animals and their owners then moved on to wellness examinations, performed by students. There, the patients had their blood drawn and basic medications were given depending on abnormalities found on physical examination. Every animal also went home with a 6-month supply of deworming medications as well as flea/tick preventive. Blood samples were analyzed under the microscope for proper platelet numbers (a sometimes challenging job, as the humidity degraded the slides rapidly) and several SNAP tests were available to diagnose blood-borne pathogens such as heartworm or Ehrlichia. If patients were deemed healthy enough for surgery, they moved on to the induction station where all the proper medications were prepared for the upcoming operation. Surgeries were performed the same day and patients went home after recovery. This was very much student-led and as veterinarians, we were there to provide advice to students and help out if needed.

There was also a significant large animal aspect to this work and farmers would bring donkeys, horses or pigs to the clinic for treatments and surgeries. Finally, a mobile team was also able to travel throughout the island and provided a unique way to care for animals that were unable to come to the clinic, usually cattle herds.

Veterinary students performing wellness examinations

On the small animal aspect, most patients presented with severe malnutrition, emaciation, intestinal parasites as well as fleas and ticks. Our canine patients often had generalized lymphadenopathy, which can be a sign of underlying infections like Ehrlichia or Leishmania, both present in this region. Due to the limited diagnostics available, a specific cause for disease was not always evident however, animals requiring antibiotic treatment were given appropriate medications. It is likely that the patient’s poor nutritional condition exacerbated some of the underlying diseases that they may have had and we were able to provide people with nutritional supplements for their animals. It is also important to remember that most infectious diseases seen during this trip were zoonotic, and treating the animal definitely helped reducing the chances of human infection. In total, 90 surgeries were performed, mostly spays & neuters in dogs and cats, although other procedures included an abdominal hernia repair in a puppy or an enucleation in a chicken (all successful, great job students!).

On the large animal side, the focus was also on parasite treatment and prevention, but also surgeries like equine and porcine neuters. The mobile team also performed field treatments and pregnancy checks in cattle herds.

The mobile unit allowed us to treat cattle herds throughout the island

The students did an amazing job organizing this trip to Nicaragua and showed impressive ability to work in conditions that can prove challenging (which included an earthquake during the clinic). This trip represents a great opportunity for them to practice their skills with a hands-on approach and recognize the impact of veterinary medicine in developing countries; they will no doubt make great veterinarians.

Working in remote areas of Nicaragua, but also Peru and Morocco, I have seen the impact of neglect on the health of animals. It is important to remember that in a country where people are struggling to survive, promoting animal health does not always take

Flyers I made about leptospirosis & taeniasis – Community-specific education should be a key part to any public health program in developing countries.

precedent. It is obvious that principles of One Health in these places go beyond the management of zoonotic disease. People depend on their animals for survival and poor conditions or disease in a herd of cattle can greatly impact revenues of the farmers, and thus their health. Therefore, a crucial part of working in the developing world is education. Veterinarians and other health professionals should educate people about the impact of animal health on their own health, whether it is about zoonotic diseases prevention or promotion of healthy food animals that will be able to produce more for the farmers.

It was great to have the opportunity to steer the public health discussion (speaking Spanish helps…)

Following this philosophy, our trip to Nicaragua had a strong educational component and I was asked by the organizers to participate in a public health session for those attending the clinic. Working in a place with a different culture and language can sometimes create barriers when trying to explain public health concepts and therefore visual aides can prove to be very helpful. To this end, the students and veterinarians had designed a couple of posters outlining these concepts and I designed informational flyers about 2 diseases commonly seen in Nicaragua. The discussion was very well received and had great participation from the attendees.

This trip is a great example of how a motivated group of people can organize a successful and long-lasting global health program that has a big impact on a local community. This was organized by veterinary students from OSU, who were able to secure funding and supplies, and has been successful for the past 5 years. I had a great experience during this trip, learned a lot and I definitely hope to be able to participate in the next trip in 2013.

The entire Nicaragua team! Thanks to Hacienda Mérida and all the students from OSU for making this experience so awesome (Image source)