Training Veterinarians for Working Equid Care The New ......Equine practitioners are making a...

Training Veterinarians for Working Equid CareThe New Equitarians

Jay G. Merriam, DVM, MS*; Mariano Hernandez-Gil, DVM; Larry Kelly, DVM;David Turoff, DVM; Julie Wilson, DVM, Diplomate ACVIM;Paul Malonee, DVM, MS; and Adrienne Otto, DVM

Equine practitioners are making a difference, one working equid at a time, through education andcollaboration. Author’s address: Massachusetts Equine Clinic, 76 Locust Street, Uxbridge, MA01569-2203 (Merriam); e-mail: [email protected]. *Corresponding and presentingauthor. © 2012 AAEP.

1. Introduction

Despite the continued growth of our profession, vet-erinary care for the poorest working animals of theworld is inaccessible to most of them. The disparityof availability is a function of many factors includinggovernment indifference, lack of information, eco-nomic disparity, and the fact that most veterinari-ans are obligated to their own practices, families,and local economies. Yet, they are uniformly altru-istic and supportive of the provision of care for work-ing equids. Connecting altruism with such needsand translating this into actual work in areas thatneed it is a problem that we in the profession mustface. It has been apparent that changes in govern-ment agricultural policies to reflect the use of equidsin traction, transportation, and food distribution areslowly coming about. In many areas, the limitingfactors are disease, lameness, and malnutrition.Having appropriate veterinary care, consultation,and training is a way to alleviate this shortage.A training program for seasoned veterinarians toallow them to fill in short-term locums or projects isbeginning to show promise as a way to approach thisdisparity. The advent of the “Equitarian Initia-

tive” and the coining of a new descriptive word todescribe it will be discussed. This paper will dis-cuss an ongoing training project supported by a sev-en-organization collaborative and its ramificationsfor increasing availability of well-trained equine vet-erinarians for both short- and long-term projects.

Getting Started

Deciding to begin an Equitarian Project is often theeasy part of taking the first steps to see results ofone’s altruistic inclinations. Equine veterinariansare routinely motivated by a desire to help that isoften in conflict with the realities of making a livingprofessionally and building a practice. We areamong the last to be consulted in disaster situationsand are overlooked in the charitable world as unim-portant to the recovery of rural populations, yet wecan appreciate the importance of working equids tothe rural poor throughout the world. There are fewprofessionals as well qualified as we to assess andtreat these animals and, more importantly, to advo-cate for them as vital parts of most developingeconomies.

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WELFARE AND WELLNESS: IMPROVING THE LIVES OF HORSES AND VETERINARIANS

NOTES

Orig. Op. OPERATOR: Session PROOF: PE’s: AA’s: 4/Color Figure(s) ARTNO:

1st disk, 2nd beb dainop 10 2-7 3394

Taking the First Steps

Where do we, as equine veterinarians, go from here?What specifically can we do to help the workinghorses of the world? How can one begin a careertrack that allows one to expand one’s reach and stillpay a mortgage? What sorts of jobs are available?Are there short-term projects one can do? Howdoes one begin to develop a career path that willallow them to use their skills, either full- or part-time? Veterinarians are problem solvers, diagnosti-cians, incredibly hard working, and altruistic. Wesee through red tape, around and over obstacles, andcut to the core of problems. Many aid efforts areoften misdirected, duplicated, underestimated, andunderfunded. Many efforts are undertaken that,while sometimes heroic and possibly beneficial (de-worming and floating teeth on horses whose mainproblem is lack of food, lameness, etc), are missingtheir mark. Reprioritization and redirection willoften result from outside examination, consultation,or combining efforts of disparate groups. In theabsence of directed outside influence by governmen-tal bodies and an increasingly distracted public, it isup to private interests to step in, educate, and, inmany cases, organize effective action.

Looking at the Success of a Small Project

Many a small project has begun as a result of vaca-tion travel or tourism, where one sees first-handanimals being worked excessively to support fami-lies in need of any type of subsistence. My own“Project Samana” grew out of such an encounter andwas fueled coincidentally by the need to expand ourstate Veterinary Medical Association (VMA) reach,both to the developing world and to young practitio-ners who wanted more of an “activist” organization.Twenty years later, it has changed lives, hearts, andthe very health of our organization. The motiva-tions for undertaking this sort of work can be com-plex, but when done under the auspices of a stateVMA, it must reflect their values and direct its ef-forts toward the animals involved.

Preparing Yourself

Training for Field WorkAs an ambulatory and hospital-based clinician, Iwas pretty sure I had seen everything, every possi-ble situation. But the first castrations in Samanawere pretty scary! Bumping into a strand ofbarbed wire deep inside a scarred scrotum on a mulewho (understandably) hated the idea of being ropeddown for sedation, was a shock. Once the surprisewore off and we got ourselves organized, it becameeasier. There is only so much preparation one cando to be ready. We have just finished the thirdEquitarian Workshop in Tlaxcala, Mexico, and I rec-ommend it to any veterinarians contemplating aproject in the developing world. The EquitarianWorkshop addresses most of the questions I had noone to ask 20 years ago, such as cultural interac-

tions, animal welfare, diseases, and local needs.Field surgeries, internal medicine, and dentistry arepart of the curriculum.

Infectious diseases are only a small part of ourwork. Many governments are very careful abouthaving outside vaccines brought in and will not is-sue permits for them. We vaccinate only for teta-nus on our surgical cases, and even so have lost 2 ofthe 1000� we have operated. The government hasan expanding rabies program, but all of their otherefforts are directed at dairy and pork production.

LogisticsOur efforts began in 1992, when, as President of theMassachusetts VMA (MVMA), I joined with twoother members and initiated an exploratory visit toSamana, a remote peninsula in the Dominican Re-public. Our contact there was a young woman whowas a graduate veterinarian working part-time forthe government on Brucellosis control and with herhusband in a tourism enterprise. The locals couldnot support a private practice, and she expressed aneed to begin an animal control effort for the smallanimals and some basic health care for the workingequids. They were primarily used to pack coconutsout of the jungle, but there was a small tourismindustry beginning with beach rides and waterfalltreks. Few of these animals had body conditionscore (BCS) score above 3, and the tourists were toolarge for many of them. The transition from anagrarian economy was beginning, but it was painful.On that trip, we spayed and neutered about 80 smallanimals and de-wormed about 15 horses. More im-portantly, we made contact with several of the im-portant horse owners in the area and talked abouttheir needs. We also began planning to go to thecascada in El Limon, several hours into the hills onseasonably accessible roads, to see the “very thin”horses there. The waterfalls were a tourist attrac-tion but only accessible to really intrepid hikers.The main use for the equids was still packing coco-nuts, but if a tourist arrived and wanted to rent one,they were then made to do double duty. It took twomore trips before we actually made it up there be-cause of the roads. When we did, it was over-whelming. Groups of 50 to 100 smallish horses andmules (Fig. 1) were waiting for us as we adminis-tered ivermectina and listened to the various com-plaints addressing as many of them as we could.The demand for services was there, we just had tofigure out the logistics of treating them. However,we still needed community coordination and sup-port. The next year, we began a partnership withthe local office of a German eco-tourism group thathad formed a cooperative of horse owners and agentsto provide a higher level of tourist services and localnatural preservation.

Over the next 5 years, we were able to catalogeach animal, its BCS, saddle sores, and other prob-lems. We became the arbiters of welfare, and if wesaid an animal was too “flaca” (thin) to work or had

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a saddle sore, the owner was given the tools to rem-edy the condition and was re-inspected at 30 days byone of the agents before it was allowed back to work.

As our work increased, so did the effort of bringingin medications. We hoarded as much as my prac-tice could afford, sent out letters to clients for dona-tions, and began the process of forming a charitablefoundation within MVMA. That took 2 years, and,once formed, has been a source of support for thisproject as well as many small animal projects bothin the state and in our other international projects.

We have had considerable difficulty sourcing med-ications in-country, both because of price and avail-ability. This situation is getting better, and wenow get most of our ivermectin and antibiotics there.We no longer bring in all of our controlled substances,needles and syringes, and surgical supplies. Locallyavailable ketamineb is of variable quality and moreexpensive than in the United States but is used.

Services Provided

Parasite ControlThe most requested service for the working equids isparasite control. We de-worm every animal wetouch. This year, we are instituting a fecal eggs pergram (EPG) survey as a follow-up to one done on asmall scale 10 years ago. Our “regulars” are nowbeing treated at least twice yearly. Ticks are also ahuge problem, with horses most affected and burrosthe least affected.

SurgeryCastration is in high demand because it makes for amore tractable, tourist-friendly animal, not really anecessity for animals only used to pack produce.In the early days, we found a high percentage ofmules to be extremely hard to handle, but afterintroducing some of our local agents to imprintingtechniques, many of the mules are more tractable.Because we are there twice a year, locals no longerdepend on brute strength to restrain the patients.We also have put some of the traveling “brujas”

(witches) out of business. We use general anesthe-sia and a castration toolc on all cases now. Hernias,tumor removals, wound resections, and many otherprocedures are routinely done. There are numer-ous saddle- or equipment-related sores and infec-tions that require resection and debridement.

Initial Plans

The single most important factor in our success hasbeen that we have been there at the request of thelocal veterinarian and have worked for her eversince. She was knowledgeable but had receivedvery little clinical training and had never spayed adog or even given an injection to a horse. However,she had a vision that the animals needed better careand that it could start with her.

Our small team crowded into the outboard motorshop that her husband owned, set up a couple oftables, and started to work. She had been driving acar with speakers mounted on it through the bar-rios, announcing our presence, and it did not takelong to have a line waiting outside the door. Wehad only one spay pack, a few bottles of premixedanesthetic, and a lot of ivermectin.

Because she was a government veterinarian, shehad sent a letter to the authorities in Puerto Plata tolet us through customs. Our arrival and transpor-tation of medications were never issues. We hadseveral occasions to send such a letter if we werecarrying a lot of medications, but never once did itseem to make it to the level of inspectors. None-theless, there is an absolute need to abide by localregulations.

How Will You Measure Success?

There are often no good ways to measure success, atleast initially. A noticeable decrease in puppy pro-duction is not often visible early on. A measurableincrease in BCS can also be elusive. In the earlyyears, often the best measure of success is seen bythe locals, for example, equids are eating better,have more energy, and show modest weight gain andfewer saddle sores.

Another measure of success is in the type of casesyou will see. Now, it is not unusual to have horseswalked several days to one of our sites for surgery.With Internet access now available to our contacts,it is not unusual to get a picture of a laceration,lesion, or tumor for a follow-up consultation.

The formation of an association of horse ownershas helped to increase the local income, the carelevel of the animals, and the beginning of a routinefarrier presence. We sponsored a farrier trainingsession and started to send tools and supplies.

Step 1: Acquire Skills

Clinical skills and expertise get better with practiceand field training. Organizations working in devel-oping countries need skilled, practiced hands to per-form and teach the required procedures (Fig. 2).Dealing with a group of panicked horse owners in a

Fig. 1. Donkey and mule Souk in Morocco.



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show barn or racetrack, just exposed to horses withstrangles or Equine Herpes Virus, is excellent prac-tice for looking at and managing disease outbreakseverywhere. Searching for a bleeder, deep in awound on a recalcitrant horse, teaches patience,dexterity, and innovation. Never underestimatethe value of your acquired skills.

Step 2: Do Your HomeworkThe web is a resource without parallel. One’s vi-sion can only be enhanced by “visiting” sites andcultures via the Internet. There is no part of theglobe that cannot be explored. What are your tal-ents, and where do you think they would be bestused? A personal inventory is the first step. Whatis your motivation? “Saving the world” doesn’tcount. What are your skills (language, surgery,lameness, infectious diseases, nutrition)? Do youhave time preferences? Can you give a week, amonth, or a year? What are your financial re-sources? Can you contribute toward expenses, ordo you need assistance?

Step 3: Make a PlanLife comes at you in many interesting ways. Along-term career in practice or at a university hos-pital can morph into second careers in places asfar-flung as Mongolia, Latin America, or the deepestparts of the rural American West. In most cases,we do not actually plan for it, but we grow into it.Advanced surgical training can be applied and ap-preciated anywhere in the world. Many communi-ty-based groups and service organizations havenational or international reach. If you join them,make sure that they also have interests and goalssimilar to your own. Most do not have any ideawhat you do or what you can offer. Pulling humanteeth or de-worming children in a remote junglevillage may not be what you had in mind. Manygroups are ideologically directed, with services beingonly a “hook” to gain access.

Common traits of a successful project are asfollows:

● A local initiative: work cooperatively at theinvitation of the local community.

● Serve a predefined area to track a measurableimpact.

● Return regularly to build trust.● Have a clear and defined focus, “Medicine is

the Mission and the Gift.”

The success of any equitarian program is depen-dent on the following:

● Identifying the needs of a specific community● Meeting local needs with quality, culturally

relevant teaching materials● Taking time to establish trusting relationships

with veterinarians and owners● Following through with consistent teaching

and mentoring

The Equitarian WorkshopMost of one’s professional education is problem-based. Looking for solutions is only effective after adiagnosis has been made. Veterinarians with clin-ical and practical experience are usually world-classproblem solvers. There are many short-time post-ings and projects that allow such transitions andwill give satisfaction and an initiation into a life thatmay or may not work out as expected but will none-theless be rewarding. With this in mind, the au-thors developed a week-long Equitarian Workshopin Vera Cruz, Mexico, to provide clinical experienceand training in real-world communities that dependentirely on working equids (Fig. 3). The curricu-lum was designed to allow direct aid and trainingunder the supervision of experienced clinicianswhile reflecting on the welfare, cultures, customs,topography, and needs of the host communities.Each day’s work was preceded by several hours offacilitated discussion in a classroom setting. Thiswas followed by hands-on sessions at the host com-munities where animals were triaged, referred to

Fig. 3. Clinic day in Puebla.

Fig. 2. Teaching in Morocco; Drs. Merriam and Kay.



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appropriate specialist areas, and treated. The ar-eas involved were welfare, dentistry, medicine, sur-gery, farriery, saddlery, lameness, and pathology(biopsy, fecals, and hematology). Participating vet-erinarians, 28 from North America and 28 fromMexico, rotated through each venue in half-day seg-ments. Instruction was done by bilingual teamswho interacted with the owners and led case discus-sions and training. Many were faculty membersfrom Universidad Nacional Autonoma de Mexico(UNAM); others were practicing specialists in vari-ous areas. Post-workshop surveys and trackinghave shown a 95% satisfaction rate with the pro-gram and the spawning or expansion of many new orexisting projects.

DentistryVery few patients have ever had dental care. Theylive on local forage, receive very few supplements,and must fend for themselves in whatever environ-ment they live. The owners realize the need forcare, and the dental station is always the busiest.We utilize the community soccer goals as an over-head support and routinely have five or six casesgoing at once. We use and train with both powerequipment and hand floats, teaching techniquesthat can be utilized by local practitioners after weleave. The range of pathologies seen is immense:fractured teeth with impactions, hooks, ramps, andabscesses. Sedation is used extensively, but manycan be managed with only head restraint. Thetraining is done by experienced clinicians on bothintroductory and advanced levels.

Internal MedicineThere are many animals presented with a broad rangeof complaints that are related to weight loss, dyspnea,work intolerance, ocular infections, and a broad rangeof general illness. Workups are done with the limitedlabs available, but bronchoalveolar lavages, skinscrapings, and cytology are done on-site. Ultrasoundimaging is sometimes also available.

Surgical ServicesThe need for basic services is real. Routine surgicalservices include castration, saddle sore resection(Fig. 4), and tumor removals. Hernias, cryp-torchids, and miscellaneous dental conditions ac-count for the balance. Maintaining standards ofasepsis, preparation, and anesthesia safety are crit-ical parts of the learning process.

PodiatryA team of farriers in training and their trainersaccompany the workshop. Participants spend timeworking with and practicing routine trims and treat-ment of many pathologies.

Saddling and Harness FitThe World Horse Welfare group provides ongoingtraining and repair services to the animalspresented.

Welfare Assessments and Community PartnershipTraining owners and caregivers is a critical part ofour training. We have developed posters, pam-phlets, and participatory games for children andfamilies (Fig. 5). Animals are also assessed at in-take for BCS, equipment sores, foot and dental sta-tus, and general health. Fecals are collected, andexternal parasites are treated. Animals are thenreferred for appropriate care at the various stations.

Jobs Versus Real WorkThere are few jobs working with any of the variousagencies and organizations that we will discuss thatare suitable for recent graduates with limited expe-rience. There are many opportunities for seasoned,skilled professionals with appropriate backgroundand interests. On the international level, mostagencies are run by professional bureaucrats whohave worked their way up to a position of authorityand are in no way ready to cede it to someone withonly clinical skills. However, once one has proventheir mettle, it is possible to achieve a successful

Fig. 4. Saddle sore resection in Mexico.

Fig. 5. Children learning burro health care in Mexico.

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career path as a staff veterinarian in a foundation-sponsored hospital or as a consultant to govern-ments and Non-Government Organizations (NGO)such as the Donkey Sanctuary and World HorseWelfare. The armed services have a constant needfor career path veterinarians in health sciences.Disaster relief agencies and the United Nationshave similar needs.

Volunteer or “Voluntourist”?

Starting on a career path in equitarian work cer-tainly will involve stepping into volunteer situa-tions. There are many possibilities available, andthe Internet is the best place to begin searching.Veterinary students have access to a stunning arrayof such choices. Seasoned practitioners may be in-clined to participate in short-term, ongoing projectsthat also involve cross-cultural and touring aspectsrather than direct participation. These are also ex-cellent venues to test one’s adaptability to longer-term situations.

Goals and Outcomes

● New graduates learn adaptability, restrainttechniques.

● Work is done under primitive conditions.● Cultural interactions are invaluable.● Problem-based learning is the order of the day.

Needs for the Future

● Scholarships for new graduates.● Supplies and support from our partners.● Support for other organizations so that they

can do the same.● Educators to help owners become self-reliant

caretakers of their animals.

Decide on the Core Value of “Animal Versus HumanWelfare”

It is difficult to improve animal welfare if it does notimprove human welfare. One cannot improve hu-man welfare at the expense of or without improve-ment of animal welfare.d

If Not Now, When? If Not Us, Who?

The use of working equids is on the increase world-wide, in the face of rising petroleum costs and de-creasing agricultural income. Refugees, due towars or famine, often have their animals confiscatedas they enter camps. In many cases, the animalwas their only means of livelihood and transport(Fig. 6). Aid agencies are focused only on humanhealth, not on the working animals. Thus, theirloss is not only inhumane, it makes recovery nearlyimpossible. Reconnecting people with workingequids would be the most appropriate, cost-effectivesolution to rebuilding lives and the communities.e

2. Conclusion

The logistics of starting and maintaining a smallproject are quite accessible to most veterinary asso-ciations. Setting up a charitable foundation is alsosomething done more easily at that level. The keyto success is commitment of more than one personand a broader array of resources. Long-term com-mitment is critical.

Suggested Reading1. Walker-Okello A. Opportunities for NGOs involved with the

draught sector to contribute to national livestock policyframeworks in developing countries. In: Proceedings. Con-ference on Working Equids. 2010;6:80.

2. Schlecter P. The European Draught Horse Federation(FECTU) and the context for work with horses in Europe.In: Proceedings. Conference on Working Equids. 2010;6:90.

3. The ethics of conducting animal welfare research in poorcommunities. In: Proceedings. Conference on WorkingEquids. 2010;6:67.

4. Working at deeper levels to enable change. In: Proceedings.Conference on Working Equids. 2010;6:123.

5. Menarim B, Fortini G, Alvarez P, et al. Clinical, radio-graphic and ultrasound aspects of lameness in urban draughthorses in Chile. In: Proceedings. Conference on WorkingEquids. 2010;6:244.

6. Towards the development of a modular e-learning syllabusfor working equines. In: Proceedings. Conference on Work-ing Equids. 2010;6:339.

7. Uriega-Montufar O, Montes-Huidobro LA, Hernandez-Gil M.DS-WHW-UNAM jointly training veterinary students ofMexico in equine practice: a way to raise equine welfarefor long term. In: Proceedings. Conference on WorkingEquids. 2010;6:350.

Footnotes

aIvomec, ivermectin liquid, 1.5% Merial, Duluth, GA 30096–4640.

bKetamine, ketamine HCL, Fort Dodge, IA 50501.cHenderson Castrating Tool, Stone Manufacturing and Supply

Co, Kansas, City, MO 64217.dKay G. Personal communication, 2011.eKnottenbelt D. Personal communication, 2010.

Fig. 6. My wheelchair is lame.



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