A vet visits a Delhi slum: day two – educating young people about animal welfare

After an overnight flight from London, I was delighted to be welcomed to Delhi this morning by a remarkable lady who works on the coal face of the street dogs/rabies issue. Bondana Dutta (or Bondi, as everyone calls her) is the founder of a small but rapidly growing NGO charity called Alliance of Animals and People (AAP).

Bondana resigned as a regional director for CRY ( one of the major Childrens Rights NGO’s) to pursue her work with AAP, and she has brought many skills and strengths to her new role. She believes that the way to improve animal welfare in the slums of Delhi is to start with the children: if she can convince young people of the importance of valuing animals, the rest will follow naturally. The children will pester their parents to do more for animals, and in due course, they will mature into a new generation of adults who are strongly pro-animal.

As an introduction to the educational projects she’s created, I travelled with Bondi to one of her projects, in a slum in South-West Delhi.

The cross-city drive to the slum gave me a taste of the lunacy of Indian traffic: half a dozen lanes of a mad mix of vehicles (from cattle-drawn carts to tuktuks to cars to trucks) barging against each other to get ahead, beeping horns instead of using indicators, yet somehow, all keeping going and reaching their destinations.

We pulled up outside the slum, and walked in through narrow laneways past people sitting outside their homes in small groups. The weather in Delhi at this time of year is pleasant: 20°C with crisp clear sunshine rather than the humid 30°C plus of mid-summer. For people and animals alike, it’s a comfortable climate to be outdoors.

After walking a few hundred yards, we came to a fenced off courtyard in the middle of an open area: around fifty children were waiting for us there. This was Bondi’s community: children aged between five and fifteen who have signed up for regular classes in animal welfare. An AAP worker, a former teacher, was giving a class when we arrived. She acted as an interpreter (the children speak Hindu, with just a smattering of English) to allow me to talk to the children.

I asked a few questions and learned a lot: most of the children cared for street dogs which they view as their “family dogs”. They feed them a mixed diet of scraps, and they make sure that they are vaccinated against rabies and where possible sterilised. I asked about what should be done if a person was bitten by a dog: the children knew all about washing a wound thoroughly then seeking post-exposure rabies vaccination.

I then asked the children if they kept any other animals as pets – cats are popular (but they aren’t as visible as street dogs here), some children kept pet fish, and one girl disappeared for a few minutes, astonishing me when she returned cuddling her pet hamster, Pooni.

I stayed for half an hour talking the the children, and the end, they sang a song to me about the importance of looking after animals well. I came away feeling full of hope and optimism: in the three years that she’s been visiting this slum, Bondi has created a population of young people who care passionately about animals, and in the process, they are taking the necessary steps to ensure that they – and their pets – are protected against rabies.

The AAP model is only being used on a small scale at the moment – Bondi would like to have more full time employees to visit more slums running classes like this, but funds are scarce. Bondi has great vision, and with the right support, her dream of all Indian children being taught about the importance of caring for animals will come true.…

A vet visits a Delhi slum: day one – an introduction to street dogs and rabies

I’m just a vet in small animal practice in Ireland, but for the next week, I’m going right out of my comfort zone: I am travelling to Delhi, to visit a slum, where I’ll be taking a look at the issue of street dogs and rabies.

Rabies is one of those diseases that just flits across the consciousness of most of us: we know it’s a terrible disease, and we feel blessed that it doesn’t exist in the UK and Ireland, but that’s about as far as it goes. The truth is that for many people and animals, it’s a daily curse.  Minor dog bites are common all over the world, especially in children. Most often minor first aid is all that’s needed: rarely, a visit to the doctor may be called for. Yet in most countries of the world, the threat of rabies in an additional worry.

If a child happens to live in India, that minor dog bite could have had desperately serious consequences. If he was lucky, he might be taken to a doctor to be given post-exposure anti-rabies vaccination. However, it’d be far more likely that this level of medical intervention would be unavailable to him. Nothing would be done other than basic cleaning of the wound. If the dog was carrying rabies, he would be infected, and in the following weeks, he would develop symptoms of rabies. He might have a fever or a headache at first, with an itching sensation at the site of bite. A few days later, he would develop anxiety, confusion and agitation. As the disease progressed, he would develop abnormal behaviour (such as fear of water), hallucinations, and insomnia. He would go on to suffer a terrifying death.

The most shocking aspect of rabies is that it is completely preventable. Vaccination of dogs in bulk programmes is inexpensive and highly effective: it can cost as little as 50c per dog. In comparison,the cost of a human being treated for rabies after a dog bite is around €40, which is over a month’s salary in the regions where rabies is common.

The World Health Organisation believes that mass canine vaccination programmes are the most effective measure for controlling rabies, and that vaccinating 70% of the dogs in an area where rabies is prevalent is necessary to control the disease in both humans and dogs. Targets are in place to have rabies eliminated from the planet by 2030 but this won’t happen unless we all start paying more attention to achieving this goal

In the recent past, mass dog vaccination programmes have allowed some countries to become rabies-free: there are many examples in South America. In Sri Lanka, this type of programme has reduced rabies deaths from more than 350 in 1973 to just 50 in 2010. Yet in over 150 countries around the world, death by rabies continues to be a threat to humans and dogs. Over 60 000 people die of rabies every year, with over 95% of them in Asia and Africa.

India is the country with the biggest rabies problem, with over 20000 people dying every year. So-called “street dogs” are part of the urban culture. They play an important role in the ecosystem by helping to deal with garbage: in areas where dogs have been forcibly removed, the local rat population has boomed, with bubonic plague then becoming a major public health problem. But street dogs also carry rabies.

The size and scale of India makes this problem seem impossible to solve: it’s the second most populous country in the world, with over 1.2 billion people (nearly 300 times the population of Ireland, or 20 times the UK). Despite the magnitude of the challenge, the answer is still simple: vaccination of 70% of street dogs against rabies, combined where possible, with sterilisation of dogs to prevent breeding. If you think of another comparison: 20000 people dying of rabies every year is the equivalent of  67 people dying in Ireland, or 1000 people dying in the UK. Can you imagine the public outcry if that was to happen? Why should we be any less outraged because the people dying happen to live in India?

I’m being hosted in Delhi by a charity called ASHA, which is primarily focussed on human health and education in the slums.  I have persuaded them to help me to investigate the severity of the rabies and street dog issue in one of their slums, and they are providing me with an interpreter to carry out a questionnaire. And the kind and passionate people at Mission Rabies have drafted a questionnaire for me to use.  In the space of ten days, I am not going to make much of a difference to anything, except perhaps to my own understanding of the issue, and my own desire to do something about it. If you read this blog for the next while, perhaps you’ll learn a bit too.

Rabies isn’t going to go away by itself: it will take the joint effort of many people with a wide range of skills from a variety of backgrounds. Could you be one of them?

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So You Want To Be A Vet? – Getting into vet school and beyond

I did and I still do! Being a vet is a brilliant job; every day is different. I get to work with great people and use the skills I worked hard to gain to help animals and solve their problems. However, it is also involves long hours, regular challenges, with both pets and people, and it can be very stressful.

The first hurdle to being a vet is actually getting into vet school and with an average of nine applicants for every place, it is one of the most competitive university courses there is. The standard of students is always extremely high and I know the selectors face a very difficult task in picking out those best suited for a career in veterinary medicine.

First and foremost, you must get the right grades at both GCSE and A Level. Without these you won’t even be considered and rightly so; academically the vet course is tough. However, as well as being a geek (!), you also need to have excellent people skills, good practical skills and, I believe, bags of common sense…..

High graduate debt, falling demand for pet health care & corporatisation. The veterinary profession is changing: is it for better or worse?

There’s a lot of debate going on right now about the future of the veterinary profession. Many vets are worried about the current trend which basically follows this path:

1) Huge demand to study veterinary, especially among young females (80% vet students are female)

2) Not enough places at vet schools: traditionally, the number of student places has been capped in order to avoid flooding the market with far more vets than jobs

3) The realisation by universities that there’s money to be made in teaching vet students, and that there’s a strong demand from students who don’t make it into the established vet schools. The first new vet school in over 50 years opened recently in the UK, and at least one more is planned. Meanwhile, in Eastern Europe, veterinary courses are taught in English, offering entry to the vet profession with a lower academic barrier if students are prepared to pay the fees

4) This is linked to the rising cost of veterinary education, with students in England paying £9000 per year x 5 years plus living costs

5) The result is that new vet graduates are qualifying with large debts, in higher numbers than ever before

6) Meanwhile the veterinary market is contracting, with people spending less money on pets, and so there are fewer jobs for vets available

7) Result: increasing numbers of underemployed young female vets with large debts

8.) Next part of jigsaw: there are fewer young vets to buy into established vet partnerships, and an increasing trend for chains of vet clinics to go “corporate”, owned by shareholders whose main aim may be profit rather than the traditional broader professional view of a vet fulfilling a calling to earn a living

9) Result: vets become pawns in the animal care field, with young female vets desperate to pay back loans by working for corporations. As employees rather than part owners, they become subject to pressures common in other walks of life (“For your bonus, you need to sell so much food, book in so many dentals, see so many people every hour”)

10) The long term potential result: erosion of trust in vets as pet owners question whether something is recommended because it is really needed, or because the vet needs to reach a target. This erosion of trust has already begun in recent years, with consumers questioning everything that professionals do: the sequence that I’ve outlined above will exacerbate this trend.

This trend in the veterinary professions seems to be a global one, and as ever, the USA seems to be further down the path than the rest of us. An excellent article has just been published on this in the New York Times – read it here……………

The Kinder Cut – Castration of horses

This is the time of year when people start to look at their cute little foals, and suddenly realise they’re starting to grow up fast… As a result, it’s also when we start to get phone calls from people to talk about gelding them.

If you are considering getting a colt gelded (“cut”), my advice would be to contact your vet, who will be able to advise you on the best approach in your particlar circumstances. However, I’m going to try and go through some of the commoner questions below, so you’ve got some basic information on the decisions to be made, the procedure, and what you’ll need to consider.

The first question, of course, is whether or not to get him cut. It’s an important decision, so these are my thoughts…
The majority of male horses are castrated, and for very good reason – very few people have the facilities, the time, or the inclination to manage an entire stallion. The old adage had it absolutely right – “You can tell a gelding, you can ask a mare, but you discuss the matter with a stallion”. Although there are some superbly well mannered stallions out there, it takes years of expert training – and in my experience they’re almost always more “bolshie” than a gelding, and much less forgiving of any mistakes. They are also much more easily distracted (e.g. by a passing mare), and prone to fighting.
Does this mean you can’t train them well and keep them happily and healthily? No, of course not – but it’s a lot harder. The majority of stallions can’t be kept in groups because of the husbandry regimes on most yards, so have to live on their own. That’s not good for their mental health, or their owners and riders! If someone has the knowledge and facilities to bring up a stallion, I don’t have a problem with that, and I wish them luck, but I’ve seen too many bored, frustrated and borderline dangerous stallions who haven’t been brought up correctly, and remain a liability.
Geldings, however, can be kept in groups, can mix with other horses, and are less likely to lose the plot or throw a temper tantrum. They also don’t present you with unexpected foals in your competing mares…

Sedatives and Sedation in Horses

We routinely sedate horses in practice – after vaccination, it’s probably the most common “routine” job that we do. So, what are we doing? How do the drugs work – and why doesn’t it always happen the same way?

“Sedation – a state of rest or sleep… produced by a sedative drug.”

That’s the dictionary definition, and it makes it sound lovely and simple – give a drug, and the patient goes to sleep. Of course, in reality (as usual with anything equine!) life isn’t that easy…

For those who haven’t seen it before, a sedated horse doesn’t lie down, but their head gets lower and lower, and they may require something to lean on to help them balance. It’s also important to remember that a sedated horse CAN still kick – they’re just much less likely to do so! It often seems that the horse is still more or less aware of what’s going on around them, but they’re too sleepy to care about it. As a result, we’d almost invariably use pain relief and local anaesthetic as well if we’re carrying out a surgical procedure.

There are a wide range of situations in which we like to use sedation. Generally, it’s to make the horse more amenable when something nasty or scary is being done to them. Of course, this varies from horse to horse. There are quite a lot of horses out there that need a sedative before the farrier can trim their feet; and there are others that will allow you to suture up a wound without sedation or even local anaesthetic (not recommended, but occasionally necessary)……

Equine Education (Part 2 – Vet Students)

Have you ever wondered who the young person trailing behind your vet is? They appear, at best they’re introduced as “so-and-so, who’s seeing practice with us”, and then they disappear, never to be seen again…

Well, the odds are they’re vet students who are “seeing practice” with your vet.

Training as a vet is a long process – vet students spend 5 or 6 years at university doing lectures, practicals and clinical work. However, in that space of time, they also have to do the equivalent of an extra year of “EMS” (Extra-Mural Studies, generally known as “seeing practice”). This is their chance to get out of the lecture theatre, away from the ivory towers and out into the real world of practice!

As vets in practice, our job is to take these students and teach them the nuts and bolts of veterinary practice. They’ll learn the science, and all the theory, at vet school; however, there is also an art to veterinary practice, and that’s our responsibility. For example, if the client can’t afford the best treatment, how do you proceed? Or if a client refuses consent for a surgical procedure, what other options can be explored?

At the vet schools, students tend to learn a lot about the more esoteric and uncommon diseases, operations and procedures – this is because they operate referral hospitals (although Nottingham uses an expanded version of the EMS system for virtually all their clinical tuition). Although they do have first opinion practices, in all seven schools the teaching tends to be biased towards the rare and exotic. Out in general practice, however, the axiom “Common things are common” applies – for every septic pedal joint, there are dozens of simple hoof abscesses!…………………..

BEVA Congress 2012 – How Horse Vets Keep Up to Date

As vets, we’re always trying to do the very best for our patients. However, veterinary medicine is constantly changing – every year, hundreds, even thousands of new papers are published, new drugs become available, and new machines and tools come on the market. What was the “gold standard” of treatment for a disease ten years ago might now be proven to be more harmful than helpful! At a recent conference (BEVA Congress – see below for more on that…), John Walmsey, one of the foremost and best respected members of the profession, gave the plenary lecture talking about the massive changes that have taken place in equine veterinary care in the four and a half decades since he graduated. The drugs we have now are far more effective, the machines and tools more robust and more useful. Even ten years ago, MRI in the horse was really rare and (to be honest) unreliable; now it’s a standard tool in working up a complex lameness. As a result, with the field of knowledge constantly changing, it’s more important than ever for vets in practice to keep up!
The process of keeping up to date is known as CPD (Continuing Professional Development), and we are expected to do at least 5 days a year. It can be made up in a number of ways, including lectures, seminars, webinars, practical courses and reading journals and papers. Like most equine vets, I receive the big journals Equine Veterinary Journal and Equine Veterinary Education, which (respectively) publish papers on equine science and equine surgery and medicine. I also try to attend relevant courses and lectures as often as I can.

In September, I was at the BEVA (British Equine Veterinary Association) Congress in Birmingham. This is one of the biggest gatherings of horse vets in the world, and I try to go most years. Congress lasts for three days of lectures and seminars, as well as a large commercial exhibition. It’s a great place to go to pick up the latest ideas, new treatments and medicines, and catch up with colleagues from across the country. I sometimes think we learn almost as much from talking over cases with colleagues as we do in the lecture theatres!

This year was notable for…

Cost of Vets – A sad story but an important message

This week I was in a situation which made me feel angry, sad, frustrated and powerless all at once. I wanted to share it because I think it highlights a really important issue about vets, pet care and cost. However, I will warn you it doesn’t have a happy ending.
There was an appointment in evening consults for a euthanasia, which in itself isn’t unusual, but this one was for a Staffie who was only six and who hadn’t been seen for a year. The history we had was brief, she had last been seen for an ear infection but not since. So, I didn’t know why her owner’s had decided to put her to sleep; I was thinking that maybe she had been under the care of another vet for a problem which had become terminal or that this was a behavioural problem like aggression.

However, when she arrived it was quite clear what the issue was. The poor dog had a terrible skin problem; she had sore and swollen feet, a nasty infection in both ears and in places has scratched herself red raw. Despite this she was lovely, happy, friendly girl, desperate for a good fuss. It transpired that she had been like this since she last came to see us, over a year ago, but her owner hadn’t brought her back or taken her to another vet because ‘the treatment hadn’t worked’ and it was ‘too expensive’, meaning that the poor creature had been itchy and painful for all this time.

I did try to speak to the man about her condition and how we might help her. Itchy skin is a common problem in dogs and although it can be difficult to find the underlying cause, most cases will respond to treatment, which is usually inexpensive. Like many illnesses we can offer different options for investigation and treatment depending on what an owner wants and the funds available but the outcome is generally an itch-free happy dog who can go on to lead a normal life. However, in this case the owner wasn’t interested in any treatment at all. He had decided he wanted her euthanased and nothing would persuade him to change his mind…………….

Toxoplasmosis gondii, Pregnancy and Cats – Fact vs. Fiction

Well over halfway through my second pregnancy, I am currently inundated with comments from clients, mostly positive, and it has added a bit of humour and lively conversation to my otherwise increasingly tiring days. ‘Do you know if it’s a boy or a girl?’ ‘How do you think your toddler is going to react to the new baby?’ ‘Are you going to come back to work after two children?’ But one question I wasn’t expecting came from a woman with a lovely ginger tom – ‘Are you sure you’re OK to examine my cat if you’re pregnant?’ I laughed and assured her that despite my expanding waistline I could still reach the table and her cat would be fine. But after a slightly confused and very embarrassed smile, she explained that she had recently been told by a friend that she would have to give up her beloved cat once she became pregnant because it wasn’t safe for pregnant women to be around cats. It had been a while since I had heard that myth and was saddened to hear it again, but I wasn’t terribly surprised. We spent most of the rest of the consultation discussing the real facts about toxoplasmosis, the disease in question, and she left very much relieved that her feline friend was not going to have to be evicted should she ever decide to have a baby, and determined to speak to her GP if she had any further concerns.

What causes toxoplasmosis?

Toxoplasma gondii, the protozoal parasite responsible for causing the disease known as toxoplasmosis, is a tiny single-celled organism that can infect many different species from mice to sheep to humans. Cats, however, are the only hosts in which the parasite can reproduce…..

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