Update from Djibouti & Ethiopia

November 11, 2008

Dear Family and Friends,

Happy Veterans & Armistice Day 2008 from the Horn of Africa. We are preparing for our last VETCAP mission, this one to Ethiopia so this will likely be my last message with any information to speak of.

Since returning from Uganda, the 354th Civil Affairs Brigade Functional Specialty Team has been joined by a third U.S. Army Veterinary Corps Officer, MAJ April Ulmer. She is overlapping with us before CPT Coenen and I depart on the "Rotator" flight from Djibouti on December 11, one month from today. MAJ Ulmer came from her post in Aviano, Italy and CPT Coenen will return to her station in Hawaii. MAJ Mickey Moppin is the fourth Veterinary Corps Officer here at Camp Lemonier, serving with the Surgeon's Cell. Mickey has the distinction of being the first MVPH (Master of Veterinary Public Health) graduate from the NCSU CVM. Dr. Jay Levine deserves much credit for starting and sustaining that program that is proving its value by producing graduates like Mickey.

The four of us occasionally convene "official Veterinary Corps Officers' Calls" at the "11 Degrees North" (our Djiboutian latitude) as pictured. NOTE: official "beer cards" assure moderate alcohol consumption here on Camp Lemonier!

Lately we have expanded our scope of work. On November 3 CPT Coenen was called to consult on a Military Working Dog (MWD) "Ben" who was depressed and off feed. Ben is a seven year old bomb detector dog who came here from Japan. He has been with only two handlers during his career, the current Sailor having been with him over three years. After a physical exam, abdominal radiograph, abdominal ultrasound, and needle tap of his abdomen it was determined that he was bleeding into his abdomen and needed surgery soon.

The Emergency Medical Facility allowed surgery to be conducted there, with Drs. Coenen and Moppin scrubbing in. There was a tumor on Ben's spleen which led to a total splenectomy and as is routinely done with MWD's undergoing belly surgery, a gastropexy ("stomach tack") to prevent future problems with bloat.

By evening Ben had recovered from general anesthesia but with an attitude, as the picture gives evidence. With luck he will be evacuated from the theater soon to recover and hopefully return to duty with no metastasis of the tumor. Ben's handler had been hoping to retire him in the near future and to adopt him into a well-earned retirement. CPT Coenen, MAJ Moppin and MAJ Ulmer did a great job on this. MWD's represent an investment of many thousands of dollars and countless hours of training time. This level of care keeps them going as part of the force.

Even though the weather has been milder and this past week it rained heavily in Djibouti (a RARE event), the days are still hot.

The black flag flying at Camp Lemonier means the heat index is too high for vigorous exertion or exercise. Even in cooler times of the year the humidity is high and the peak daily temperature gets > 90 degrees F; in the hottest times of the year 120 F is normal.

Posters on Camp Lemonier remind all assigned to take their malaria preventative medications as prescribed.

I take mefloquine hydrochloride once a week as do most serving here. Malaria is less prevalent here than in the other countries we have worked in but with the recent rains we expect to see a rise in the Djiboutian mosquito population and an increase in the risk.

The guidance from the Commander of the Combined Joint Task Force – Horn of Africa is posted for all to see.

Admiral Greene's guidance emphasizes that we are "Helping Africans Solve African Challenges" through the "3 D's": Diplomacy, Development, and Defense partnerships to increase Security, improve Stability, and strengthen Sovereignty in the Horn of Africa.

Our VETCAP projects are good examples of this guidance in action. The projects are coordinated with the Embassies / Department of State (= Diplomacy), funded by the U.S. Agency for International Development (= Development), and conducted by the 354th Civil Affairs Brigade, Functional Specialty Team (= Defense).

USAID partners with Non Government Organizations as much as possible, such as on animal health initiatives evidenced by the poster promoting camel vaccinations and health care that we saw on our pre-deployment site survey (PDSS) for the next VETCAP in southwest Ethiopia to start later this week.

The Ethiopian VETCAP will be a change from our previous ones elsewhere. Rather than treating animals we will be training 28 new Community Animal Health Workers (CAHW's, called "cows") in Key Afer, a remote town whose name translates into "Red Earth." We traveled there on October 26th with LTC Wyesa Dinka, our Ethiopian Liaison Officer to meet with the pastoralist association officials who will conduct the training with our assistance.

The classes will be held between November 23rd and December 5th. It will be a challenge because these are adult learners, most will be of low literacy, and at least four languages will be involved: Ahmaric, the Ethiopian national tongue; Benna, the local dialect; a second local dialect spoken by a couple of the trainees; and English. The curriculum is a standard one which has been established by the government. We will emphasize as much hands-on training as possible. On our survey trip to this area we visited a local clinic run by Americans Drs. Trent and Tabby Cox, both veterinarians who graduated from Texas A&M and who have trained CAHW's at their clinic. They have been in this area of Ethiopia for seven years as missionaries with the Christian Veterinary Mission.

The photos show some of the CAHW's they trained spraying goats and cattle for ticks. Their clinic has the only cattle head gate that I have seen in Africa, made by Priefert from Mount Pleasant, Texas. Ticks get much attention from a medical viewpoint because they are so prevalent in East Africa and bring along with them infections that seriously affect livestock production.

The Cox's treated us to a delicious Benna meal of greens, potatoes and maize/sorghum griddle cakes, accompanied by Ethiopian coffee.

The greens are leaves of the moringa tree and are very nutritious, a source of beta-carotene, Vitamin C, protein, iron and potassium. http://www.treesforlife.org/our-work/our-initiatives/moringa Our hosts cooked them with some potatoes and they tasted much like collard greens to this Louisiana native. The bread was as close to southern corn bread that I have had in six months, and along with the husk coffee (made from the covering of the coffee bean which was discovered in Ethiopia) and freshly ground pepper paste, it comprised the best meal I have had in Africa.

Our trip back to Addis Ababa from Key Afer proved the old saying from Pliny the Elder (I think): ex africa semper aliquid novi, or "out of Africa, something always new" .... certainly new to us, some newer than others:

calves still nursing cows way past weaning time (happens even in North Carolina!)....

"wonkay" (spelled phonetically) sheep on the road with their white bodies and colored, mostly black heads ....

cylindrical "barrels" high up in trees that turn out to be placed there for bee keeping

LOTS of water flowing beside and across roads causing lots of erosion ....

and spectacular morning views in Arba Minch ("Forty Springs") of forest and lakes hundreds of feet below and miles beyond. We returned to Djibouti on Halloween and began planning the final stages of the VETCAP.

As a final shot I'll send some photos of the outstanding group of Soldiers and Sailors that I have been working with.

The group photo was taken the night we said goodbye to LCDR Steve Kummeth (second full row, center), commonly called "Beaker" before he redeployed to the U.S. The quality of my comrades is exemplified by the guy standing to my left, at the right end of the first full row. Sergeant First Class Sean Berk is an Army Reservist who started his Army career on active duty as a tanker and deployed in the Balkans on OPERATION JOINT GUARD in 1997. He later joined the Army Reserve and became involved with Civil Affairs. When deployed to Iraq his vehicle was hit with an IED (Improvised Explosive Device) and he suffered some hearing loss.

In Uganda he was the Operations NCO for our VETCAP there and took his turn working the cattle, as you see him framed between Ankole horns in the photo. He's a great soldier and is the mission commander for the Ethiopia VETCAP. They just let me go along for window dressing. Having somebody with little hair, and what there is of that being gray, lends the appearance of gravitas to the mission even if it isn't deserved.

The last photo is of my "Retirement ceremony."

The day I turned 60 in September was when I would have started drawing my Army retirement pay, but since I was on already on the payroll, that will have to wait. Suffice it so say it was an honor to pass that milestone in the company of Soldiers, Sailors, Airmen and Marines. Only Soldiers are in this photo but we proudly serve with all the rest.

The Ethiopia CAHW Training VETCAP is 13 Nov – 8 Dec. CPT Amanda Coenen and I get on the "Rotator" flight for the U.S. one month from today, Dec 11, 2008.

See ya'll soon - all the best!

Jim Floyd, DVM
COL, VC, USAR (Ret)

Thursday, July 31, 2008

Dr. Shimbalo (Sp?), the ministry veterinarian we met on the first day we arrived, was at the office site where we always pick up Mama Safe and Freddy, et al. We discuss how the work is going and the animals we treated yesterday. He takes the EDTA blood sample we drew and will have a smear done for tick borne RBC parasites, not failing to mention that we should also have taken a lymph node aspirate in any case of suspected tick borne disease. We have a good discussion of therapies they use. They use label doses (“manufacturer’s recommendations”) of drugs such as oxytetracycline and pen-strep, which is what we did yesterday with our treatment of the more mature cow with OTC injectable at 4 mg/kg. They stay with label doses and train their field workers to do this. I assume that these antimicrobials are effective at those doses because they may not have been used widely, although the isometamidium (“Veridium” or “Samorin” by trade names) that are used for prevention and cure of trypanosomiasis are certainly widely used. He also mentions that stacking treatments such as buparvaquone (“Butalex”) for theileriosis/East Coast Fever along with the babesiosis treatment we have, imidocarb (“Imizol”) i.e. the same as “Diampron” that we used in Devon in 1979, and even along with OTC as combination therapies is an ok practice. They do not like multiple antigen vaccinations, however; hence their reluctance to immunize with both FMD and Lumpy Skin Disease at the same time.

We go to a new site for working animals today. An old unfilled dip tank reveals just how deep they are. I estimate the depth is ten feet at least. This one has not been used in a while. A nearby concrete walled building has “16-3-1980” etched in the concrete to memorialize its construction date. I am told by Anna, one of the Extension workers who rides out with Amanda Coenen and me today, that the square tank to the side of the dip tanks is for conserving water and premixing the dip. Still not sure the exact function but that sounds good. In any event, we are not using the dip tank and the number of cattle to be worked is relatively small. By the end of the day, which we declare over by about 11:30 AM, we have only worked about 200+. These are small herds and the cattle are somewhat thinner on average. One of the young men has an “Alabama Crimson Tide” t-shirt. I take several pictures and will send to the Auburn crowd.

I do a stand up interview for the “Combat Camera” crew which is composed of Air Force personnel, including one still photographer, one motion picture cameraman with a Sony, and one who is a Public Affairs guy. I manage to talk about cattle infectious diseases and how the Tanzanians work their cattle for longer than necessary, but they keep prompting me to talk more: “Why is this mission important to the CJTF-Horn of Africa?” “What would you say to students who might be visiting here about what you are doing?” “What has been the greatest challenge?”

I talk about the importance of tick borne diseases here in East Africa and about how CPT Coenen and I lack clinical experience with the particular ones they have in abundance. I mention that we treated an animal with signs of East Coast Fever yesterday and that it was the first one I had encountered, along with all the FMD vaccines being the first I have administered. I mention that it would be great to have our veterinary students from NC State here to share in these clinical experiences, emphasizing that our knowledge of Foreign Animal Diseases is critically important to our ability to keep the US free of them.

While I am talking Amanda takes a look at a cow that had gone through the “crush” earlier and then had injured her leg in a fight of some type. Her right rear metatarsus has a complete fracture on the distal end above the fetlock. This is a mature cow; the fracture is not at the epiphysis but it is complete; not compound yet but it will be if given the chance. She is standing but cannot bear weight on the right rear, obviously. Although we discuss making a splint and using the small amount of water activated casting tape we have, it is obvious that there is no way to stabilize the fracture and the best course of action is slaughter and salvage. With the help of Freddy, Mama Safe and Major (Dr./MD) Asez (sp?) of the Tanzanian Peoples Defense Force who is with us every day along with LTC (Dr./MD) Macheka (sp?), we inform the owners and the village head that the prognosis for successfully healing the fracture is hopeless. I help the 300 kg cow, who is in lactation (she also has a neck bell, indicating some worth) at about 5+ years old, to walk to a shade tree and then we depart.

We have no firearm with which to shoot her or drug that we could use to euthanize her, which would not be appropriate for slaughter anyway. I am guessing that if they do slaughter her they will cut her throat. Very sad that we couldn’t help her or them, but it would have been hopeless given the location and nature of the fracture. We considered going through the motions of splinting her but CPT Coenen and I agreed not to and also convinced Mama Safe of the wisdom of this. She and the Major talk to the owners and people, who I hope understood.

We leave and return to the hotel by 12:30 PM in the early afternoon, a very light day. We believe that there was a failure in communication which prevented any numbers of cattle being treated today. CPT Coenen takes on the task of arranging the two “VETCAP” boxes with drugs and equipment so we can better find things. She is doing a great job. Don’t know about me.