Friday, August 1, 2008

On the way to the day’s work site we stop at the Ministry office and Mama Safe gives me the report from “Mkwakwani Vet Care” that the blood sample we gave to Dr. Shimbolu yesterday showed “few Theileria prioplasms.” As it turns out that cow had been vaccinated for East Coast Fever (I had noticed a circular ear “button” (looked like an RFID tag from the US) but did not notice that it was the evidence of ECF vaccination. Because of this status, the recommendation was to treat with “30% OTC” (300 mg/ml oxytetratcycline) or “inject with “(1) Butalex /Parvequone and (2) Oxytetracyclines.” Mama Safe explains that this recommendation is because of the previous vaccination.

We had treated the animal with injectable OTC (note: it was 100 mg/ml; we don’t have any Tetradure or 300 mg/ml) at 4 mg/kg as per label dose, leaving two additional treatments for the following two days. Our references on ECF vaccination state that the modified live organisms are injected simultaneously with oxytetracycline or followed seven days later by parveqone or buparvequone. Not having any clinical experience with ECF, we estimate that our treatment of that cow with OTC was according to the recommendations and leave it at that.

We go to another new site today which is a good ride from Tanga. We stop on the way to pick up a village elder who is dressed in a long robe and has short, white hair. He looks every bit the wise man. We arrive at an area with a circular corral constructed of acacia branches, about 20 yards in diameter with a “crush” leading off one end with no funnel or narrowing where the crush joins the circle. Trouble to come? We are accompanied by two mini-buses of about a dozen midshipmen from the US Naval Academy who are visiting CJFT-HOA and Tanzania. They visited a well drilling site yesterday and are to spend part of the day with us.

We set up the vehicles to the side of the crush and the Tanzania’s start running the cattle through. I am asked to give the middies a briefing on what we are doing. There are not many questions although a few arise during the briefing and after as they observe. The first question was about how thin the animals appear, to which I respond that they are in good shape for Zebu cattle. Most are in pretty good body condition, the grazing not having been too bad thus far this year. They are asked to participate in herding the animals, which three or four of them do and are pretty game.

The amount of whipping of the cattle that the Tanzanians are engaged in is clearly worrisome to a few of the middies, as it has been to us. I explain that this is their way of doing business and we have not set this VETCAP up as an educational program in cattle handling, although we might want to do that as part of a future effort to promote the faster working of the animals. One female midshipman asks about how animals are slaughtered and I confirm from LTC Machera that the slaughter process is universally of halal type by cutting the throat. One middie asks if we are pregnancy checking; he had some background on a ranch somewhere I am told. Dr. Machera mentions to the group of middies that we are also interested in maintaining a healthy supply of animals to provide food for the people and to reduce zoonotic diseases. The middies depart by late morning.

At midday CPT Coenen and I are asked to conduct an ante-mortem exam on a 150 kg heifer who is to be slaughtered. She is tied by the legs and in lateral recumbancy. She appears healthy and is slaughtered by having her neck cut and bled, which mercifully goes pretty fast. We conduct a post mortem exam and she is clean. Many of the Tanzanians gather wood for a fire with four posts set at each corner about two feet in height and from which a frame is made of green wood for the meat to cook. The first pieces put on the “grill” are liver, kidney and tongue, followed by muscle. It is brought first to us for sampling and is not bad, especially with a little salt which they have.

The village elder who had been present yesterday when we had examined the cow with the fractured metatarsus speaks with me. He speaks very good and deliberate English, better than other Tanzanians I had encountered yet. He expressed the opinion that the advice we gave to slaughter the cow was very good and he appreciated that we had given it. That made me feel much better about the previous day’s business, having seen the disappointment in the faces of those responsible for that animal.

It turns out that all of the cattle we are working today are owned by one man, the only one so far who I have seen wearing a cowboy hat, or what could pass for one. He is on the ground herding with the others and is a somewhat larger man than the average. MAJ Azes (sp?), one of the physicians from the Tanzanian People’s Defense Forces, tells me that he began with only three cows. He is obviously very smart or very lucky, or a combination of both. He also may have other means of livelihood but I can’t determine that.

Toward the end of the day the animals, which are tending to be larger, are not moving out of the circular corral and into the “crush” lane very well. It’s taking a long time to finish up. They try to cut out a group from those in the corral and herd them over to the crush entry, which typically ends up with many rejoining the main group despite being hectored and beaten vigorously by a number of stick-wielding Tanzanians. The problem is that they can’t readily see the small opening to the “crush” lane as an escape route, and until we get some of the workers to step away from the other side of the “fence” right by that entry they are also seeing people in their “flight zone.” It is one of the more frustrating episodes we have had when it comes to seeing the consequences of poor facility design. The irony is that the cattle are largely contained by the brush corral and the stick fences, which the Tanzanians admirably repair with strips of bark “twine” as the fence becomes weak during the day.

I decide to make the conduct of a cattle handling course a long term goal, and will make efforts to see if we can make that happen in the future. I predict it will take a few years and that the best way to do it would be through the Tanzanian Ministry of Agriculture, which has good extensionists like Fred Manju and Mama Maud Safe who have worked with us every day. Dr. Shimbolu, the Ministry veterinarian who we have met with twice, told me that they conduct training for these laymen every few months, which is apparently effective given my estimation of their understanding of the diseases we are working with. My impression is that Tanzania is ahead of the other countries we will visit, including Kenya and Uganda with regard to its Ministry infrastructure and extension system, so it would be the place to start.

I note that a few cows have the yellow ear button that the ECF vaccinated cow we treated a few days ago had. Closer exam of these tags shows them to have “ECF vaccinated” printed on the edge along with an ID number. We close up shop at day’s end having worked between 1200 and 1300 total cattle. I confirm from our Tananian PDF physicians that “sleeping sickness” in humans is not a disease of high incidence now and that controlling tsetse flies in cattle is a way to reduce the disease in people; they also express that cattle can be a reservoir for some trypanosomes that affect people. Upon return to the hotel we learn that Saturday CPT Coenen and I are to accompany LTC Pope and MSG Holland to conduct a PDSS (Pre-Deployment Site Survey) with LTC Machera and Mama Safe to the sites that the next VETCAP phase will work at in November.

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.

Monday, July 28, 2008

Left at 8 AM, usual time for VETCAP departure from Hotel Mkonge, in convoy of four SUV’s and one van. Picked up Ministry of Agriculture (Livestock?) folks including Mama Safe and “Freddy” plus others to head to Pongwe site, same as Friday. We are told to expect 900 animals but by the end of the sunny, hot day we have worked >1400, including 40 owned by one of the Ministry extensionionists to whom we give 40 doses of FMD vaccine and enough injectable ivermectin to treat 40 cattle @ 400 kg; good deal for him. I get some sun on my face, neck and arms as the temperature gets into the 90’s (F) by my estimate.

Amanda Coenen and I are asked to inspect two goats who will be slaughtered for lunch. We do an antemortem inspection and then a post mortem, with able assistance from one of the Ministry personnel who is pretty spiffy at finding the parotid and retropharyngeal lymph nodes. Despite the busted gut and hair on the carcass, we pass them both as essentially healthy. I am befuddled by feces in the spiral colon I mistake for a lymph node chain, but other than that don’t look too bad. At lunch, which is not ready until about 4 PM, the boiled meat, liver, bananas and cucumbers / onions are not too bad although I pass on the liver, as always.

We finish up and return to the hotel. I commandeer Menano, our driver, to take me to the Tourism kiosk in town to ask for location of Commonwealth Graves Commission cemetery. Same guy there on Saturday tries to talk me into getting him to tour me there rather than showing me on the map. I decline and will find it on my own. After cleaning up and sending emails to Mother, Twila, and also to Family and Friends along with pictures, I walk to the Tanga Yacht Club and have fish and chips along with a Bushmills and water and then a Tusker Beer for supper. All in all a good day.