Reports of terrorist activity in Mashreq Shams region

Those beautiful faces of Mashreq Shams live in a challenging geographic and political landscape. As we drove out of the community towards Sbeitla (on Sunday), we witnessed a roadside arrest by military police. Then two days later, we read reports about terrorist activity (possibly Algerian) in the area of the community where we had just been.

These news reports put things into perspective and remind us to be ever cognizant of cultural and political context. Its no wonder donkey health is not high on the list of concerns for the locals. 

"A suspected terrorist was killed and several others were injured late Tuesday night, after clashes with the security forces in the region Mazreg Shems not far from Jebel Smama, another terrorist underground in Kasserine.  An extensive search operation was immediately started looking for the terrorists on the run, said the spokesman of the Ministry of Interior, Mohamed Ali Aroui ."

http://www.tunisienumerique.com/tunisie-kasserine-un-terroriste-tue-dans-des-affrontements-avec-des-securitaires/234729

Another report pointed out the effect this terrorist activity might have on the upcoming elections.

To read more, go to:
http://uk.reuters.com/article/2014/09/17/uk-tunisia-security-idUKKBN0HC0WB20140917

Tunisia Veterinary School Workshop

The day after our intensive community event in Mashreq Shams, we prepared for our workshop at the Sidi Thabet School of Veterinary Medicine. Tricia worked on the slide presentation for her lecture, while Jaber made sure the logistics were in order. 

Early Tuesday morning we drove to the school with our slides, tools, and high hopes of a successful workshop for a group of about 25 senior students. The topics were an overview of our project in Tunisia, body condition scoring, equine dental care and the basics of hoof trimming. Dr. Emna Brour, our cheerful new donkey welfare champion, joined us for the workshop and took many of the photos.

We laid out all our tools and the anatomy lab loaned us skulls and lower limbs. We had a very motivated and attentive group and a special guest - a donkey who waited patiently to be the star of the morning. Tricia spoke slowly in English and by the expression on the students' faces, she could tell they understood what she was saying. They politely asked thoughtful questions and nodded in reply to her comments. Jaber was always ready to clarify any confusion by explaining in Arabic.

We had a great room for the slide show and live animal demonstration

the quietest member of the class listens to Tricia with one ear

Tricia was a happy speaker with an engaged audience

After a review of anatomy and function of equine teeth/jaw and the consequences of pathology, the procedure of dental floating to reduce sharp points was explained and we passed around the tools. We used the donkey we had seen in Mashreq Shams with the severe tooth hooks and cheek abscess as a case presentation.

Jaber demonstrates filing the teeth on a skull

We took a break from the lecture format to have a demonstration and student hands-on dental filing practice with the donkey who was waiting so quietly.

Tricia explains the 'two finger and a thumb' technique of gently grasping the tongue to make the oral exam easier

the students were eager to try this new skill and were quick to be proficient at it...

and they remembered to make friends with the donkey first and that the tongue is not to be used as a handle

these young professionals stayed focused on the demonstration of floating

...and most of them had a chance to give the floating a try (Emna looks on in the background)

We gathered again for the lecture on hoof anatomy, pathology, and trimming. We had several good before and after pictures from the cases we had seen in Tataouine to demonstrate the importance of hoof care, and how easy it is to control overgrowth and cracks.

The students appreciated Jaber demonstrating the tools with the anatomy specimens and he explained some of the finer details in Arabic.

To finish up the lecture, we discussed their options for acquiring dental and hoof tools, including  finding local blacksmiths to craft tools at a reasonable price. We encouraged them to use online resources to look at dental and hoof tools and procedures as well as studying the fine art of determining an equine's age by its teeth.

When we moved back to the donkey for the hands-on experience, the students had not lost their enthusiasm for the workshop and remained very engaged in learning. Jaber started with demonstrating the trim...

 Then he provided close guidance as the first students practiced a trim with the nippers.

It didn't take long for the students confidence to grow and they were on their own, rasping while we stayed nearby.

We all had such a wonderful experience sharing and learning. Many of the students thanked us personally for the interactive workshop and gave us positive feedback. They liked the alternating format of lecture with hands-on work and they enjoyed learning something new while having the opportunity to practice in the same day on a real animal. The demonstration helped fill in the bits they missed due to the language issues. Ideally, in the future, we would like to invite more students and have additional animals to work on.

It was hard to leave but the students had to get back to their clinic duties and our guest donkey's teeth and feet were treated.

Shadi bids us goodbye and thank you on behalf of his classmates

We'd worked up quite an appetite, which was taken care of at a local barbeque venue. In the style of veterinary case presentations, complete with before and after pictures, here's a view of our lunch.

By this last week in Tunisia, Tricia has let go of her food hygiene standards...especially when she's hungry and the vendor has such a nice smile - she doesn't care if the meat was refrigerated or whether he washed his hands or when the last time the butcher block was bleached !

"Before"... (well, actually since we were so hungry, we'd already started before the photo could be taken)

"After"... coke, grilled sheep, sausages, bread and tunisian pepper salad...ALL GONE!

As we left Sidi Thabet, we had to stop the truck for a large herd of sheep crossing the road to graze in an olive tree grove.

We headed home with a very satisfied feeling - sharing skills with future colleagues, having a delicious local lunch and seeing a healthy herd of sheep enjoying their day - pure veterinary joy.

Local faces of Mashreq Shams, Kasserine

A description of our day in Mashreq Shams would not be complete without showcasing some of the people we met. These beautiful faces reflect the history and tenacity of the region in a backdrop of many challenges and political uncertainty.

The faces were a reminder to Tricia, the 'sheltered and not very well traveled ' American, that people find purpose and joy within their own cultural context. There are commonalities that all humans have. Parents love their children; kids crave connections and love to laugh; women gather together to share; husbands and wives have their private conversations; and strangers are curious about each other. As veterinarians, we notice animals can often be found as a delicate thread weaving these relationships together.

The pictures from our iphones and GoPro screen shots may not make the cover of National Geographic. Nonetheless, we think when you look at these photos, you will appreciate what we experienced in person. (click on the photo for fuller screen view)

Meet the donkeys of Mashreq Shams

The donkeys of Mashreq Shams came in a variety of ages, colors and sizes - weanlings to old aged; white, grey, brown and black; large pony sized to very small. One thing they did seem to have in common was a need for dental, hoof or wound care. Many needed a bit of husbandry advice diplomatically directed to the owners. Most donkeys had curious handlers who were amazed at our ability to easily work with the donkeys, especially looking in their mouths.

Here's a few unique characters we met:

A sweet guy with broken ears - perhaps from rough handling because we did see a few owners restraining the donkeys by twisting the ears.

This young donkey was the recipient of a creative approach to weaning (metal spikes attached to halter so his mother would discourage him from nursing)

Even though he doesn't look too happy here,  this donkey was one of the better cared for donkeys whose owner recognized the importance of using sturdy but soft material for halter and pad rigging.

Many owners worried about the donkeys biting and some used muzzles

this donkey waits in line next to a motorbike

Our exams began with getting baseline information about sex, age, purchase cost, and value; then we noted the body condition score and obvious lesions. Getting consistent records was a challenge - some handlers were not the owners or didn't have the info; the men tried to interrupt the women; many owners expressed the donkey didn't have any health problems. However, in addition to widespread low body condition scores, the primary issue we observed was overgrown and chipped hooves. We were able to trim most of the hooves with nippers, but a few required the toeing knife.

Tricia and Jaber use the toeing knife to remove excess toe as Lina watches the new technique

Almost all the donkeys' legs had bands of ruffled white hairs - signs of scarring from being tethered and hobbled. We had one case whose legs had several fresh rope burns. He was the only donkey to be resistant to treatment and tried to bite and kick as we tended to his wounds. The owner said she just keeps putting the ropes higher up his legs and wonders why she keeps him. We showed her the felted ankle rope cover Tricia made and she nodded in agreement that padding would help prevent more wounds. Perhaps if his wounds have a chance to heal and he is in less pain, he will have a better demeanor.

We saw a donkey with a deep wound on its poll (area on top of the head behind the ears). This gave Tricia the opportunity to show the other version of the felted rope cover which was on the halter she had purchased on the way to the event. This halter caught the eye of three women sitting nearby who spent a fair amount of time checking out the novel felting cover idea. We didn't exchange too many words, but the smiles and nods were evidence a creative seed was planted.

Not all the donkeys had sharp dental points, but they all received a basic dental filing because we wanted the owners to know they were being treated equally. We saw an extreme dental case early in the day and asked the owner to bring the donkey back at the end of the event. This older donkey was very thin with long rostral (front) hooks on the upper first cheek tooth on both sides of his mouth.

He had an obvious external abscess on one side. Upon closer look inside his mouth we saw the cause of the abscess was due to the tooth hook penetrating the inside of the cheek and there was actually a fistula. He also had sores on his tongue and other places on his cheeks.
We started working on his mouth before we took pictures. It's really hard to get a good photo of the inside of a equine's mouth, especially a small donkey.

This photo shows the hook on the side without the abscess after we had started to file down the point. Tricia's hand is holding the tongue out of the way and you can see the lesion on the tongue right next to her pinky finger. The tooth is twice as long as it should be and interferes with the normal grinding process as well as cutting the inside of the mouth.

Ideally, a veterinarian would use a molar cutter or power tool and full mouth speculum/head stand system and chemical sedation to deal with this extreme case. We didn't have those luxuries. What we did have was patience and humanpower and a very well behaved donkey.

 

We took turns filing and holding the mouth open and managed to get the tooth reduced by half which was enough to be certain it would not protrude into the cheek allowing the abscess to heal.

We tried to convince the owner he could use a file to keep the point under control, but like most of the other donkey owners he was very reluctant to go near the donkey's mouth. We were able to explain to him the importance of providing softer feed.

It was a long hot day for the team and the owners but the donkeys didn't seem to mind waiting around. One by one they got their turn and then headed home. A few people said they had to leave to go have their afternoon tea.
 


We were fairly exhausted but satisfied we'd made a good impression on the community and knew we had made a few donkeys' lives a little better for at least a little while. We may have even inspired a few kids and adults to pay more attention to their donkey's health. With time our hope is that the community will notice the donkeys can do their jobs more efficiently with a better husbandry.

Tricia (kneeling), Zouhair on the special dental patient, Lina, Ahmed, Shadi, Jaber, Amine and the donkey owner (with his father looking on in the background). Thanks to Emna (not shown) who took the photo !

We packed up our tools confident the veterinary students would be welcomed back to Mashreq Shams for another donkey care day.

the remains of the day in the truck bed bid goodbye to Mashreq Shams