Armed with a desire to help rebuild the veterinary infrastructure in Afghanistan, Dr. Susan B. Chadima recently volunteered her veterinary expertise at the Kabul University Veterinary Faculty Animal Health Clinic in Kabul. The clinic reopened in January 2005 after it was destroyed in 1992, reportedly by fighting between Mujahadeen factions.
As a small animal practitioner, Dr. Chadima primarily trained the university's faculty and fourth- and fifth-year veterinary students in small animal procedures during her six-week trip, ending in December 2005. In Afghanistan, students start the veterinary curriculum directly after high school, or after passing an entrance exam, and then complete five years of studies.
Having arrived at the end of the academic year, Dr. Chadima provided mostly hands-on clinical training, such as physical examinations, sterile procedures for surgery, and basic anesthetic protocols. "Small animal services, as we know them, are essentially nonexistent in Afghanistan," she said.
Dr. Chadima founded the Androscoggin Animal Hospital in Topsham, Maine, in 1985. She serves as the AVMA House of Delegates alternate delegate from Maine.
In Afghanistan, Dr. Chadima worked with the Kabul clinic's staff to offer basic small animal health services for a fee to the public. "Historically (in Afghanistan) veterinary services ... were provided by the government," she said. "One of the goals (of the clinic) is to introduce the whole concept of fee-for-service, both for large and small animal services."
Located less than two miles from Kabul University's main campus, the clinic is staffed by three of the university's veterinarians, a veterinary assistant, and a paraveterinarian. It is open six days a week. The clinic provides small animal services, including rabies and distemper vaccinations, spay-and-neuter operations, deworming, and microchips for animal identification.
For farm animals, the clinic offers vaccinations, parasite control, pregnancy diagnosis, simple surgery, and more. The clinic features seven rooms, including a large-animal examination room, small-animal examination room, small-animal surgery room, classroom, and storage room. All animals are outpatients because the clinic doesn't have boarding facilities.
Developing the clinic
Dr. Chadima became interested in volunteering in Afghanistan after attending an Iraq and Afghanistan strategic working group session at the AVMA Annual Convention/28th World Veterinary Congress in July 2005.
At the meeting, she met with William Bell, Maine VMA executive director, who had recently spent time working with the Afghan Veterinary Association.
Bell introduced Dr. Chadima to Dr. David M. Sherman, country program director for the Dutch Committee for Afghanistan. It was Dr. Sherman who presented Dr. Chadima with the opportunity to work at the Kabul clinic.
Dr. Sherman was the state veterinarian in Massachusetts. After taking a one-year leave of absence to work in Kabul, he resigned from his post in 2005 to stay in Afghanistan and continue to build a national network of veterinary field units to serve the needs of livestock owners. The DCA has offered aid and assistance to the population of Afghanistan by improving the health and productive output of the local livestock for more than 16 years.
In January 2005, the DCA closed a nearby clinic that it had operated to train paraveterinarians and shifted the staff, equipment, and clientele to the Kabul clinic. The DCA wanted to help reestablish practical, clinical training for the veterinary students. In addition, Dr. Sherman said, the DCA gives modest supplemental salary support to the clinic staff members, and a vehicle and driver to bring faculty and students from the main campus to the clinic.
"DCA is the main actor in setting up private veterinary clinics in Afghanistan," Dr. Sherman said. "We wanted the (Kabul clinic) to be managed as a self-supporting, fee-for-service enterprise so that the veterinary students would not only learn clinical medicine, but would be exposed to the principles of practice management ... to better prepare them to enter the private sector after graduation."
The DCA's activities at the clinic represent less than 1 percent of its efforts in Afghanistan, as measured in budgetary allocation, Dr. Sherman said. The primary focus of the DCA is to work with several other organizations on implementing the $11.9 million United States Agency for International Development's Rebuilding Afghanistan's Agricultural Markets Program project on veterinary privatization.
Prior to the DCA's involvement, the Ministry of Higher Education, Kabul University, and the Mayhew Animal Home in the United Kingdom funded the clinic's reconstruction, which was completed in 2004. Since that time, Dr. Sherman said, the Mayhew Animal Home has renewed its support for the clinic by providing some equipment.
The U.S. Army also provided supplies. Drs. Michael Lennon and Mark Martinez—both lieutenant colonels for the U.S. Army—helped organize the efforts.
"Task Force Victory facilitated the delivery of a large amount of donated medical material from both the University of Oklahoma veterinary school and the (Massachusetts VMA) to the veterinary school in Kabul," Dr. Lennon said. "We also supplied a lot of excess Army medical equipment—for example, surgery tables, surgery sets—and the vaccines, and medications to get the clinic up and going."
Unlike a U.S. clinic
Along with overseeing Dr. Chadima's trip, Dr. Sherman organized a nine-week volunteer stint for Dr. James Q. Knight, director of animal sciences at Becker College. He arrived at the clinic in May 2005.
During his visit, Dr. Knight demonstrated surgery and sterile techniques to groups of about 40 fourth- or fifth-year veterinary students from the university. He performed hernia repair surgery on a calf, which was done in the large-animal room. He operated on several chickens, spayed and neutered some animals, and put a cast on a puppy's fractured limb.
Dr. Knight's array of patients represents the two types of clients the clinic supports: area villagers with livestock and foreigners with companion animals.
Along with tending to the animals, Dr. Knight worked with the staff to set a fee schedule for all clients. The fee schedule approximated roughly half of what practitioners would charge in the United States, but nearly 10 times what Afghans would typically be charged. The foreigners were willing to pay the costs, Dr. Knight said, and so the clinic started generating approximately $100 (U.S.) a day.
Dr. Knight also treated several animals at the Kabul Zoo and began weekly rounds for the veterinary students there in conjunction with the zoo director and veterinarian.
One of Dr. Knight's main challenges at the clinic was getting veterinary supplies. Before he left for Afghanistan, he worked on sending an anesthetic machine to the clinic, only to find that the machine could not be shipped from the United States because of U.S. regulations. He finally obtained a machine for 10 days from a nearby human hospital in Kabul.
Dr. Chadima also ran into problems. "Electricity is by generator only so, it's seldom turned on," she said. "It was a 15-minute procedure just to turn on a microscope." Heat was also a concern, considering it was winter.
Despite the challenges, Drs. Chadima and Knight agreed they benefited as veterinarians from the experience.
Dr. Chadima said, "It really reemphasized the important role that veterinary medicine plays in both human health and animal health, and how critical it is to the economic survival of so many people in the world in a way that we're not used to thinking about in the United States."
"It was a refreshing change for me," Dr. Knight added. "You start out working in the field—performing surgery out in a pasture or desert—so you get used to dealing with what you have. This was sort of like stepping back 30 years."
Though the efforts of Drs. Chadima and Knight are appreciated, Dr. Sherman said, the DCA is not sure they will continue to use volunteers. The DCA anticipates funding from other agencies will soon become available to support the recruitment of paid teaching clinicians and other academic advisers for the veterinary faculty.