African, US veterinarians have meeting of minds

Dr. Olatunji Nasir is an ambitious man. He dreams of having veterinary clinics in all the major cities in his country in the next five years—all with the same standard of care. He is CEO and medical director of Truthmiles Animal Hospitals Ltd. in Ikeja, Nigeria, which has two locations. He’s been successful at tapping into the burgeoning dog ownership in southern Nigeria.

In the past, owners preferred dogs such as pit bull–type dogs, Mastiffs, and Doberman Pinschers, mostly for security purposes. But he’s begun to see more small dogs in recent years.

“This has to do with millennials. More younger people are owning pets,” he said. “These owners spend more, too. The older folks say, ‘I don’t even do this for my kids.’”

To help further elevate his practice, Dr. Nasir is taking part in a pilot clinic-to-clinic twinning program that connects select companion animal veterinary clinics in member countries of the African Small Companion Animal Network with clinics in the U.S. led by AVMA members. The program, coordinated by the World Small Animal Veterinary Association Foundation, began in 2018 with funding from Zoetis, thanks to Dr. Eileen Ball, the company’s global associate medical director for commercial development and life cycle innovation.

Dr. Nasir and two other veterinarians from Nigeria, Drs. Abubakar Bala Muhammad and Kunle Abiade, have partnered with three practitioners from Caring Hands Animal Hospital Inc., which has eight clinics in Virginia.

“What is happening in the U.S. is light years ahead. You look at the possibilities, and we’re limiting ourselves (in Nigeria). But the clients are not as rich where I am. People spend more on their pets in the U.S., but it’s still possible to raise the standard of care in practice,” said Dr. Nasir, who is the ambassador for AFSCAN in Nigeria. “It has brought hope to me to do better.”

Making connections

Dr. Kevin Stevens, who owns Ballito Animal Hospital on the east coast of South Africa, is coordinator of the pilot AVMA-AFSCAN Twinning Project and an AFSCAN board member. He said the project seeks to promote sustained relationships and mutual learning that will help veterinary professionals better understand one another’s perspectives, challenges, and needs and enhance companion animal health and welfare and understanding of disease surveillance and control.

It’s a good mental exercise to think about a case without the tools we normally rely on, like an ultrasound that is immediately available to us on the ER (emergency room) floor. The biggest lesson I’ve learned is focusing on the core of veterinary practice and not relying on the bells and whistles, when most of the information we can get through pretty low-tech means.

Dr. Shana O’Marra, chief medical officer, DoveLewis Emergency Animal Hospital

He and a working group composed of representatives from each of the sponsoring organizations manage the pilot program, which in its first year also includes veterinarians at the nonprofit DoveLewis Emergency Animal Hospital in Portland, Oregon. DoveLewis veterinarians are partnering with a group of veterinarians from Kenya, Namibia, and South Africa.

The goal is for twinned practices to do virtual grand rounds monthly and connect informally between scheduled rounds to talk about anything practice related, be it business management or general case management questions, for example. Going forward, U.S. and AFSCAN veterinarians at all of the twinned clinics in the pilot program, plus Dr. Stevens and other members of the program management team, plan to come together four times a year to hold virtual grand rounds. Dr. Nasir even had a chance to meet his U.S. counterparts last year face-to-face at the AVMA Convention in Washington, D.C. The pilot program management group hopes to facilitate a first face-to-face meeting of all AFSCAN and AVMA member practitioners at AVMA Convention 2020 in San Diego.

The AVMA-AFSCAN Twinning Project not only helps make global connections and promotes the one-health concept but also develops a network among the African clinics to connect and share practical advice. This network helps enhance the clinics’ business practices and the veterinary profession overall in AFSCAN member countries.

“We’re starting to build by country to country and encourage individuals to engage with each other,” Dr. Stevens said, adding that two practices in Zambia have started twinning with two clinics in the U.K. in a second pilot program being administered in partnership with the British Small Animal Veterinary Association.

Communication usually happens via GoToMeeting, WhatsApp, email, and DropBox, working around different time zones and schedules. Occasionally, issues crop up because of internet and electricity outages, which aren’t uncommon for parts of Africa.

Veterinary medicine varies widely from one AFSCAN member country to another—or even from city to city. In Nigeria and Kenya, practices may have first-class medicine and all the equipment a typical U.S. practice may have, Dr. Steven said. But in countries such as Zambia, Namibia, Ghana, and Mozambique, clinicians might not even have a microscope. They also likely have to send blood to laboratories in South Africa and wait days for the results. Dr. Stevens, in South Africa, has a video endoscope and digital X-ray machine, but practices just miles away hardly have any equipment, let alone the latest technology.

“You have to respect the different levels of practice,” Dr. Stevens said.

A universal experience

Dr. Shana O’Marra, chief medical officer at DoveLewis, recalls one of the first cases she presented to her twinning partners. It involved a CT scanner, which the African veterinarians didn’t have in their clinics, forcing her to take a step back.

“It’s a good mental exercise to think about a case without the tools we normally rely on, like an ultrasound that is immediately available to us on the ER (emergency room) floor,” Dr. O’Marra said. “The biggest lesson I’ve learned is focusing on the core of veterinary practice and not relying on the bells and whistles, when most of the information we can get through pretty low-tech means,” such as a comprehensive physical examination and repeated assessments.

She enjoys being exposed to different infectious disease processes or discussing how to approach an unknown toxicosis. In particular, Dr. O’Marra is impressed at how skilled her African counterparts are at blood film evaluation. The discussions are a way for everyone to step outside their local pattern recognition and talk about the basics of medicine in a clinically applicable way.

“It’s not as if the American veterinarians have a leg up on the African vets. It’s very much a meeting of the minds,” Dr. O’Marra said.

She quickly noticed similarities when she brought up professional wellness and how to foster that in a hospital setting. The African practitioners said they shared many of the same struggles, from difficulties in setting personal boundaries to burnout.

“It was really interesting to hear from them that it’s all universal,” Dr. O’Marra said. “It’s not all about workplaces, because they are so different. We are veterinary providers, and we all have the same tendency to give of ourselves till we’re depleted.”

Her goal is to meet with her counterparts at the AVMA Convention and host them at DoveLewis as soon as this year.

One-on-one time

At AVMA Convention 2019 this past July in Washington, D.C., Drs Stevens and Nasir met with Dr. Beth Sabin, AVMA director of global outreach, and others on the pilot program management team to discuss how to measure the success of the AVMA-AFSCAN Twinning Pilot Program and how to proceed as it moves into its second year. In addition, Drs. Nasir and Stevens met with Drs. Brian Neumann, Jeff Newman, and Karen Murphy, the lead twinning program veterinarians at Caring Hands. They also had a chance to attend continuing education sessions. Zoetis and AFSCAN paid for the travel expenses, and the AVMA covered convention registration for Drs. Nasir and Stevens.

“The big challenge nowadays is it’s a virtual world. It can bring a global veterinary perspective in vet practice,” Dr. Stevens said. “But to meet people face-to-face makes a huge difference. To participate in a procedure and see it yourself in practice is totally different from the virtual world. We’re trying to do relationship building to where it becomes a face-to-face relationship, and there is interaction. It makes the experience that much more real.”

Dr. Stevens hopes more participants can meet at AVMA Convention 2020 in August in San Diego. In the meantime, the twinning pilot program just kicked off its second year with a call for a limited number of additional U.S. clinics, led by AVMA member veterinarians, to twin with three practices in Tanzania.

The pilot program, as approved by the AVMA Board of Directors, will run at least through December 2021, with potential to continue two more years.