Working with Morocco's Horses: Journey's End
- Jun 25, 2007
Follow along with student Jeremy Campfield as he posts electronic journal entries on TheHorse.com during his month at the American Fondouk Hospital in Fez, Morocco.
The American Fondouk is a full-service animal hospital in Fez that treats 50-100 animals per day, and more than 20,000 annually (in 2005, the hospital serviced a record 22,000 animals). Fez is considered the northern capital of Morocco, and it is the cultural and religious capital. The Medina (old city) in Fez is the largest contiguous car-free area in the world, with some streets as narrow as two feet and none wider than 16 feet.
The hospital's resident veterinarian, Denys Frappier, DVM, will serve as Jeremy's advisor.
Frappier at one point in his career was the head veterinarian for the Canadian Olympic equestrian team and has participated in six Olympic Games. He originally volunteered for a one-year stint, but was so struck by the plight of the people and animals of Morocco that, 12 years later, he is still working at the Fondouk.
Post 1: Ready to Go
Since no typed words will truly describe the goings on in Fez and the Fondouk, I can only recommend that anyone who gets the chance try and visit Morocco. Be forewarned that the culture is very different in all respects, and as an American you are a source of income for the people here. Moroccans can get pretty creative about getting tourists' money. There are a number of good travel references available, but the best situation is like the one I had at the Fondouk, where I lived with locals who could show me around and explain all of the ins and outs of functioning in this country, including how not to get ripped off. Speaking French was a tremendous advantage as well. Mohammed described it best today when he said "Morocco is always an adventure that starts the second you step off the plane." If you do decide to visit Fez, be sure to stop by the Fondouk and say "hi" to Dr. Frappier and meet the staff. The doors are open to the public weekdays from 7:30 a.m. until 1:00 p.m. Spending just an hour or two observing what goes on in the Fondouk is guaranteed to be an eye-opener.
The political plight at the Fondouk seems direr every day. The depot of supplies and drugs are still sitting at the airport. Now the airport has been calling the Fondouk and threatening to return the shipment to the U.S. if the Fondouk does not pick it up. With no sign that Morocco is going to budge and grant the proper customs authorization for Dr. Frappier to pick up the supplies, the life blood of the Fondouk is trickling away. This is indescribably frustrating and has recently been a source of constant stress for the Fondouk's employees.
While the working animals in Morocco have it hard, many of the people are suffering as well.
As a near-future equine veterinarian (assuming that pesky board exam goes alright later this year), my time in Morocco has renewed my passion for veterinary medicine and offered me a totally new perspective of the role of the veterinarian in society. I could barely communicate with the rural Moroccan farmers, yet I constantly felt displeasure in observing some of their practices. Regardless of how I feel things should be done, or the political battle between the Moroccan government and the American Fondouk, the bottom line is that these animals never asked to be thrown into their current situation. They just need people who will devote themselves now to alleviating animal suffering and try to educate the horse owners, even though the latter makes pulling wolf teeth seem a piece of cake. The work at the Fondouk must never stop.
Working at the Fondouk is as much an emotional journey as one of veterinary science. After just a month here, I would easily stay and continue to work tirelessly for these animals, without thought about my student loans, salary, or what kind of truck I want to drive. Now I understand why Dr. Frappier has stayed here all these years with no plans on leaving.
Thanks again to everyone who followed the blog and many thanks to The Horse for bringing this situation to the attention of horse enthusiasts everywhere. To learn more about the American Fondouk and/or to make a donation, you can find their Web site at www.americanfondouk.org.
I have been forever changed by this experience.
I am sitting in the train, which has just pulled out of the Fez station. I had no idea that I would have so much trouble leaving. I'm actually finding myself a bit choked up, after having made so many new friends and feeling so good about helping the region's horses. This experience has touched me in a way that's impossible to describe.
Murphy looks a little confused... This is right before I left, so I got to enjoy the donkey smell on my clothes for the 5 hour train ride. It was worth it!
After a whole night of packing and preparing to depart, I stayed up to work this morning and enjoy the final moments of my Moroccan adventure. Working was a bit difficult because I was unwilling to get dirty, which would entail unpacking my bags for a change of clothes. I stayed surprisingly clean while passing a nasogastric tube for a fractious colicking mule that kept trying to go down, without so much as a few drops of mineral oil on my shorts.
The morning was bittersweet. I was sad to see that the neurologic mare had managed to rupture a hind flexor tendon over night, leaving her unable to bear weight on the right hind without the back of her fetlock touching the ground. The owner decided to sell her the butcher for 100 dirham (about $12). Moroccan people do not eat horse, but the meat will be used for dog food. The fact that the horse will go to slaughter before the proper withdrawal time for the medications she was administered really makes me appreciate our USDA and the strict regulations in the U.S. regarding drug use in food animals. There's no explaining such things to the Moroccan people. This mare's owner just sees the 100 dirham and would probably go so far as to walk into the Fondouk and take her away against doctor's orders.
I stood dejected in front of the mare's stall only to turn around and see a beautiful Arabian weanling. I talked to his proud owner for a while, who told me that the colt is destined to be a Fantasia horse. I didn't get to attend a Fantasia event this trip, but that's just one more reason for me to come back. The colt had a two-finger umbilical hernia. Doc referred him to a private practitioner for the repair.
In the last few minutes before I headed to the train station this afternoon, we managed to round everyone up for a great group photo. Then it was time for me to pose with our favorite pet/mascot at the Fondouk, Murphy.
Murphy is an orphaned yearling donkey that was dropped off at the Fondouk because his owner felt he would never be able to work. The farmer was right: Murphy has every major problem in the book. He is tiny (I estimated about 140 lbs), with hooves about as big around as my thumbs. The hooves don't hold him back as much as his hind legs--his hocks rub together and periodically catch on each other as he tries to walk. Thankfully he's also cryptorchid so we won't be expecting any baby Murphys any time soon!
The greatest part about Murphy is that he's the most friendly and happiest donkey I've ever seen. He acts like a dog. We let him out to graze in the concrete courtyard in the afternoons. He keeps the place clean, eating every little sprout pushing up through cracks and in the dirt around the Fondouk's trees. I laugh out loud every time I see the little guy. Doc said they will be relocating Murphy to a farm where he will not be expected to do any work. If I had even a quarter acre back home I would have taken him with me!
Sadly, this concludes the day to day journal. I had a great time sharing my experiences with all of you, and I truly appreciate the encouraging e-mails that so many have sent. I hope that the articles have been informative and entertaining. I'll write one more post to highlight some final thoughts before I get on the plane.
Well, the end of my stint here is approaching. I spent little time in the hospital today in order to get some last minute things done before heading back across the Atlantic. I finally got a chance to see the Medina! The Medina in Fez is the largest in Morocco, comprised of a maze of narrow alleys packed full of small shops, cafes, etc. The most impressive part was the tannery, where leather is processed the old fashioned way into all sorts of attractive merchandise.
I finally got to see the hard working animals that I've been helping to treat for the last four weeks in their usual milieu. They are essential for transporting the heaviest of loads through the streets of the Medina, where no autos are allowed or would even fit. Surprisingly, most of the animals I saw on active duty looked pretty well cared for. Alas, the rubber shoes were rampant but actually did seem to prevent the donkeys from slipping on the slick stone walkways, which tend to be sharply inclined. Our visit to the Medina was cut short when the "tourist brigade" stopped Azami (the farrier), asking him what he was doing touring four Americans around the Medina. They are trying to cut down on fake guides who charge tourists too much money to show them around the Medina, engaging in all sorts of shady business. Even after we explained to the officer that Azami was our friend and co-worker, Azami was ordered to leave the Medina. Ridiculous considering that the Medina is where Azami lived for 36 years. That incident left a bit of a bad taste in my mouth.
The evening ended on a terrible note. The other students and I returned from dinner to find that someone had left a dying dog propped against the doors of the Fondouk. He was old and in rough shape, and he looked lifeless except for his continued attempts at difficult breathing. We immediately woke up Doc to get the euthanasia solution and put the dog down.
I will be taking the train out of Fez tomorrow afternoon. I'll be staying overnight in Casablanca because of my early morning flight on Friday. Not much left to do but get packing and reflect on all that I've seen and learned here. I'm looking forward to posting the most important lessons and the general impressions I've gained. I'm not, however, looking forward to leaving and I have promised the staff at the Fondouk that I will return the next chance I get.
Today was exciting and fast-paced. Since it wasn’t nearly as busy as yesterday, I enjoyed taking a little more time with the patients.
Today’s funny moment was during another teeth floating. This mule had a mouth full of stalactites and stalagmites that warranted the power float. And since we weren’t too busy, I enjoyed the luxury of having the time to do a thorough job. The mule’s owner obviously (even though I couldn’t understand a word he was saying to me) needed to get back to work pretty soon. Every time I turned around to grab a light or rinse the float, he tried to take off the mouth speculum and open the stocks as if he had an important rendezvous to get to. I was laughing as I finished the floating; this owner reminded me of a few of the more demanding horse owners I’ve met back home.
This is the cart injury horse. We knocked her down to put the pieces back together. Please disregard the split in Azami's coveralls; I know that drives all of the ladies here pretty crazy!
I was keeping busy when I heard Azami exclaim “wow…look what just walked in.” The horse was spurting arterial blood all over the courtyard from beneath her hind legs. The story went that this mare spooks easily, and she did so while pulling a cart today. It must have been a sight to behold as the cart broke apart and a piece of the wreckage penetrated the inside of her thigh, severing some large vessels and severely damaging the muscles and other soft tissues. While unfortunate for the horse, I was excited that we would get to treat a fresh wound, since most of the traumatic injuries we see are weeks old and infected. This wound repair went well. We were a bit worried about putting her under general anesthesia considering the blood loss, but she did fine and recovered uneventfully. We’ll keep her as long as possible to manage the wound healing.
The neurologic mare from yesterday is doing much better. She is still showing the neuro signs, but seems more comfortable and has been eating and drinking. We have to pass a urinary catheter several times daily since she still cannot urinate on her own. I have high hopes that she will pull through.
Azami spent a lot of time translating Arabic for me today so that I could communicate directly with the animal owners and help things move along more quickly. I was staring at a gray horse that was showing signs of advanced neurological disease. When I went through the usual "please tell me what the problem is," I couldn’t help but laugh when Azami relayed the message that the mare hadn’t urinated in three days. I couldn’t believe that the owner didn’t seem to mind the fact that the poor animal could hardly stand! I suppose he would have figured it out sooner or later when she just fell over in the street. Forgive my sarcasm, but some of this stuff gets pretty hard to swallow at times. We hospitalized the mare for further observation and treatment. Indeed she has a raging urinary infection in addition to the generalized ataxia and some cranial nerve deficits. Our working diagnosis right now is equine herpesvirus-1 infection.
Unfortunately, we will not be able to confirm such a diagnosis because confirmatory testing such as antibody titers is generally unavailable and not cost effective for the Fondouk. The prognosis is guarded, but we are treating her and monitoring her condition closely.
I talked to Dr. Frappier today about another aspect of the situation that makes diagnosing diseases almost impossible. The owners seldom answer questions truthfully, or they just do not know the medical history because they don’t see the animal every day. A great deal of veterinary medicine depends on acquiring an accurate and detailed history of the problem at hand and any past problems. Since that information is completely unavailable, we are blindfolded in a sense when it comes to prescribing an appropriate treatment. It makes things very difficult, but Doc seems to have learned to accept the fact and do the best he can under these circumstances.
Hassan Metsqual accepts his new Championship title.
I spent a fantastic Sunday afternoon at the horse show. Doc drove us about two hours to the Royal Polo Club Equestre Dar Es-Salam in Rabat, where “la Semaine du Cheval” (the Week of the Horse) is going on. This event is a weeklong competition presented by la Federation royal marocaine des sports equestres, under the High Patronage of His Majesty the King Mohammed VI. This year, this event incorporates the Moroccan national championship in jumping and dressage.
Doc was mobbed as soon as the car turned into the polo club parking lot. He is obviously a popular fellow with the jumping crowd. One rider seemed to be particularly happy to see Doc; it turns out that he is Hassan Metsqual, a contender for the Moroccan national title in jumping. The reason he was so happy to see Doc is that his horse, Ramazoti is a 13 year old that Doc nursed though acute laminitis three years ago. She then ran into some hock problems with persistent back pain, which Doc addressed as well. Hassan asked us to wish him luck and headed to the barns.
The competition was very entertaining. Best of all, Hassan took top prize and is the new Moroccan champion. During the second round, he and Ramazoti completed the only flawless run of the competition for the win. The crowd went crazy.
I did get a sense of how serious Moroccans are about their horses. Far from the intense labor and neglect I’ve seen at the Fondouk, this event was a portrait of people who have a long history of horsemanship and are very much into their horses. A huge banner of King Mohammed VI on horseback loomed over the arena, displaying the importance of the horse to the nation of Morocco.
I have to admit that I slept in a little bit this morning after last night's long colic escapade. The colicking horse from last night died early this morning. We couldn't find any specific or focal lesion on necropsy, just massive, gas-filled intestines.
Hang on to your lunch...
This pylorus was completely blocked by bot fly larvae, causing a stomach rupture.
With the day off on an already somber start, a mule with severe colic was being treated when I walked down to the courtyard. This one looked very bad off; the distressed look in his eyes despite medical treatment efforts revealed much about how the story would end. We finally euthanatized him this afternoon. This necropsy was much more revealing than the last. The stomach was completely infested with bot fly larvae. There were not just a few; the pylorus (the outflow tract of the stomach into the small intestine) was completely obstructed by the larvae. Because ingested contents could not leave the stomach through the pylorus and the fact that horses are unable to vomit, the stomach had ultimately ruptured--we found feed material freely floating within the abdomen.
On a lighter note, we spent some time with the lame horse that came in from Rabat yesterday. The diagnosis was straightforward. He was markedly lame in the left fore at the trot, after having sustained a jumping injury three days ago. He had a palpable bow just proximal to the sesamoids, and the flexor tendons were sore on palpation. The annular ligament was constricted, trapping fluid within the flexor tendon sheath proximal to it. We applied dressings and a bandage; stall rest is obviously indicated and we'll be seeing the horse back next week.
This afternoon I helped Houssine stitch a donkey's ear back on. Like so many cases, we're not sure of exactly what happened, but this donkey's attitude may have driven his owner to extremes. Not having worked much with donkeys in the past, I had a good time talking to Houssine about these tough little animals. Their stubbornness is amazing. Doc swears that they're smarter than horses in that they're capable of mentally abusing a person! The one today was no different--after sedation and copious local anesthesia, the beast was still shaking his head and squirming around in the stocks. It made for a challenging ear repair, but I think the ear will stay together.
We changed our plans and decided not to go to Rabat this evening. Two of the other students are not feeling well, and these past couple of days leaves us wanting to stay here and rest at the Fondouk. We're still planning on taking a day trip to Rabat on Sunday for the horse show.
One of the finer animals for sale at the souk.
The most dramatic case today was a bloated goat (the bloat persisted despite medical therapy yesterday). Suspecting a foreign body obstruction of the GI tract, which is very common around here because animals have easy access to all kinds of trash, we performed a rumenotomy. We removed a large amount of huge plastic bags and various other garbage from the rumen, which made for a very rewarding surgery. Considering the volume of the trash, I wonder how hard the goat had to try to eat all of that stuff.
A horse trailer pulled up around 5:30 pm, a sure sign that tonight would be a long one. The trailer had come in from Rabat carrying two very nice eventing horses. One was admitted as an emergency colic, and the other was to be evaluated for lameness (the lame horse will wait in a stall until tomorrow). The colic horse came off the trailer looking not so bad, but he had been painful for two days already, not passing manure, and a vet in Rabat had already trocharized him twice to release gas from the GI tract. We didn't get any net reflux from the stomach, but he was only minimally responsive to pain medications. We did the best we could with the available supplies to rehydrate and keep the horse comfortable. Even without the availability of diagnostic procedures, his clinical signs including progressing severe pain and abdominal distension suggested that this horse needed surgery. Equine laparotomy not being an option anywhere in Morocco, the owners had to stand by while their prized animal suffered and progressed toward inevitable death. I finally headed to bed at some wee hour, still hearing the sound of steel shoes on concrete most of the night as Adnan, the night watchman, continued to walk the horse around the courtyard.
I have wanted to write a little bit about the animal trading, donating, etc that goes on here at the Fondouk. The perfect opportunity presented itself today in the form of one very funny situation. This one had us all laughing pretty hard. A couple of weeks ago, a man dropped off his mule for a hernia repair. Being very poor and in need of a mule to continue to work and support his family, he borrowed a mule from the Fondouk (the Fondouk occasionally keeps and cares for abandoned or unwanted healthy animals, to be given or loaned to individuals in need). Well, today the same man came back to the Fondouk with a completely different mule that had a wound he wanted us to look at. We asked him where the loaner mule was. As it turns out, he traded the Fondouk's mule for the one he brought in today (who knows for what reason--maybe the other one didn't work hard enough). We all laughed for a while; you have to have a sense of humor about this stuff. When we demanded that he "undo" the trade and bring back the same mule that the Fondouk loaned him, he told us that would be impossible because the person he traded the mule to is a butcher! If he was really being honest, maybe the motive was that the Fondouk had fed the mule enough to make it attractive as a food animal. In any case, whether he was trying to put one over on the Fondouk or not, his mule that we originally performed the hernia repair on is not yet ready to return to work. I suppose we'll sort it all out if he does come back to get his original mule.
The Fondouk's attitude about situations like this is one of understanding; I don't suppose you can blame such poor people for doing anything they can to survive. There are some people, though, who take advantage of the Fondouk by dropping off an animal for care, and then not returning to pick up the animal until they need it again for work, which might be months later, during a harvesting season. Those people are opportunists who know that their animal will be well cared for and fed to gain weight during their time at the Fondouk.
Today was pretty slow case-wise. We have some exciting things in the works. We're planning on going to see the animal souk (market) tomorrow. It will be an early one--people arrive from everywhere as early as 2:30 in the morning to do business. We probably won't partake in the festivities quite that early, but we'll try to see the souk before 6 a.m., when the market is at its busiest. Also we might be heading to Rabat this weekend for a horse show. I'm looking forward to comparing that event to the ones I've seen in the states. We also might get to see an event known as Fantasia--a type of contest of skill on horseback which involves up to thousands of riders separated into teams by their hometown and firing rifles (hopefully not at each other). I'd love to learn more about this activity; it will definitely make for a great blog entry if all goes as planned!
Houssine explained to me an interesting belief that the Moroccans have. I was talking to him about castrating practices here. For one, hardly anyone castrates any animal. I noticed early on that we don't see any gelding horses. The horse folks here must be pretty seasoned stallion handlers, as I've seen people (wearing sandals) walk into the Fondouk leading two stallions side by side, neither wearing more than a very thin rope halter and tiny lead rope. My conversation with Houssine turned toward the mules, which are routinely castrated despite being born infertile. The reasoning behind this can only be described as puzzling. Apparently, people hold the belief that if a mule were to mount a filly or mare (horse), then that filly or mare would become infertile. How does one respond to a statement like that? That is just one example of some of the beliefs that are rampant around here, but that will most likely never be changed because they are stubbornly perceived as absolute truth, having been passed down for generations.
The donkey that came in with colic yesterday did not make it. We continued supportive therapy today, but it was too little too late. On necropsy, we found that most of the small intestine was compromised and necrotic. The lesion was such that surgery early in the course of the disease would have been the donkey's only chance at survival. I got a bit frustrated by having to stand back and watch the disease progress without the proper equipment to make a definitive diagnosis or the ability to do anything to possibly save the animal's life. However, some good can come from this case: the other vet students and I, who watched and followed the animal's clinical signs as the disease progressed, have found a new appreciation for what we will be striving to prevent in our own animal patients in the future. We have now seen a case of small intestinal strangulation progress without surgical intervention and correlated our clinical observations with the ultimate findings on necropsy.
Several more colics came in today. I wonder if the recent increase in colic cases has something to do with the unusual weather we've been having. I'm told it hasn't been as hot as normal here for June (which doesn't bother me personally). At sunset, there have been strong winds that are borderline cold! The colics we keep seeing are fairly mild, probably brought on by dehydration, and resolve with medical treatment.
Otherwise, our morning was fairly uneventful with a lull just before lunch time. Several more sheep came in with respiratory problems, as is common this time of year, when everything is very dry and dusty. One common parasite here seems particularly unpleasant: Oestrus ovis is a bot fly that deposits its larvae to mature within the nasal passages and sinuses of sheep. Affected animals tend to present with bilateral nasal discharge, and that sign during this time of year is considered to be pathognomonic. Any sheep that come in with nasal discharge are treated immediately with the proper antiparasitic, but a complete exam is still performed to rule out other concurrent respiratory problems.
Tonight Doc took us to see a concert: Requiem de Verdi, performed by La Symphonica Toscanini. I don't listen to classical music very often, but I really enjoyed the show. We were lucky enough to catch a glimpse of the Moroccan Princess Lalla Salma as she exited the concert with her entourage and guards. She is the wife of Morocco's current King Mohammed VI.
Houssine places the trochar to release gas from this donkey's massively bloated abdomen.
We saw one donkey with colic and obvious severe abdominal distension. In ideal conditions, exploratory abdominal surgery would have been the best option. Here at the Fondouk though, his last chance was the placement of a trochar through the body wall into the large colon to release gas and relieve the severe bloat. After we placed the trochar, foul-smelling air rushed out for a solid 10 minutes while the bloating decreased before our eyes. It seemed to me that the donkey started feeling better immediately. Now, only time will tell whether he will make it. If there is a primary lesion such as an intestinal torsion which does not resolve solely by releasing the gas, we expect that the gut will continue to distend and the condition will worsen. The owner kindly agreed to leave the donkey with us for observation, continued treatment, and/or euthanasia as needed. This afternoon, the donkey appears much more comfortable, his vital parameters have improved, and his abdomen still appears normal.
The morning ended with another abuse case. The mule came to the Fondouk because "he won't work anymore." I couldn't believe that it was only recently that the animal had shut down. He was covered with traumatic wounds, hematomas, lacerations, etc. I could hardly find a section of normal skin, and the more severe wounds were draining copious amounts of pus. He stood with an arched back while shifting weight between his hind legs, obviously in serious pain. He was euthanatized.
I didn't get up close to any horses during our little road trip. At a few towns just south of the Atlas Mountains, however, we did see large numbers of horse-drawn carts transporting people and goods. I noticed severe lameness in about 80% of those animals that were trotting as we passed by them in the car. That kind of sight made me pretty homesick, as I thought about all of the horse owners back home who pay so much attention to staying up to date with their farrier and maintaining their horses' soundness.
Jeremy's first clinical experience with tetanus.
The Fondouk did reopen its doors to the public last Wednesday. However, the situation is far from resolved. Doc still cannot pick up the necessary supplies. Another aspect of this situation involves conflict between the Moroccan and Canadian governments (Dr. Frappier earned his DVM in Canada). Moroccan officials are unhappy with the fact that Moroccan veterinarians must pass an equivalency exam in order to practice in Canada. Therefore, they do not feel that a Canadian (Dr. Frappier) should be allowed to practice in Morocco, and would rather see a Moroccan veterinarian take charge of the American Fondouk. That idea makes me cringe; however, Doc assured me that the MSPCA would not stand for such a change. There is no easy and quick fix for this situation, but Doc may have found a solution that will at least allow him to pick up the supplies on Tuesday.
Doc didn't waste any time in putting the students back to work tonight. He asked us to examine a mule in a stall and give a diagnosis. When we got to the stall, the mule was recumbent with apparent neurological problems including incessant muscle contraction, and a fairly recent wound over the right shoulder. This was the first clinical case of tetanus I've ever seen. Euthanasia was the best option at that point given how far the disease had progressed and the poor success rates of unavailable extensive treatment.
The desert trip was a fun distraction for a while, but now I'm looking forward to resuming work tomorrow.
The opportunity has presented itself for the other four students and I to go trekking in the desert! Since the Fondouk is closed again today, we are leaving this morning. We’ve rented a small car. The plan is for us to drive to Merzouga, which is south of Fez, and south of the Atlas Mountain range. We will charter a camel trip (lasting two or three days--that’s yet to be determined) into the desert dunes and oases from one of the hotels in Merzouga.
I will be entirely without internet access until I return to Fez on Saturday or Sunday. I’ll keep my eyes and camera peeled for anything horse-related that might be of interest. I’ll post a summary of the adventure upon my return to Fez, at which time we’ll hopefully also be able to resume treating the animals here at the Fondouk.
Post 10--June 4: Closed Doors
The Fondouk is closed today. The reason for this stems from the currently unstable political situation between the Moroccan government, the Fondouk, and Dr. Frappier. Doc has recently run into serious problems with the government's Ministry of Agriculture, which does not want to recognize him as a DVM (despite the fact that he's been practicing here for the past 14 years). The most puzzling part is that Dr. Frappier's Canadian diploma has been translated and recognized by Morocco's Ministry of National Education's Department of Higher Studies as the DVM equivalent in this country. Because the Ministry of Agriculture's "departement de l'elevage" will not sign off on his already-approved diploma, Dr. Frappier cannot even pick up a large depot of veterinary supplies that is currently waiting for him at the airport, since a DVM's signature is required. Needless to say, the situation is getting tougher for treating animals here at the Fondouk. We're running out of drugs and supplies--we used the last of the X ray films last week.
Political impasse closes the Fondouk.
Personally, I don't see a problem with the Fondouk maintaining a show-horse practice or with Dr. Frappier continuing to work for higher echelon equine clients by virtue of the stellar reputation that he's gained after years of equine practice all over the world. The time spent working with those horses does not affect the care of the less-fortunate patients in any way. I also think that Dr. Frappier should not have to completely give up working with top-notch horses, considering how much good he has done at the Fondouk and his love and dedication to equine practice.
Dr. Frappier's decision to close the hospital on a weekday was not taken lightly. He hopes that closing the Fondouk will serve as a powerful political statement, and that someone at the U.S. embassy will take notice and attempt to facilitate his position here. The Fondouk was closed for similar reasons only one other time, which was about two years ago. Back then the tactic was effective, and the Fondouk was able to resume work. Unfortunately, it is the animal patients and their owners who will ultimately suffer from the turmoil. People have been knocking on the Fondouk's doors every 10 minutes or so, to learn that their animals cannot be seen today. The Fondouk will also be closed tomorrow. We'll have to play it by ear and see what comes of closing today and tomorrow before Doc can decide how to proceed from here.
Post 9--June 2: Off to the Races
Saturday morning we headed out of town to catch some local horse racing. Eight races were scheduled for the day. Oh my, what a cultural experience that was! The scene as we drove down the dirt road through an old potato field was hilarious. I did a double take when I saw the track, which is just a plowed section of the field; it's very hard dirt and littered with rocks (although I think most of the potatoes were gone). No rails, no starting gate. I gave up trying to find the barns or wash racks or anything that resembled a horse training facility. The horses were scattered among the olive trees, tied to the vans they came in on. I use the word "van" loosely because they sure looked like the open top garbage trucks we have in the U.S.! The grooms and jocks milled about in preparation.
Down the home stretch! Notice some interesting riding styles...
Doc Frappier dropped us off to get out of dodge ASAP, but he couldn't escape one trainer who wanted to talk about a colicky horse.
The horses were Arab-Barb crosses. There were some nice horses, some of them showing the Arabian dished-head more prominently. They varied greatly in size and a few were quite small.
The goings on were surprisingly well organized considering that the whole operation was obviously a temporary setup that gets thrown together by the locals on race days. There was a large tent where the older gents were sitting, which also contained the weigh in--a flat scale and a table where the officials sat. I got the chance to speak with an official from the Moroccan ministry of agriculture, who introduced himself to our out-of-place group of American students. I was surprised to learn that the races are actually sponsored by the Moroccan government. He even let me take a peek into the envelope he was holding, which contained the list of purses. Most of the sums were in the several hundred Dirham range, with a few up to 20,000 Dirham (about $2,500).
I was also impressed when I inquired about drug-testing practices. They perform testing on random days (this Saturday was not a test day), collecting blood and urine from first and second place, as well as one random from each race. Samples are shipped to different labs in Morocco and France for analysis.
My jaw hit the dirt when a jockey--of all people--walked up with a tray to serve us all hot mint tea, Morocco's traditional beverage. It was almost as good as mint juleps!
The races were started behind a red rope at the drop of a flag and usually took several tries, involving much yelling and runaway horses. The races were exciting. And since there's no rail to keep spectators off the track, everyone kept walking in front of each other for a better view of the home stretch, moving farther out onto the track until they were standing just yards away from the running horses. At least one older gentleman worked to move people back, and I was startled when he began screaming at me in Arabic and beat me with a piece of paper to coax me out of harm's way. It was all in good fun and made for a very memorable video! The hollering continued later with an altercation on the track among several men. It got pretty heated and I expected the fists to start flying any minute, but they didn't. While we had no idea what the situation was, we gathered that a trainer or owner hadn't been happy with the start of that race.
I can't say that the husbandry was any more ideal for the horses than the facilities. They were tied back up immediately after racing and there was no water in sight.
What a fun trip back in time this was. I can imagine that the early days of Thoroughbred racing in our country probably played out as a similar scene. I didn't see any open wagering, but I'm fairly certain that the old men under the tent weren't there purely for the entertainment.
Post 8--June 1: A Shocking Case
As promised, today was very busy after yesterday's Souk. We rushed through routine deworming and wound treatments as people brought in their newly purchased animals this morning. One man walked in with eight donkeys in hand!
The slew of normal activity was interrupted abruptly with a bit of commotion at the front door: I heard several exclamations in Arabic as I caught a glimpse of a group of men carrying something into the courtyard--I didn't believe that I could still be shocked after what I've seen here already, but I was. A mule was carried in, slung over and tied to a couple of poles. When they laid her on the concrete, I could see that the right front leg was dangling irreparably, despite the makeshift bandage wrapped around the injury itself, just below the elbow.
As Houssine cut off the bandage, the overwhelming number of flies, maggots and numerous other insects were a good clue that we would find an open fracture (bone fragments penetrating the skin). The injury itself wasn't the most disturbing part. What got to me was that the fracture had happened four days ago. Your guess is as good as mine as to why someone didn't put her out of her misery much sooner. We euthanatized her immediately.
Azami laughs as I struggle to keep it together!
This afternoon we performed a standing mass removal from the chest of a gray mule. We found that the softball-sized melanoma was firmly attached to the jugular vein and some large arteries. We were finally able to separate the tumor away from the surrounding tissues without too much bleeding. The removal was a success and the owner was extremely grateful for our efforts.
It looks like I'm going to get to go watch some local horse racing tomorrow! We're meeting a local horse owner early tomorrow morning and he is going to take us to see the show. I should get lots of great photos. I wonder if there will be any wagering. Getting out to do fun things like that has been a fantastic part of the experience here.
Dr. Frappier and the Fondouk's team are incredibly accommodating toward the visiting students. There are five veterinary students here at the moment including myself. Matt Cantrell is from Purdue University, Tamerin Scott and Lindsay Tangeman are from Western University, and Shannon Guy is from the University of Minnesota. We've all been so grateful for this learning experience and are amazed at the lengths that Dr. Frappier goes through to make this a great environment for students. They just finished building a swimming pool here at the Fondouk, which they are going to start filling tonight!
Now we're just waiting eagerly in hopes that the wells hold enough water to fill it...
Post 7--May 31: Market Day
Thursday in Fez is a day of the Souk, or market, where a lot of livestock is traded. For that reason, the caseload tends to be light on Thursdays, but many people will come to the Fondouk tomorrow with animals they purchased today.
A sad sight walked through the doors this morning. The donkey was three-legged lame, his left hind hoof severely traumatized and sloughing off. The injuries were secondary to a common method of restraint here: ropes or wire (or whatever they can find that will work) tied around the legs. The restraints are generally placed around the pasterns and/or cannon bones as well. Most of the animals bear the white hair and scarring over all four legs from being restrained in this way. I suppose it's cheaper than putting up fence. The donkey we saw today obviously had to be euthanatized. The owner said that the injury was only three days old, which is kind of hard to believe. The most likely scenario we could theorize was that the donkey was left to graze while tied up for an extended period of time while the rope became tightly wrapped around the pastern, causing devastating tissue damage and disrupting the blood supply to the hoof. Probably the owner not gone to check on the animal until three days ago.
The donkey's hoof was traumatized and sloughing off.
I was relieved that were allowed to euthanatize the donkey today and end his suffering. Not all sick or injured animals are so lucky here. The locals will oftentimes refuse euthanasia because of their feeling that it is not up to people to "interfere" with the process of life or death. In those cases the owner will take the animal home to suffer until they die on their own because "God wills it."
The foal we saw on Monday did not come back today, so I may never learn whether or not he survived.
The horse with the injured eye (see yesterday's picture) was brought back today. The swelling had gone down a little bit to reveal a small section of cornea. The owner agreed to continue returning on a daily basis for continued treatment and monitoring.
To continue my discussion yesterday about the importance of the farrier work done here, today Azami showed me his method for trimming the longest hooves, when nippers just won't do the job. He uses a hammer to pound a sharp straight blade through the hoof, removing most of the excess length. In cases like this, the ideal situation would be repeated trimming every three weeks or so to try to correct the severely underrun heel and reestablish hoof balance. Unfortunately, Azami usually gets only one chance to help the animal. He told me that only about 30% of the owners follow his recommendations to come back for repeated trimming.
Old vehicle tires are reborn as shoes for working animals.
The swollen conjunctiva and surrounding tissue made examining the orb impossible.
Pretty light work day at the Fondouk. Most of today's patients were of the small animal type. I'm feeling a little better although still not 100%. I took advantage of the lull in large animal patients to spend some time with Azami, the farrier. Fitting right in with my farrier stereotype, Azami loves talking about horse feet. Of course laminitis was a topic of discussion.
Laminitis is one of the few things that the donkeys and mules do not have to worry about, as they are rarely affected. Azami explained that when he does see a case of laminitis, it's usually because someone buys a horse, and then feeds it loads of grain out of ignorance. Like many conditions around here, it's not seen by a vet until it's too late. Azami has seen plenty of P3s sticking out of the sole of the foot.
I also asked questions about the recycled-tire shoes adorned by many of the working animals. The reasoning behind using the tires is that it's free and creates traction for the animals on the slippery stone streets of the Medina. Unfortunately, they apply the shoes so that they cover the entire sole, creating a wet, nasty environment for bacteria and yeast to live. I shudder to think about how often the shoes are reset; Azami literally has to trim inches of hoof at a time when the animals are brought to him. I'll get my hand at trimming some donkey feet over the next few days!
A mule came in this morning with serious eye trauma. The conjunctiva and surrounding tissues were so swollen that the eye itself could not be examined. Today's treatment was aimed at reducing the inflammation so that a thorough exam can be performed tomorrow. The mule was sent home with a hood to cover the eye. I'm going to (tactfully) ask more questions during tomorrow's visit to try to ascertain whether the trauma was human-induced. Azami pointed out to me another common area of trauma. I saw a bunch of donkeys with a lot of swelling around the tail head and rump--apparently the "gas pedal" for a donkey-powered cart involves swinging a wooden stick.
Dr. Malika Kachani from Western University was visiting the Fondouk today. She gave us some lessons about various infectious diseases and helped us prepare blood smears and other diagnostics. Several hemoparasites are rampant in Morocco, including the tick-born disease known as theileriosis, which is important as a cause of death in cattle.
Post 5--May 29: Sensing the Patterns
Unfortunately, I wasn't able to participate with very much of the work today. I woke up this morning feeling pretty ill. I don't think it will affect me for too long. I was still able to hang out and see some interesting cases in between swigs of Pepto!
The allograft is trimmed to size and applied prior to being sutured in place.
Wound management is an everyday necessity here. The working animals experience all sorts of friction injuries over the withers, girth, hips, etc. from improperly fitted "tack" and poorly distributed weight loads. A common procedure used to treat the more severe of these injuries is the placement of full-thickness skin allografts. These skin grafts are harvested from a different animal of the same species (usually from the intact skin of an animal that is euthanatized for any reason), and are preserved and refrigerated for later use. The goal is not for the graft to be accepted by the recipient as their own skin, but rather to create a favorable environment for wound healing. The graft is kept moist and maintained for as long as possible, until it dries out and must be removed. I removed one such graft yesterday. While it wasn't a pretty sight (the smell was awful and maggots were involved--that's right, maggots), the underlying tissues had granulated in nicely, covering a wound over the withers that had once exposed bone of the thoracic vertebrae. We placed an allograft over an open sore on a donkey's back today. I'll get to follow this wound as it progresses, although the graft might not be removed before I leave here, since the allografts are maintained for as long as possible--up to several months in some cases.
In addition to helping the animals in Morocco, I am also trying to gain an understanding of the culture, specifically those aspects that involve husbandry practices and treatment of animals. I don't think that I'll ever truly grasp the peoples' unwillingness to educate themselves about their animals and change their current mentality, but I can try to describe the overall environment and attitudes.
First off, there seem to be two populations of animal owners here. The rural farmers and laborers tend to be a bit more conscientious and show some concern: for the most part, these people bring in equids that are in comparatively decent condition. The other group is those who work in the more urban areas as porters on streets and in the Medina: these folks seem to neglect their animals as long as possible before a trip to the Fondouk. The theme across the board, however, is one of tradition and poverty. A horse's value never exceeds the price paid for it, regardless of whether it has faithfully delivered years of service to its owner. For this reason, the private veterinarians in Fez do very little business. When the cost of caring for the animal exceeds its monetary value, there is no motivation to pursue treatment. It's kind of like when you or I decide whether to fix an old used car (excluding those people who get sentimental about their cars!).
The traditions of horsemanship here are based on domination and negative reinforcement. Very few of these horses will turn to face me when I walk into a stall, let alone show any curiosity or greeting. While I'll never proclaim to be an expert horseman, it seems to me that working with an animal who wants to do its job because of proper training would require much less effort than having to constantly beat the horse to try and make a point. It's a far cry from natural horsemanship or horse whispering, but it's a way of life for these people.
Post 4--May 28: Ups and Downs
My first weekend here in Fez was quite the adventure. Mohammed, an employee at the Fondouk, showed us around the "new downtown" area, which is much like a U.S. city; it has a lively atmosphere with many places to shop and eat. I also got a superficial view of the Medina, which is the ancient city. The Medina is kind of a sensory overload, with its crowded narrow alleys packed with merchants, all of whom seem eager to speak with Americans (many of them speak very good English). We'll be seeing more of the Medina later this week.
The injured foal is loaded back onto the moped to head home. We hope to see him back on Wednesday.
I was happy to see a couple of good-looking and well cared for Warmbloods: a stark contrast to the herds of neglected working animals. The Warmbloods presented for mild lameness. Performing some lameness exams with Dr. Frappier was a welcome distraction from time with the suffering and mistreated animals. The experience also reminded me of a great blessing: digital radiography! Today was my first experience developing plain X ray films by hand--and I REALLY miss digital.
The day ended on a great note when a pregnant ewe presented with an abdominal hernia. Hernias are extremely common here in all of the large animal species, and are usually due to blunt force trauma by other animals or handling practices. The ewe was very old and past the end of her pregnancy term. Because she was a high risk pregnancy and the hernia repair would fail if she were left to lamb on her own afterwards, we decided to perform a caesarian section and repair the hernia at once. We elatedly delivered three live, healthy lambs. The surgeries were successful, and mom was sent home with her new babies. Experiencing so many cases in one day with all of their ups and downs is physically and mentally exhausting!
This week should bring lots of nice horses to the Fondouk, as people prepare for a horse festival in town. Over the weekend I also saw pictures of some local Arabian racing. It looks completely crazy: the racing takes place on hard ground in wild, unmanicured fields full of rocks. Some of those races will be going on next Saturday, so I'll try to go see it and take some exciting pictures.
Post 3--May 25: Getting Settled
I am feeling more comfortable here at the Fondouk, and today I started to function better in the clinic. I was even able to get up and going when the doors opened this morning at 7:30. The daily routine here is that walk-in patients arrive between 7:30 a.m. and 1:00 p.m. Then there is an hour break, after which we do the more involved procedures, surgery, etc., and continue treating any inpatients. So, no animal owners enter the Fondouk in the afternoons, when we stay busy finishing up all of the procedures to be done that day.
Patients of all shapes and sizes come and go.
There are not really "appointments" as far as I can tell. I entered the courtyard this morning to find about a dozen people waiting with their horses, donkeys, and mules in hand. Houssine, the large animal technician, started working through the cases one by one, providing necessary treatments, and kept me busy giving injections, doing physical exams, treating minor colic, etc. Treating so many animals at once had my head spinning; I had to keep checking which injection was for which mule or sheep or goat. All the while a continuous menagerie filed into the small animal treatment room--pigeons and chickens in addition to the cats and dogs, all of which are seen by Houria, the small animal technician. Dr. Frappier stays busy between all of the cases to help make the difficult decisions. The technicians are incredibly self-sufficient, surely owing to their extensive experience and training. They've all been graciously willing to teach and answer my questions (we are able to communicate in French quite well).
Notable cases today included a large head laceration (a graphic reminder of why we prefer rust-free trailers with plenty of head room), a dog that had apparently been attacked with a knife (amputated tail in addition to multiple lacerations), an Arabian foal with septic arthritis, and a mule with a prolapsed rectum. The latter, which seems to be a daily occurrence here, are a preventable management problem. The combination of poor quality forage and feed, dehydration, and constipation are the main factors leading to a prolapse. While relatively easily to treat, the animals don't seem to particularly enjoy it.
Ring bits, which can cause tongue paralysis, are a common piece of equipment.
Such a scenario of people not willing, able, or caring enough to follow the doctor's instructions and husbandry advice is replayed as the day goes on. I can tell that the technicians get irritated (understandably) on occasion, as they spend their time and efforts to treat injuries that should and could have been prevented. Another example: I made the observation today that many of the equids' tongues seem to just hang out of one side of their mouths. When I asked Dr. Frappier about it, he showed me the ring bit that is commonly used for leading; the pressure it exerts can eventually cause permanent tongue paralysis. At one time, the Fondouk tried to distribute humane, properly-fitting halters and snaffle bits. Despite being given a snaffle, an owner returned with an animal in the same old ring bit again. When Dr. Frappier demanded an explanation, the owner replied that he had sold he snaffle! Very frustrating.
As the Fondouk is closed on the weekends, I'll post another entry when the clinic opens back up on Monday.
After three planes, a train, and almost 30 hours, I finally arrived in Fez completely exhausted. Dr. Frappier welcomed me, and I soon found myself eating a much-needed meal in a beautiful Moroccan hotel/restaurant. The horse speak began immediately--a client wanted Dr. Frappier to examine two of his Arabians before an upcoming race. After some conversation over a bottle of wine, we headed to the American Fondouk, where I will be working for the next month. As we drove past the high white walls and through the wooden gates of the Fondouk, I felt immediate excitement and a surge of new energy. Several concrete stalls housing open right into the main courtyard, which is also surrounded by the treatment area, farrier station, and apartments. I went to sleep feeling that this is truly going to be an amazing experience.
I was awakened at 2:00 a.m. by the sound of prayers in Arabic broadcast over a loudspeaker in town, and again at 6:00 by a donkey braying in the courtyard.
Jeremy's new "home away from home."
I hope to settle in over the next couple of days and get more involved. Dr. Frappier is a wealth of knowledge and experience, and I am sure to learn a tremendous amount over the next month.
Jeremy keeps an eye on a patient's recovery during a sophomore year surgery lab at University of Florida.
Clinical experiences in veterinary school consist mainly of specialized procedures in a referral practice setting. Vet students are taught, for the most part, the gold standards of how animal diseases should be treated. As a student, working in Morocco will be an opportunity for me to solidify my basic veterinary knowledge and be challenged to function in a not-so-ideal world without advanced techniques or optimal facilities. This is also a chance for me to be of service and contribute to the veterinary community. The nature and geography of the country will present opportunities to see diseases and conditions that I might not encounter elsewhere. Animal neglect will be rampant for sure, in addition to the possibility of infectious diseases that are rarely (if ever) encountered in the U.S., such as foot and mouth disease and African horse sickness. It will also be exciting to learn horsemanship and agricultural practices that differ from the American norms.
I will be leaving on May 22, hopefully prepared for hard work and very high temperatures. I expect that I’ll also have time to enjoy the local culture--I hear the Moroccan cuisine is outstanding! I am looking forward to sharing my experiences with readers of The Horse.
About the Author
Jeremy Campfield, DVM, graduated from the University of Florida in 2008. He then completed an equine-exclusive ambulatory practice internship at Peterson & Smith in Ocala, FL in 2009. Currently, he works at a central California equine practice.
POLL: Feeding Alfalfa