US Army Helps Rabies Control in Afghanistan

 

Dr Loren Adams, a private veterinarian from Iowa, relates his experiences of a recent US army mission to Afghanistan that increased rabies awareness and canine vaccination.

 “America has been conducting military operations in Afghanistan for 10 years. In 2007 the Army National Guard fielded the first 'Agribusiness Development Team' (ADT) staffed with Soldiers from agricultural backgrounds. Their mission was to develop 1) agriculture sector jobs in Afghanistan, and 2) increase Afghans’ confidence in their government.  After training and preparation in the US, I began to work in Afghanistan’s Kunar province in August 2010. I was the veterinarian in the group which also contained experts in agronomy, soils, and irrigation, along with a robust security force.  Once in Afghanistan I worked closely with Kunar’s Director of Agriculture, Irrigation, and Livestock (DAIL) - Haji Mohasal Khan, and Kunar’s Director of Veterinary Services- Dr. Mohammed Ghalib. We developed a variety of projects designed to promote the businesses of local veterinarians. Our ADT used US federal funds to employ over 36 veterinarians in animal vaccination and worming projects that treated over 39,000 animals in 42 villages throughout the province.

Early on I began laying the groundwork for a rabies awareness and control project in Kunar’s capital city of Asadabad. I felt it would be important to include the local veterinarians and government in planning and implementation of the program. Several online resources were helpful in the planning stages, including the Blueprint for Canine Rabies Control, and the World Rabies Day website which already had educational resources written in the local language of Pashtu.

We hosted a veterinary seminar in December for Kunar’s veterinarians. Each veterinarian indicated he had seen cases of rabies in dogs and livestock, and Dr. Ghalib remarked that he had seen a child die from the disease. Laboratory testing for rabies is available in Kabul, but very few samples from outlying areas. Security is poor, postal systems are not effective, and many Afghans do not call for veterinary assistance when an animal is sick. In Afghanistan the reservoir for rabies is the dog population, so my project centered on increasing awareness of the population about rabies along with a canine vaccination program. Teaching children how to avoid dog bites, and educating the health care sector on proper bite wound management was also important.  Security issues were complex and heavy armored personnel carriers were required for any meetings that could not be conducted at our camp. The language barrier was a problem, but we hired interpreters that were capable of bringing the message to the Afghans. My friend Dr. Ghalib also attended every meeting and was instrumental in presenting the messages correctly where cultural differences were often evident.

I wrote two public affairs pieces for radio broadcasts.  Because throwing rocks at dogs and hitting them with sticks is common in Afghanistan, I wanted children to hear a message stressing the importance of treating dogs with kindness as part of dog bite prevention.  Another message advertised the upcoming free dog vaccination program and encouraged vaccination of all dogs in the community whether they were owned or not.

 In early discussions about the vaccination campaign, issues of killing stray dogs were debated, as this was part of the national rabies control program. I presented evidence arguing that vaccinating 70% of all dogs and avoiding euthanasia was the preferred method, and although cultural and ideological difference persisted, euthanasia was avoided in our project. Medical supplies and 2,000 doses of dog vaccine (costing approximately US$0.61 per dose) were purchased though Afghan suppliers and I made dog catching poles in the camp. I was able to obtain human prophylaxis rabies vaccine to immunize seven local veterinarians.  Finally in April 2011, these veterinarians vaccinated over 1,500 dogs over a three week period and issued rabies certificates. Much advice about rabies and vaccination was also given, and apprehensive owners were invited to watch neighbors’ dogs being vaccinated to help convince them to have their own dogs vaccinated. All the veterinarians were pleased with the program that gave them work and put them in contact with locals where they could discuss their important role in preventing the spread of rabies.

Working with the Department of Women’s Affairs in Kunar, educational training sessions for 3 groups of women livestock care workers were also conducted. We also provided training for 45 of Asadabad’s hospital medical personnel. The staff was presented with fliers containing basic information on the risks of rabies and basic wound care, and wound care was demonstrated by camp medical personnel. We were frequently told rabies prophylaxis vaccine for patients was unavailable in Afghanistan.

Further education to 400 students at a boys’ high school and to 75 agriculture students at Jamaludeen Asadabad University was well received, but one planned for a girls' high school had to be abandoned, as we were not allowed to enter the school. An education official later reasoned that any class taught by a male outsider would be fuel for the Taliban to discourage teaching of girls further.

I am pleased with how much we accomplished in a community surrounded by an ongoing war. Our program dramatically increased rabies awareness for thousands of citizens and their provincial governmental leaders.  I also recognize that more can be done to further the program, especially expanding it to smaller villages around the province.  I have encouraged the government to continue with this program and a yearly vaccination campaign for two to three weeks each year.”