Evaluating Food Insecurity and Malaria-Free Progress in Vientiane

By Dr. David Zakus and Debbie Spicer

Our first visit to support Health Poverty Action in Laos, supported by VWB/VSF, was an adventure we were both really looking forward to.  Leaving Toronto just as winter was beginning to take hold was a kind of relief, and landing in Vientiane after about 36 hours on the road, surely didn’t disappoint.  Arriving at night wasn’t ideal, but presented no problems.  We were met at the airport by Thomas Weigel, VWB’s representative in SE Asia, which was great, and en route to our hotel he quickly gave us some orientation which continued the next day at lunch.  This wasn’t our first time to Laos, but we had been tourists before and had not stayed for too long, though we had begun to gain a great appreciation for the country.  This appreciation has certainly continued to grow during our whole 16 days of this trip, which ended on December 13, when we left as we arrived, late in the evening.

Our first ten days were spent in Vientiane, getting oriented to the sites, sounds, food and pace of life, all the while continuing to learn about the new nutrition and malaria projects we have come to support, in both the baseline assessments and evaluation and capacity building.  A true highlight of our days in Vientiane was a whole afternoon at the house of one of the senior staff, as part of a monthly office get-together, which involved a homemade feast of fish, chicken, vegetables, herbs (often eaten just freshly picked and washed) and the ever present sticky rice, which usually comes in an individual serving basket.

A lovely HPA-VWB dinner

What a wonderful way it was to further get to know all the great staff in the Vientiane office, which is run by a most capable and likeable manager, Ronaldo Estera, from the Philippines.  We mention capable because he seems to really excel in human relations, and program development and management.  David, being a professor of health services management for some 20 years, found the office here being run with all that he holds important in creating effective teams and achieving results, in particular building a strong organization culture.

After a great orientation, which also involved a long weekend with the country’s national day, we headed to the southern provinces where we gained exposure to the local project staff and their work.  En route to Khong in Champasak province, site of the new malaria project which is supported financially by Comic Relief, we stopped at a malaria control post and met the village health and malaria volunteers in their office, which was part of the malaria volunteer’s home, and then later visited a nearby community health centre.  At both we learned about the services provided and the work accomplished.  We learned  how the workers engage the communities and how proud they are to be part of HPA’s work overall.  Continuing on, we stopped at an area of amazing waterfalls on the Mekong River, with Cambodia way in the distance, and had one of the best fish lunches we have ever had.

Arriving later that day in Khong was also exciting as the Friday evening was the beginning of a major annual boat race festival.  Khong, being a small riverside town, was exploding with people and energy including a rock concert in a big field where a giant stage had been erected.  We enjoyed more great fish and vegetables and the ubiquitous Beer Lao, which truly seems to be a national drink, all the while sitting on the edge of the big Mekong River.

Photo of the boat race in Khong

The next day, now Saturday, saw the boat races start before 9am and continue for most of the afternoon.  The highlight was watching the HPA supported village team race past us to glory finishing in the winner’s circle, and all the while paying witness, through their shirts and hats, to HPA’s ‘Together towards a malaria-free Laos in 2030” campaign. Wow, we were now getting fully integrated, wearing our t-shirts and getting noticed by many local people.

Debbie wearing her HPA malaria-free shirt

The malaria program in Champasak has many strategies, like case detection and treatment, health education and behaviour change, and it’s focused on migrant and mobile hard to reach rural populations who are the most vulnerable to the devastating disease.

Before leaving the next day we had a most delightful fish, herbs and sticky rice breakfast at the home of a local staff member, and then headed back north, through Pakse (after stopping to pick up some local coffee beans) to Khaek, the provincial capital of Khammoune province where we were to meet with local officials for HPA to finalize its MOU with various levels of government.  The meeting took place the following day, and was so interesting, with at least 35 officials all participating to finalize an agreement of how to implement a very large and complex nutrition and food security project, funded mostly by the EU but also with the People To People Foundation, SODA (a local civil society umbrella organization) and HPA itself.

Though we had to leave early to get back to Vientiane for our flight out of Laos the next day, we got a good sense of how things work in Laos and how things are to proceed, especially after a detailed meeting with HPA leadership about many aspects of the project.

As we write we’re in our final hours in Vientiane, full of appreciation, learning and respect for such a great HPA staff, their government partners, the communities to be engaged over the next few years and this wonderful country overall.

Better Livelihoods from livestock in rural Laos

By Dr. Anne Drew

IMG_4347smallDr. Anne discussing body condition of a goat with Mr. Phok, one of the Village Veterinary Workers.

Sepon is a remote district in the extreme west of south-central Laos, just 40 km. from the Vietnam border. With my husband Thom, I’m here for 4 ½ months, assisting with a project called Resilient Livelihoods for the Poor(RLP), in which Vets Without Borders is partnered with Health Poverty Action, a British-based NGO that has worked in Laos for 23 years.
RLP in Sepon works with 400 extremely poor families in 25 ethnic-minority villages, to start them in income-generating enterprises of their own choosing. Nearly all of the families chose small livestock enterprises, and most of these chose goats. The goats are a hardy local variety, much prized for meat for special occasions, and excellent demand exists for them here and just across the border in Vietnam.
In my capacity as Animal Health and Nutrition Adviser, I’ve been assisting the Lao Livestock Health Adviser, Choummala, a graduate of the Veterinary program at the National University. Over my first 8 weeks we conducted an animal health survey in the project villages, evaluating the health and productivity status of the goats, pigs and poultry, in the second year of the project. We visited a random selection of households in each village and conducted a short interview, with questions about reproduction, disease and losses, and feeding. Then we examined the animals and collected fecal samples for quantification of parasite loads. We treated any sick or injured animals that we found as we went.
The goats obtain all of their feed by free-range browsing now in the dry season, but in the rainy season are sometimes kept in for cut-and carry feeding. Ill health and losses are often caused by parasitism, injuries, and sadly, theft. Young kid mortality is also high. These results highlight appropriate education and interventions to increase the success of the enterprises.

IMG_3978smallMs.  Choummala interviewing Ms. Huay about her goats as she works at the loom under her house.

Since mid-March we’ve been implementing an advertising and vaccination/deworming campaign in each project village. We call an evening meeting and after introductions, show 2 videos on the rationale for vaccinating and deworming livestock. These were produced in Lao by CARE International, but we had voiceover in Brou, the minority language, added. Discussion of the videos and personal experience follows, with prizes for participation. We’re also promoting the services of the three Village Veterinary Workers trained by the project, and explaining the need to charge for the service – so the activity will be sustainable. Then, starting early the next morning, we move through the village in 2 teams, treating animals at as many households as will accept the service. Starting early enables us to find the animals and the owners still at home, and avoids the intense heat in the middle of the day.

IMG_4158 1smallMr. Muey in Latuengnai, presenting his goat for examination.

Government counterparts from Livestock and Fisheries, Rural Development, Labour and Social Welfare, and Planning and Investment participate, so the work goes quickly. We vaccinate against devastating endemic diseases: goats for Foot and Mouth Disease, cattle and buffalo for Hemorrhagic Septicemia and FMD, pigs for classical swine fever, chickens for Newcastle, Fowl Cholera and Fowl Pox, ducks for Fowl Cholera and viral enteritis.

IMG_3310smallAnne and Thom (with assistants not shown) treating a septic goat with a maggot-infested wound.

A durable calendar noting important times for livestock care and sales and promoting the VVWs was produced, and one is given to every village household.Participation by project households has been excellent, as they are already aware of the procedures and benefits. Non-project livestock keepers are coming on-board in smaller numbers. As more families see and understand the benefits, we hope that every biannual campaign will see increased participation.

IMG_5105smallMs. Choummala recording vaccination/deworming date, and next treatment date, on a calendar promoting livestock health care.

IMG_5886smallThom restraining a young bull for vaccination.

IMG_4993smallThe vaccination team in Palongnai village, with VWB volunteers, 2 Village Vet Workers, Ms. Choummala, government counterparts, and the village goat group leaders on the right.

IMG_5853smallMr. Phon, one of the village Vet Workers, vaccinating a goat for FMD.

 

A Day In The Life – VWB Uganda: Part 1

Text and photos by Jamie Neufeld, VWB intern and WCVM veterinary student, with Kyla Kotchea, Shauna Thomas, and Veronica Pickens

photo1cOur dining room, office, and lab in Mbarara.

While in Uganda, we are based out of Mbarara, a dusty town in the southwest of the country. We are renting an apartment at the Mbarara University of Science and Technology residences that triples as our office and laboratory. This photo features Veronica, Kyla, and Shauna with several VWB intern essentials: water, sunscreen, coffee, bananas, books, and beetroot smoothies.photo2An under-construction pen – do you reckon the goats will appreciate the view?

Most mornings begin with picking up our translator and dear friend, Vivian, and driving out to one of the sixteen community groups we work with. The groups are scattered throughout the countryside near a small town called Kaberebere, where we often stop to pick up chapati for our lunches. Chapati is made out of flour, baking soda, water, salt, and oil. It is fried in a large pan and resembles a crepe or big piece of naan.
The area of the country we work in is incredibly beautiful, to the point where our translators may becoming tired of our enthusiastic exclamations about the hills, streams, and species of plants that are foreign to us. The red dirt roads provide a scenic contrast with the diverse, lush greenery, and banana plantations take over the majority of the countryside.photo3The Kahenda Widows Group meets once a month. At their meeting we learned about the troubles the women are facing with theft in their community and accessibility to cervical cancer screening and treatment.

The VWB goat pass-on project has been in country for ten years, with the University of Saskatchewan and the Foundation for AIDS and Orphaned Children (FAOC) being major partners. The project focuses on impoverished women, many of them widows and the only income contributor in a household of 8+ people. Livestock and land ownership favours men, but it is acceptable for women to raise goats. Goats are hardy and manageable animals, making them ideal for empowering these women by giving them the means of going beyond goat farming to provide for their families, pay for school fees, buy mattresses, electricity, pots and pans, clothing, menstrual pads, and much more, like moving beyond agriculture and owning/operating small businesses. In the short amount of time working alongside these women we have heard many awe-inspiring success stories.photo4Vivian (right) translates the conversation between us and Margaret, chairperson for Akatete.

The project wouldn’t be possible without our Ugandan translators who are passionate and knowledgeable about the women’s groups and goat pass-on. Their relationships with the women and community members are invaluable while traveling from home to home to chat with beneficiaries, or needing directions along the way. The language spoken in this area is Runyankore, which is one of the 40+ languages spoken in Uganda. We have learned the local greetings and pleasantries, which is most often received with much delight.
photo5A newborn kid belonging to Innocent, whose mother originally received goats from VWB. He has taken over the goat care since his mother has become less mobile.

On July 20th we will be passing out goats as loans to beneficiaries who have demonstrated need for the animals, knowledge of goat husbandry (which we will happily teach them), and have built a proper pen. When a member receives a pair of goats, the loan must be repaid by passing a female kid on to another member in the group, and selling a male kid with profits going into the revolving fund, which functions as a bank. The groups meet once or twice a month and pay a small fee (about one Canadian dollar) per sitting that goes into the revolving fund. The money is loaned out when members have medical expenses, fall short on school fees, or want to improve their homes, and is retuned with interest.
To reiterate, the member receives one or two goats, passes on at least two goats, and then has a pair to make profits from. The groups that have embraced the pass on scheme have succeeded with goat husbandry and become a more sustainable community. Several groups have accumulated enough money in the revolving fund to buy all the grandmothers mattresses or chairs, pay school fees for every child, or invested in sewing machines or big sauce pans to either rent out or utilize as another income generating source.
photo6Rose stands proudly next to the pen she built, tick spray in hand. Rose has a strong pen with a door and a lock for the necessary security measures, but we advised she clean under her pen every day to prevent respiratory distress in her animals.

We work with many women like Rose from Kyenyangi. Rose farms goats, chickens, beans, maize, matooke, and an assortment of fruits to provide for her household of eight people, plus her eldest daughter’s postsecondary education in Kampala, where she is studying to become a lab technician. Before Rose joined the project, her home did not have electricity, she was without a cell phone, and was able to feed her family twice a day. Rose received goats from VWB, repaid her loan within one year, and has succeeded in raising goats through vaccinating, spraying for ticks, and deworming. Her home now has a solar panel for electricity and her family eats three times a day, sometimes four. Rose has been a member of the FAOC/VWB project for over five years and gave us full-hearted thanks for how the project has enriched her family’s lives, which should be passed on to all of the previous volunteers, interns, and project supervisors.
photo7Under the shifting shade of a few trees, Kandabe Gaude sorts through freshly harvested beans to take to the Monday market.

73-year-old Kandabe Gaude from Kyera enthusiastically rounded up her grandchildren so they could practice their English when I asked about who lives in her household. She supports five grandchildren and four of her own children by selling goats, beans, matooke, mango, avocado, and oranges. Four of the people in her care are HIV positive, so a portion of her income goes towards transportation to pick up medication and attend medical appointments.
Veterinarians play an important role in global and public health, as the wellness of people, animals, and the environment is all interconnected. The goat pass-on project is a people-first approach where animals are farmed as a means to bettering the livelihood of families. We spend more time speaking with members than practicing medicine, where we learn about individual and community challenges so we can continue improving how we work together.
After a wonderful meeting under the shade of a few trees, Gaude poured 1/2 kg of these hand-sorted beans into my camera bag as a gift to take home and soak.
Watch this space for Part 2!