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Tag: Pain Management

Online learning vs the university experience

With education secretary Gavin Williamson recently coming forward to suggest that universities should reduce their fees if they choose not to return to face-to-face teaching, the question is being asked once again if online teaching can really hold its own against the real thing?

Loneliness

One of the main trials of the vet course has always been its difficulty. It’s hard, both academically and at times emotionally (and, when you’re called upon to tip a sheep, sometimes physically), there’s no getting away from that.

Online learning doesn’t reduce the course’s difficulty, but it does have the potential to exacerbate it, especially for those with attention deficit disorders who benefit from a more tangible learning environment.

The online platform is also unable to replicate that feeling of camaraderie you get from the live experience. If you can see your coursemates struggling on a particular topic you are also struggling with, then at least you’re reminded that you’re all in the same boat; but when you’re struggling to comprehend a lecture in your room by yourself – day in, day out – it can be easy to feel that maybe you’re the only one having trouble, and that you’re falling behind the rest of the herd.

The little things

All vet students and new grads will still remember the horrors of 9am lectures. Let’s be honest, nobody actively looked forward to them – especially, I’m sure, my fellow Bristol students, for whom struggling your way up one of the many formidable hills in gale force winds and torrential rain was a rite of passage.

Saying that, you always end up missing what you don’t have, and while a classroom of shivering 20-somethings with 150 coats attempting to dry on the one single lecture hall radiator may not sound like the epitome of a good time, it’s just one of the little things that builds a person’s university experience.

There will be highs and lows, good days and bad days that all make up the tapestry of academic life. While some may prefer to listen to recorded lectures in bed, I think being given the choice is inherently necessary.

Isolation

There are also an often-unheard body of students, for whom those lectures represented the only opportunity to interact with people and have space to learn. Sadly, not everyone at university has a living situation that supports their learning, whether it’s a disruptive home life, unreliable Wi-Fi, or any other number of things.

I don’t think this is something that universities fully take into account, and I feel especially sorry for international students paying incredibly high fees while entirely unable to explore their new surroundings or get the experience they were advertised. For those who study far from their homes and families, online learning has the potential to be incredibly isolating. I know my own mental health has certainly suffered as a result, and I’m sure I’m not alone.

Screens, screens, screens

When I was little, my mother used to tell me that if I stared at a screen for too long my eyes would turn square, and although I’ve since dismissed it as a method to get me to tidy my room instead of watching Power Rangers, I now fear it may be true…

I know that may sound a little “six of one, half a dozen of the other” seeing that in-person lectures use projectors and laptops as well, but I truly believe online learning massively ramps up your screen time. Even in 3-hour long lecture blocks, we would still be given short breaks between lecturers, you’d turn to talk to your friends and maybe focus more on the lecturer than the words on the slides.

When your only way to learn is via your laptop, and your only way to recharge after those lectures is also your laptop (Netflix, Facebook, Twitter, Instagram, and so on), you could easily pull a nine-hour shift sharing predominantly at a screen. Excessive screentime has been linked to postural-injuries, back and neck pain, negative impacts on sleep and emotional states, eye strain and migraines.

Imperfect fit

Obviously, everyone’s experience of the past two years has been unique and, as such, I’ve found that my fellow students tend to have mixed opinions of online teaching platforms or “blended learning” (when the majority of your work is done online, but augmented with a smattering of in-person teaching, perhaps once a month).

Some of my cohort really enjoy having all of our lectures at the touch of a button, while others have struggled with the lack of contact with their peers and mustering daily motivation.

Personally, I can see both sides of the coin, but I think it needs to be accepted that while there are merits to both the new and old system, the two are simply not comparable – and like every teaching system, neither are a perfect fit for every student.

August 25, 2021
The other side of the consult table, part 2

Never have I seen my cat so happy as the days post-operation when she was flying high on pain relief (I personally remember being quite grumpy the days after I had a tooth removed, but Bluebell seemed entirely unphased), but that doesn’t mean bringing an animal home from an operation is plain sailing.

The initial internal struggle of a vet student handing their beloved pet over to fellow vets is shortly followed by the hurdles of “medication dose mathematics” and valiant attempts to get said pet to ingest said medication.

I once thought myself quite adept in the arts of pill-giving when Bluebell was on a course of steroids, up until the day when she’d had enough and spat it back out directly into my jacket pocket.

However, once these hurdles have been mastered, teaching my parents to do the same can be a whole other ball game…

A little knowledge goes a long way

I think having even a little veterinary background can be a useful thing when you bring a pet back home from something big like this. You are reassured by the knowledge of what to expect and what can be counted as “normal”.

Whether it’s coming downstairs to a very full litter tray in the morning – as was my poor mother’s experience – or dealing with some temporary behavioural changes, a reduced appetite, sleepiness or cleaning up after the occasional accident.

Forbearance

It’s all part of the process. No human wakes up right as rain the day after a big procedure, and when you’re only small, even a minor operation can be a huge ordeal. As with most things, patience is the key.

I do feel quite sorry for the animals who undergo to the trauma of an operation and are then forced to return to the scene of the crime a week later in the guise of a “check-up”.

But, thankfully, when we bundled Bluebell bottom-first into her carrier for the second time, all was well.

Fang facts

In fact, we learned she is managing to lose not only weight – which, since she’s always been a bit of a chonker, came as a nice surprise – but teeth!

Only one in the actual teeth clean however – apparently another five have been lost at some point in her life, with all of us being entirely none the wiser!

Luckily, I think the fact that she is still a chonker is evidence enough that losing those teeth didn’t phase her in the slightest.

March 24, 2021
Chasing waterfalls
Sticking to what you’re used to is both safe and comfortable; getting to where I am now was neither of those things. All through secondary school, people told me trying to become a vet was too much effort – that if I was having to try as hard as I was, then maybe it wasn’t worth it.

Now, as I prepare to intercalate between the third and fourth years of my vet course, I have people balking at the idea of taking on an additional hurdle.

The truth is I’ve been hurtling along these tracks I’ve laid for myself for an awfully long time – back before I knew superhero wasn’t a viable backup career or that, sadly, you have to be born a princess.

A different path

It’s a scary concept to hop on to a new path for a while – one that isn’t so black and white – and steer in the direction of what I think is north. But it’s also very exciting.

From September, I’ll be undertaking an MSc Global Wildlife Health and Conservation course – and recently receiving an update email on what my intercalation course will look like post-outbreak made me almost giddy with anticipation.

Government guidelines and international pandemics permitting, I’m looking forward to a lot of hands-on, skill-based learning, working on interpreting data and building my own research project (more on that to come).

Less of the same

All vet courses taught up and down the country are very similar (because they have to be) and, therefore, reward you with a certain skill set and career outlook. By intercalating I am hoping to expand each of these to narrow in my sights on the areas of animal-centred fields that strike the strongest chords within me.

From the first day of vet school my eyes began opening to the impacts of our lives on the populations of the species with whom we share this planet; issues I wasn’t happy to tolerate and didn’t even know I had been.

Big, jaw-dropping horrors like dolphin hunting, stereotypes of captive animals and chicks on conveyor belts hurtling towards a meat grinder, down to the more subtle disasters such as quickly evaporating insect populations, awoke in me the drive I’d had as an infant to do this job in the first place.

Making animals better

As a six-year-old girl, my idea of what it meant to be a vet was simply “a person who made animals feel better”. At that age, I don’t think the concept was any more nuanced than that. But looking back, 15 years on, I don’t think it has to be.

I know I’m not alone in wanting to leave this world a little better than I found it, and if this next year I’m embarking on brings me a little closer to my goal then I wouldn’t want to lose a single second.

Complicated

The big problems the veterinary community faces – along with the world as a whole – aren’t going to be changed overnight. My own lifestyle is an embodiment of just how complicated they are:
- I agree all animals are entitled to freedom from pain and suffering, and although I try to reduce my consumption of meat, I am not vegetarian or vegan.
- I do not believe in the captivity of large aquatic mammals, but as a child I enjoyed my visits to SeaWorld and wildlife parks to watch the dolphin shows.
I don’t expect to solve the big issues or answer the big questions, but I want to contribute in any way I can.

Unfortunately, conservation and exotics are not currently primary areas of study on the veterinary course, and yet I cannot help but pursue them. I hope to bring the worlds together in the coming years, and fight for change with a double-edged sword.
August 12, 2020
Overcoming impostor syndrome

Are you used to doing things well, with certain skills coming naturally to you?

Often, when you do come up against something that is more of a struggle, or you have to work harder to accomplish your aim, you then doubt your worth and whether you really are good enough. If something is difficult, then are you not as good as you thought?

Embrace the struggle

A strategy to overcome this persona is to embrace the struggle. The truth is, if you are not experiencing struggle, then you are not growing at all.

When we experience difficult situations, it is a sign we are learning new skills and expanding our knowledge. It is important to remember that struggling at something is not a sign of lack of competence or inability, but just a learning phase.

Leap of faith

You should never wait until you feel confidence to start taking action – confidence and competence will only come through action and taking that leap of faith, so it is about changing your behaviour first.

You are a work in progress, and no one on earth knows everything or is skilled in every walk of life.

Strategies

Do you feel like you have to know everything before you can start a project or take action. Perhaps you are endlessly looking for new certifications or training to improve your skills and knowledge? Maybe you only apply for jobs where you meet every bit of criteria, or you may not speak up or ask a question for fear of looking stupid.

Sometimes this can lead to crippling self-doubt where you are letting opportunities pass you by or you miss the boat.

If you say “I should be able to do this”, this could be another sign of impostor behaviour.

Some strategies exist that could help – although this first one is pretty tough, especially if you have the “I should know” mindset.

1. Get comfortable in learning

The first strategy is to get comfortable in learning when you need to learn. Not before, but at the time, when it is needed. Many people would find this stressful, but it is super time efficient and prevents you learning things that are not needed in the now.

Think to yourself: “I will acquire skills and knowledge when I need them, not just in case I need them.” How much time would that free up?

2. Ask for help

Are you someone who has to accomplish everything solo? Do you feel like a failure if you have to ask for support or help? Perhaps you see vulnerability as a weakness, and that if you ask for help it means you have failed or are not good at what you do?

The main tool for overcoming this line of thinking is remembering that vulnerability does not equal failure. In fact, not asking people for help, support or an opinion robs a colleague of being someone of contribution and value.

Flipping this to another perspective, what could you learn from others? How could you improve what you do by getting another perspective and insight? It could save you considerable money, time and pain down the line, even if its makes you feel weak in the moment.

Asking for help is really empowering, as it means you are allowing someone to shine.

3. Have a ‘trusted other’

One tactic I have found that helps overcome impostor syndrome is to share that feeling with a trusted other – it actually weakens its power over you.

An impostor syndrome is usually made up of secret self-talk and thoughts. Giving it a voice can free you up – plus, often saying it aloud will make you realise its triviality.

June 24, 2020
Commonly held beliefs that don’t do us any good, pt 2

Belief #2: if you can’t afford to care for an animal then you shouldn’t have one

You, young doctor or nurse – living in your privileged society of excess, with your years of study, working in an industry that exists largely to minimise animal suffering – have certain expectations of what “taking care of an animal” looks like.

Of course, we should always strive to do the best we can for any animal in our care, but we need to learn to put judgement aside when an owner’s abilities don’t stretch to meet our expectations.

Saying “if you can’t afford to care for a pet then you shouldn’t be allowed to own one” is a subjective and biased opinion.

What defines an appropriate level of “caring for your animal” is based to a large degree on your background, prior experiences with animals and financial circumstances.

Where is the line?

Let’s agree that if someone takes an animal in your care, it is his or her responsibility to meet its basic needs – make sure it doesn’t starve, freeze or cook to death; don’t cause it unnecessary suffering through wilful abuse or neglect; and satisfy at least some basic emotional needs of connection, and freedom from fear and pain.

Beyond that, where is the line?

You could argue provision for core vaccinations should make the cut into what constitutes basic levels of care, but I can assure you many unvaccinated animals around the world live very happy lives.

I’ve seen many colleagues spit venom about “careless owners” who “don’t deserve to own an animal” when a dog presents with a pyometra, so should we make neutering a minimum requirement of pet ownership?

Should every pet owner have the means to pay for at least full bloods and an ultrasound? What about major life-saving surgery? An MRI? Chemotherapy? Specialist referral?

If a line in the sand does exist, then it’s poorly defined – and, like the line between beach and ocean, it’s a line that will shift with every wave, tide, and storm.

Collision course

So, how does this belief hold you back?

If you subscribe to this way of thinking, you’ll be on a constant collision course with a large part of the population. It’s a mindset that will set you up for daily antagonistic interactions with the people who present their animals to you, instead of creating those all-important relationships that were mentioned in part one.

None of this will benefit your patients, your clients, or yourself. To put it simply: you’ll only make yourself resentful and miserable.

Burden of care

Where things do become complicated is when individuals expect a high level of veterinary care without being willing to pay for it.

When the burden of care – and blame for lack of provision of its gold standard – are shifted solely on to the shoulders of the veterinary community, the relationship starts falling apart.

This, of course, is rubbish – and should be treated as such.

It’s a problem that vets who have the capacity to provide high levels of care will grapple with, and can be the topic of many more blogs.

For the purpose of this post, let’s just say we should always aim to help – to the best of our abilities, and with a consistent level of caring and lack of judgement – any person who presents their animal into our care, despite their individual expectations and capacity of what constitutes a good level of care.

March 11, 2020
Tree of life

Seeing a “tree of life” can be an intimidating sight. When you see this number of pumps for one patient, you instantly know things are pretty serious. This sight is almost a daily occurrence in our ICU.

Now, your first reaction may be to turn around and walk quickly in the other direction. However, rather than feel overwhelmed at the whole sight, think of the saying: “How do you eat an elephant? Piece by piece.”

Take things one step at a time.

Step 1: stop and reset

The “tree of life” in full effect.

Take a deep breath and reset. This is important, as these patients are complicated. If you’re not mentally ready for handover then you will miss important details critical for understanding the patient as a whole.

Step 2: understand the patient

It is important to know what is going on with the patient as this will provide context to the “tree of life”.

If you are handing over, make sure it is comprehensive. If you are on the receiving end of a handover make sure you are paying attention, and ask questions or seek clarification.

Step 3: group the meds

Grouping the meds helps chunk them. Group them into categories such as pain relief, antibiotics, antiarrhythmics, pressor agents and supplements (such as glucose and potassium). It also puts their use into perspective.

Step 4: know what the fluid therapy plan is

This step is often forgotten. Always ask what the fluid status of the patient is. Also, at what phase of the fluid plan they are in – correction of perfusion, rehydration or maintenance. Also, consider if there are any on going losses being accounted for.

The next time you walk into an ICU and are about to take handover of a patient who has a “tree of life”, it won’t be such a daunting task if you follow this process. I truly acknowledge anyone out there who has learned to see this sight as an exciting challenge, and the chance to learn and make a difference.

February 6, 2019
Reflecting on the good moments

As me and my (non-vet) partner sat down for a rare mid-week breakfast together, I made an offhand comment about “having” to vaccinate 15 puppies that day.

“What do you mean ‘have to’?” was his response. “Most people would love that, and you get paid for it.”

I considered this – and, while I’m more of a kitten person than a puppy person, who doesn’t love puppies? It‘s the little things like this we, perhaps, take for granted.

Sharing the joy

All too often, as vets, we focus on the negatives: the long hours, on call, the stress of trying to keep to time when everything goes belly up, the emotional strain, the difficult clients, surgical complications, mystery cases with unanswered questions… the list goes on.

In the midst of it all, while we‘re able to show enthusiasm during the puppy or kitten vaccine consult, sharing the owners’ joy is soon forgotten when it is swiftly followed by a few challenging consults or clients.

At the end of a couple of stressful working weeks (for a number of reasons), I found some peace having formulated a plan for a couple of complicated medical cases and finally convincing a difficult client to get on board with a particular treatment.

Living the life

It‘s the little things, such as vaccinating puppies, vets, perhaps, take for granted. Image © Gorilla / Adobe Stock

It’s easy to get wrapped up in the vet lifestyle – researching cases when you get home at night (and even when you don’t), not being able to sleep because, subconsciously, you’re trying to work out the best course of action for one of your patients.

Rattling off the list of procedures or appointments for the day will just seem the norm to other vets, but take a step back and remove the “vet blinkers” and actually think for moment about what we do.

If you talk to any non-vet friend or family member about your working day, they often show seemingly exaggerated enthusiasm or squeamishness. It’s tempting to brush this off, but it’s usually genuine. From their perspective, our “normal” work can be fascinating.

Everyday heroes

We may not be saving lives in a dramatic fashion every day (or maybe you do), but, as vets, we get to help a number of animals on a daily basis and, as a result, their owners.

This can be done in what feels like the smallest of gestures sometimes; as much as we may resent the notorious anal gland appointment, what that actually involves is giving a poor dog (or cat) almost instantaneous pain relief.

While I don’t think any vet will particularly enjoy an anal gland appointment, my point is to look at the bigger picture: what may be mundane to us does actually make a difference to the individual – our day-to-day routine work is far more interesting than a lot of other jobs.

Let it go

Being a vet is mentally and physically draining at times, but no day is the same and we will always have stories to tell.

So, if you’ve had a bit of a crap week (or haven’t), take a moment to think about what you’ve actually done in the past few days and enjoy the good moments – whether that’s the puppy vaccination or draining the really satisfying cat (or, in my case, cow) abscess. Then think of the clients who have been thankful for your help (even those who don’t show it) and let go of the bad moments in between.

September 19, 2018
Accountability and responsibility: which causes more fear?

It’s very daunting standing in your first consult as a real, qualified vet – even if it is “just a vaccine”, which invariably turns into “actually, this has happened“, or “now you mention it“, and so on.

But why is it we have that constant feeling of being on edge – more so than a few months previously, when we were still students?

A noticeable shift certainly occurs to being an actual vet, rather than someone who always has a supervisor to have the final say, or take the brunt of the backlash of a mistake.

However, is it the accountability or the responsibility worrying us the most?

Pressing concern

Mistakes are inevitable, but rarely catastrophic. IMAGE: pathdoc/Fotolia.

As soon as we swear the oath enabling us to register as veterinary surgeons in the UK on graduation day, we become accountable to the RCVS.

In the past year, I have witnessed more than one speech telling us a) not to be scared of the college, and b) not nearly as many complaints, disciplinaries or registration removals occur as we think.

Exact figures aside, the take-home message has been: if you don’t knowingly do anything wrong or illegal, the likelihood of serious consequences is very low. You can’t get struck off for making a simple mistake.

The veterinary press, however, seems to over-represent those who are struck off or reprimanded; after all, you never hear about how many vets were not struck off this month or doing their jobs as they should.

Perhaps this is where the unease stems from? And why the RCVS seems so keen to tell us these individuals convicted of misconduct are a very small minority of the profession?

Are new grads really scared of the RCVS?

Talking to my colleagues, the general feeling is we understand we won’t get struck off for making a mistake. However, if the fear has anything to do with our regulatory body, it’s more the confidence knock we would have as a consequence of having a complaint against us made to it.

Of course, an element of worry surrounds being banned from practising as a vet, but I don’t think I would rank it top of the “things to be afraid of as a new graduate” list.

Instead, in that list, I think responsibility carries a greater weight. As students, we were always supervised and, ultimately, the fate of an animal’s life never truly rested in our hands. Any decisions we made were either backed up or steered in the right direction by clinicians.

Now, it’s down to us. Yes – other, more experienced colleagues should be in each practice with whom to discuss cases or reaffirm decisions, but when it comes to the consult room, you’re on your own.

Experience is king

Jordan, pictured during her final-year rotations.

What if I miss a heart murmur? What if miss signs of glaucoma, a pyometra or a lump? The list goes on. What if I could have done more investigations earlier? What if I misdiagnose something and prolong pain because I didn’t prescribe the right treatment first time?

These questions going on in our heads, coupled with a niggling feeling we have forgotten something or misread a dose, are the root of the fear. I believe this is what scares us, more so than the RCVS.

The animals – and us inherently wanting to do our best for them – makes us worry. We worry our lack of experience could be at the expense of an animal’s health – or even their life.

The only way to get past this is to gain that experience to have confidence in our decisions and learn from the mistakes we will, undoubtedly, make.

My mum said to me this week: “This is the only time you’re ever going to feel like this,” and she’s right. (But don’t tell her I said that). Even if we start a new job in the future, we will have a lot more experience under our belts, so shouldn’t, in theory, feel as lost or scared as we do now.

Being a new graduate vet is a unique position for a myriad of reasons and we need to embrace it. The fear that comes with this newly found responsibility will ease with time, and we can take our careers in whichever direction we choose.

August 16, 2017
Stitches

Legality within the veterinary profession can be a bit of a minefield, especially when it comes to things like drug licensing. This leaves many new graduates in fear of doing something against the law without even realising.

However, while some veterinary legal principles are complicated but clear, others are genuinely vague, leaving us unsure on where we would stand in a court of law.

A stab in the dark

It was recently reported that stab victims, scared of the inevitable police involvement if they were to present at A&E, were turning to vets to have their wounds sutured, albeit at a handsome price of about £200. While the morality of doing a procedure such as suturing on people may be questionable, the legality certainly is.

The RCVS clearly states vets are not legally allowed to prescribe pharmaceutical products for people, but they have no specific guidelines on wound treatment.

It could be argued that, ethically, suturing should involve the use of some form of local anaesthetic (either by a local block or a transcutaneous patch) and, therefore, cannot be allowed as this would involve drug administration.

However, that’s not to say a person can’t consent to old fashioned gritting their teeth and bearing temporary pain for the sake of saving a four-hour wait in A&E.

Friend or foe?

For those who could be potentially incriminated if they sought medical help at a hospital, you can sort of understand why they’d ask someone else, like a vet, for stitches. But they aren’t alone…

A number of vets who become injured either on the job, or elsewhere, will seek the help of their colleagues, rather than take the majority of a day off to wait for the NHS to achieve a vastly similar result. After all, vets are pretty damn good at suturing and would arguably do a better job than the junior doctor on an emergency ward.

You could discuss the ethics of whether a vet should help someone who needs medical attention in varying situations and whether they are legally allowed to do so. However, charging for the service is an altogether different matter – stitching up a fellow vet, or even a family member, wouldn’t raise the question of fees, but a stranger who walks in off the street?

Cash in hand

A BBC article from 3 March (Stab victims ‘paying vets to stitch up their wounds’) reported the “going rate” to be around £200 – does this not infer the image of an underground medical procedure market, whereby vets can earn a bit of extra cash to extend their services to animals of the two-legged kind?

You have to admit, when you consider the rough cost of a bitch spay at around £150 (weight and complication-dependent), that figure has quite an impressive profit margin. Once a vet charges for the privilege, it becomes a business venture, not just an act of goodwill.

Stab victims are reportedly turning to vets to have their wounds sutured, in an attempt to avoid police involvement. IMAGE: vzmaze / fotolia.

And yet the NHS is screaming for help in A&E departments. With average waiting times at an extreme high, it’s begging prospective patients to consider whether their ailments are worthy of the emergency room or whether they could be seen elsewhere – the GP, minor injuries, pharmacy… and now the vet?

By applying skills used on animals every day, would vets not be easing some of the burden on our struggling NHS?

Risky business

But what if something went wrong? An infection of a wound, of which the bearer couldn’t explain who sutured it, should surely raise some eyebrows – and, after all, with vets being legally unable to prescribe drugs to people, the injured party could not return to the surgeon responsible and ask for antibiotics.

This is where the legal grey area becomes pertinent. Where would a vet stand if sued for wound breakdown? Members of the Veterinary Defence Society are supported for claims against their actions involving animals… but humans?

There are a lot of unanswered questions that, for me, make conducting procedures such as suturing on members of the public too risky.

Final decision?

It may be different if it were a colleague or close family member who understands the trust he or she is putting in you to do a “simple” procedure works both ways. However, even then, it’s not without elements of risk.

On a wider scale, should we, as a profession, be seen to advocate such practice? Or should our representing bodies be defining the limits of our medical interventions and reprimanding those who see the injured public as a business opportunity?

But then, would we live in even more fear of being prosecuted just for helping a fellow vet who knows full well what he or she is agreeing to?

March 20, 2017
Musings on a month in Morocco

Obviously I’m biased, but I think the University of Glasgow offers the best selective rotation options of the vet schools in the UK. Numerous opportunities exist to go abroad, with a variety of options based on species or type of practice.

Jordan spent a month working with American Fondouk.

The traveller in me was never going to pass up an opportunity to take to the skies, so halfway through my final year (eek) I found myself with five classmates on a plane to Morocco.

Language barrier

American Fondouk is a charity clinic for the working equids of Fes. Every morning the gates open at 8am and a stream of mules, donkeys and horses wander in with various ailments.

My French is minimal and Arabic non-existent, so history taking usually involved the owner pointing at the affected body part and translation with the help of a multilingual staff member. Even so, the histories were usually little more than “he fell over” or “it’s been like this for a week”.

Clinical exams were also not without challenges. For a start, it’s important to note donkey “normals” are different to those of horses (at first, we thought everything was hypothermic), and mules kick – in every direction.

Normal’s not normal

“It’s been like this for a week…”

Treatment of outpatients could vary from ivermectin and a dental to admission and intensive care for critical cases. It was just a case of dealing with whatever walked through that door.

Certain normal parameters for horses are different in Morocco than in the UK and for a while I couldn’t understand why so much fuss existed about PCVs of 40% – it turns out the Moroccan normal range for PCV is much lower than I was used to.

A full hospital with multiple high-maintenance inpatients certainly kept us on our toes for the month. However, after a couple of weeks, we’d gotten used to a lack of sleep, the protocols for treating certain conditions and the general craziness our daily lives had become.

I felt competent with a number of practical skills I’d never tried before I came to the clinic and could diagnose a tetanus case before it was even off the box. Wound care and bandaging were daily requirements – it was astonishing to see how well some seemingly horrific wounds would heal and the animals recover.

Ethical dilemmas

Acting in the interests of the animal without its owner’s permission is not allowed in Morocco.

The hardest thing I found about working at the clinic were the ethics surrounding euthanasia.

To the owners, these animals are often their only source of income – their livelihood – and the economics of replacing a mule are heartbreaking. Emotions run high when a seriously sick mule with a heart rate through the roof, suspected of a surgical colic, desperately in need of the pink juice would leave the owner with nothing.

The other logistical obstacle is the legal status of these animals. In Morocco, these animals are considered property of the owner and as such, permission must be gained before euthanising an animal.

Acting in the interests of the animal without permission is not allowed, so if an owner is not contactable, some unavoidable suffering may occur. This is limited as much as possible through pain relief, despite knowing what ultimately needs to happen in the interests of the animal.

Outside the box

On the whole, we were able to do our best for our patients and provide the optimum care.

I had a great, albeit exhausting, month. Working in a busy environment with somewhat limited resources pushes you to think outside the box and embrace different approaches to problems.

I learned a lot, gained confidence and even managed to discharge a patient in stilted Arabic by the end.

November 17, 2016