In addition to the heterogeneity of formal practitioners in district and regional veterinary clinics (discussed above), ‘informal veterinary practitioners’ also add diversity to the spectrum of veterinary practices in Ghana. Informal practitioners are people who deliver veterinary services outside of official government approval (position, area of affectation, or qualification). In this section, I demonstrate how two main types107 of informal practitioners compete with local field vets who, while officially in
charge, are challenged in their practice of veterinary medicine by the former.
The first type of informal practitioner are livestock farmers or farm personnel. Farmers occasionally gain a minimum level of veterinary knowledge through vets or NGO programmes such as on what products to buy and how to administer them. These may however, not always be medical products, and they may not always enhance their animals’ wellbeing. Once, in District Two, I walked through an industrial poultry farm with Afia where we witnessed the hatchery keeper vaccinating hundreds of chicks against Marek disease. Afia asserted that only veterinary officers were legally authorised to vaccinate chicks. Afia firmly disagreed with this but felt that she had no authority to stop it and wanted to continue working with the farmer (that day, she vaccinated his dogs).
On a visit to a farm with Dr B, we saw pigs that seemed to have black skin. Dr B informed me that these pigs were not naturally black but had in fact been ‘bathed in dirty engine oil’. The farmers did this to rid the pigs of mange mites, he explained. Sometimes, he continued, pig farmers would mix an acaricide (medicine used against mange) with the oil before applying it on the pigs to enhance the medicine’s action. Dr B considered this practice to be painful for the pigs, as the oil penetrated their skin. I asked what an alternative might be, and Dr B replied that he would inject them with Ivermectine which is a famous anti-ectoparasite drug. I asked if Ivermectine was perhaps too expensive. ‘No’, he said, ‘they [farmers] just don’t know and they want to manage things themselves’. On another occasion, I accompanied Dr B to a cattle farm where he treated some cows with antibiotics that the farmer had kept in a chest full of drugs (picture in Figure 13).
107 I identified a third type of informal practitioner - a senior vet who practised veterinary medicine outside of
his management duties. However, I treat this case of informal practice in Chapter Five, as it is less problematic for district vets on a day-to-day practical level than the two cases described in this chapter, and is more relevant to the sharing of information in veterinary networks.
The second type of informal practitioner are lay people who have received minimal levels of veterinary training. In the same way that farmers attempted to apply what vets taught them, vets knew that Community Animal Health Workers (CAHWs) and Agricultural Extension Agents (AEAs) often continued delivering a wide range of animal health services after training programmes (which were generally focused on preventing a specific disease through, for instance, targeted vaccination) were over and supervision by vets in rural and semi-rural areas ceased.
In rural Ghana, the FAO has carried out many projects aiming to boost animal health services in poor areas by training community volunteers (CAHWs) in primary care for livestock and by distributing basic drugs, and vaccines for specific campaigns. The rationale behind training CAHWs is that they represent an ‘outreach component of vet clinics and pharmacies’ (Catley et al., 2004:225). In Ghana, such training, provided by international organisations like the FAO, has occurred regularly over the last decades.#89 A senior coordinating staff member of the FAO in Ghana confirmed that CAHWs were
Figure 13. A farmer’s chest, full of medicine bottles, some of which were used by Dr B to treat the farmer’s cows.
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aimed at compensating for the shortage of vets in the country.108 For him, the ratio of the number of
vets to the number of farmers was too low and thus the workload for vets too high. He said: ‘farmers
lose interest in vets who don’t come’! At the time of my fieldwork, there were still some CAHWs in the
northern part of the country (Mockshell et al., 2014) and the FAO was planning on training new batches of CAHWs. #89
AEAs (agricultural extension agents), who make up the largest workforce in agricultural services, cover much more territory than vets do.109 Some vets believed that, like the CAHWs, AEAs also learned how
to execute basic animal care via international-funded occasional projects and that they would continue delivering these services even after they were not officially required or expected to do so. A senior regional official #77 for MoFA explained to me why he thought these AEAs or CAHWs were credible as animal healers in the eyes of the general public. The first reason was that training programmes often taught them how to carry out simple veterinary acts (such as wound-dressing, dealing with ecto-parasites like ticks, fleas, mites and or basic sterilization surgery), giving them and the public confidence that they possessed the necessary skills to replicate veterinary procedures. The second was that they live locally and could easily get to farms and homes in areas where vets were not present. A third reason was that they usually wore white gowns, as did most official vets, and fourthly, they often promised to provide certificates to make official what had been done to the animals.
However, for district vets, these programmes represented illegitimate competition as well as a public health hazard. Notably, I remember Bernard being very anxious about AEAs because they sometimes ‘tried to solve problems with farmers directly’, and thus short-cutting vets. Similarly, in a policy review from 2014, senior officials from the VSD described CAHWs’ roles in remote areas as illegitimate:
CAHWS work in remote communities in the regions; they are not paid for services rendered by livestock farmers and they are not included in government structures and are not recognised by the Veterinary Council of Ghana. CAHWs were introduced in by the World Bank under privatisation but the system did not also work [sic] in sedentary areas where some did work up to the level of full vets (Luseba, 2014:32).
108 CAHWs were generally taught how to administrate deworming, antibiotics in the water (for poultry), and
first aid care. They also learned how to recognise symptoms or lesions that were signs of disease and which affection it was likely to be (for the most common ones). #89
109 ‘The coverage of Animal Health Technicians, who specialize, per farmer was described as relatively low with 1 per 5000 farm households, while the agricultural extension officers tend to be cross purpose specialists covering corps and livestock and described as being 1 per 1,500 households’ (MoFA/AU-IBAR, 2013:4).
Because of the activities of these unqualified animal health workers, most vets, including Bernard, always recommend the post-exposure vaccine following bites from pets, even if the owners report that the animals have been vaccinated. In Bernard’s opinion, all dogs and cats should be assumed to harbour rabies so that vets do not ‘take any chance’ of letting the disease infect someone, which would be fatal. Indeed, according to him, if an informal practitioner delivered the said vaccine, it might have been administrated improperly or with a ‘fake’ product. Bernard would systematically refer the person who had been bitten to a medical professional right away to receive the post-exposure vaccine.#62
This perception, that unqualified animal health workers are inept and are damaging to the veterinary system, is widespread. Yet, this system is reinforced by the fact that, in Ghana, drugs and some vaccines are available in pharmacies (which are officially registered or not) to anyone (as discussed in Chapter Two). Members of the public can get their own products and administrate them to animals without much regulation or any control system.110 For this reason, the spectrum of actors involved in
animal treatment at the local level is much broader than is assumed by the formal veterinary system. In addition to employed district vets, as promulgated by legislation, in reality, the system includes a considerable variety of people – such as farmers, (former) CAHWs and AEAs – who carry out veterinary acts without official qualifications and outside the mandates of their jobs.111
A senior lecturer at one of the faculties of vet medicine pointed out that informal practitioners undermine the economic viability of veterinary practice in rural areas:
Private practice is for urban areas. You cannot survive in a private practice for livestock because of the presence of ‘quacks’ 112 and because the farmers inject themselves. Drugs should be
controlled and authorised only on prescription. But for this to happen, we’ll need a strong motivation from the veterinary council.#76
110 Once, Bernard sent me to buy an antibiotic for him in the nearby town and I was not asked for any
prescription
111 My intention is not to point out illegal or illegitimate activities and label them as such, but to show how the
boundaries of veterinary practice extend beyond the formal system.
112 This word was used by my participants to talk about informal veterinary practitioners in Ghana. The labelling
of people offering local informal services for animal health as ‘quacks’ is not new. The literature on veterinary practice in Europe centuries ago confirms this; see for example Curth (2010) where the expression ‘dangerous
quacks’ refers to informal healers portrayed as degrading the health of animals due to their being unqualified
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According to him, private vets who attempted to work in rural areas would fail because it is not an economically sustainable environment for them. For him, this is due to the existence of this parallel system of animal health service delivery by informal practitioners. He added that this short-cutting of the official veterinary system is dangerous because it can mask the circulation of a disease, can lead to losses when treatments are inappropriate, and can result in drug resistance in animals and humans. He argued that it is also bad for the profession as the poor results of drug administration by non- experts portrays to the public a negative image of vets.
I could not approach or contact any of these informal practitioners. The phenomenon was presented to me via my research participants, who themselves did not know these people, and had only heard of them through their clients, or suspected their AEA colleagues of carrying out such practices. It was tricky to talk about this problem without being able to really see it, but it came to my ears so frequently that I could not ignore it. Because the vets did not often – if ever – encounter these informal practitioners face to face, it seemed as if they found them to be easy scapegoats; targets to blame for issues occurring in vet field practice. Indeed, vets depicted them as people who circulated from one village to another delivering animal health services illegally and hiding like ghosts to avoid getting caught. They were seen primarily as being out for money (mainly through the sale of drugs and vaccines) rather than being motivated by public health goals.
Providing resources for continuous official veterinary supervision of trained volunteers during and after programmes may be critical to avoiding the development of competition between district vets and informal practitioners. Frontline livestock volunteers can enhance animal disease surveillance in that they offer more widespread coverage for disease detection in remote areas, but, only on the condition that there is a solid system of regulations which guarantee that volunteers/CAHWs continue to be supervised by veterinarians after programmes are over (Catley 2004). Yet, such continuity of supervision has not been taken into consideration in Ghana, as one interviewee coordinating FAO volunteering programmes declared that it was the responsibility of district vets themselves to carry out follow-ups.#89 However, considering that field vets are overburdened with their current workloads, and experience a lack of support and the inability to secure financial and material resources, vets become more and more reluctant to collaborate with the FAO in new livestock volunteer training programmes.
This section has shown how district vets are forced to compete with informal practitioners, whom the vets perceive as threats to their professional establishment and sustainability, which affects their role in (zoonotic) disease management.
Conclusion
In this chapter, I examined the local settings and practices of veterinary medicine in different clinics delivering services in one region of Ghana. I sought to understand how veterinary staff were organised, which types of animals and medicine were prioritised, and the characteristics of the physical spaces and local socio-political contexts in which they operated. With this presentation of five government clinic settings, I found that, while some things were common to all vets, a lot differed. The ways district vets organised their time, and the backgrounds and main activities of staff members all presented some variability and reveal the extent to which government vets exercise agency – within their institutional constraints and material conditions – to organise their practices and determine how things might work at a local level. This suggests that the landscape of veterinary practice across Ghana is very heterogeneous, even at the district level.
Across these different settings, I identified five main practices that explain vets’ intervention in animal health management on the ground: practice as operational space; practice as mobility; practice as transaction; practice as an occupational hazard; and practice as competition. These five practices represent dilemmas in that they exist at the interface of 1) institutional constraints, 2) professional strategies, and 3) the clinical setting of each clinic and its local district/regional context. In other words, I argue that veterinary practices in Ghana are not so much determined by what vets are meant to do, but by what is actually possible on the ground as well as what is perceived as good for the profession.
This chapter has shown that elements of clinic settings do not straight-forwardly lead to appropriate or expected decision-making and practices. Instead, settings and practices shape each other in a range of ways. In each case, the ways different vets make their jobs workable is through seeking to manage their settings, which in turn allows for certain practices to happen. This results in wide- ranging diversity and heterogeneity and sometimes makes vets’ work less visible and unaccounted
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for as not all cases they see or treat are reported to higher levels of the veterinary services due to local dynamics.
Returning to the overarching research question of this thesis, which seeks to interrogate the influence of veterinary practices in the scope for OH, this chapter has also shed light on key challenges for vets in engaging in zoonotic disease management in relation to the main veterinary practices I identified in the region. It has shown that some interventions are impossible, either due to scarce resources (such as the lack of an operational space or a vehicle) or – considering the many informal practitioners competing to deliver services – the lack of access to animal owners. While animal disease management in general is difficult, zoonosis management appears a luxury. If interventions are possible, they are not necessarily the best options for vets as they struggle to balance clients’ interests and perspectives, their own duties to generate revenue and meet their own costs, and their own health risks; all while being accountable in cases of outbreaks.
Nonetheless, despite all these limitations on the ground, vets are situated in a professional context that may support a greater role for them in zoonosis management, with the rise of the OH concept bolstering this potential. In the next chapter, I explore the main perspectives of veterinarians and ask how vets in Ghana see their professional role in relation to zoonoses and OH.