Female district veterinary officer at a regional veterinary meeting: ‘Give me a clinic and you will
see how much [money] I raise!’#75
The availability of good clinic space was important for veterinary practice in Ghana. For Ghanaian district vets, a good clinic space meant that offices should be spacious, well-located, well-equipped, and secured for the medium to long-term future. These essential qualities were present in regional settings as well as the first district I visited, but field vets from Districts Two and Three had little such satisfaction from their own clinic spaces when I met them.
For example, the local MoFA had previously allocated no clinic space at all for Afia’s team. At the time of my fieldwork however, her team had been given one room (see Figure 7) in a government building, but this space was not guaranteed very far into the future because of government plans:
Field notes extract from visit to District Two: ‘They [the local Assembly] announced that they would
destroy the building for enlarging the road but now we don’t know anymore. It’s not coming’ said Afia. I asked about the adjacent office that was empty. She replied that the people using the office left because of the announcement of destruction of the building. She had been asking the Assembly senior staff for permission to use it but had not received any answer. She added: ‘we painted the walls last year. We used to keep the place clean but now we stopped because the building is probably going to be destroyed and built again’.#60
The fact that Afia and her team did not know if their clinic space would remain available in the future affected their ability to invest in improving it. If allowed to use the adjacent room, they could separate the ‘office space’ (desks and chairs to receive clients and do paperwork), from the ‘clinical care space’
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where animals were examined and treated (animal table, all medical equipment and drugs). As it was, one technician complained to his regional vet officer that his office was ‘not an office’, that it was ‘too
small’for good veterinary practice.#75Indeed, the four of us frequently struggled to move or sit without bumping into each other. Add the presence of pets and their owners expecting attention and one can imagine how chaotic it got, making it almost impossible to conduct several consultations simultaneously. Under such busy conditions, as was often the case between 9.30 and 11.30 am, consultations and treatments in Afia’s clinic often took place in the corridor on the first floor of the Assembly building, with this sometimes blocked access to other government offices on the same floor. Extending the current clinic space into the vacant next room would also allow the team not only to stop disrupting other business taking place in the building, and to set up a hygienic corner in which to eat their lunch, away from where animals were examined and treated. Another benefit from more space would be to mitigate the risks (to both vets and clients) of being bitten or scratched by pets reacting to manipulation or treatments as there would be more space in which they could retreat to get away from upset animals.
Bernard also reported experiencing challenges with the lack of space for his practice. He had access to, but did not make use of his allocated office in the district MoFA building because the location did not make much sense for him (see next section on mobility), and he would greatly benefit from a better-located office. I came to understand this when we discussed the reposting he obtained at the end of my stay:
Bernard was really happy to be formally moved to the district in which he and his family lived. At the time I visited, he was planning on developing the available office in the district into an operational vet clinic. A few days before Bernard’s official transfer, we went to see the office together as he was really looking forward to this new and more convenient base for his practice. It was about five minutes from his house by motorbike, located in the MoFA building, near the district police station. It was spacious and empty of any furniture or decoration and the walls were painted green. The fridge did not work and there was no table or other material for conducting consultations, which Bernard complained about. He shared his worry about having to find the necessary equipment to make the place operational and attractive, since neither the Assembly nor the local MoFA, according to him, could fund the renovations.#65
The examples from Bernard and Afia demonstrate how crucial sufficient spaciousness, ideal location and temporal security of their clinic spaces are to vets’ abilities to operate adequately, and yet, the actual material circumstances of many are far removed from having these essential characteristics. From Bernard’s account especially, we see that despite the emergence of an available and promisingly
well-located space, he still struggled to outfit it with the necessary equipment (discussed further below).
Despite government veterinary practice being seriously resource-limited and lacking the sophisticated medical devices found in private clinics,#26 basic medical care still requires a minimum of equipment which district vets cannot forgo. Thus, they have been forced to develop strategies to acquire and maintain this basic gear for veterinary care, and these strategies vary across districts. Vets often used private resources to compensate for the lack of support coming from the government. A few years ago, Afia had to invest her own money to purchase an infusion stand, which is indispensable when animals are too weak and need rehydration by fluid infusion. She made the point that pet owners often called her as a last resort, after waiting until their animals’ health had deteriorated so critically, that she had to be able to carry out emergency care like infusions. Beside the infusion stand, another example of personal investment is the big block of ice that Afia brought from her own home fridge every morning. This was to preserve vaccines and other products that need to be maintained at cold temperatures in the clinic’s fridge since there was no electricity in the building where Afia and her two colleagues worked. The company in charge of providing electricity had cut it off months ago because, according to Afia, ‘the people in charge of the building have not paid their bills’.#54
Vets cannot purchase everything they need using private funds and sometimes, the lack of diagnostic devices, such as blood analysis kits, X-rays and ultra-sound machines, prevents vets from delivering any treatment at all. When it is a matter of life and death for an animal, vets also consider their own reputations. Letting an animal die is not something owners forget and, sometimes, it is better for a vet not to act if he or she lacks the necessary equipment to save an animal’s life as owners may accuse them of poor care (see below). Diagnostic equipment can provide evidence to support vets’ decisions in these cases, but without this, it can be difficult to make a case that an animal is too weak to survive and justify non-treatment through intuition. As the salaries of vet surgeons are much higher than those of technicians95, there are significant disparities in the investment capacity between clinics held
by these different practitioners and thus higher chances of technicians experiencing such difficult choices.
Paperwork constitutes an important part of veterinary practice and is an activity greatly facilitated by the provision of basic technology equipment. In Ghana, vets must submit reports of their activities to
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regional office coordinators as well as visit banks in their respective nearest towns to deposit the money they had collected from service charges on a monthly basis. Writing a report may seem a trivial task in high-income settings, but it is more of a struggle for Ghanaian vets. One of Afia’s vet colleagues had recently acquired a personal laptop shortly before my visit. Afia suggested that this was a hugely positive development for the clinic because this staff member could now type up these monthly reports on his computer instead of one of them having to go to an internet café. However, Afia regretted that they did not have a desktop computer and printer in the clinic, which would allow everyone to complete a portion of the report at work, and print it directly.#59 Dr B also had a laptop, but a broken printer meant he also needed to print elsewhere. Bernard mentioned that he used to ask an administrator at the MoFA office of his district to type and print reports for him, but this administrator had since left, and thus he also had to go to an internet café, which was very inconvenient for him. If there were good internet connections, vets could send their reports via email, perform corresponding online bank transfers, and spare themselves a monthly trip to town. Instead, these tasks are difficult for vets based in remote areas, who are far from town and information technology. Not only do these difficulties impact vets in their local contexts, but they also have consequences at higher levels. A senior officer working at the VSD HQ asserted that district vets’ struggle to transmit data to the regional office on time and that this often delayed the whole chain of reporting to the HQ and to international organisations (like OIE and AU-IBAR).#85
If investing in expensive material was out of question for most district vets, recycling small artefacts was a common strategy. Syringes and needles are good examples of basic requirements for a clinic to operate as injections were one of the most frequent acts of care. The staff of District One and Two clinics recognised that they had no choice but to keep used syringes, clean them with water and re- use them. They had all learned that ideally, one would dispose of individual syringes after use, as there is a risk that germs could be transmitted via the same needle from animal to animal, but they could not afford the 30-40 GHc per week for the approximately 10 injections they delivered each day.96 In contrast, at the regional government clinic in town, all sterile material was used only once
and thrown away.
As we can see, setting up and maintaining a clinic as an operating space is a big part of practising as a vet in Ghana and is the foundation of vets’ abilities to safeguard animal health. The lack of diagnostic
equipment and of basic facilities especially impedes (zoonotic) disease identification and management. As discussed in the next section, vets also demonstrate discretionary practices when reaching out to, and making themselves available to, farmers and livestock.