Veterinary field practices are not simply the delivery of veterinary care from vets to animal owners, but are a context-dependent negotiated activity. Everitt argues that such negotiation in veterinary clinics involves many factors such as owners’ financial resources and the perceived value of the animals (Everitt, 2011). What vets do, therefore, is not only preventing or treating infections per se, but navigating both their own interests and motivations and those of the owner.
However, in Ghana, what animal owners/handlers want is often not aligned with what public vets are inclined to do given their professional interests and responsibilities. Firstly, frontline vets feel they have a duty to generate money from their services to ‘save’ the veterinary department at the national level (this is explained later in Chapter Three). The monthly amounts of money raised by each vet is publicly shared and judged by colleagues at regional veterinary meetings, as I once witnessed during my fieldwork. The regional director also compiles this monthly reported data (see Figure 11) and measures veterinary activities (number of acts performed) and the revenue generated per district and in the region as a whole.99 In his eyes, revenues generated by district vets served as indicators for
estimating the quality of public veterinary service delivery in each district.
99 Observations at a regional veterinary meeting (#48). The regional vet director said: ‘Let me give you the money the VSD has lost for [name of region] from January to July 2014: We were supposed to receive 125 952
GHc and only collected 2620 GHc. In [name removed] region, they collected 30 000 instead of supposed 120
For public vets, collecting money from clients is difficult because the latter sometimes refuse to pay for services received. This usually happens for two reasons: either because clients do not value the service (they do not consider there is a problem to be solved) or because they cannot afford to pay for it. At slaughter sites for instance, butchers may refuse to pay for meat inspection (see Figure 12) because this service is imposed on them by government regulations and, according to vets, butchers do not value nor need inspection for selling their meat.
Figure 11. Example of veterinary revenue generated by one district over a month.
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As butchers can sell meat without certificates accounting for its safety, they are unlikely to seek them unless forced to do so. According to vets, this leads to some of the butchers trying to ‘get away
without paying’ for meat inspection:
Butchers who brought animals for slaughter had to pay about 35-40 GHc for the abattoir service, two GHc per animal for veterinary inspection and sometimes dues to butchers' associations. Dr M mentioned that the butchers sometimes refused to pay inspection fees. His strategy was to try and persuade the butchers to pay as much as possible. The revenue coming from the abattoir was essential for the survival of the VSD. Dr M told me in a proud tone ‘last month the vets collected 7 000 GHc’. He said he believed that they could do 10 000 in the future.#51
Some district vets, like Dr M in the example above, still provided certification for inspected animals for which fees had not been (fully) paid because of their concern for appropriate disease control procedures and an interest in retaining working relationships with the butchers. In doing this however, the vets often opted not to officially declare the animals slaughtered as this would free them from having to account for the associated lack of revenue. Already identified as a problem for vet practice in the early 2000s (Turkson, 2004), in 2014/15, vets also often struggled with clients who refuse to pay for drugs and treatments or diagnostic laboratory tests, as they either cannot afford the official prices, or think such services should be free. This happens because, according to some of my participants, some drugs, vaccines, lab tests or veterinary services were free of charge in the past. However, Ghanaian district vets must now buy drugs and vaccines – except in the case of provision through large-scale funded prevention campaigns – in pharmacies which sell human medicines, or in
Figure 12. Inspection fees from a letter from the VSD (Accra) sent to all district vet clinics as a reminder in September 2014.
shops selling agricultural products. Drugs in these establishments are not subsidized by the government. Sometimes, clients’ refusal to pay in full forces vets to negotiate prices with them. I witnessed a few such negotiations with clients when I visited the district clinics.#47,#55 Vets made their final decisions around price on a case-by-case basis and took into account clients’ views and financial situations. Thus, in the end, services delivered and prices paid differed across clients. Although negotiating prices was an opportunity for vets to exert discretionary power after these transactions, vets would, most of the time, have lost some money for having sold a drug for less than its initial cost. Nonetheless, vets had yet another opportunity to exercise discretion after such transactions. They could decide not to declare to higher levels of the VSD that the treatment had taken place, nor to report the related service charge. In this way, the service charge paid by the client might compensate for money lost on the drug, as the vets would not send these funds to the bank. District vets reacted differently to this opportunity. One of the vets described above did not leave much space for negotiation and occasionally paid (using his own money) in entirety for diagnostic tests100 or drugs in cases of zoonoses, which he found too important to overlook.#33,#50 Another chose to declare all service charges, sending the right amount of money to the bank (Ministry of finance, see diagram in Figure 2) every month, no matter how much was collected from clients. This vet therefore, had to contribute personal monetary resources. Another however, declared what he received only when he had recouped his investment which, as a result, meant that only about half of his activities were declared. Such choices have the effect of under-representing the number of veterinary activities happening in the country, and thus the presence and prevalence of disease itself in national-level data.
After generating money, the second responsibility field vets have vis-à-vis their profession is to manage outbreaks. Reporting an event or the presence of activities commits district vets to being accountable for them. I witnessed however, that a certain number of actions that should have been reported were left undocumented precisely to avoid creating situations in which the vets would be held accountable for given problems, but for which they did not have the resources to deal with appropriately.
100 The same day we had this discussion, he had paid for a TB diagnosis test in a herd we had visited since the
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District vets were often careful with the amount of responsibility they claimed when overseeing inspection at slaughter facilities in their districts. For example, Dr B indicated in a monthly report to the regional vet office that there was no slaughter slab in his district, even though there was at least one. This was because, as Dr B told me himself, he needed to first get the butchers on board for meat inspection. If he reported the slab’s presence, it would mean that he would be accountable for visiting it and inspecting its animals and meat in accordance with the rules. But, in the absence of an established agreement with the butchers, he could not inspect the slab and thus would not report its presence so as to avoid being blamed for not doing his work or for any outbreak which might arise from there. Similarly, a vet in District Two refused to inspect a local slab in his own district because of the lack of hygiene there. He explained that it was highly likely that he would be blamed for meat- related illness in people consuming meat from the slab even if he did the inspections well.
Taking responsibility as a field vet also meant being accountable in the event of an outbreak in one’s area. Once, when I saw Bernard take organ samples in small plastic bags from the local abattoir, I expected he wanted to run some tests on them. I was surprised when I learned the actual purpose: he explained that the samples were not for testing, but to prove that he had indeed inspected the cow. In the case of an outbreak, and of an associated possibility that he would be suspected of having missed an inspection, lesion-free organs would serve as proof that he did his work properly. If he did not take such samples, he could potentially face the blame of the entire community for failing to diagnose a case of zoonosis and in the process, lose his community’s trust (I discuss the importance of trust from vets’ clients in Chapter Five).
The lack of power vets had to enforce regulations (described in Chapter Two) meant that district vets had to persuade their clients to change their behaviour, which often was in vain:
In the cases where butchers refused to pay inspection fees, Dr M explained he was ‘supposed to prosecute’ them but that he would not do it because it would create a climate of conflict between them and would make the situation in the abattoir much worse. The lack of hygiene in the abattoir also broke regulatory requirements (organs were cut and washed on the floor and faeces from the intestines and the blood often came into contact with the meat), but there was ‘no way’ to sanction the company because, according to Dr M, the legal texts supporting related regulations had only been discussed but not voted in parliament and therefore no enforcement was possible. He also reported that he saw butchers unintentionally spit on the meat. Only butchers working for the abattoir company were supposed to enter the building but other butchers liked ‘to follow their animals all along the chain and check that the workers are doing well’ which created an atmosphere of tension and made the space difficult to access for vets. Dr M felt powerless about this. According to him, the butchers and the abattoir company did ‘not care much about the
quality’ of the meat vis-a-vis good levels of animal welfare and hygiene ‘but only the quantity’ of meat that could be produced.#51
This section shows that veterinary practice in Ghana can entail financial exchange that involves negotiation with animal owners or handlers, in order to act upon animals. Vets struggle to meet their clients’ needs because public health interests (as specified by their profession) and clients’ interests are often in contradiction. Vets deal with this by using their discretionary power, by deciding when and how much to charge, when to report, when to bear the costs themselves, and when to forgo intervention. These decisions and the exercise of this discretionary power are ironic in that while they make it possible for vets to continue to work in these local settings, they sometimes simultaneously undermine vets’ ability to manage and control zoonoses. The next section explores how, in such contexts, vets look to minimise their own health risks.