Help save thousands of horses from epizootic lymphangitis APPEAL Prepared for Content approved by: Director of Veterinary Programmes, Francesca Compostella
APPEAL Please save Ethiopia s horses from pain and suffering Every year, approximately one fifth of working horses in Ethiopia are struck by a highly contagious and often fatal disease. These poor horses may die after three months of unimaginable suffering. The disease is so devastating that owners often believe they have no choice but to abandon their hardworking animals when they become too sick to work. These helpless horses are left to fend for themselves with nothing to eat or drink and without shelter from the blistering heat. This devastating disease is called epizootic lymphangitis, or EZL. Caused by the fungus Histoplasma capsulatum var. farciminosum (HCF), this highly contagious disease is easily spread by flies and infected horses, as well as infected equipment. The fungus can enter the body through the horse s eyes or an open wound, or the horse can simply breathe the fungus into the respiratory tract. Nodules form and rapidly spread through the lymphatic system, up the legs and across the horse s neck and face. Soon, the nodules turn Borte was suffering from painful ulcers and skin sores up his leg and was unable to work into infected ulcers which start to weep, attracting more flies and spreading the disease to other horses. Not only are the ulcers terribly painful for the animals, but they also increase the risk of a secondary infection such as conjunctivitis or lung infection. Ethiopia has the highest population of horses in all of Africa and the climatic conditions encourage the disease to spread. This means that EZL is particularly widespread in Ethiopia, causing untold misery not only to working animals, but also their owners, families and the community as a whole. SPANA currently runs the only EZL treatment programme for horses in Ethiopia, and we urgently need your help to provide vital medicine. Many desperately poor cart horse owners like Negesse are affected by EZL each year If owners cannot obtain medical help, they will often abandon their horses, either because the horses are unable to walk because of the pain, or because owners lose customers due to the terrible sight and smell from the ulcers. These horses are left to die a slow and painful death. Alone on the roads, they are at risk of being hit by cars or attacked by hyenas, and are often the victim of stonethrowing and beatings from other owners who fear their own horses may catch the highly infectious disease. 1
Tackling EZL SPANA is the only charity working to tackle EZL in Ethiopia. There is no vaccine and if not caught early enough, it is a death sentence. When horses are brought to a SPANA clinic in time, we have a good chance of saving them using a combination of topical iodine and oral potassium iodide medications. Oral potassium iodide is a very expensive medicine, and is not readily available in Ethiopia. We have researched alternative treatments, but results show that potassium iodide is by far the most effective option. Many families depend on their animals to make a living and losing a precious animal can mean falling even deeper into poverty. Negesse Gudissa relies on Borte, his cart horse, to earn enough to sustain his family a wife and four children. So when Borte fell ill, Negesse walked with Borte for one and half hours to reach our Bishoftu centre. When Borte arrived at the centre, the SPANA vets diagnosed EZL and saw the disease had spread entirely up Borte s left leg, leaving him in crippling pain, unable to work. Borte was sedated as his leg was so painful he would not let our vets near enough to treat it. Once he was calm, they gently cleaned, lanced and drained the nodules on his infected leg and applied iodine to treat the wounds and reduce the chance of the infection spreading. They also provided potassium iodide for Negesse to add to Borte s food at home to treat his whole lymphatic system internally until the nodules healed. Luckily for Borte, his owner brought him to our Bishoftu centre where SPANA vet and Clinical Skills Teacher Dr Reta was able to give him life-saving treatment After thorough treatment and plenty of rest, Borte made a complete recovery, but many other horses are not so lucky. I had even decided to abandon my work and look for another option. I never thought that he could recover from this nasty disease. I have seen many other horses dying, said Negesse. Negesse is very grateful that SPANA vets saved Borte I deeply thank SPANA and I am very thankful for giving my horse's life back. Thank you, thank you. 2
SPANA s EZL Programme Owners are often able to identify EZL as it is so widespread, but, if we cannot provide the medicine required to treat their animals, they simply cannot be helped. Without treatment, the horse s wounds will not heal and they will die. We need your help to continue fighting this terrible disease using our three main strategies of treating, teaching and training: 1. Treating infected horses through a four-stage treatment plan of cleaning and lancing the skin nodules, applying iodine to wounds and providing oral potassium iodide medication. 1. Cleaning Once the horse is sedated, all wounds are cleaned thoroughly with antiseptic. 2. Lancing The nodules are incised with a scalpel to drain the pus and the area is thoroughly cleaned again. 3. Infusing Tincture of iodine is applied to the nodules to clean them and reduce the infection. 4. Oral Dosing Potassium iodide is added into food: typically daily for five days, then four times a week for four weeks. 2. Teaching owners that any infected horses must be brought to the SPANA clinic as soon as possible. Although many owners can identify the disease, they often do not realise how important early treatment is. Early intervention is crucial for the treatment s success, as well as commitment from the owners who are responsible for adding the medicine into the horse s food and providing plenty of rest. 3. Ongoing training on diagnosis and treatment of the disease for veterinary students and qualified vets through our clinical skills centres and continuing professional development (CPD) courses. 3
Help make a difference How you can stop the suffering of horses in Ethiopia SPANA s approach to tackling EZL is highly successful and there has been a marked reduction in EZL prevalence in the areas surrounding SPANA mobile clinics. We treated 764 horses with EZL in 2016 and, as word spreads about SPANA s life-saving treatment, we expect to see even more at our clinics in 2017. As owners learn about the importance of early treatment, more horses are brought in at the early stage of the disease. The earlier they are treated, the less medicine they need to make a full recovery. So, with less medicine needed, we expect to be able to treat more animals, roughly 7% year on year, for the same cost. Delivery plan & Budget 2017-2019 We spent 9,193 on potassium iodide in 2016 and have budgeted for a 5% increase each year due to inflation. As EZL is such a major problem in Ethiopia, two SPANA vet technicians dedicate over 50% of their time treating it. Animals Treated Medicine Cost Staff Cost Total Cost 2017 817 9,652 9,223 18,875 2018 875 10,135 9,684 19,819 2019 936 10,642 10,168 20,810 Total 2,628 30,429 29,074 59,504 EZL is a constant risk in Ethiopia and we urgently need to raise 59,504 to save 2,628 horses over the next three years. SPANA s treatment programme gives each horse with EZL the best chance of survival and can prevent a family falling further into poverty. Please help us raise 59,504 to save thousands of horses from an agonizing death. 4
From: Nigatu Aklilu Sent: 22 February 2017 12:44 To: Geoffrey Dennis Subject: EZL Information Dear Geoffrey Thank you so much for coming to visit Ethiopia to see the conditions for yourself. I am very worried about the constant threat of epizootic lymphangitis here at the Bishoftu clinic. The medicine supplies are very low and the number of early presentations of horses with EZL is increasing each year. It is clear to us that word of mouth about our successful programme is spreading amongst cart horse drivers and farmers which we celebrate, but we urgently need extensive supplies of potassium iodide. As promised, these are the details of the treatment programme: it is an intensive treatment programme as the topical treatment is only going to kill the organisms that become exposed when infected nodules are lanced. The systemic effect of the disease (weight loss, debilitation) will not be tackled by topical treatment so the oral treatment is used to access the organisms that are circulating in the horse s lymphatic system. As you saw during your visit, the potassium iodide is given orally. It is absorbed via the intestines in to the bloodstream then distributed throughout the body in order to treat the organisms trapped inside the body and inside cells. Additionally, the disease will be shed to the outside and potentially infect new cases via the pus released from ruptured nodules applying potassium iodide kind of seals the lesion and kills organisms near the surface to prevent flies landing on it and transferring the infection to another animal or the environment. My clinical staff are hardworking and committed but supplies are nearly gone. As you know, the medicine is very expensive to get here in Ethiopia. At the moment, treating an infected horse costs us almost the same amount you would pay to buy a new one! We expect to treat over 2,500 horses over the next three years and estimate the total cost of potassium iodide we need to do this at 30,429. We are being faced with so many cases that I have to ensure two of our vet technicians work solely on EZL treatment on three out of five days a week. I can t afford to continue this vital work without your help.. I hope you can raise the funds, Geoffrey. Our animals are suffering and will not live if we do not treat them soon. Sincerely Nigatu Aklilu SPANA Ethiopia Country Director P.S I have attached details of Borte who we recently treated. There are some before and after pictures so supporters can see the treatment at work.
SPANA CASE STUDY REPORT Location: Bishoftu, Ethiopia Prepared by: Dr Nigatu Aklilu Animal details Description Name and age Work Type Work hours Owners name and occupation Family Injury/ illness Injury/ illness signs Injury or illness cause Horse, male Borte, 15 years Pulling cart, fetching water for family and other animals. Seven hours a day, five days a week including two market days. Mr Negesse Gudissa, cart horse owner and driver. He is 30 years old. He has one donkey and seven cattle but only one horse, Borte. He worked as cart owner and driver for the past four years. Negesse is married and a father of four children (three boys and a girl) Moderate epizootic lymphangitis About 20 nodules and ulcers on the left forelimb. Most of them ulcerated and involved chest lymph nodes. It caused swelling of the whole limb with lameness. Borte is affected by the fungal organism Histoplasma capsulatum var farciminosum. The fungus is very resistant in the environment and transmits by contact with infected animals, materials and flies. Treatment Borte was treated using oral potassium iodide powder orally (25 gram per day once for the first five days followed by 30 gram every other day for four weeks. The iodide powder was given mixed with wheat bran. We also applied tincture of iodine on each nodules for the whole visit times. Each nodule was lanced as they appear using scalpel blades after sedating the horse. The treatment stopped when all ulcers were healed. Advice given to animal owner by SPANA staff We advised the owner, Negesse to dedicate his time and effort for Borte's treatment. The treatment demands effort from both our team members and the owners. Negesse was also advised to give rest for the horse on treatment days. Owner's compliance is very crucial for the success of EZL treatment. Negesse was a good owner and implemented all our advices.
BORTE, CASE STUDY PHOTOS 1. Before treatment: Borte had 20 painful nodules up his left leg and was unable to walk 2. Dr Reta Tesfaye treating Borte for EZL 3. Negesse with Borte, whose leg is in the process of healing 4. After treatment: Borte s leg is healing and he is much more comfortable