Hello, it's Anthony Chadwick from the webinarett welcoming you to another episode of Vet Chat, the UK's number one veterinary podcast. And I'm super pleased today to have Shereen Williams on, who is a graduate of Nottingham Vet School, one of the originals, acclaimed to fame. And er also represents Brooke Action for Working Horse and Donkeys as the global animal health advisor.

So, Shereen, thank you for coming on the the podcast. Brilliant, thanks so much for having me, really nice to be here. And Brooke is such an amazing charity, you know, I've, I've obviously known about Brooke for a long time, and not quite since when it was founded in the, in the 30s, but you know, certainly during my veterinary career, and so thank you for all of the, Fabulous work you do for working equates, but of course as I've been learning.

You do treat other animals as well, don't you? Yes, I mean, yes, we were founded in 1934 by a wonderful woman called Dorothy Brooke, who, was actually the wife of an army general based in Egypt. So yeah, our organisation really started, after the First World War, when Dorothy Brooke, was Really quite horrified at the plight of the war horses that had been so pivotal in helping helping with the war effort and then were continuing to really support the post-war effort in helping rebuild and cities and work for local people.

It was obviously a really difficult time across the globe. And their health and welfare was really suffering, and that's really what she has started the organisation to address is where these animals are helping people, can we do more to help them? And, and that really has continued, over the last 100 years and still is at the heart of everything we do.

But certainly as part of the animal health team, which I'm, I'm part of a wonderful global team of vets, barriers and agro pharmacists, and we realise that vets treat more than one species and we don't have equine vets in the countries in which we work in these vets are treating every single species of which working equids are actually a smaller proportion. So when we're thinking. About our work, which really focuses on teaching and training.

So what we, we don't provide treatments ourselves other than in real emergencies and we don't have hospitals or sanctuaries. What we do is have a local teams which go and work with those people who are providing animal healthcare, of which there is always somebody, they might be community and Animal health workers, they might be para vets or they might be veterinarians, but somebody is usually providing some treatment to the animals, and our work certainly around that is, to mentor and to train those animal health practitioners and to strengthen the system in which they work in. So that's how we've kind of come to be involved in in wider projects around animal health, not just simply focusing on horses and donkeys.

And obviously we're doing this recording, I'm in Liverpool in the centre of Liverpool and, and you're very close to Liverpool Street in London, aren't you? You're in the city. We are, yes, like I, I came into the office hoping for better Wi Fi than the rural area where I live.

I'm not sure that's been true, but yes, our, our UK office or sort of our global HQ is based just outside Liverpool Street station. So yeah, it's a bit of a funny world where we're getting off the train with bankers and lawyers and and we're an organisation full of animal welfare advocates, but it's, yeah, it's a really nice place. We've actually next week we've got, Our international senior leadership teams, so our country directors from each of our countries across Asia, Africa, and Latin America are actually coming for a, an in-person meeting.

I think it's only the 2nd 1 since COVID, so it'll be, we, we do a huge, a huge amount online. But there is still need for face to face meetings and, face to face training, so we do have, we travel to the countries that we work in, and we also have our colleagues come here to to our office here as well. And it is nice, I think it is important to do face to face.

I'll be at the webinar vets saying it, you know, we've done obviously webinars for the last 13 years. And a lot of stuff can be done online and in fact it's good because it's saving carbon and saving. Money as well, but obviously, it is great to be able to meet face to face as well to develop those relationships.

Yeah, I guess in a similar way that you were probably slightly ahead of the, well, quite a lot ahead of the COVID times, and I guess in the same sense we were because we've always used online training. We have a huge online learning programme. We do a lot of online learning and online discussion, but it is.

Working with animals is a practical, vocation, isn't it? And I think during COVID, we pushed it to the limits. We had, we had fire training about how to build fires to heat metals to certain temperatures, being live streamed from Newmarket to quite a rural area area in Senegal, and that was obviously because we couldn't travel.

But I think a good example of where actually that training would be most beneficial in person. Yeah, no, that's brilliant. And obviously, veterinary surgeon from er Nottingham, did you do some practise in, in ordinary practise before you went into Brook as well?

Yes, yes, it's, yeah, we're always proud to say that we're the guinea pig, yeah. And then we had, yeah, wonderful. I mean, obviously everyone, well, most people don't they, they love the vet school they went to, but we had a really, I think, unique experience at Nottingham because we were the first new vet school for for quite a while, which was a bit controversial.

In itself. But I think we had like a very quite a young, dynamic teaching staff and we knew them really well because at the start, there was more of them than they were of us. And so yeah, we kind of kept up with that alumni very closely and and and it's been really positive.

But following, yeah, following graduation, I worked, I I did go straight into equine welfare, but based very much in the UK at that time. So I worked for Red Wings, and the Horse sanctuary, and the equine welfare organisation based in Norfolk, and worked very much in the center's hospital there treating at the time there were 1200 horses, donkeys, and mules that had been rescued. Also worked very closely with the RSPCA and I think within about 6 months of graduating, I was one of the vets at Appleby Horse Fair.

So working so that was really wonderful to kind of see, that I guess different horse owning community. Which I maybe hadn't been as exposed to a vet school as yeah, I've sort of seen much more performance horse work. And I think equine welfare and and these kind of communities was much more the area that I was interested in.

And then after that I worked in practise in mixed practise in Bedfordshire for a few years, 2 or 3 years, and, and that was also really good to be in a sort of commercial vet setting. So obviously charity work comes with a lot of challenges, but talking to owners or having to charge for your time or dealing with insurance claims isn't one of them. So I think that was really good for me in the sense of kind of exposing.

And just being part of the, the veterinary community. I then went travelling for a year, which was wonderful. And, went backpacking around Asia and Africa and had a wonderful time, did do some, animal work, also did, some.

Community education work and and things like that, but on the whole had a really good year and then I worked in Australia for, for a year again, so based in Victoria, and that was mainly some mixed but mainly small animal kind of locum work and to mix in with kind of being. People to travel around Australia and that's actually then where from there is where I saw the advert for the Brook job and it's, to be honest, working for an organisation like Brooke had always been my long game. It's one of the reasons that I went into veterinary medicine, my Dad, is actually from Sri Lanka, so I spent a lot of time growing up, spending time with our family there, and that was really the driving force behind me wanting to be a vet is kind of seeing animals in lower and middle income countries and Understanding animal welfare from a different cultural perspective is really what drove me into veterinary medicine.

So, somewhere like Brooke or these kind of international animal health organisations had always been where I'd wanted to be really. Yeah, I had to do my interview from a camper van in somewhere in Australia. So, yeah, and that was, yeah, before the days that Zoom was quite so commonly used.

So, but yeah, it's been, yeah, and then I've been here, it'll be 8 years soon. So it's been, and continues to be good fun. Yeah.

Yeah, no, excellent. Obviously, as you said, there's challenges working, you know, for charities, as there are for working in clinical, you know, commercial practises as well. But obviously working in these countries also where infrastructure isn't always as strong as it is in the UK and and elsewhere.

And, and I know, for example, you know, there's a difficulty in getting hold of pharmaceuticals sometimes for, for basic treatment of, of the horses, cattle, dogs and cats that we see. And I know you're doing some really interesting work with WVA at the moment around trying to develop essential medicine lists, which obviously has been something that's been quite common in the human field, but maybe not so much in the animal field. Perhaps tell me a little bit about what you're getting up to in that area as well, which sounds so fascinating.

Yes, yes, it's certainly It's a big part of my work at the moment. And again, it kind of really stems from the way in which Brooke works, which, as I mentioned, is to work with local animal health practitioners to be there while they're doing their job in a normal setting as opposed to kind of in a more what we might consider kind of artificial charity run hospital setting and. And one of the benefits of working in that way is that we can understand the real life challenges of what we call this kind of last mile animal health setting.

So where we've got the, like the local animal health practitioners, be they para vets, community members. Those people that are treating animals on a day to day basis. And so Brooke work with over 6000 of them across Asia, Africa, and Latin America.

And when we looked at our data from, from when we're working and mentoring them. We could see that consistently across years of our work, more than half of them don't have access to medicines that we would say are essential, such as pain relief or broad spectrum antimicrobials, and that's despite us working very closely with them. So we'll see huge improvements in their clinical practise.

So our vets are mentoring and training. Them to handle animals better, to take pulse rates, to, to do, to listen to lung sounds, to do lameness exams. So all of those kind of areas, their clinical practise is really improving their communication with owners is really improving, but what we just could not get above this 50% is that what they're carrying in their kit in the field.

And that really made us think like if this is happening for us, is this happening in other places too, or is this just something that Brooke is experiencing? And then we see what we did in the first instance is look at government health posts, so particularly in Ethiopia where we felt there was more of an issue. We looked at, I think more than 700 case records from government.

That posts across a certain period of time to see what were the medicines they're actually using. And if we're honest, it was actually worse than we were expecting. What we saw with that is that there was no access to pain relief at all, but we are seeing surgery happening with so we're seeing caesareans, we're seeing all the things you would expect.

We're seeing dehorning. These incredibly painful procedures we're seeing infectious diseases, all with not being, not having access to any non-steroidals or or form of pain relief at all. And then actually what, what we are seeing used is that 100% of the cases, were treated with either an anthementic or an antimicrobial, and I think it was about 87% of all cases would have a combination of Oxitec.

Strep and Ivermectin, because those were the drugs that the vets have available. And obviously, I don't think you need to be a specialist in the animal welfare or antimicrobial resistance to understand that that is a real concern. So from that, we then sort of started to look at this is a huge topic and and a big concern.

And became aware that the World Veterinary Association were also looking into a sort of similar issues, and we actually launched a joint project of which the first stage was a a global survey to to understand better the experiences of the global veterinary community. And I guess, unfortunately, but unsurprisingly, what we saw was that this is a really big issue. So we had more than 700 responses from 36 different countries, and of those 80% of the respondents felt that vets' ability to address animal health needs were restricted due to challenges in accessing medicine.

We had more than 1/3 didn't have access to medicines to perform humane euthanasia. 10 countries reported the unavailability of any form of pain relief. And again, more than a third highlighted a lack of access to vaccines such as foot and mouth, and tetanus and rabies.

So the, the problem was big and and global. And so I think when we put our heads together and Trying not to have a big panic or feel a bit hopeless, we often look to our human health colleagues and think, well, this has probably been or is or was an issue within global human health at some point. How did they address it?

And certainly the World Health organisation, have done a lot on this, and they estimate that more than 2 billion people. Have no access to essential medicine and this effectively cuts them off from advances in modern science and medicine. And I think when we think about the animal health world, we do tend to lag behind them.

So while we don't have the numbers of animals affected by this, I think we could assume that it was larger than that. And the way in which the sort of at the base of so much of the WHO work around this is this essential medicines list of which they created their first one in 1977. And it's updated every 2 years.

And importantly, it's not a compendium of every medicine, it's a prioritised list. So globally, what are the medicines that are essential for, for people to do their jobs? And what we realised is that we don't have that same equivalent in the animal health world, and we really felt that this was a gap that needed filling, and that's where this project has has really grown from.

No, that's fantastic, and I think it's it's so important to realise that, you know, using the Parito principle, probably 20% of the medicines treat 80% of the diseases, so things like rabies obviously really important, your painkillers, your euthanasia, products. So actually going for, for example, something like phenylbutazone, which you can only really use in horses is perhaps not the answer, but go for more of a a broad spectrum non-steroidal like a meloxicam that can treat obviously many different species. Yeah, and that that is exactly our learning on this, and I think why Brooke is so involved in in a project that spans so many species.

So, the Essential Medicines list our project with the WVA, it builds on the success of Wasava, so this the small animal veterinary Association, and they In 2020 released a list for cats and dogs, and I was quite jealous really that they only have two species to worry about. I was sort of, when we looked at the, the list for livestock, we've got 8 species. So we've got large ruminants, small ruminants, aids, pigs, poultry, aquaculture, bees, and rabbits, and we're actually in discussions about whether we need to add camels on as well.

So it is a really large project and but certainly from Brooke's point of view, that has very much been our learning that going for an individual, I guess an individual medicine and certainly an individual species is within animal health systems that are stressed, that are weak. It isn't sustained. So it would be easier or in the short term for us to ship buzone over to the countries where we need it or to arrange for that to be purchased.

But long term, that's not sustainable. And what we know to be true is that in 5 years that that supply will not be there anymore. And so this project certainly looks at strengthening access to medicines for all animals and sort of really looking at that system strengthening.

So for example, if you want countries need to be able to create their own regionally appropriate list, obviously what's relevant in Europe or America or parts of Asia will not be relevant to Africa and And vice versa. But what this list really should do is act as a blueprint on which countries can form their own committees, use the evidence from the expert working groups that we formed to then form their own lists, and then go about lightly a process of prioritising or looking at what do they think should be available, what actually is available, how should they prioritise. That where, where are the weaknesses in their systems and that will be different for different countries, for example, thinking specifically about one of our countries that we work, that this is a really big issue and is certainly Ethiopia and yeah where it would and sometimes it does, it does feel like the thing that you want to do, which would be to take over a big suitcase of phenolone.

Certainly history has taught us that that is not the way in which to address things in a sustainable way. If while that might be kind of a sticking plaster on a, on a, on a bigger wound as such, in the long run, it won't actually improve access beyond a very small number of animals and And that can be really difficult, I think, especially for our teams and certainly even for myself on, on my last visit to Ethiopia and with two of my colleagues, Abdi and Moles, we were faced with a horse that had actually been attacked by a hyena that's quite actually unfortunately quite common there because animals will be tied up outside grazing and And wild animals are are roaming and, this animal had an incredibly large wound that was completely infested with maggots. The animals certainly looked systemically unwell.

And there was, yeah, myself, my two colleagues and the local government vets that were kind of looking at this, animal while we were actually there doing a a different training. And it just really became clear that for all the skills and knowledge and competency of the four vets that stood around that animal, we didn't, what we had access to was pen strep, and that actually was it. So what we needed.

Was obviously a more appropriate antimicrobial pain relief, sedation, potentially, euthanasia medicines, whereas the conversations we were having to have where do we use pen strip? Do we try and put this animal down without access to humane euthanasia drugs and like what's what's worse here. And so what we ended up doing was cleaning the wound, which obviously would have been incredibly painful because it wasn't stated, and sort of trying to keep flies away and and such like.

Giving it a course of pen strep, which questionably not the right thing to use for for working aqui. And then using our own paracetamol. So we had first aid kits for ourselves.

I mean, paracetamol, yes, can be used, but in usually by my experience in conjunction with other non-steroidals, and it just really hit. For us that, yeah, for all for all of the skills and knowledge there for that animal, it didn't make a difference that there were 4 vets really stood around it because we didn't have access. And and one of my colleagues there my last was was saying that it's really like doing your job with one hand tied behind your back, and that really resonated for me.

And, and so it's incredibly challenging for us, especially for our colleagues, but what we need is not to kind of parachute medicines in that will then disappear. And we need sustainable supply chains and demand from vets, from owners, from communities for these medicines so that they can exist within the animal health systems within that country, and that they will be there for the for the long run and for other animals that are outside of the like the reach of equine welfare charities or other animal welfare charities. We need all vets to have Access to these medicines so that they can use the knowledge and skills that we take so long and carefully build in people, and so that they can use those skills to make good decisions and have positive outcomes for for the animals and owners.

We really need, you know, as well as export or import, we, we need to actually develop centres within countries or certainly within regions to start producing. Nonsteroidals, anaesthetic drugs. You know, different types of antibiotic because obviously as you say, if we're just using the same antibiotic all the time, there's almost certainly going to be resistance that develops in those situations, isn't there?

Yeah, and this is the thing, it's a huge, this like access to medicines matters to more than just vets and animals as well. Like this is a one health issue. We know that, yeah, we're getting the overuse of particular antimicrobials because they're the only ones that are available or where in our experience, where there isn't access to pain relief, we're just seeing the continuous use of ivermectin and oxitec cycline and steroids because that's, that's what's But we know that diseases or antimicrobial resistance, also like food safety, these animals are going into the food chain, biodiversity, these don't aren't confined to borders.

These are global issues that will affect the the one health, the wider one health and environment, and we can't really afford to, to ignore them. And yeah, that's where coming, it is a huge, it's a huge issue that I think globally we have a responsibility as the veterinary community to, to address. And I think that.

We the the starting place for this is that every all these big projects have to start somewhere, don't they? And I think having this essential list of veterinary medicines, prioritised lists in each country ideally, that then. Can act as a a way in which countries can audit themselves, they can look at what they said they need, what's actually available, and then they can prioritise which ones they need and how they get them and that yeah, that will be different in different countries, but I certainly think Like the potential for the livestock numbers across Africa and Asia, but in Africa in particular is huge.

These are huge markets that at the moment, like, as we said, that there's no non-steroid tools available. And like that to me seems like a huge opportunity for farmer to be involved in this. And obviously for me personally, I want animals to have access to.

Relief. But there's also a huge business opportunity here. So I think we, as the veterinary, the international animal health community and the vets within that need to put our heads together and think how we make the case for this for so that others see the need, but also the potential, in these markets that that that we see, to be honest.

And of course this list I know is, is imminently coming out to be published. We we're recording this in at the end of May and hopefully, certainly by the end of the summer this will be out there and available as a essential medicine list which can then be adapted to the various regions and countries as well, so. Yeah, it sounds like a fantastic initiative by Brooke and by WVA.

I know it's it's being sort of checked and looked at at the moment, so we will definitely push this when, when it does go live as well, but it's, it's a really fascinating subject, and it's something, you know, as a vet in the UK I really don't think about because I'm not aware of those issues, you know, we have non-steroidals, we have different types of antibiotics, we're, we're very, very. Fortunate, as you say, what we can do for animals, because if we took all of our medicines away from us. It would be a really, really tough job, you know, as you say, even doing basic cleaning of wounds in an animal that has no sedation, one is dangerous for the animal, dangerous for the vets, it's not right that the the animal needs to suffer during that, so.

Thank you so much for this fabulous work you're doing and we are looking forward to the publication so we can . Promulgate this podcast even more. Wonderful.

Well, thanks so much for having me and following the work that we're doing. It's really been a huge pleasure to be here. Thanks so much, Shereen.

Thanks everyone for listening. This is Anthony Chadwick and this has been another episode of that chat. Take care, bye bye.