Seeing clinical veterinary practice in Luang Prabang, Laos

Helen Law, Final year Veterinary Science Student, The University of Sydney

As part of my final year internship programme I was fortunate to complete a placement rotation within the livestock projects (ACIAR AH/2012/067 AH/2012/068) conducted by our Faculty in collaboration with the Department of Livestock and Fisheries (DLF) in Luang Prabang, Lao PDR. These projects are funded by the Australian Government through the Australian Centre for International Agricultural Research (ACIAR) and my travel was supported by a successful application by the project leadership to the New Colombo Plan program. I attended this placement in October, 2016, with Brianna Smits, one of my close friends also completing the final year of the Bachelor of Veterinary Science at The University of Sydney.

Luang Prabang is a UNESCO protected city in the heart of Laos. It’s heritage buildings and lively main street full of cafes, restaurants and market stalls was a fabulous location to settle in and spend a month. Luang Prabang is located in a large valley surrounded by impressive mountains. During our stay here we spent time in the office at the Department of Livestock and Fisheries as well as out in the field, in the laboratory or at the SK Veterinary Clinic. This Luang Prabang clinic is possibly the only companion animal clinic outside of Vientianne Capital, as small animal clinics are rare in Laos and only have only recently emerged.

The SK Veterinary Clinic is located on one of the main roads in the town, just a short bicycle ride away from the DLF office. It is open from 9am until 7pm, 7 days a week. All of the clinics consultations are walk-ins and not by consultation appointment. The veterinarian is not always present during opening hours as throughout most of the day, they work at the DLF and are available to be called into the clinic by clients, plus spend their evenings at the clinic. Brianna and I spent a number of our evenings and some Saturday shifts with the clinicians at the SK clinic. This was an interesting, rewarding and challenging experience. The major challenge was the language barrier, making it especially difficult to obtain a thorough history. Kindly, the clinicians were more than happy to translate the history into English for us. It was interesting to compare the approach of clinics here to what we have seen in Australia, particularly regarding their lack of facilities. The limited diagnostics available made a thorough history and physical examination even more essential within each consultation. The clinic itself is quite small, consisting of one room with an attached bathroom/washing room. The main room acts as the waiting room, reception, treatment room, pharmacy, surgery and consult room, all rolled into one. It was impressive to see what could be achieved in such a small space.

Figure 1: Brianna and I, on our first day at SK clinic, treating a dog with dehydration

External parasites presented frequently at the clinic, with subcutaneous injections of ivermectin given to multiple dogs that presented with tick infestations. Rhicephalus sanguineus is the most common tick found in South-East Asia. Ticks are capable of a carrying a vast range of disease, including some zoonotic tick borne diseases including Ehrlichiosis, Anaplasmoisis, Heptazoonoses, Babesiosis, Dirofilariasis and Bartonellosis. The stray dog population in Laos is a reservoir for ticks and other external parasites, and with the warm, humid climate, this provides the ideal ecosystem for the maintenance of a large tick population. Regular parasite prevention in small animals did not seem as common here as what we have observed in Australia. Preventatives against ticks and fleas, such as Nexguard and Bravecto, would be ideal products to introduce into the Laos market and maybe the SK clinic will begin to promote these to the expanding client base in the future.

The SK Veterinary Clinic offers surgical neutering services, although none occurred during our time at the clinic. Interestingly, we saw a female dog present for an injection with methylprogesterone as a method of chemical contraception rather than performing an ovariohysterectomy. The clinic promotes vaccinations against such as canine distemper, canine adenovirus 1 and 2, parvovirus, parainfluenza virus, with additional vaccinations against zoonotic diseases, including leptospirosis and rabies. Rabies vaccinations are offered free to animals on Saturday and Sunday and disease prevention is an important and growing aspect of the SK clinic activities.

Parvovirus runs rampant in Luang Prabang and throughout Laos with plenty of clients presenting their dogs to the clinic with a high suspicion of parvovirus infection. Whilst working at the clinic we observed and treated quite a few dogs with suspected parvovirus, with the lack of diagnostic work up due to minimal facilities and financial constraints causes most parvovirus cases to be diagnosed presumptively.

An example was a 4-5 month old male puppy presented to the clinic one Saturday morning after 4 days of lethargy, inappetance and diarrhoea. The clinician had seen the dog the day before and had given it supportive fluids. On physical examination the puppy was very lethargic with an elevated respiratory rate with increased effort. The puppy had a prolonged skin tent and tacky mucous membranes indicating dehydration. While on the examination table the puppy produced some watery, dark and foul smelling diarrhoea. At this point suspicion of parvovirus was very high. A catheter was placed and a total of 300mL of 5% dextrose fluids was administered intravenously throughout the day, the puppy was also administered intravenous metronidazole. The dog was also given a vitamin injection and enrofloxacin intramuscularly as well as an amoxycillin-clavulanic acid injection subcutaneously. The clinician made up an oral medication containing metronidazole, L-dacin suspension (aluminium hydroxide gel, aluminium hydroxide, magnesium hydroxide and simethicon) and a cephalexin solution. The puppy remained in the clinic on fluids and under observation for most of the day and was picked up in the afternoon, by which stage it was looking brighter. The clinic is not well equipped to deal with critical patients, particularly overnight so the puppy was sent home with oral medications and subcutaneous fluids and directions to keep the clinic updated and to return the dog to the clinic if it needed more fluids or deteriorated. The puppy recovered and enabled us to witness a particularly interesting case in comparison to our experiences in Australia.

Overall, working at the SK Veterinary Clinic in Luang Prabang was a rewarding and a fantastic learning experience. We have enjoyed our time here at the clinic and are looking forward to see what the future holds for the SK Veterinary Clinic!

Figure 2: Parvo puppy receiving intravenous fluids