In November 2023 I travelled to Luxor, Egypt on behalf of the BEVA trust, to assist treating working horses and donkeys at the ACE (Animal Care Egypt) clinic.
ACE is a charity set up in 2000 to provide free veterinary care for the local animal owners. In 2006 they built a clinic on the outskirts Luxor. The workload is mainly horses and donkeys but they also have a busy small animal clinic and treat the odd sheep, goat or camel that arrives.
The clinic is well organised and run, employing 6 Egyptian vets and about two dozen Egyptian lay staff. Ex-pat volunteers also help with the day-to day management. Equine Facilities include a walk-in clinic, several exam rooms, horse wash facilities, 25 stables and 6 sand paddocks for in-patients Equipment includes a digital x ray, ultrasound, fibre optic endoscope and powered dentistry.
The local economy revolves around Tourism (Luxor being an ancient capital of Egypt and full of important historical sites such as the Valley of the Kings) and agriculture (the clinic is deliberately situated in a sugar cane growing area). As a result our patients where mostly donkeys used for pulling farm carts and carriage horses used for pulling the ornately decorated “Hantour” carriages around Luxor. These carriages a both used by Tourists, to see the sites and also by locals as a cheap taxi about town. We also saw a few “dancing horses” which performed at weddings etc and a few riding horses from the west bank of the Nile where there are a number of riding schools usually frequented by tourists and ex-pats.
Days began about 8:30 am with a check of in-patients before, daily rounds were held to discuss in-patient care. The vets then split up with some staffing the small animal clinic, some the walk-in equine clinic and some treating the in-patients.
Wounds, colics and lameness where the most common reasons for equids to be presented. Wounds were very common -often from fighting with other horses or from road traffic collisions (which was unsurprising given that “defensive driving” is an unknown concept in Egypt). The wounds were rarely fresh, often being 2-3 days old.
Minor wounds, rubs and abrasions were almost ubiquitous in the animals treated. I found that “purple spray” works just as well in Egypt as in the UK. Many clients turned up just to wash the dirt off their horses then asked to use the purple spray. They would then spend the next ten minutes turning their horse purple, before one of the vets would prise the spray from their fingers. On occasion we ran out and had to substitute a colourless antiseptic spray. This did not go down well with the owners who clearly felt that it was inferior.
Cases of colic were also numerous – often with a history of a sudden and extreme change of diet. There are no facilities for colic surgery in Luxor, so surgical cases had to treated palliatively until the owner gave consent for euthanasia (which for cultural and religious reasons was not always freely given) or the animal died. This a salutary reminder of just how well set up the UK equine veterinary industry is and also just how potent flunixin can be in masking signs of surgical colic.
Euthanasia was carried out by sedating the animal heavily with xylazine and then infusing saturated magnesium sulphate solution through a drip set until the animal collapsed. This appeared to be a fairly humane method.
Lameness was common but nerve blocks or even trotting-up was unnecessary. If the horse was not clearly lame at walk it was not presented to us. Tendon and ligament injuries abounded and many horses had chronic active tendonitis that they were expected to work through as they simply could not be given time off to allow to heal. Many tendon injuries had been previously bar fired.
I was told that laminitis was not uncommon. This seemed surprising to me as none of the patients were fat or old. The explanation was that was usually caused by the owner feeding sudden large amounts of grain followed by pounding the horse up and down the tarmac roads in the carriage- in other words more a true carbohydrate overload laminitis than an endocrinopathic one. Interestingly I did see one case of PPID – in an elderly pony on the west bank belonging to a English ex-pat. I was asked to give a second opinion on it for Dr Assma Ali, one of the clinic vets, who suspected PPID but had little experience of the condition. To me it just looked like every single one of my geriatric patients on the Wirral – a classic case. Again, this reminded me that we were not in the UK anymore and could not expect to see the same distribution of diseases that I would at home.
Infectious respiratory disease was also fairly common – none of the working animals were vaccinated and outbreaks of equine influenza had left some animals with permanent damage to their lungs and airways.
Treatment at the clinic was free, but the vets were careful not to give too much away. Supplies of certain medicines seemed quite restricted but others were clearly freely available “over the counter” in local pharmacies. Often the clinic vet would give first aid treatment before writing a prescription (in the form of a scribbled note in Arabic on a scrap of paper) and give it to the owner. The owner would then toddle off on foot before returning perhaps 30 minutes later with a small plastic bag containing a quantity of crushed ice and a vial of tetanus antitoxin, or a box of twenty, one litre bags of saline or 150 rifapmcin capsules or pretty anything else inbetween that they had bought at a pharmacy.
Most of the horses were not well trained beyond basic leading and were used to being fairly roughly handled. A fair amount of shoving, pushing and pulling was required to get them to do pretty much anything. As a result, many were very defensive and sometimes outwardly aggressive towards humans. Almost all handling was done with the animal tied “hard and fast” to the wall rings – including for injections, stomach tubing and dentistry. Hobbles and twitches had to be used fairly frequently, but once restrained the majority became very compliant. Firm restraint was the standard but I did not see any excessive force used by the clinic staff at any time.
Most patients walked in, but a fair number were transported in on the backs of open pick-up trucks (Ifor Williams does not have an Egyptian branch). The horses could jump in or out of the trucks from the ground, although many owners took advantage of the clinics loading ramp. Egyptian horses did seem to struggle with slopes (Luxor being very flat), however none took more than five minutes to get loaded back on the truck – especially if the clinic groom Achmed got involved -he was very skilled at bundling them on. I suspect UK horse owners would be outraged if they saw how Egyptians travelled their horses- however they could learn a lesson-or-two in loading from the locals – there was none of the hours-long messing around that we often see in clinic car parks when our UK patients don’t want to go home.
One of the reasons I was asked to go to Luxor was to provide some CPD for the vets. We managed both lectures and practical sessions – particularly on ultrasonography, which paid off quicky when we started using in on clinical cases and found many significant findings including hydronephrotic kidneys, colitis cases, abscess and pneumonias as well as many musculoskeletal injuries.
I had been told that Egyptians were very hospitable and had a good sense of humour. I found these to be both true. I was very well looked after and the daily work was carried out to the sound of laughter as the team members teased each other and “took the mickey” one another constantly. The clients also could have a good sense of humour (“Welcome to Alaska Doctor!”).
Fridays is the Islamic day of rest, and the clinic was emergencies only. I was encouraged to go out and explore Luxor and on the first Friday took a guided tour of the Valley of the Kings and got to meet Tutankhamun (who did not look too bad considering he is 3000 years old). On the second Friday I planned to visit the sites in central Luxor, but Dr Ashraf, a local vet asked me if I would like to assist him in castrating a colt for one of the west bank riding schools – not a common surgery in Egypt as most the male horses were left entire. I agreed and we travelled over to the west bank to find our patient (a good looking 3-year-old colt) in manager-lined, concrete-floored shed in the back streets of west Luxor. The shed was also our operating theatre, so we swept the horse droppings to one corner, induced field (shed) anaesthesia, and quickly carried out our surgery. The riding school grooms then sat on our patient until he was recovered enough to stand. All went well and the patient recovered quickly and smoothly. Inevitably the riding school found a few more animals for us to look at, and by the time we had finished I had missed my chance to tour the east bank sites. I was not upset – it had been a great experience. How many UK vets can say they travelled to their first patient of the day by taking a ferry across the Nile?
What did I learn from my trip?
• Egyptian horses are tough animals leading tough lives.
• Egyptians are hospitable and humorous.
• The Egyptian equivalent of “while you’re here..” is “one more thing Doctor”.
• Purple spray is universally effective.
• Just because an animal is in terrible condition does not mean that the owner is not trying to look after it.
• Both Egyptian and UK horse owner will insist the lameness is “in the shoulder” – although the Egyptians were sometimes correct.
• Read the labels on drug bottles carefully -they are not always the same strength (or even the same drug) as at home.
• It is surprising how much of a donkey you can patch up with duct tape.
• Never get between an Egyptian horse and his breakfast.
I would like to thank the BEVA trust for organising the trip, all the Egyptian staff at ACE for being so friendly and helpful as well as Helen Collins for looking after me. I would also like to thank my employers at the University of Liverpool for allowing me to go and in particular my colleagues in the Equine Practice for holding the fort whilst I was away.