Buffalo Trypanosomiasis, A One Health Approach

In Indonesia, we traveled to a remote village, Cegog, the most remote village in Java and the buffer village closest to the protected Ujung Kulon National Park. To give some perspective on what it means to be a “buffer village”, the Rhino Protection Unit took a video recording of a large, adult male Javan Rhino just 4 km from where we were staying.

This trip was not originally planned as part of our internship. However, alarming results from a serological analysis done on the water buffalo in Cegog months earlier prompted an emergency response from WWF. The serological analysis was done on the entire 101 water buffalo by WWF veterinarians, Drs. Kurnia, Gita and Zulfiqri. The results yielded a 91% seroprevalence of trypanosomiasis in the herd. This is contradictory to the normal endemic prevalence of around 10% to 20%. Thus, this was an outbreak that required immediate action.

In mid-June, during our first field sampling trial in Sumur buffer village, we received the news. Dr. Nia and Dr. Gita asked me to help with the outbreak by first drafting a one page Emergency Outbreak Response Protocol for Trypanosomiasis in Water Buffalo. This legislation was to be sent to WWF headquarters in the United Kingdom, to grant us funding to address this outbreak and future outbreaks. It also was translated in Bahasa Indonesia to be distributed to government officials for approval to work in Cegog. This was the first time I have been involved with writing legislation, especially in the context of conservation. I thoroughly enjoyed the process and learned immensely from it.

From the literature and having a basic understanding about the bureaucracy behind Javan Rhino conservation, I tailored the document towards the economic benefits of addressing trypanosome outbreaks.  Money talks, when it comes to conservation.  I structured the protocol into four components. First, the treatments proven to be most effective in mitigating parasite loads in water buffalo: Diminazene Aceturate (DA) at 7 mg/kg intramuscular injection to a seropositive animal maximizes efficacy (often curative) and decreases the risk of parasite resistance. Next, I addressed the importance in creating good relationships between veterinarians and farmers. Farmer education of the life cycle, clinical signs, health impact, and economic loss accrued from chronic trypanosomiasis in their herd builds trust and incentive for a long term veterinary care. Additionally, informed farmers allow earlier detection of outbreaks and rapid response. The third component was diagnostic testing. Antibody Detection ELISA on blood samples from every buffalo during a suspected outbreak is the recommended method, with simultaneous trapping of Tabanid flies – the vector of trypanosomiasis – and PCR on fly blood meals for presence of trypanosomes. The fourth component was on prevention. Prevention requires creating a more proactive and structured approach towards dealing with trypanosomiasis. Yearly testing and physical assessment, along with farmer education and subsequent treatment of herds twice a year with effective drugs, are the most cost- and time-effective ways to reduce prevalence of trypanosomiasis. My conclusion reiterated that it is paramount to address these emergencies early and effectively, to not only reduce the economic burden on farmers and the Javan economy, but also to protect one of the most endangered and praised species to Indonesia: the Javan Rhino.

Dr. Nia and Dr. Gita really liked the approach I took towards addressing the outbreak, and distributed the document to be reviewed. Several weeks later, we received word that the request was approved.  We were going to Cegog to address the current outbreak and put what I had written into practice. I was then asked to create an abbreviated physical exam checklist to specifically address trypanosomiasis.

I used the same method we are taught in veterinary school to address a disease process. First, I tailored my history-taking questions towards identifying factors that may indicate the presence of chronic trypanosomiasis.  I asked farmers about the presence of abortion and about any decrease in market value in their herd, specifically regarding decreased weight and meat quality. Another important consideration is the function of the water buffalo outside the context of meat or extra revenue. These water buffalo are the organic machines that till their rice paddies and make work on the paddy much more efficient. This decreases the time it takes to farm and the number of personnel required to work on the farm, which allows other members of the family to work additional jobs or go to school. Chronic trypanosomiasis leads to chronic anemia, consequently causing cachexia (muscle wasting) and lethargy – decreasing the productive lifespan of the buffalo and the overall working interval for each buffalo.  This directly correlates to a less productive farm, and mitigates the listed benefits of owning buffalo.  Buffalo are sold earlier into slaughter, further decreasing the productive value of each buffalo and the number of birthing intervals possible. In order to assess the impact of trypanosomiasis on farm productivity, I tailored my questions towards these consequences.  From just an economic standpoint, it is clear that this disease has a complex net of negative impacts that further perpetuate the socioeconomic problems these remote villages face.

My next step was to customize the physical assessment to specifically look for trypanosomiasis, by looking for key clinical signs and establishing a diagnostic protocol to rule out other disease.  Thankfully, much of the diagnostic rule-outs have been established in this herd. The veterinary work done on this herd earlier in the spring ruled out many of the diseases that look like Trypanosoma evansi, such as hemorrhagic septicemia and anthrax (all diseases that were proposed to be a cause of mortality in the Javan Rhino). Using what I have learned from the physical exam of the cow in veterinary school, I created a checklist of clinical signs to look for the manifestations of chronic trypanosomiasis in water buffalo: TPR, clinical signs of surra (cachexia, lethargy, weakness, recumbency, CNS signs, conjunctivitis, edema, inappetence, dyspnea, diarrhea), and signs of anemia (pale mucous membranes, cold extremities from poor peripheral perfusion, lameness, tachycardia and bounding peripheral pulses).

With the checklist (also translated in Bahasa for Dr. Zulfiqri and Dr. Gita), we conducted physical exams on the entire water buffalo herd in three days. First, with mediation from Dr. Zulfiqri and Dr. Gita, we met with all of the farmers to educate them on the common disease of water buffalo, including trypanosomiasis, hemorrhagic septicemia and anthrax. We reiterated the negative impact these diseases have on their buffalo’s health, and thus the economic benefit of establishing veterinary care for the buffalo. We also brought multivitamin tablets, oral de-wormers and an intramuscular ATP and B-vitamin supplement. To promote good veterinary-farmer relations, it is paramount that our interventions do not end at simply coming to the village, assessing the buffalo, and then leaving. WWF made sure to give the buffalo medicine that would help promote immune system function, RBC and muscle regeneration and de-wormers to combat trypanosomiasis and secondary infection. This would hopefully show the farmers observable improvement in their buffalo which would reflect the benefits of continuing to allow veterinarians to assess the health of their herds in the future. Also, if we find clinical evidence of trypanosomiasis, establishing respect between veterinarian and farmer is critical in allowing WWF to later return and treat directly for trypanosomiasis.

Next, with approval from the farmers, we spent the three days working two hours in the morning and two hours in the afternoon to work with the herd of buffalo (101 individuals). During the day, the buffalo were led into the forest (the national park) to pasture. It is likely that buffalo walk the same paths the Javan Rhinos uses for browsing and foraging, which goes to show the urgency of a trypanosomiasis outbreak in this buffalo herd and the potential implications of disease transmission to the rhinos.

The PE success was variable on the buffalo. The buffalo are only tied by rope to a small piece of bamboo in the ground. There are no squeeze cages. The buffalo were also wild compared to their docile bovine cousins. Quite often, I would have to duck and dodge out of the way of their huge horns. I often had to rodeo with them to get temperatures or access a mucous membrane to look for pallor and CRT.  Overall, I produced about 20 thorough physical exams out of the 101. The rest were observational, relying more on the history, looking for key historical information such as abortion, lethargy and decreased productivity and wholesale value. For some, this may have seemed like a nightmare. But, I loved every second of it – diving out of the way from buffalo, rodeoing them to get any meaningful information.

What did we find from the work we did in Cegog? Results were highly variable between farmers. Some herds were in better condition than others. All herds had very high ectoparasite loads , and consequently had very poor skin condition and hair coat. Most herds had emaciated individuals and evidence of muscle wasting. Most farmer histories included decreased overall whole sale market price, lethargy and decreased productivity. Most herds had evidence of anemia (pallid mucous membranes, poor peripheral perfusion, prolonged CRT). Most animals were mildly dehydrated (5%). There were several herds with abortion storms, as well.

There were some hurdles that limited our ability to maximize the efficiency of our work. The buffalo were difficult to work with, and don’t like veterinarians – especially tall, white, hairy ones with Cornell scrubs. There was variable physical exam data, most being observational. Farmers were inherently wary of outsiders. We were the first foreigners this village had ever met. Dr. Zulfiqri and Dr. Gita were very helpful in mediating my questions on history. However, Dr. Zulfiqri and Dr. Gita seemed to think the farmers may have provided false information on history with regards to the presence of abortions and of illness and poor herd productivity. It is likely the conditions of these animals are far worse than I described.

So, what should we do next? Firstly, a more thorough PE survey must be done on every buffalo. I likely missed many individuals with fever and anemia due to lack of physical exam accessibility. Also, a more thorough diagnostic work-up, such as a CBC/chemistry and QATS, should be conducted on the most clinically sick buffalo. Finally, a more efficient system to developing the clinical history for individual buffalo, such as a number system for each farmer’s buffalo, though ear tattoos.

After I completed the summarized physical exam assessment of what I found in Cegog, I presented my findings to the WWF Ujung Kulon team. I think the information I gathered will be a great foundation and resource for when they return to Cegog for future work. After my presentation, the team discussed what they thought (all in Bahasa). Dr. Nia translated, reiterating that they had liked the way I presented in the context of One Health, especially regarding the economic benefit of establishing a better veterinary-farmer relationship. She told me that the work I did on the original one page emergency response protocol had prompted WWF to organize a group to go once a year to villages like Cegog to establish the treatment, education, diagnostic and prevention protocols I helped create. They also planned to make the missions One Health-focused, by including environmental scientists and human physicians to address public and environmental health problems.

All in all, there is a lot I learned from this experience about the complexity and bureaucracy in addressing conservation issues in Indonesia. I learned a lot about conducting veterinary work in a developing country. I also became more knowledgeable about the vector biology and clinical manifestations of trypanosomiasis in water buffalo. Additionally, regarding veterinary work in a developing country, I concluded that developing good veterinarian-farmer relations is paramount. Establishing preexisting trust is the only way to successfully educate farmers on the human, environmental, and animal health benefits for instituting long term veterinary care for their buffalo. Veterinary care for these buffalo not only enhances the economic gain for these villages, but reduces the risk of zoonosis between human and buffalo and reduces trans-species transmission of disease to the Javan Rhino and Banteng.

By utilizing the tools of One Health, we can address a vast array of conservation issues – from tackling problems locally, such as this example, to addressing national, international and global conservation issues. It is very clear to me now how complex these issues are. Not one person, nor one profession can fix all the complex problems involved in conservation. Confronting human, animal and environmental health requires collaboration between institutions, disciplines, cultures, and countries. I am beyond fortunate to have had this realization at the start of my veterinary career. I cannot wait to see what is in store for our profession and myself in the field of One Health.

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