I have just returned from a stimulating fortnight at Akagera National park, Rwanda, where I ran a One Health workshop, held under a professional training initiative which the Royal Veterinary College (RVC) has been responsible for implementing in Africa through the African Union IBAR on behalf of RESPOND, as part of the global Emerging Pandemic Threats programme of the USAID.
Twenty four senior public health staff, livestock veterinarians and wildlife health researchers from 10 African countries participated in the training, learning about One Health – an integrated approach to health and disease, highlighting inextricable links between human and animal health and the health of the ecosystems they inhabit.
This was a very different workshop! It moved away from the conventional model of static lectures for a few days, political hand-clapping and turgid recommendations squeezed out of a bored and reluctant audience, to a more dynamic event. We mixed a few lectures into a lot of debate and group discussion, problem-based learning activities, with alternate days of intensive field practicals. The field days varied from looking at ecosystem health issues to small group dialogue with the very poor and stressed communities, individuals, male and female, young and old, farmers, pastoralists, shopkeepers, mostly recently settled refugees after the genocide. The workshop continued without a pause for 10 days. We were all exhausted, although it seemed short.
The health issues identified during the workshop were acute and fascinating, both with respect to animal and human health, ranging from elephantiasis, to acute undiagnosed arthritis (Borreliosis?), HIV,TB, rabies, trypanosomosis, malaria and fevers of unknown origin (only 3% of “malaria” cases were confirmed as such in one busy clinic that we visited).
The communities we visited are embedded in a rapidly changing environment, given scarce small land parcels, carved out of a 70% degazetted National Park, with still intense interfaces with livestock and wildlife, and with seasonal water and food deficiencies. It is a hard existence, but even amongst this chaos some farmers were showing remarkable skill at conservation agriculture techniques and considerable resilience in the face of challenging health and disease threats. They were less concerned about their personal ailments than the issues of rainfall, soil erosion, crop failures and wildlife conflict issues which all have a direct impact at the community level and on their nutrition. One Health to these people is about ecosystems and their services first and then human and animal health second.
The workshop participants were given a real taste of what One Health means and they were exposed to the changing ecology from within the National Park boundaries, learning about bulk grazers to decomposers, scavengers and lichens – neither plant nor animal, to the agro-ecological human landscapes with all the threats this is presenting to biodiversity loss, water cycles and quality, soil nutrition, disease emergence and ecological instability.
The main outcome of the training was strong advocacy for a One Health approach, taking into account the ecosystem, humans, domestic animals (especially livestock) and wildlife, undertaken in a comprehensive manner and through action at all levels. One Health is crucial to disease surveillance, outbreak investigation, disease control and prevention measures at the intersection of human and animal health.
As one of the participants commented during the workshop, “ We have to find a way to make this One Health work. We owe it to our people, our animals and our environment, after taking it all for granted for so many centuries!” This is easier said than done, as human health systems are better developed than other systems in most countries, followed by livestock and finally wildlife, which is often neglected.
There is a need to “sell” a One Health approach at all levels. The ideal would be to have a permanent One Health structure established at the highest levels globally and nationally, but also at a community level. The challenge with the current One Health approach is that we are still not thinking from an ecological perspective. At the global level, WHO/ OIE and FAO are challenged to agree on a definition of One Health. The UN hopes to create a policy on One Health, but this is still work in progress. Then there are the multiple challenges of implementing One Health approaches in traditional communities, in ways that respect local knowledge, but also address prevalent misconceptions about health and disease.
The path towards One Health is rocky, but the workshop in Rwanda has brought it home to the participants and to myself that it is worth the effort – a robust One Health approach can support sustainable development and the well-being of communities in Rwanda and beyond.
Contributed by Richard Kock, Professor of Wildlife Health and Emerging Diseases at the Royal Veterinary College