Patients Without Borders: Using Telehealth to Provide an International Experience in Veterinary Global Health for Veterinary Students.

There is an increasing need to produce veterinarians with knowledge and critical thinking skills that will allow them to participate in veterinary global health equity delivery, particularly in the developing world, where many people remain dependent on animal-based agriculture for a living. This need for veterinarians trained in global health is reflected by the demand among students for greater exposure and education. At the same time, many students are held back from on-site training in global health due to constraints of cost, time, or family obligations. The purpose of this article is to describe the use of a telemedicine approach to educating veterinary students at Tufts Cummings School of Veterinary Medicine. This approach simultaneously provides expert consultation and support for a pro bono hospital in the developing world. The development of a telemedicine teaching service is discussed, from initial ad hoc email consultation among friends and associates to a more formal use of store-and-forward delivery of data along with real-time videoconferencing on a regular basis, termed tele-rounds. The practicalities of data delivery and exchange and best use of available bandwidth are also discussed, as this very mundane information is critical to efficient and useful tele-rounds. Students are able to participate in discussion of cases that they would never see in their usual clinical sphere and to become familiar with diagnostic and treatment approaches to these cases. By having the patient "virtually" brought to us, tele-rounds also decrease the usual carbon footprint of global health delivery.

The role and importance of farriery in equine veterinary practice.

There is a lot of room for us to become the central source of medical information regarding shoeing and lameness in our own practice area. This takes a good bit of effort and a real "outreach" to client and farrier. It can be done with the one tool we are best at--the acquisition and careful dispensing of information that we can put together regarding the health of the foot. Such information includes the following: 1. Radiographically guided hoof trimming and shoeing. 2. Ultrasonography. 3. Digital radiography. 4. Thermography. 5. Nutritional and health counseling. Become the "local" expert in hoof health and farrier science. Publish a newsletter on the subject, and speak to small groups clients. Participate in farrier education at both the national and local level. Attend and/or speak at farrier symposiums. Do not be intimidated by the Internet. We have more "gurus" than they do. Tap into the stream of educational materials available, such as journals, videotapes, and colleague recommendations. Realize that you do not have to convince a national audience of your knowledge; the one client in front of you at the time is plenty. Take time to talk to farriers; discuss your ideas based on fact or clinical experience rather than dictating your thoughts, and do not lecture them unless you have a tray full of slides. Give them a goal rather than a prescription engraved on a stone tablet (ie, "we'd like to see this horse grow a little more heel"). Let them "choose" how to accomplish your goal. It is a good idea to be respectful in all discussions with people who carry hammers and bend iron for a living. All of us need to realize that there are probably more horses in the world today that spend their entire working lives unshod and without the benefit of our combined expertise. There is little doubt that they would be better off with our help in many instances, but the fact remains that many lead long productive lives unshod. This fact can lead to some confusion among many clients who suddenly ask for a "'mustang" trim or others who advocate a return to "natural" trims, not ever realizing that we have changed all the natural patterns of their horses' lives and physiology by introducing confinement, artificial bedding, weight bearing, and artificial diets, altering hoof growth in the process. Shoeing, hoof care, and hoof repair become necessary in many situations of domestication. We need to be skilled in assessing the appropriateness and quality of the shoes and technology used and thus help in the adaptation to demands placed on our equine patients. Conversely, we can use the principles of the natural trim and apply them to the foot as shown in Figs. 1 and 2 (Fig. 6). One must be aware of the latest in shoeing "fads" and realize that although certain shoes are suddenly popular because they solve one type of lameness, they are not always a substitute for tried and true methods (Fig. 7). Become familiar with the options, and work within the confines of your knowledge and with the assistance of a competent farrier.