Reflections

i left Todos Santos this morning at 4:15 am on a mini-bus. i thought i was lucky to avoid the chicken bus down the mountain...my legs certainly had a bit more room, but the Guatemalans are over achievers when it comes to winning the 'how many people can you fit into a vehicle' game, and we had 18 other people in the van with me...i am glad i don't have personal space issues.

i have left Todos Santos with still one day of sterilizing and 2-3 days of spays to go. unfortunately i must get back to work in ontario and Dr. Enid Stiles arrived on Saturday to tag team me off. it is with mixed feelings that i leave Guatemala. i will be glad to get back to some comforts of home but will miss the friendly smiles of the community and the dogs and the spirit of the project. and of course the team.

the time i was there went pretty well. we saw many dogs we had seen in january and were able to continue our sterilization campaign on new dogs. we were also able to double the number of spays we had done in january...and the team still has a few more surgery days ahead of them. these days are difficult, stressful days as we are operating under exceptionally foreign conditions. the dogs ooze more, they are underweight and not always what we consider ideal surgical candidates. plus it is cold. with our successes always come complications from which we learn and continue to improve our protocols and procedures. some day it will be old hat.

as i left todos santos this morning i saw an incredible orange moon hanging in the valley. it was huge...what we call a harvest moon back home. i wondered when i would back to this village. and when i did return would the dogs i know still be alive. i know we have done some great work in todos santos...and funds willing, will continue to do so. this is not a short term project. but it is a project that is desired by the community. the peace corps volunteer told us last night at dinner that she appreciated the work that we are doing and is thankful that she can walk out in her town now without getting bit or attacked by dogs. can you imagine what it would be like to live with that fear day after day??

so now i sit in antigua. i have had a hot shower and am going to find something other than rice and beans and potatoes and tortillas to eat for dinner. a big plate of vegetables would be amazing. now that i have good lighting in my new room, i see that i have hundreds of bed bug bites along my entire mid-drift. thankfully they are not too itchy...yet. while tonight i will be very comfortable, i will be thinking of my team and sending good wishes their way for a successful remainder of the week. i will be wishing i was back with them in todos santos. i will also be wishing for the continued improvement in Terry's health and for the speedy recoveries for our surgical patients. but i don't think i'll be wishing for tortillas.....

Buenos noches.

Terry

The dogs were quiet last night. Most nights we are serenaded through the night with dog packs barking and howling, and chronologically-challenged roosters crowing all night long. Yesterday was our 5th day in Todos Santos and our first cold rainy misty day here. People were staying inside and it seems even the dogs were staying close to home. We all had our best night´s sleep.

We´re starting to gel as a team and getting a routine down. Every morning we meet at 6:30 AM and carry the supplies and equipment to whichever Todos Santos community we are in that day. We are a strange sight as we walk through the streets carrying big green supply cases, duffel bags and 3 tables - though not as strange as the 1st day we arrived on the ´chicken bus´from Huehuetenango and carried all our packs and luggage up what seemed like a steep goat trail up the mountain to Las Ruinas where we are staying.

We´re doing the canine chemical sterilizations this 1st week as well as the rabies vaccines and flea treatments. If there are any complications from the sterilization, they usually occur in 72 hours so we want to be finished our last one while we are still here to monitor and treat patients. So far no serious complications.

If patients come in sick we treat as best we can with our limited supplies. While doing a housecall on a post-procedure patient, Kate saw a Rottweiler lying by the roadside and looking very weak and emaciated. Terry (many of the dogs here have english names like Doggy, Smoky, Scooby etc) the Rottweiler had been sick and not eating well for awhile and eating nothing for the last 3 days. He turned out to have a severe infection of his prepuce, probably from getting bitten by another dog, and was getting septic and was in quite a bit of pain. He was treated with subQ fluids and antibiotics and pain control and the following day, Roberto (one of the team and a Spanish-speaker) and Andres (our English-Mam-Spanish translator) carried Terry to the community we were working in that day and we kept Terry there all day to treat him with IV fluids, IV antibiotics and more pain control. We kept him warm and dry and later in the morning the little boy from the family came with 2 buddies and his grandfather to visit the dog and to try and get him to eat. Terry wouldn´t eat for us but when the little boy offered him cookies, Terry gobbled them down. The little boy stayed there most of the day feeding him when Terry wasn´t sleeping and by the end of the day, Terry´s vital signs had improved and he was looking better.

Roberto and Andres carried Terry home at the end of the day yesterday and the family set him up in a confined area sheltered by a tin roof. They built a good fire beside him to keep him warm and covered him with a blanket. We asked them to feed him some good soup and meat (most dogs here are fed tortillas and bones and whatever they can scavenge).

Late last night before climbing back up to Las Ruinas and bed, we checked on Terry and found him looking brighter, eating and drinking well. We left the family 2 hot water bottles and said we would be back in the morning.

This morning we went back to check on Terry before our clinic started at 7 AM. He was standing in the area by the fire and the owner told us he was walking around a little. He was eating well and they had been feeding him sopa de pollo (chicken soup). The hot water bottles we had left them were warm and obviously recently refilled to keep him warm. We checked him out and things were looking much better. Gave him his morning antibiotics and told them we would be back at the end of the day and would visit twice and day until he was OK again.

This afternoon we´ll continue with the male sterilizations, rabies vaccines and parasite control. This weekend we start spaying the female dogs that we´ve vaccinated this week and whose owners wish them spayed. We continue through next week until Friday. Rabies control is really important here as all the dogs run loose and there is quite a bit of fighting.

At the end of the day we´ll head back up to Las Ruinas. I´ll keep my eye out for Domingo Mendoza Ramirez. He is about 70 or 80 years old and every day I see him working hard in his fields, building a fence out of maize stalks, to keep animals out of his fields. We chat: he asks me where I´m going and how I am. After we chat he always says:
Nos vemos mañana. We´ll see you tomorrow.

It´s been an incredible experience here in Todos Santos so far. A combination of old-time James Herriott type medicine with the housecalls and limited supplies and more modern medicine with the prophylactic sterilizations and vaccinations we are doing.

Nos vemos mañana.

Fortunato

Today was a really slow day, this would be why I had time to write this blog!

These clinics in Todos Santos would not be possible without the help of some comunity leaders. Most of them help me in many ways like getting apropriate rooms, a truck for transporting supplies from community to community and some time being present all day to ensure all goes well. Today for exemple I was happy to have Fortunato help. Fortunato is very well known and respected in Todos Santos.

A dog owner came to have her dog sterilised but was afraid that it was a sin to do it! It is against nature and God would not want her to do it. Fortunato had a chat with her in Mam of course. And the lady felt much better with her decision.

Mam is the mayan dialect spoken in Todos Santos (theres 21 mayan dialect in Guatemala). It is a very hard language to learn! I have been trying to learn it for 2 years now....the only problem is that I dont have anybody to practise with when I go back home!

Well.....I hope tomorrow will be sunny because recovery is always a chalenge on rainy, cold days like today, and we start our spays on Saturday......

Got to go back now....Ton teka at nim xyan tuj tnom Todos Santos.

Cold and Rainy

Today our friend the sun disappeared. It is drizzly and chilly. The team is doing well, although yesterday we did have two of our techs out with various gi related manifestations. Not a nice place to be when you are sick. Thankfully they are feeling better today and are back in action.

Our clinic today is in the Salon de El Centro...which is just the community centre in the centre of town. It is a big gym, with open windows at the ceiling. It is cold and we can see our breath: plus it is raining into the building through the windows that run along the sides of the building. It is a challenge to keep the dogs that are sedated warm. We have a butane burner which we use to boil water for hot water bottles and two space heaters.....but only one functioning power outlet which is located along one of the sides walls where the rain is coming through the windows. Good times.

Today our clinic is slow. Basically there are very few dogs coming to see us. We have had a good turn-out at the other 3 days so I am not sure why today is different. Perhaps our signage is not as good, perhaps the community leader for el centro has not encouraged his members to attend..or perhaps it is just the rain. Marjo, our head technician who has been to Todos Santos many times, went to the radio station this morning and made another radio announcement to remind people. This is the third radio announcement regarding our clinics. We will see how the rest of the day goes.

Our days this time around have been much lighter than our January trip. The main reason is that we are seeing a number of dogs that we sterilized in January so they only need deworming and rabies vaccination. This is a good reason for things to be a bit lighter.

We have hospitalized our first patient. Terry is a Rottweiler we sterilized in January: It was a big deal to sterilize him because he is a purebred and the people that have purebreds here want to preserve the ´good genes´. I was going to do some houe calls yesterday and walked past his house. He was standing there emaciated, drooling and looking exceptionally uncomfortable. He looked awful and was definitely not the big burly dog we sterilized in January. I had Andres our local translator find the owner and find out what was going on with Terry. The owner said he hadnt been well since we sterilized him in January´: Ok - so that was 11 months ago! On further questioning it turns out he was ok after the sterilization and then got hit by a car a number of months later...and had had a poor appetite for the past 3 months. And had not eaten anything for 3 days. This dog looked like he wanted to die. On physical exam I found what looked like old bite wounds on the cranial aspect of his prepuce and pus was just dripping out. His prepuce was huge and the cellulitis and swelling extended into his groin. The testicles felt absolutely normal and were non painful. He was lame and having difficulty chewing...I think he was septic. I am pretty sure this dog´s current problems are not related to his sterilization in January. Too long a time lapse and it looks like he has multiple bite wounds on his prepuce and his leg. The owner had had the local veterinary supply guy, Pauncho, come out and look at the dog. pauncho had given him an injection that very morning: Who knows what it was. Pauncho is also the guy who does dog castrations in town....but it doesn´t hurt the dogs because he ties their muzzle with binder twine and uses antibiotics. And I assume he does it like you would a piglet. Poor dogs. We have tried to explain about the pain to him, but it doesn´t seem to be flying just yet. I think because Terry¨s owner associated his recent illness with the January sterilization he didnt want to bring the dog to us....and it took quite a while to get him to warm up to us treating Terry: But we started with SQ fluids, IV antibiotics and pain meds yesterday, and today he let us bring the dog to the clinic where we got a catheter in and he is now on IV fluids and IV antibiotics: we have flushed the abcess and are keeping him warm and comfortable. Today he seems better although getting him to eat is a challenge. But we will do what we can and will hope that over the next week we can improve his situation. The client is much more open to us helping him out and has done a big turn around. Baby steps.

Off to the farmacia to see what I can find for poor Terry! Buenos dias.

Heavy Into Rice and Beans

Here we are in the second day of our clinics. So far so good. As in January, we have the good fortune of having an excellent team. Great technical skills, a laid-back approach to being in a foreign land and a good sense of humour. Oh- and of course the ability to eat rice and beans and various carbohydrates without complaint...and not too much gi upset as yet...although to be honest we do have one team member who now considers Immodium a very good friend. But of course, we have only been here a few days, and do have a number to go....we´ll see how everyone is next week.

I arrived here on sunday, a day later than the rest of the team. My flight was uneventful and I somehow managed to get all my supplies and anesthetic drugs here without any complaint from anyone at any borders or the airlines. And I was only a little bit concerned with my Esterisol getting broken as it got tossed on top of the chicken bus for the 2 hour bumpy ride into Todos Santos. The term ´bumpy´is abit of an understatement...it is more like a 2 hour kidney bruising, nauseating carnival ride in an old school bus that was not made for the giants of Canada. My knees were bruised and locked by the time I got to TS.

The team seemed to adjust to life in Todos Santos very quickly and had taken Sunday to not only get the surgical packs and supplies in order, but to take some time to hike up the mountain a bit. The rugged, hilly terrain is challenging to function in...it is sort of like being on a stepper all the time. A fantastic crash course in getting in shape quickly. The first few days are always hard here...but usually by day 3 or 4 it is easier to breath and the hills don´t seem so bad.

This is my third time here in Todos Santos. It is always nice to come back here. The people are so friendly and they always remember us. It is also great to see dogs who we have become attached to still alive and doing well. I love seeing Nosey come running up to us as if we are long lost family members. In reality I am sure she just sees us as tourists with tortillas in our pockets! And my other good friend Betty who I came to know last May: how do these dogs survive here??

Yesterday our clinic was in Los Pablos, today it is in Che Cruz. We have seen about 40 dogs so far today and I think we saw about 55 yesterday. We are vaccinating and chemically sterilizing male dogs at the moment and are booking spay appointments for the weekend. We have seen many of the dogs we castrated last year. They seem to be doing well and it is great to see the pride in the people when they bring in their dog with their vaccine certificate from January and we tell them they are doing a great job.

well - i will sign off for now. Have to go to the farmacia to see what meds I can get for a dog and then back to the clinic. Beunos tardes.