Arrived back in Guatemala for Phase 5 of Veterinarians Without Borders - Canada's project in Todos Santos, Guatemala. The project has been expanded greatly this year with 18 team members. We've seen some changes over the past 2 years. This project originally began with a focus on chemical sterilization of the male dogs and immunization against Rabies. The chemical sterilization provided a way to quickly sterilize a large number of dogs, with the added, cultural benefit that it didn't involve surgery nor removal of the testicles. The main downside of the Esterisol procedures was that if the injections were done exactly right, they could result in severe necrosis of the testicles. This occurred, according to the literature, within 5 days of the injection and so the initial 3 clinics (2 in 2009 and 1 in 2010) were geared to doing the male sterilizations the 1st week and then doing female surgical spays (+/- vaccinations) the second week so that the VWB-VSF team was still available in case corrective surgery was required.
2012
Last March, in 2012, we brought a small team to Todos Santos and did only surgical sterilizations (male and female). The change from the chemical sterilizations of the males was because there had been a severe delayed complication with the chemical in Chile and we didn't want to risk it, nor we're we able to be there long enough to treat any delayed complications. The team last year was composed of:
Elena Garde and Guillermo Perez from Chile, Program Directors for VSF in Latin America;
and then 6 veterinarians from Guatemala:
Dra Andrea Portillo, Dra Blanca Romillo (with Dra. Contreras)
and 3 final year veterinary students: Sharon, Gaby and Lorna.
We did a mixture of vaccinations & surgeries, trading off the various areas. Dra Andrea Portillo has done a lot of work with the McKee project and taught at the veterinary college. Dra Romillo also taught at the veterinary college and Dra Contreras has helped with the project since 2009. The week went well and it was reassuring to know we could do a fully surgical clinic and that the owners were willing to have their males surgically sterilized rather than chemically as we had done during previous clinics.
This year we are planning to do up to 300 rabies vaccinations and physical exams in 5 days as well as 60 to 70 surgical sterilizations (spays and neuters). The challenge for veterinarians coming from North America is that we have to do our surgeries in very different, and riskier-for-the-patient, conditions. We have no access to oxygen or gas anaesthetics. Our anaesthetics are all only by injectable drugs and not the drugs we are used to. In Canada we usually give our patients a narcotic and a sedative before the full anaesthetic, and then we induce (completely anaesthetize to unconsciousness) our patients with anaesthetics drugs and we continue the anaesthetic (maintain the anaesthesia) using gas anaesthetics usually. In Guatemala, most of our drugs are unavailable and so, not only are we not using oxygen support and gas anaesthesia, but we are using new drugs. Last year we used drug called Zoletil that is not available in Canada (though it is available under the name Telazol in the USA). Our only narcotic in Guatemala is injectable Tramadol which is a fairly mild narcotic. We have access to Ketamine which we also use frequent,y in Canada but we usually combine it with midazolam or diazepam. Midazolam is not available in Guatemala and diazepam is available to veterinarians only in very small amounts. The Zoletil mixture worked very well last year and we were excited that we have a good protocol for our surgeries, using only drugs available to veterinarians in Guatemala. Unfortunately this year Zoletil has not been available for many months and so we will have to use drugs that tend to be more problematical to use safely and to monitor. It's also hard to find information in North America about one of the drugs, Xylazine as there are newer drugs of this same class that are safer and work better so there is not a good reason to use it much in Canada. We received the dosing regimen that some of the vets in Guatemala are using and they got the regimen from vets in Panama. The doses of the two main drugs are much higher than we use in Canada. We'll be starting out slowly and seeing the effects then increasing as needed.
I'm very excited to meet up with Elena and Guillermo when they fly in tonight from Chile. We'll all drive up together tomorrow along with an American from a veterinary clinic and foundation in the USA. Today Stacey and I had to do some shopping for supplies. We took a taxi from the B&B to a couple of shopping centres to try and get some of the supplies we needed. We were also trying to get a Internet stick working for Stacey's MacBook. We weren't able to get it working last year and the 1st stick we tried at the airport wouldn't work. We went to a TIGO store at the Cemaco mall and bought a stick but the vendor didn't know how to make it work. He recommended we go to a larger TIGO store at Oakland Mall which we did. Sort of an upper end mall (Steve Madden, L'Occitane etc) and a very helpful TIGO client service centre. The woman said Macs required a driver to work with the stick and downloaded it for Stacey. After 20 minutes we tried the laptop and Stacey had internet access - very exciting. Success at last.
We will have a big team this year.
A new clinic, Allandale Veterinary Hospital, has joined us from Barrie Ontario and they are bringing 5 team members down as well as another technician from Barrie. We also have a 4th year veterinary student from UPEI, a woman from Edmonton, myself and a technician from Victoria, a woman from a veterinary foundation in the USA and 3 veterinarians from Guatemala. We've been very lucky in past years with our teams, which have varied year to year. Everyone has worked together well and made a contribution. The conditions are challenging, especially having to do surgery without the equipment, supplies and anaesthetic protocols we are used to using. I'm looking forward to meeting everyone this year and seeing how things go.
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