Stories from the Field
2013 HSVMA-RAVS Clinics in Guatemala

Trip leader David Turoff, DVM is blogging from the field about his experience in Guatemala during the 2013 HSVMA-RAVS clinics.

Be sure to check back for updates and photos!

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Friday, June 21, 2013
Cidabenque, Peten, Guatemala

We arrived last night in Flores, the departmental capital of Peten -- the northern-most department of Guatemala, after about 24 hours of continuous travel, and what we have come to regard as the normal array of customs challenges and logistical impediments. This is the 13th year that we have been working in Guatemala, and of the three countries in which HSVMA-RAVS has programs (the others being Nicaragua and Peru), this is the one where we have had the least success obtaining import permits for the medications, supplies, and equipment we need to work. As a result, the passage through Customs is always a bit of a stressful event. Without import permits, confiscation of all of our supplies is a real possibility, but once we were able to talk our way through we were able to relax.

After a night in the hotel in Flores, we proceeded by van provided by our long-time local contact, Amilcar Paz de Lopez, to the town of Cidabenque on the Rio Mopan, which roughly marks the border with Belize. There, we unpacked inventory we stored here and organized for our first work day tomorrow in the neighboring town of Cruzadero, about 5 kilometers away.

We did see one clinical case today -- a horse belonging to Miguel Recinos, the owner of the private family home in which we stayed. The gelding sustained a wire cut to the lower leg five days ago, resulting in an infected tendon sheath and 4/5 lameness. He was treated with regional limb perfusion, wound irrigation, tetanus prophylaxis, systemic antibiotics, and anti-inflammatory medication. We will continue to treat him daily throughout the week.

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Saturday, June 22, 2013
Cruzadero, Peten, Guatemala

Today was our first work day of the campaign, and the case load was much reduced from previous years, perhaps partly due to how often we have been here, but mostly due to the torrential rains throughout the day. At times it rained so hard that the surgeon could barely see the incision during castration, but everything went well. All told, we treated 23 horses including five castrations and a severe corneal ulcer. A low caseload is actually a benefit on a first day, as it gives all of our team members a chance to get to know each other and coordinate our work styles.

Our team this year consists of myself (Dr. David Turoff), Drs. Raul Casas and Shelley Lenz (both long-time recurrent participants), Dr. Alejandra Cosenza, a veterinarian from Guatemala City who we hope will become a permanent part of this program, a farrier, and three veterinary students. Chris Hadel, our farrier sponsored by Humane Society International is on his second international trip after joining us in Nicaragua last January. Randy Gomez is a Guatemalan veterinary student in the first year of his studies. Krissy Netherwood is a senior veterinary student from UC Davis, and Lise Aanestad is a Norwegian student in her final year of study in Budapest.

We function well as a team, and look forward to our day in Nuevo Modelo tomorrow. Thankfully, rain is not predicted in the forecast.

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Sunday, June 23, 2013
Nuevo Modelo, Peten, Guatemala

Nuevo Modelo is an interesting place. It’s right on the Rio Mopan at the end of the road, and the second-most remote place we will visit this year. It is a largely indigenous (Mayan) village of about 400 people, many of whom speak neither Spanish nor English. We were here for the first time last year and had an extremely busy day. This year was fairly busy as well with 47 horses seen, including five castrations under general anesthesia and one standing due to a respiratory problem that made anesthesia more risky.

In addition, there was a severe saddle sore and several wounds to treat, and a couple of chronically lame horses to examine. The case load would have been higher, but the recent rains brought the river up so high that it was impossible to swim the horses that would have come from the other side. But at the end of the day, the river had gone down a bit, so Amilcar and I took a rickety canoe across to vaccinate and deworm 18 horses there, which may have actually been Belize because we were on the east side of the Rio Mopan, but it was hard to tell for sure.

Everything went well with no major complications, and Chris Hadel stayed especially busy training a couple of local young men to trim feet and to use and care for the basic tools which we left them to carry on with. We look forward to returning next year.

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Monday, June 24, 2013
Los Encuentros, Peten Guatemala
Salpet, Peten,Guatemala

Although we had a busy day ahead with two communities to visit, we started by re-treating the horse with the infected tendon sheath belonging to our host, Miguel Recinos. The gelding had a bandage change yesterday after improving dramatically after his initial treatment, so bute was withheld last night to judge his lameness without it, and he is still markedly improved. Regional limb perfusion was repeated, and the infection appears to be responding well.

Our first community, Los Encuentros, is one we have visited many times in the past, and is really just a group of small fincas near a river crossing. We treated ten horses there, including three castrations and several tack-related back lesions.

Our next community, Salpet, is more of a small village with a church, tienda, and school where we usually set up our work site. It typically has the most difficult to handle horses we see in this part of Guatemala, and in the course of a busy afternoon we resorted to side-lining several in order to vaccinate or induce anesthesia. Amilcar vaccinated three horses himself while mounted with another wrangler on the opposite side of the patient, which worked surprisingly well. Chris Hadel stayed busy trimming and instructing three local young men, with whom he left rasps at the end of the day. Thanks to the generous support of HSI, these are the first professional farrier services ever offered in this part of Guatemala.

We treated 33 horses in Salpet, including nine castrations, numerous chronic lameness problems, and four horses all from the same property with accesses at the poll. From one, we were able to drain about 80 cc of flocculent sero-sanguinous fluid.

These are horses living with cattle, and due to the possible etiology of Brucella and the zoonotic potential, we were emphatic about warning the wranglers about taking care to avoid contact with pus during aftercare (i.e., wear gloves, which we dispensed.) I am doubtful that these lesions will resolve fully, and would like to have some way to do follow up prior to next year, but we lack those means currently.

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Tuesday, June 25, 2013
La Polvora, Peten, Guatemala

La Polvora is a tiny community along the main road from Flores to Belize, which we have not visited before. We are here this year at the request of David Hernandez, a trainer in La Polvora who brought his horses to our clinic in Cidabenque last year. His horses were easily the most tractable and well-socialized that we have seen anywhere in this country; in effect, he is the “horse whisperer” of northern Guatemala. He is self-trained in cooperative, rather than coercive, handling techniques, and his methods -- arrived at independently -- are markedly similar to those used by “natural horsemanship” practitioners in the US and Canada. Not surprisingly, even his dog is also the most friendly and well-socialized that I’ve seen here; he’s a nice person and a good guy, with a gentle manner and a terrific sense of humor.

We treated 25 horses there -- which is a pretty good turnout for a first visit to a small community -- including three castrations, a few mild saddle sores, and a foreign body extraction (a piece of wood in the neck of a horse).

Chris Hadel -- displaying creativity and inventiveness even beyond the already impressive baseline of most farriers -- fashioned a makeshift, but nonetheless effective, forge from some cinderblocks, charcoal, and a foot-powered air-mattress pump, and demonstrated back-country hot shaping of shoes for several local kids interested in learning farriery. This is important, because ill-fitting shoes are one of most prevalent conditions plaguing the horse population in the country.

Overall, it was an interesting and rewarding day. When I have a better internet connection, I’ll start a Shutterfly site where pictures from the trip will be posted, including some video of Hernandez and his horses.

We will certainly be returning to this community next year.

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Wednesday, June 26, 2013
El Rondon, Peten, Guatemala

El Rondon is the most remote place we serve on this trip. It’s on the east side of the Rio Mopan by about 10 km, and I’m pretty sure that Belize considers it part of Belize (though the people who live there un-ambivalently consider themselves to be Guatemalan). Last year, the river was so high we almost didn’t get here (and then almost didn’t get back); this year was easier.

Very few people here have vehicles, and the default means of human and cargo transportation is the horse. The ground is tilled by oxen pulling plows, and the harvest is by hand (by “puro machete”, in local parlance.) It’s not the sort of place where you might expect to be able readily to change people’s opinions about things, but sometimes one can be surprised.

Euthanasia is frequently indicated in this part of the world (by North American standards anyway), but rarely permitted due to very strong local beliefs that only God should take a life. From the outside perspective, this leads to a lot of unnecessary suffering in horses with terminal or untreatable problems. Today we were presented with a mare with a four month old foal at side, a body condition score of 1, and a severely contracted flexor tendon of the right fore, with trauma from weight bearing on the dorsal aspect of the fetlock. No extension of the fetlock was possible, and anything resembling normal locomotion was impossible for her.

We approached the owner with some apprehension about euthanizing the mare because, historically, we have had almost zero success persuading owners with horses this severely compromised to allow euthanasia. He listened carefully to the prognosis, talked it over at length with his young children, and agreed to have the suffering of the mare ended.

Euthanasia methods are also something of a conundrum here. Chemical euthanasia with barbiturates, as practiced conventionally in North America, is out of the question because effective carcass disposal is impossible and scavenging dogs and buzzards would be poisoned. Three methods of euthanasia are acceptable and available. Gunshot is fast, easy, and effective, but ugly, especially in a country with a recent 36 year history of violent civil war. Anesthesia followed by IV administration of Mg sulfate (Epsom salt) works well, but we had no Epsom salt. The third method involves deep anesthesia followed by trans-rectal laceration of the aorta to cause intra-abdominal exsanguination, and this is what we did in this case.

The rest of the day was busy and productive, with 40 patients, nine castrations, five dental cases (including a 12 year old horse with a sagittal fracture of 211, successfully extracted), several severe saddle sores, and many hoof trims performed and two local guys trained to do basic trims by farrier Chris Hadel.

Border disputes permitting, we will certainly return next year to this very deserving and interesting community.