No es suficiente

by Ahne Simonsen, DVM

September 20, 2013

HSVMA-RAVS volunteer veterinarians, Drs. Kim Thabault and Sarah Gomez-Ibanez, with a Nicaraguan client and his horse, Blanco, after his enucleation.
Ahne Simonsen, DVM/HSVMA

¿Cuánto cuesta un café en Boulder?

The question came from a Nicaraguan gentleman, whose arm was draped gently over the withers of an old white gelding. Although his tone was conversational, I could tell more than mere intellectual curiosity was driving his query. My initial thought was “probably too much” but as my mind was racing to piece together my response in broken Spanish, I let my eyes sweep over the panoramic view in El Boté, one of the most remote areas of Nicaragua.

I was standing in a clearing the size of a football field. The field was empty when we arrived in the pre-dawn hours of this morning. Our two four-wheel drive trucks, crammed with team members and supplies, had powered through the thick mud from the previous day’s rain—mud that now made our clinic conditions slick and potentially dangerous. Other team members had walked from town in order to collect buckets of water from the river for use in the clinic. Using a tarp, the lone soccer goal and our vehicles as posts, some of us strung up a makeshift tent to protect our gear. Others turned the truck beds into dental stations. Then, as if on cue, the morning light was upon us and horses began to appear, trotting out of the Nicaraguan rain forest and into our clinic clearing.

A Long Journey to Care

Many of our clients had ridden for hours, or even days, “ponying” a large number of horses, mules, and donkeys with them through the thick vegetation. Most of our clients were men or boys with an age range from surprisingly young to amazingly elderly. This year, patient numbers climbed into the hundreds each day, yet clients rested, joked, and laughed, enjoying each other’s company while they waited patiently for the opportunity to receive veterinary services for their working equines.

Dr. David Turoff, true to his word, has returned to that very same field on the same day of every year since 2007, armed with medical equipment, supplies, and a team of dedicated veterinary professionals and eager veterinary students. Most years, the clearing fills quickly and the team is busy providing tetanus and rabies vaccinations, cleaning bat bite wounds, repairing and educating on bridle and saddle sores, anesthetizing and castrating stallions, floating teeth with a Dremel and hand tools, trimming overgrown hooves, de-worming, battling ticks, surgically removing sarcoids that are limiting tack placement, and discussing work horse nutrition and husbandry, until dusk turns to dark. A few of these years, the field has been quieter on that first day. The “regular” background noise of whinnies, nickers, brays, squeals and hee-haws mixed with the sound of hooves kicking at flies and male dogs squabbling over female dogs is absent. These are the years when the coffee harvest is running later than usual and Dr. Turoff’s patients are still hard at work in the mountains. These are the years when responsibility must trump opportunity. In an area where opportunities are scarce, this means many working horses will go without veterinary care for the year.

The majority of the equids receiving services at the HSVMA-Rural Area Veterinary Services (RAVS) Nicaragua clinics are working horses, donkeys, and mules. In Spanish, they are referred to as “beastias” or “beasts of burden” and the name is unfortunately appropriate. They live a different lifestyle than show or companion horses, sharing the hardships of rural or urban community life with their caretakers. Without working equids, most community members would not have access to transportation or life’s basic essentials. Daily, they haul food, water, and materials for warmth and provide transportation to schools, work, and socialization.

Creating Sustainable Community Veterinary Care

The HSVMA-RAVS team on a break during the day-long drive to El Boté.
Ahne Simonsen, DVM/HSVMA

Two years in a row, I was fortunate enough to be a part of the RAVS equine team in Nicaragua: A core group of Nicaraguan and American volunteer veterinary professionals dedicated to field work and passionate about mentoring veterinary students from both countries in the challenges of field work and community sustainability. The team only works with supplies that can be accessed in country so the mentorship that Nicaraguan veterinary students receive during the clinics can be focused on addressing relevant challenges they will face as veterinarians in their own communities.

At each location I visited, the importance of creating sustainable community veterinary care was glaringly obvious. I saw the need in each set of prominent withers and buttocks, in each baseball-sized saddle sore, and in all the overgrown hooves and under-run heels. I also saw the need in each caretaker’s work-weary eyes as they listened intently while a Nicaraguan veterinarian educated them on nutrition, tack fitting, and hoof care.

The reality of the scenario is quite bleak. A global mismatch exists. More than half the world’s population is thought to be dependent on horses for their livelihood. There are approximately 100 million working equids worldwide. The majority of the world’s working horses live outside of the United States and Europe. The majority of the world’s equine veterinarians call the United States or Europe home. As a result, 1% of the equine veterinarians in the world are trying to treat 90% of the world’s equids; an impossible task and a recipe for daily suffering. Whether I am waking up from my bed in Boulder, Colo. or my camping mat and sleeping bag while working a RAVS small animal clinic on a Native Nation, not a morning passes without me thinking about that Nicaraguan gentleman and his old white gelding, “Blanco.”

We enucleated the gelding’s left eye, which had been damaged riding home through the rain forest shortly after last year’s coffee harvest. Blanco recovered from his anesthesia quite nicely, his caretaker never leaving his side. Since the gentleman had ridden two days to get to the clinic in hopes that we could help his work companion and friend, and it was now the darkest dark I had ever witnessed, he agreed to find a place to rest for the night in town even though he did not know a soul in the community.

Before he headed to town, the gentleman thanked us profusely for helping his companion. We complimented him on his gelding’s good manners and sweet demeanor. Then I shook his hand and thanked him for each cup of coffee I have and will enjoy, knowing that my answer to his question about the cost of that simple luxury is no es suficiente or clearly, “not enough.”