Stories from the Field
2013 HSVMA-RAVS Annual Trip to Nicaragua

We are happy to have Dr. David Turoff sharing stories from HSVMA's Rural Area Veterinary Services 2013 clinics in Nicaragua. Photos will be posted at a later date.

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January 17, 2013

After the usual and more-or-less expected issues of delayed flights, lost luggage, difficulties clearing customs and out-of-service ferries, we arrived last night on Ometepe Island in good order, and ready to begin work. The hourglass shaped island is formed by two volcanoes rising from Lake Nicaragua. It is the largest island in the lake, as well as the largest volcanic island inside a fresh water lake in the world. The community we will visit today, La Concha, is new to us, and was arranged by Muriel Gomez, who has been a local contact and has been providing us with transportation services in his van since we first began coming to Ometepe 6 years ago.

La Concha is the closest community to Moyogalpa, where we will stay for several nights of our campaign, and is about a 20 minute drive away on the relatively good roads of this part of the island. Historically, we have seen many cases of vesicular stomatitis (VS) in Moyogalpa, where we have come to regard the disease as endemic, but only sporadically in other communities on the island.

It will be interesting to see the incidence of VS in La Concha. In Esquipulas, another community we will visit which is about the same distance from Moyogalpa but in the opposite direction, VS is apparently not endemic. Muriel expects about 100 horses to be presented in La Concha, and he's usually right.

We are a diverse group this year, including veterinarians from the US, Canada, Costa Rica, El Salvador and Nicaragua, and are fortunate to have three Nicaraguan veterinary students with us, as well.

I'll be providing updates on our activities over the course of the next five days—internet connectivity permitting—as we circumnavigate this island visiting a total of six communities.

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January 18, 2013
Moyogalpa

Muriel had predicted we'd see as many as 100 horses at our clinic in La Concha yesterday, and, as usual, he was not off by much: 112 horses were seen, a phenomenal turnout for a first visit to a new community.

Yesterday went about as well as it possibly could have. The worksite was physically well suited to the task-which is, to say the least, not always the case! Some are pretty inconvenient and others downright dangerous.

The response from the community was almost universally positive. Several young children gathered around Chris Hadel, our farrier, to watch him work. Most importantly, many spontaneous and independent comments from community members led several of us to believe that La Concha would be receptive of, and willing to support, a local veterinary practice. This was of special interest to the Nicaraguan students who are part of our group, and promoting the establishment of local veterinary care providers is one of the explicit goals of the HSVMA-RAVS program in every country in which we operate.

The case load was the usual mix of routine preventive care: vaccination and deworming; dental work and hoof care; and castrations (we did 12). Fortunately, there with no major or even minor complications. We saw a few cases of hoof lesions that might have been ascribed to vesicular stomatitis, but no oral lesions. VS, on this island at least, appears to be a disease very amenable to prevention by isolation- as we have historically seen many cases each year here in Moyogalpa, only about 12 kilometers away.

Later this morning, we'll leave for Urbaite and Balgue, two communities we have visited many times in the past. Balgue marks the end of the paved road on the island, and from there to the far end of the island four-wheel drive vehicles will be required. More reports to follow as we make our way around the island...

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January 19, 2013
Balgue, Ometepe Island

The worksites today are communities we have visited every year since the expansion of the HSVMA-RAVS program in Nicaragua. In years past we have divided into two groups to serve the Urbaite and Balgue on the same day. I have never liked this arrangement, primarily because due to weight and space limitations and other logistical considerations, we only have one complete set of farriers' tools and one complete set of dental instruments with us. Also, it's always been worrisome to be separated and out of communication with the rest of the team- Balgue is usually beyond cell phone reception and has never had land-line telephone service.

Therefore, we decided this year to work both towns sequentially as a complete team. This turned out to be a fortunate decision, as the turnout at Urbaite was much smaller than in previous years due to the fact that another North American veterinary group had been there offering similar services a few days earlier. With the small case load of about 30 patients, we finished quickly and moved on to Balgue, further along the southeastern coast of the island, where we saw well over 100 animals (somewhat in excess of case load in past years.

This type of occurrence points out the value of the recently implemented Equitarian Initiative of the American Association of Equine Practitioners (AAEP), one aspect of which is to coordinate between the various groups involved in equine veterinary fieldwork, specifically to avoid duplication of their programs. Speaking with the locals in Urbaite leads us to believe the other group that visited before us was from Wisconsin. In planning next year's trip, I will find out for certain in order to coordinate; it may well be we that we wind up not returning to Urbaite and concentrating on the more remote and difficult to reach communities on the far side of the island.

Even with the light morning workload at Urbaite, it was a busy and productive day with nearly 150 animals seen, and none of us were reluctant to call it a night, get some sleep, and prepare to leave the pavement and the internet behind tomorrow as we head out to La Palma.

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January 20, 2013
La Palma, Ometepe Island

La Palma is the first community we encounter in our circumnavigation of Ometepe where almost no one has a vehicle, and virtually everyone has one or more horses or mules. The paved road ended about 15 kilometers back in Balgue, and from there on, transport is only by well-maintained four-wheel drive vehicles, or the "original four-wheel drive," the horse. Nothing on the ground moves faster than three miles per hour.

It's an extremely friendly village, primarily involved with subsistence agriculture, and fishing and vegetables for the market. The horses are well handled for the most part, and the owners are appreciative of the services we provide – many are interested in and attentive to the details of their proper care and handling. Our farrier Chris identified one especially interested owner, and trained him over the course of several hours to do a decent basic hoof trimning. We left him with one of the two nippers we brought for distribution, and a couple of rasps, on his promise that he would put them to use for the care the whole community's horses.

The case load in La Palma was high, as it has been on our two previous visits, with about 110 total horses seen, 14 horses gelded, many dental interventions performed, and a steady stream of various minor problems to address.

After the last horse was treated, we packed up and moved on about another 12 km to the next village, San Pedro, where we will sleep under the stars in the courtyard of the local school which will be our work site the following morning. A few of the horses seen in La Palma actually live in San Pedro. They made it back home faster than we were able to arrive there in our very well-maintained four-wheel drive vehicle!

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January 21, 2013
San Pedro, Ometepe Island

We arrived in San Pedro last night and had dinner at the home of Anibel Sanchez, an unofficial but influential leader of this community of about 1000 people. We slept outside in the courtyard of the local school, with stars and a waxing gibbous moon overhead. We drifted off to slumber to the sounds of howler monkeys in the forest during the night, and awaking to the sounds of thousands of tropical birds at dawn.

San Pedro is a village with special significance to this project and to me. Dr. Shelley Lenz, a mixed animal practitioner who has generously donated her time to HSVMA-RAVS projects in the last ten years, including many times in Nicaragua, has taken things further by a giant step. She is in the final stages of purchasing property here in San Pedro, in order to build a small veterinary clinic to be staffed by some young Nicaraguan veterinarians whom we have been mentoring for the last several years.

This is a difficult process to navigate in a culture with almost no history of modern veterinary services and no history at all of a self-sustaining veterinary practice, let alone the ability of a Nicaraguan vet to actually earn a living. It will require a delicate touch and some luck to properly navigate these waters. The clinic building will be constructed using the proceeds of a yoga retreat to be held on the other (more tourist-oriented) end of the island, then stocked with a basic supply of equipment and medications and staffed initially one week per month by NicaVets. NicaVets is an association of students and graduates of the Universidad Nacional Agraria (UNA) in the capital of Managua, and is led by UNA graduates Drs. Faran Dometz and Jasson Figueroa.

The hope and expectation, is that the NicaVets clinic will eventually provide the opportunity for a Nicaraguan veterinarian (or several!) to eventually live and make a career on this island. This will, of course, require charging for services, but in an economy that was until recently based on subsistence agriculture with minimal participation in the larger economy, some flexibility will be required. We envision that clients unable to pay cash for services will make in-kind contributions, such as materials or labor. This will initially be truly a community effort; no grants will be written, nor other outside funding sought. At the risk of sounding pretentious, we consider ourselves to be part of the community here in some sense.

The day itself went well: a normal case load; no disasters; a substantial lunch provided by the community; a rough drive around the far end of the island; ending with a night at an ecolodge in the tiny town of El Porvenir. Tomorrow, we visit Esquipulas, the hometown of one of the Nicaraguan students with us. We have been many there times previously, and will likely have our busiest day of this trip.

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January 22, 2013
Moyogalpa, Ometepe Island

Yesterday we worked in the village of Esquipulas, the home town of Fernando Ponce, a Nicaraguan veterinary student in the final stages of his education, and with whom we have been working with for 4 years. The turnout there is always good, partly because Fernando has dozens of family members there, and partly because we have built a real relationship with the town over the years.

This year was no exception, and we saw 125 patients. We have been so busy this trip that we ran out of ketamine in San Pedro, and had none left for Esquipulas (we can restock for the second week in Nicaragua when we return to the mainland tomorrow). Fortunately, both Drs. Tom Parker and Silvia Colladay are with us, and both are experienced with standing castrations, so we were able to proceed – partly also due to the fact that the horses in Esquipulas are relatively well handled. The balance of the caseload was routine, with the dental and farrier stations staying busy throughout the day. Fernando has an especial interest in podiatry, and worked with our farrier Chris Hadel all day.

At the end of the day I took a small crew (Drs. Kirstin Macdonald from Winnipeg, Canada and Claudia Pichinte from El Salvador, and several NicaVets students) to the monastery where the yoga retreat to sponsor the NicaVets clinic in San Pedro will be housed. There are five horses in residence there and we had been asked to just vaccinate them. We only brought vaccines with us but on arrival, that kind of lazy corner-cutting got the outcome it deserved: one horse had a severe corneal ulcer and another had a severe wound. We had to send back to Moyogalpa for supplies to deal with those, and work by flashlight. Yet one more opportunity to learn from experience—they seem never to end!

Later this morning we will return by ferry to the mainland, restock for a day's work with the carriage horses in Granada, and then journey up north to El Bote.

I'll have more to write from Granada later, and if I can find the time to set it up, a link to a Shutterfly site where several thousands of pictures will eventually be posted.

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January 23, 2013
Granada

We began the HSVMA-RAVS program in Nicaragua six years ago here in Granada, in cooperation with Dr. Tom Parker, a New Mexico based practitioner who has been working in Nicaragua for about 10 years, and one of the people instrumental in making this program a success. His generosity with his time and knowledge gave us a leg up that could not have been duplicated in any other way.

At first, we would work for four days here (in addition to worksites in other parts of the country) and the workload was well matched to the resources available. Each year, as other groups arrived to do work here as well, our workload dropped; therefore we scheduled to stay fewer days here and concentrated our resources on more remote regions. We planned one day here this year, and to say the least, resources were not well matched to work load: we saw 225 horses today, many with serious problems. In the 12 years I've been doing this, this is more than I've ever seen in a single day with a crew of about 12 people, and frankly, we're whupped. We got it done, though!

This increased workload was partly due to a change in physical worksites: from the facility of the Granada Carriage Drivers Cooperative, our former site, to the parking lot of the local baseball stadium, which is easier for many owners to reach. Dr. Parker, however, says most of it is because there have been few programs here recently to service a very large population of working horses. This is one more indication of the importance of the AAEP's Equitarian Initiative, and one of its most important functions: that of coordinating between programs. A related issue is that some parts of the country, including Granada, are on the cusp of developing a viable domestic veterinary service model for working equids, and we need to discuss and seek ways to foster that. Tonight, though, it's Chinandega vs. Granada in the Nicaraguan Professional Baseball league playoffs at the stadium.

Tomorrow we leave early for El Bote, an agricultural (primarily coffee production) hamlet in the mountains just south of the border with Honduras, where we expect to see about 450 horses and mules over the course of three work days. Some of the owners will ride for two days to reach us. It's accessible only by four-wheel drive, and it takes about 10 hours to get there from here, and it's well beyond any internet signal, so the next blog entry may not be for a couple days.

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January 24, 2013
El Bote

Due to a series of minor but cumulatively time-consuming delays, we arrived tonight in El Bote after about 12 hours on the road. El Bote is about as remote a place as there is, on the Pacific side of the cordillera which divides Nicaragua (the Atlantic side is largely true wilderness, except along the coast).

There is a lot of history here, and history is kind of what brought us here in the first place. The rural development cooperative with which we work, Asociación de Trabajadores para Desarrollo Rural - Benjamin Linder (ATDER-BL), is named in memory of a mechanical engineer working on a small-scale hydroelectric project, one of the first American citizens killed by the U.S. government-backed Contras during the civil war in the 1980s. A friend of mine who knew Ben Linder suggested this site and put us in touch with ATDER-BL, which now so values and supports our work here that they contribute $1000 each year toward the rental of four-wheel drive vehicles to get our team here. This is a prodigious effort on their part – many Nicaraguan families live on less than $1000 a year – and an example of the recruitment of local resources that can occur as a project matures and becomes reliably recurrent.

Boanerge Rocha is an impressive young man who was working for ATDER-BL as an agronomist in watershed management when we first met him six years ago. He was so interested in, and inspired by our work here that he decided to become a veterinarian himself, and when we arrived tonight, one of the first things he showed us was his degree as a Doctor of Veterinary Medicine from Central Nicaragua University. Nicaragua is the second poorest country in the Western Hemisphere after Haiti, but some things are progressing here.

Tomorrow we begin work on the local baseball field, and expect to see between 100 and 150 animals.

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January 29, 2013 - final post
Granada

We’re back in Granada after three full days in El Bote, and an uneventful journey back. The task today is to count and pack our remaining inventory, and it’s a pretty trivial job this year; we have nearly nothing left.

We treated almost 600 animals in El Bote alone, and 1,129 total animals on the entire trip. I projected, and supplied for 850 animals, so in terms of raw numbers this was a wildly successful trip- especially since we provided not only the routine preventive care (vaccination and deworming) done, but performed many surgeries as well, and many serious problems, some of them life-threatening, were addressed.

The number of animals seen in El Bote presents a somewhat counter-intuitive anomaly to me. Boanerge Rocha has opened his new practice there, and I would have expected that would diminish the case load, but he is overwhelmed with work, and it’s had the opposite effect. The local population has apparently developed such confidence in Dr. Rocha and in veterinary medicine generally, that an increased patient population has been recruited, although the actual overall population is stable. This is part of the cultural change we have worked to achieve.

There is a growing and persuasive school of thought that the number of animals treated in this type of work is of little importance, and that only the meta-changes really contribute to long-term sustainability. While this may be true to some degree, it’s also true that there is great satisfaction in bettering the lives of individual animals and owners, and that in Nicaragua and other host countries in which we work, there is such absolute scarcity of resources that maintaining a high standard of care will have to involve a continuing flow of resources from the developed to the developing economy, and that therefore a more expansive definition of “sustainability” to include that standard is indicated.

But there is also this: five senior students and recent graduates from Nicaragua and El Salvador, with minimal exposure to hands-on experience with horses, were part of our team, and a case load of that magnitude provided enough teaching opportunities that each of them is now capable to anesthetize and castrate a horse, roughly determine a horse’s age by dentition, perform basic equine dentistry, and do a good hoof trim. It does not obviate the need for continued resource redistribution, but that’s “sustainability.”

 
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