Stories from the Field
2012 HSVMA-RAVS Clinics in Peru
We are happy to have Dr. David Turoff and RAVS volunteer Angie Gebhart sharing their experiences during our 2012 equine clinics in Peru. Be sure to check back for updates (as internet connection allows) while RAVS is in the field!
All posts below are by Dr. Dave Turoff and Angie Gebhart, except where noted.
August 16-17, 2012
Not even customs hassles and mismatching flight schedules could dampen our excitement to begin the 2012 HSVMA-RAVS trip to Peru. Although U.S.group members Drs. David Turoff, Lydia Martin, Jennie Lane, Jon Cheetham and Tom Parker, farrier Brooks Varnum and translator/equitarian developer/community outreach extraordinaire Angie Gebhart made efforts to arrive in-country on the same flight for ease of customs clearance, same-time arrivals were not possible in all cases and resulted in a lot of airport juggling. Whereas the first two participants to land in Lima went through customs without trouble, the second wave of people faced three pieces of missing luggage and a looming connecting flight to Cusco. Luckily, two of these pieces of baggage were found after some questioning and searching, but we have yet to see the last bag. Thankfully, it did not contain any veterinary supplies. The experience reinforced the need to ship supplies in several boxes in case one is lost, as it was this trip, our work can still continue. However, shipping multiple boxes can cause considerably more time in inspections, especially when one comes up missing. Additionally, the airline refused to let one of the boxes fly due to a summer embargo on boxes, so we had re-pack the durable solar power generator in that box into a canvas bag.
Our close contact with Maria Teresa Guzzinatti of VIDA DIGNA, a privately-owned Peru animal rescue, as well as the cooperation of the veterinarian at the agriculture section of customs allowed us to pass through customs even though one bag was still missing (although it did not contain any worrisome medicines). This bag should be mailed to our hostel after its arrival in Lima late tonight. One thing that saved us time and frustration was that customs officials did not seem as concerned about inspecting veterinary or farrier instruments, just the regulated medications. The ability to share our dentistry tools with the genuinely curious customs agent and conversations between new colleagues about their past international veterinary experiences reminded us of the reasons we love doing what we do and helped us get through these logistical roadblocks.
Once the last person arrived from a severely delayed flight, all of our equipaje was safely checked on the flight to Cusco. Although most of us slept on this flight after 24-36 hours with no sleep, the views of the Andes Mountains upon landing were enough to keep us awake and looking out the windows with the thrill of finally “being there.” We met our wonderful guides/facilitators for the week, Inez and Michele from Yanapana, Peru, and nursed a bit of altitude sickness. Two of the Peruvian veterinarians, Drs. Carlos Montoya and Veronica Orozco, as well as veterinary students, including one from Bolivia, also joined us in Cusco. After reclaiming boxes of supplies from last year’s inventory from storage, we re-organized our mixture of boxes and luggage in preparation for our trip to the village of Lucre tomorrow, about a 40 minute drive from Cusco.
We were treated to a nice dinner in the cool mountain air tonight and walked around the market, churches, and plazas in town. There was a processional through the streets honoring St. Francis, patron saint of the animals, and we were happy to take pictures and appreciate this fitting first night in Cusco!
August 18, 2012
Today the HSVMA-RAVS team visited the village of Lucre, about a 45 minute drive from Cuzco. Initially, there was some confusion about the proposed work site with the first option —essentially a gravel pit—being rejected as too dangerous. Eventually, we wound up at the local sports complex with a shade structure under which we set up supplies and a large soccer field on which to work. A better site would be hard to come by anywhere.There was a relatively light case load, but everything went quite well. One case was especially interesting. A young stallion had been castrated by his owner two weeks previously, by "ligating" the testicular cords with strips of tire inner tube, and allowed to necrose off. One testicle had done so, albeit with a great deal of inflammation, but the other was still attached by a necrotic and fibrosed cord. We anesthetized the gelding and debrided both cords thoroughly. It is still possible that a scirrous cord will result so we encouraged the owner to return the following year for further surgery, if indicated then. Six horses in total were castrated today.
Another out-of-ordinary case was a foal that presented with a significant limp. The owner reported that another horse had kicked the foal, but very limited inflammation nor a digital pulse were obvious, only a small wound only mildly sensitive to palpation (out of proportion to the limp). The owner reported that the situation was improving, although slowly, so no treatment was done.
We were surprised—and some of us quite excited—to see some burros today as well. This has been an uncommon sight on past years’ trips. For the most part, these burros only required a bit of farrier care. No severe dental cases were treated today.
Overall, we were impressed with the quality of horsemen at this location. We saw many horses with appropriately-trimmed horses, with some left to be desired regarding the fit of the shoes. Shoes seemed to be too small which can cause overgrown toes and underslung heels. Farrier Brooks taught basic nipping and rasping techniques to two very interested men who have done quite a bit of farrier work in the community—with machetes. We put them in contact with the group from YANAPANA who knows how to access some tools that are sold in Lima. Most of the horses were very docile and had very durable, well-shaped feet with minimal cracks or flares.
One docile mare was checked for pregnancy and found much further in along in her gestation than previously thought (near term). After our workday we were lucky to visit a 16th century church and some local artesanías before a wonderful, vegetarian supper of quinoa burgers and coca tea.
August 19, 2012
Our work today was in a town called Saqsaywaman, famous for its smaller-scale Incan ruins. Our worksite was beautiful, nestled between mountains, but quite uneven so space had to be used well. A multitude of entry and exit points to the worksite, including tourists on horseback passing through periodically, made for slight chaos. Many of the horses who arrived in the morning were brought there by young boys hired to be wranglers for tourism, and they did not know much about the horses’ health histories. So we got a slow start to the day, waiting for the owners to show up.
Another difficulty was that many horses showed up without any form of halter or lead rope and instead wandered in as part of a herd. Some of the horses had a 20- or 30- foot rope around their necks by which they were led, but sometimes there were one or more horses on the end of the same rope. Needless to say, the few donated halters and lead ropes we brought along were well-used and appreciated.
Six horses were castrated today with routine ease. It was interesting to see many of the horses presented with shoes on, courtesy of a local farrier, although a few were so worn down that only a portion of the shoe remained. Upon explaining to the owners the importance of trimming and shoeing properly to maintain the position and protection of the internal structures of the foot, some were clearly surprised that the hoof had these intricate structures that dictated how the feet should be trimmed. One or two of the men who were clearly responsible for the hoof care of the majority of the animals circled around the farrier station where they learned better ways to fit shoes and how to use the tools. A correction from yesterday’s blog: VIDA DIGNA, an animal welfare organization based in Peru and headed by Maria Teresa Guzzinati, is responsible for putting horse owners, and specifically up-and-coming farriers, in contact with proper farrier tools that we so take for granted. VIDA DIGNA has also already donated a few of these supplies.
Quite a few saddle sores were evident, which we cleaned with chlorhexidine with sedation in the majority of the cases. Another recommendation we could make to the owners of these animals was that they apply honey to the wounds daily to soften the tissue and aid in healing—an available remedy.
On every trip, there is a least one dental case which justifies the entire effort. Today, we were presented with a horse in his mid-teens with rostral hooks on his upper first cheek teeth so long and sharp, as a result of malocclusion, that in a few months the hooks would have grown so long as to prevent the horse from closing his mouth or chewing at all. In the absence of veterinary intervention, the horse would have been doomed to die of starvation for pure physical inability to eat.
After sedation and about 40 minutes of careful grinding with the portable, solar powered equipment we have with us, the dentition of the horse was restored to full functionality. There is not much in life more satisfying than watching a horse graze normally for the first time in years. Of course, the anatomic abnormality remains so we impressed upon the owner the importance of returning with the horse to our clinic next year to avoid the recurrence of the condition.
In total, 103 horses were treated today in Saqsaywaman, the majority of them being used in tourism.
August 20, 2012
Today was a travel day from the large city of Cusco to a small mountain town called Mollepata. Our 3 hour drive brought us through rugged mountain switchbacks, potato fields and impressive irrigation. We were thankful to have our luggage on top of the vans covered in plastic as the last half-hour of the drive was on a narrow gravel road winding up the side of the mountain. Once we arrived in Mollepata (a humble hostel but with award-winning views of the Andes), we re-stocked supplies in the courtyard. We will work in this community for three days.
After enjoying lunch prepared by our cooks inside a house that is being constructed down the street from our hostel, we observed some ladies practicing the traditional weaving techniques taught by the social service division of YANAPANA. These ladies brought us to their shop where they sold handcrafted scarves, bags and other crafts made of alpaca and llama wool, as well as homemade jams and marmalade.
There was a bit of confusion about tomorrow’s worksite, which Maria Teresa and Michele had to discuss with the community members at the municipality. Instead of the fenced-in sports field that had been used in prior years, we will be situated in an open field just down the hill from the town’s main plaza. We prepared another game plan for the triage station to help keep arriving animals and owners organized; more aligned with what the group has done in years prior.
We saw a few of our patients being run down the main street of town, following one girl in front with another young girl shepherding them from behind. The uneven clip-clop of some loose and missing shoes guarantees us of much work for tomorrow...
August 21, 2012
We were prepared to see many horses at this location today, and the town of Mollepata did not disappoint. An almost steady flow of horses throughout the day brought us to a total of about 120 horses. Like days prior, many owners came with 10 horses and only a few halters or ropes.
Another problem we noticed with high numbers of horses per owner is that it is often hard to recommend that one of the horses travels to the dentistry or farrier station while the owner continues to hold the rest of the horses for physical exams. Most participants felt that today our triage station was better systematized, with one or two veterinarians always present to examine the teeth while others took health history, vaccinated and dewormed—one horse at a time. It was also helpful to have a representative from YANAPANA available to check-in horses, take payments and keep track of the order of arrivals.
At this location, we have historically capped the maximum number of horses at 10 per owner (and of course more if there are time afterwards), and each owner is asked to pay 3 soles, calculated as one third of the daily wage of the lowest-paid worker in the economy. The reason for this nominal charge is to counter the development of “learned dependency” and give the owner a more dignified role in the transaction, to underline that the animals have value, and to set the precedent for local vets eventually to earn a living providing services. The money is used to subsidize the participation of Peruvian veterinary students.
Many vampire bat wounds were observed today, and we recommended they be cleaned and that eucalyptus oil be applied to repel the bats. When asked about specific health concerns of the horses they had brought, an overwhelming number of owners requested vitamins to be administered. An appropriate response given by Carlos and other vets was that the vitamins are found in pasture and the other things the horse eats, not one-time injections. We did notice, however, that many owners requested dewormer and vaccines, due likely in part to well-versed explanations and teachable moments on past trips here.
Additionally, three cases of strangles were carefully treated. The first presented with nasal discharge and evident labored breathing, and even began open-mouth breathing when it became stressed. The animal had a very low heart rate and temperature; pleuropneumonia was suspected. It was emphasized that the caretaker of the horse watch while we administered anti-inflammatory meds and antibiotics so that the owner can continue to treat the horse, although we asked the horse to return tomorrow so that we can treat again before leaving Mollepata. The other cases were less sick but still dehydrated. Antibiotics and anti-inflammatory meds were given and a salt mash was recommended to encourage drinking.
Multiple sarcoid cases were observed and treated. One especially severe case was multiple sarcoids of two- and three- inches in diameter in the flank area, a one-inch diameter on the prepuce and 20 more small sarcoids surrounding the thighs, abdomen and penis. It was decided that removal of these sarcoids, as well as some around the eyes, would cause more damage to the animal and healing was not probable. We saw a large variety of body condition scores today, ranging from 2 to 5, including a showy Arabian stallion and some curly-haired mules and horses, supposedly with Persian heritage. However, several cases of saddle sores warranted a careful explanation of how to properly pad under a saddle and how to cut away parts of the pad to allow room for high withers. Of course, we also recommended to the majority of these owners that their horses need to gain weight in order to absolve this problem. Thankfully, Maria Teresa and Dave both agree that the number of saddle sore incidences is down about 80 percent from four years ago, when this annual trip began.
It was also evident that the horses were better socialized and calm this year than in years past, although it is still frustrating to see that many owners make their horses more agitated than they need to be. We discussed the need to emphasize proper “breaking,” or gentling techniques. One owner brought up a somewhat humorous old wives´ tale when he presented his horse with severely deformed feet with serious flares to one side. He insisted that we not trim his horse´s hooves because the horse lives on a hillside and needs his hooves to be shaped this way.
After school let out in town, kids crowded around the castration and farrier stations. Jennie and Angie put them to work reading and coloring in their coloring books, and the kids really seemed to remember the reasons for castration, proper nutrition, trimming hooves, etc. when asked about it at each station.
At six o’clock, Dr. Dave Turoff led a charla (informal talk) at the municipality about the basics of equine dentistry. The half dozen attendants seemed to appreciate the talk but had questions about some other health aspects, especially concerns about strangles (gurma). There was an outbreak of strangles recently and owners are very concerned about how to control this disease, and so had questions about treatment (penicillin was recommended). Owners also had questions about pasture and vampire bat bites.
August 22, 2012
We were disappointed to see frequent poor horsemanship today. It is always frustrating to have to decide between allowing an owner who knows his horse best to continue to hold the rope, or to request that he step away so that the horse relaxes. An interesting observation that we made today was how much the horses here relax when their eyes are covered. Oftentimes the owners’ first response is to throw a colorful scarf over their horse’s eye before injecting, trimming hooves, or working around the hind legs. Several veterinarians remarked how unlikely horses in the U.S. would calm to this treatment. Also, the horses here relax immediately when a rope is thrown around their neck or placed around a hind leg, but have the opposite reaction when a human approaches them with the same caution and care.
Several horse owners became frustrated while waiting in the lengthy farrier station line, but it was emphasized to them that the work is hard and takes time. One man observed several horses this morning, and then was taught how to use the hoof knife, rasp and nippers. He will be bringing his own horses tomorrow. He was very interested to learn how much the job can pay in the United States, and especially with the fact that horse owners will pay a professional to travel around and provide this service, so we emphasized the potential there is for him to start a farrier service business like Brooks´ here in the area. The Peruvian and Bolivian veterinary students continued to learn trimming and shoe pulling techniques at the farrier station, although the majority of the horses presented with extremely long feet caused by leaving the shoes on for extended periods of time.
The most frustrating case of the day was an eight year old mare with a sagittal fracture and consequent root infection of her 308 tooth (left lower jaw, midway back). There was a missing fragment at the buccal (cheek) side, and the crown of the tooth was therefore tapered and difficult to engage with extraction forceps. Horses of this age also have very long roots, further complicating extraction, and after about 90 minutes of trying, we were forced to accept defeat. A lot of necrotic tissue and rotten feed material was removed, but in the end, the problems will likely remain. We left long-term antibiotics and pain meds with the owner and will try again next year.
We were glad to see that the highly-infective strangles case from yesterday returned for further treatment. A tracheostomy was performed in which a handle from a plastic juice jug was cleaned and inserted into the trachea. The animal began to breathe easier and will return one final time tomorrow. Another animal presented with symmetrical abscesses on both sides of his croup, covering about half of the gluteal area. Jennie used a scalpel to clean the area because it was already draining and continued to flush it; much to the owners’ surprise, the solution entered one hole and came out another. Although the owner insisted that he had not done so, we suspected IM oxytetracycline had perhaps been injected there for a past respiratory infection.
A group of veterinarians traveled outside of town to the Mountain Lodges of Peru, where 20 more horses were dewormed and vaccinated. MLP owns a string of tourist lodges on the trek to Macchu Picchu from Mollepata to Soraypampa, over Salkantay Pass to Collpapampa and Macchu Picchu, which is the route we are also taking to care for some of the horses used on these isolated treks. MLP’s social service division is YANAPANA Peru, which has been mentioned in previous posts and is the provider of logistics and infrastructure support for the trip. We are also allowed to camp at MLP’s sites along the way. Of this group of horses, some were recommended to come down the hill to Mollepata for dentistry or farrier work. A hoof abscess was also found and treated while there.
After school let out, several kids were entertained as Angie helped them to identify the parts of the horse in Spanish using a calm old white horse named “Gringa.” She cooperated very well and the kids seemed thrilled to learn where body parts like the knees, elbow, ribs and cannon bones are on a horse.
Just over 100 horses were seen at our second day today in Mollepata.
August 23, 2012
Although we expected to see fewer horses on our third and last day working in the town of Mollepata, we in fact saw over 100 horses again. The day began with a difficult dentistry case in which our patient, a mule, decided she didn’t care to receive this service and left the worksite while slightly sedated. A bit more sedation and the procedure was completed without problems.
We saw our first pair of Shetland ponies today — a mare and a stallion with a lot of attitude.
A six-month-old foal presented with a severe skin ectoparasite, or fungus, covering the entire body and face. The hair and skin were peeling with a greasy residue so we bathed the cooperative (and appreciative) foal in a betadine wash and instructed the owner of how to repeat this again. The foal was also dewormed and sent home with an additional dose of ivermectin to readminister several weeks later.
The kids today loved playing a memoria (memory) game about horse care — and a few adults even joined in.
After dinner, we set to work repacking our supplies for the trek beginning tomorrow. It is important that we carry as light a weight of supplies as possible because they — along with our personal luggage — will be traveling 15,300 feet across the Salkantay Pass to our next worksite, Huayrac, via mules. We also limited our personal luggage to 6 kilograms (or about 13 pounds) per person to provide for the easiest load possible for the pack animals, although we were also warned to bring plenty of layers up into the mountains with us!
Tomorrow begins the real adventure...
August 24, 2012
There’s nothing like a 5am open-air truck ride to wake you up! We loaded ourselves and our supplies into the back of a livestock truck to go up the mountain to Soraypampa’s Mountain Lodges of Peru location (pampais Quechua for a flat plain). Along the drive, we spotted our first glimpse of the glacier, Salcantay, which we would soon be traversing to get to our next location. For those of us newcomers to the trip, our anxieties rose just a bit as we observed the sharp, snow-covered ridges covered in glinting snow seemingly miles above the nearest peak. We were assured that the trek was doable, but we were cold from the wind and ready for breakfast by the time we arrived at the lodge. We warmed up a bit before treating several of the horses at that location -- just vaccinations and deworming. Our wonderful cooks set up their propane stove outside on the plain and we had breakfast and tea before loading our string of about 20 pack animals.
The hike was gruesome at times, mostly because of the altitude and the fact that many of us have been recovering from respiratory illnesses. One of our wonderful compadres from YANAPANA, Michele, gave us trekking tips to always look back at what we have already achieved, eat lots of snacks and walk in pairs. Most of us agreed that the sights of the Andes around us were dizzying. Our hike was broken up by beautiful caves, lakes, free-roaming cows and horses, and spectacular views. We made it to the pass over Salcantay at 15,300 feet and began the (almost) just as laborious descent, but with altitude working for us this time. We were lucky to also have two extra horses to use to ride or put our day packs on. All of us made it to the small plain of Huayrac in 6 to 7.5 hours, of which we were all proud. Our tents were set up behind the MLP lodge before dark and we had a wonderful dinner and tepitiado (a liquor of tea and pisco) to celebrate our adventurous spirits. We are all astounded at how well we are eating on this trip -- the cooks are very resourceful and seem to know just what kind of nutrition we will need, including pasta before our big hike, three course meals with desserts to die for and unique varieties of soup at the coldest parts of the trip.
August 25, 2012
Field veterinary work is often at the mercy of the ambient conditions, of which we were reminded frequently today. We all agreed that today was also a day of creative problem-solving.
Many of us woke to wet tents and clothes from the almost relentless drizzle throughout the night, which continued through most of the morning and late afternoon. After searching for a flat, level work site, Dave found a run-in shelter about the size of seven or eight 12x12 stalls. Many pitched in to clean out the manure and dirt from the floor so it was ready to be a dry, out-of-the-wind worksite. Our first patients showed up soon after — a group of seven horses which had all been infected with strangles earlier in the year. One even had a healed draining tract from an abscess of the left guttural pouch which, we hypothesized, was what had saved this horse from his painful infection. A few of these horses showed ramps and malocclusions, and when recommended for dentistry the owner at first declined. After carefully explaining to her that the procedure can help her horses to eat better and gain weight because they often develop sores on the inside of their mouth from unkempt teeth, she eventually accepted. Another of her horses was severely splay-footed and required corrective trimming.
The next owners were a group of brothers who brought three horses and one mule for castration. We decided to lay a horse down first in our creative enclosure — the run-in shed — since mules can sometimes be harder to sedate. The surgery went well, but upon standing up the horse almost immediately showed some small intestine hanging from the incision. It was incredible the way the entire team worked together to anesthetize the animal a second time and combined forces to correct the ailment in about a 90 minute surgery in the field. It’s gratifying to realize what a skilled surgeon with a good support team can achieve with some improvisation, even under marginal conditions, and we were all grateful to be working under cover instead of out in the freezing rain.
We explained to the worried owner that this animal may have experienced a scrotal hernia sooner or later because of his enlarged inguinal ring, and how fortunate it was that we were there to help the horse during this highly unusual and potentially catastrophic event. We carefully explained that the near evisceration was a result of a larger-than-normal inguinal ring and that this is a complication of castration that happens in less than one of every 1,000 horses castrated.
We all worked together again to build two more walls for the corner of the shed in which we were working from two ladders, two pieces of PVC pipe, a few bed frames, rope and tape. The horse stood from his second surgery with relative ease after we performed a warm water enema to elevate his body temperature and rehydrate him. We also covered him with some plastic feed sacks in which we had carried some of our supplies. We “borrowed” some chaff-like feed from the MLP storeroom and gathered as much grass as we could for this youngster who was used to eating only pasture. He quickly began eating both types of feed and, fortunately, remained calm in his improvised enclosure while we took turns staying with him and checking on him through lunch and the rest of the afternoon.
There were only a few other horses present for us to look at today (besides the other three for castration), and needless to say they all went home after waiting out in the rain — and even some snow! — while we were focused on the extensive corrective surgery. One mule needed his hooves trimmed badly, but even after a large amount of several sedatives given IM and chasing him around a huge boulder to try to shorten his rope, he was untouchable so he was also sent home.
The castrated horse stayed with us through the night. In fact, we set up our tents inside the long run-in shed just next to his makeshift stall to keep an eye on him throughout the night. In the morning he was bright-eyed and hungry, and had defecated throughout the night. We sent him home with the owner, who understood to keep him quiet for four weeks and to give the antibiotics we had dispensed. The owner was very cooperative with our post-op instructions and seemed thankful to be going home with such a considerably-healthy horse.
We have already spoken with a few arrieros(wranglers) about seeing their horses in Collpampa tomorrow, so we are looking forward to the next day. We will hike tomorrow morning and hope for less rain than today brought us. It is for sure a shorter trek than the last, but we are all looking forward to more mountain views!
Dr. Jon Cheetham also contributed to this post.