November 2, 2009: 5 am The alarm clock rings before sunrise. I dress quickly in our dimly lit, unheated room where it is just bright enough to see my own breath hanging in the frigid air. There’s little time for restful sleep between the noise of late night musical festivities, dogs fighting in the streets, and the crowing of roosters at dawn. Mornings are uncomfortably rushed. The building we are using for surgery today is a half-hour hike away, and we need to get an early start to make the most of the few hours of midday warmth and sunshine, so breakfast is a brief 10-minute pit stop at the local tienda for hot coffee and pan frances (white breadrolls).
The veterinary team I joined here two days ago has almost completed the vaccine and neuter clinics for this visit and has just started spaying the females. My jaw drops as I enter our makeshift surgery room—it looks like something out of a war movie: tin-covered walls, a dusty floor, poor lighting, and no central heat. Benita, a local villager who has been hired to translate for us, takes patient histories and helps the villagers sign consent forms.
My first patient of the day is Chaquira, a small, slightly foxy-looking mixed breed. “You are a lucky little perra (dog),” I tell her, feeling a healthy layer of muscle and fat over her ribcage. Without veterinary care or regular meals, most of the dogs in this mountain village are thin, flearidden, and carry a host of greedy, calorie-robbing internal parasites. Chaquira looks remarkably well cared-for—her body weight is normal, her coat is shiny, and her eyes sparkle. I am secretly relieved at her apparent good health; the work environment looks like enough of a challenge for today.
Surgery in a rustic, high-altitude setting is an exercise in creativity, to say the least. In place of multi-beam surgical lighting, we have simple headlamps; instead of fully adjustable surgical tables, we have wooden desks propped up with bricks, and with no fluid pumps on site, we hang the bags by rope or nail, and our diligent technicians count drip rates manually. A little pressure cooker serves as our autoclave for sterilizing instruments, and a butane camping stove boils water for scrubbing, filling hot water bottles, and warming IV fluids. I take a long look around while scrubbing in and realize what a feat it is to be running a very basic yet functional operating room in such a remote area. I dry my hands and glove up; Chaquira is on the table and ready for surgery.
Not long into her spay, I am disturbed by the amount of bleeding. Small vessels that should be clotting quickly on their own aren’t, and I’m spending precious time clamping them all off. Dr. Kuzminsky, who led the first team here in January, explains that the oozing I am seeing is not unusual and there is suspicion that either blood parasites or chronic malnutrition are causing mild clotting problems. I sigh at this unwelcome news—surgery and anesthesia reduce body temperature quickly, so with no central heating and only hot water bottles to keep our patients warm, we need to work quickly to prevent hypothermia. I carry on, juggling the need to control bleeding while minimizing surgical time.
I find myself unusually deep in concentration performing a procedure that is normally effortless. I notice the strange silence between me and my technician, a blunt reminder that monitoring a patient in these conditions leaves no room for the leisurely chit-chat that routine surgery typically allows. At home, the dogs are kept under general anesthesia by gas, and their vital signs are tracked with sophisticated monitoring equipment, much like in a human hospital. Alarms ring if breathing or heart rates go beyond the normal range—a terrific safety measure to back up skilled observation and direct patient monitoring—and gas levels can be adjusted quickly and easily as needed. Anne-Marie, my technician, has none of these luxuries. She is keeping Chaquira under general anesthesia with IV drugs instead of inhaled gas, and adjusting her drug rate based on continuous monitoring. Not a minute goes by without an evaluation of heart rate, breathing, muscle tone, and other indicators of how deeply “asleep” her patient is. Even with meticulous monitoring, Chaquira gets a bit too deep about halfway through the spay, and Anne-Marie has to assist her breathing for five minutes and administer a special drug to increase her heart rate. Nonetheless, I am able to carry on with the surgery virtually uninterrupted; Veterinarians without Borders (VWB) only takes on technicians who are highly skilled and very experienced, and I have full confidence in Anne-Marie.
In just over an hour, the spay is done and we move Chaquira to the recovery area where she is bundled in blankets and hot water bottles in front of the propane space heater. I sit with her as the anesthetic drugs slowly wear off, my back sore from hunching and my stomach grumbling for lunch. Before the sense of deprivation gets the better of me, I stroke Chaquira gently, and appease myself with a reminder of why I am here on this difficult but compelling project.
In 2007, when VWB was first contacted, the dog population in this remote Mayan village was out of control. Pet dogs, kept mostly for protection from intruders, other dogs, and wildlife, were breeding with each other and with strays. Dogs had become the main reservoir of rabies and some of the strays were aggressive towards people. Tourists were afraid to walk the streets and the community was living in fear. Efforts to reduce the stray dog population by mass poisoning had been unsuccessful. Pet dogs were inadvertently baited, strays were not reliably targeted, and poisoned dogs died a slow and excruciating death. The people of Todos Santos wanted a humane and sustainable solution, and VWB was eager to help them build a culturally suitable program to reduce the risk of rabies and keep their dog population in check. The first phase of the project focused on rabies vaccination, neutering, and establishing whether females could be safely spayed in such challenging conditions. Surgery proved to be rigorous, but feasible, so a key goal of this second phase was to sterilize as many female dogs as possible. Lunch arrives, and we alternate between filling our bellies with rice, beans, and soothingly warm tortillas, and keeping a close eye on our patients in the recovery area. We are 8,000 feet high in the
We are 8,000 feet high in the mountains, nestled in a steep valley between two towering mountain ranges. Weather changes dramatically throughout the day, and by mid-afternoon, when the western mountains suddenly cast cool shadows upon us, we want our patients settled in at home by a warm kitchen fire.
At 2 pm, the Mendozas, Chaquira’s family, return and Benita talks to them about the special care she will need. In this indigenous Mayan culture, dog ownership does not mean what it does in Canada or the United States. Pet dogs sleep outdoors, and aren’t fed much more than the occasional tortilla. They roam the village freely and scavenge most of their food. Without specific homecare instructions, many of our patients would succumb to hypothermia and malnutrition, so Benita gently explains how important it is that Chaquira stay indoors overnight on a thick blanket near the warm kitchen fire, and that she be fed some protein for the first few days. Most families can afford to provide eggs but, for some, providing chicken is a struggle—it means less for themselves that week. Benita is able to acknowledge and empathize with the hardships of her fellow villagers, and she is able to encourage owners to do the best they can for their dogs without appearing insensitive or culturally inappropriate.
Mrs. Mendoza says she can provide Chaquira with eggs and chicken, as they have done well with their crops this season, and she thanks us for our help. Tia, her youngest, shyly hands me a picture she has drawn of all the animals at home. She points out the dogs: Chaquira, Mecca, and Princessa, and tells me how she especially loves them.
Just as the Mendozas head off with Chaquira securely in their arms, three children arrive to pick up another patient, Paloma. Roberto, Paloma’s surgeon, glances over their heads for a moment, then turns back to them looking concerned. “Donde estan tus padres?” he asks. The eldest replies matter-of-factly that their parents are busy drying the corn. It is a struggle for some of the villagers to take time off to come to our clinic. The Todosanteros are quite poor, and work very hard to support themselves. A trickle of tourists, many seeking the intricately hand-woven garments the village women are renowned for, brings some money into the community, but the villagers sustain themselves mostly by growing crops and maintaining a small number of chickens and pigs for eggs and meat. Paloma’s family lives a 45-minute hike up the mountains, much too far for her to walk so soon after surgery, and the children are not strong enough to carry her all that way themselves.
It is tempting to call a tuk-tuk (threewheeled taxi), just as it is tempting to send dogs home with nutritious food and bring in more sophisticated drugs and equipment that would make surgery easier and safer, but we don’t; the short-term heroics would come at the cost of long-term success. We have stepped in to help solve a crisis, but with the firm intention of stepping aside as soon as we are able to leave a culturally suitable and sustainable solution in our place. With the dog population now under temporary control, it will be easier to secure government help to maintain the program, but we must be careful to do our work in a way that the Guatemalan veterinarians who will eventually replace us can sustain.
Roberto furrows his brow, adding “adults at discharge” to the daily debriefing agenda, then smiles warmly at the children as he laces his hiking boots and bundles Paloma in a warm blanket. He grabs a cell phone in case he has trouble finding his way back and tells us he’ll see us at dinner.
Most of the team stays on site for a few more hours doing discharges, cleaning instruments, and preparing kits for the next day, while a couple of us run though the list of housecalls for patients who are recovering slowly and need a bit of extra TLC or medication. Despite the remote location and the poverty, cell phones are ubiquitous and allow clients to get in touch with us easily if they have any concerns. We pack a small drug kit, stethoscope, and thermometer, and go over the call list with Andres, our guide. There are no addresses in Todos Santos, so housecalls are typically long, adventurous hikes with our trusty tri-lingual translator (English-Spanish-Mam), who asks for directions from villagers to locate our patients and helps us communicate once we find them.
Walking through the village and visiting homes provides a fascinating glimpse into Mayan culture. This community is one of the few places in Guatemala where traditional clothing is still worn. Men dress in striped red pants, dark blue chaps, and shirts with large, elaborately embroidered collars, and women wear long, dark skirts with strikingly vibrant, ornately woven blouses, often carrying babies swaddled snuggly in a huipil over their backs.
We turn onto a narrow path between two fields of mixed crops where tall cornstalks act as scaffolding for beans, and the foliage of both provide shade for the thriving squash below them. At the end of the pathway, we reach the Duarte home, where I see two women weaving busily on backstrap looms and enjoy the faint smell of burned wood coming from the chuj (sweatbath).
We have come to check on Luna, who has been lethargic and refusing food since surgery two days ago. Luna is resting comfortably in the kitchen. She is a bit quiet, but her incision looks good and her gums are moist and pink—I am happy with her overall appearance. The family says that she has been turning her nose up at tortillas and demonstrate her disinterest with a fresh one off the stove, but quickly point out that she perked up this morning with a warm bowl of sopa de pollo (chicken soup) and is actually doing much better now.
The rest of our housecalls are equally uneventful; the occasional dog needs some additional pain medication or incision bandaging, but most just need a little extra food and warmth, something that villagers are not accustomed to providing for them.
With rounds done and kits packed, we have an hour or so to spare for a cold shower and laundry before suppertime. Normally we congregate at a local restaurant for supper, but this evening is a special occasion: we have been invited to dinner by the mayor’s office. When we arrive, I am relieved to see that we have not come under-dressed. Back home, such an invitation would surely call for formal attire, but here, clean, warm clothes were the right pick—no one raises an eyebrow. The mayor’s representatives, all wearing dark half-length chaps atop their trousers and black leather jackets, clothing worn only by certain men in the community who are of distinguished rank, welcome us as their honoured guests.
“Salud!” one of the officials belts out soon after we are seated, holding his glass in the air. We join in his toast: “To the people and dogs of Todos Santos!” and are treated to a simple but hearty meal of tamales, potatoes, frijoles, and, of course, corn tortillas, while we review where we stand with this daring and vital project.
The community is very pleased with our help so far. Villagers have noticed a big drop in the number of aggressive dogs roaming the streets since the project began, and there is hope that, over time, this will help with tourism and economic development, especially once other aspects of this complex problem are addressed. The mayor is impressed with the results of our work and has committed to even greater support of the project next year: a driver and truck for transporting equipment and some patients, storage facilities, and a suitable central location for clinics.
The positive feedback is tremendously reinforcing and well-timed, given the hard work still ahead; there are several underlying problems that will need to be addressed for longterm success.
Poor waste management is sustaining a stray dog population that will not go away until their food source does. Strays are drawn to the slaughterhouse, the market, and the dump where they scavenge leftovers. The mayor is ready to work on these problems and would like us to assist him in developing a responsible pet ownership program, one of our past recommendations for this community, so that pet dogs will not need to scavenge for survival. He and our team leader agree that resolving these fundamental problems will require involvement beyond those of us at the table, including cooperation with government, Guatemalan veterinarians, and nongovernmental organizations.
This is a tall order—but it looks like help and support is on the way. A University of Guelph engineering professor who is a member of Engineers Without Borders, has offered to help troubleshoot the complex waste management issues, and the Guatemalan veterinarian in charge of rabies control who visited us on site expressed great interest in helping support the project. In fact, she has already begun networking to stimulate participation from the Guatemalan veterinary community.
The welfare of both the strays and the owned dogs will need to be taken into consideration when waste becomes unavailable as a food source, so a fair amount of planning and coordination between these various organizations and the community will be needed. The solutions will be complex, yet there is a sense of optimism brewing among us. We are energized by the air of accomplishment, and tempted to continue socializing late into the evening. But with an early morning ahead of us, we wish our kind hosts a buenas noches and hike back up to Las Ruinas, our rented home, to call it a night.
Despite exhaustion I cannot sleep. My bed feels empty—I’m used to cuddling up with my two dogs. I lay awake thinking of my girls back home, snoozing on the sofa by the warm fireplace, with full bellies and no worries in the world. It is hard for each of us here to accept the vast cultural differences in pet ownership, to reconcile how someone can care about a dog yet leave her to scavenge her meals. Then I think of Tia’s drawing, of the worried faces of villagers when they leave their dogs for surgery, and the affection they display when reunited, and wonder if despite our very different ways of caring, our love for our dogs might, in fact, be much the same.
It will still be a few years before we outsiders can step away from Todos Santos knowing that the local people are in charge of their own solutions, and the road to success will probably be much like the village roads themselves: rugged and steep. But I know that we will get there. With continued hard work and careful planning, the wish for improved health and wellbeing of this charming community will surely come true.
VWB is a not-for-profit organization whose mission is “To work for, and with, communities in need to foster the health of animals, people, and the environments that sustain us.” Visit www.vwb-vsf.ca for information on their remarkable projects and guiding principles.