Zach Kline, Masaya, Nicaragua, May 2014

I awoke on June 10th in a manner so naturally and free of anguish that I could hardly believe it was as early as 6AM. Being one of the world’s worst morning people, I had to consider the possibility of mind control or possession before acknowledging the factors of my current situation that allowed me to raise from slumber so smoothly. The room could be considered very “open” in that all that separated the “windows” in the wall from the outside world were ornately patterned steel bars and decorative curtains. The lack of glass windows allowed the cacophony of nature to carry quite well into our “habitación”—making for a seriously effective natural alarm clock. Had I been a fella a little less enamored with the still-novel avifauna of Nicaragua, I probably would have wished ill will upon the raucous birds as I trudged through my morning routine. However, the country’s proximity with the equator caused the sun to rise (and the birds to chirp) right around 6AM–the time we would have to be up and ready for clinics anyways. Plus, birds have no “alarm off” or “sleep” functionality readily accessible to sleepy humans, so ignoring the tortuous reminder that I would eventually have to remove myself from my bed was conveniently not an option.

Nicaragua2014D3.1My host mom, “Mama Zenelia” had let me and my roommate Tim know that water shortages were short-term, albeit common, occurrences that plagued the city a couple times a week for a few hours at a time. Unbeknownst to even our host mother was the apparent severity of the drought that had befallen the nation during the summer months—especially during what was supposed to be the region’s rainy season. That morning many of us took our first “bucket showers” in Nicaragua (the first one ever, as it was for me!). The cold, intermittent bowlfuls of water served as a humbling reminder of how precious clean, fresh water is as a resource, and of the wanton waste of it observed back in the United States. Having come back home, I hope to apply the lessons learned from living without fresh water readily available although it was a mere 48 hours, as much as I utilize the obtained surgical skills—it will be a dark time indeed when our faucets begin to run dry.

Nicaragua2014D3.2Our clinic site was a short drive into the suburbs of Masaya—a small schoolhouse named “La Abejita” (the little bee). The structure was a 2-room cinder block building with a sheet metal roof and concrete floor. Following suit with classic Nicaraguan style: the doors and windows were open to the outside world, adorned only with black colored steel bars. Despite the marked difference between the physical appearances between this schoolhouse, and the buildings where I completed my early education, the feel was very much the same. Colorful posters featuring characters from popular cartoons and Disney movies adorned the wall, teaching the alphabet, simple arithmetic, and important national symbols of the country; just as they would in the US. From the ceiling hung an assortment of crafts made by the students for “Día de Madre” (Mother’s day), some of which I’m almost certain were made from macaroni glued to construction paper.

While the educational posters that decorated the walls of “La Abejita” would be considered objectively simplistic, I found it humorous (and a little bit embarrassing) the degree to which they captured our collective gringo attention. I recall a couple of us studying perhaps a bit too intensely a poster of Woody from Toy Story detailing the names for basic body parts. “Tobillo” I thought as I stood there “yeah, that was the Word for ankle, wasn’t it?” A moment later I remember remarking to a fellow vet student how strange it might be for the owners to entrust the lives of their pets undergoing surgery to a group of students with the Spanish competency of a Nicaraguan three-year old. Many moments (read: days) later I would thank myself for at least remembering the Spanish word for ankle as I sat with a sprained one against the wall of a schoolhouse at our last clinic site in Diriamba.

Nicaragua2014D3.3Despite how dumb our group must have sounded to the locals, we set about our task to remove the accursed reproductive tracts of their aforementioned pets. While the first two clinic days in Leon seemed sufficiently tumultuous to me, lead Veterinarian Faran Dometz assured us that the first two days amounted to little more than a practice round—Masaya would be the first true test of our group’s efficiency. The VIDA mobile clinic is nothing more than about 8 folding tables and five large cases full of supplies and we had been charged with the task of knowing the ins and outs of one of three stations: Intake, Surgery, and Recovery. While all were distinct segments of the same clinical beast, each station had a lot of overlap with respect to the supplies utilized. Combined with the rather modest stockpile of drugs and equipment one might expect to find a volunteer-based free clinic, the process of moving an animal through presentation into surgery was often a struggle for resources. Thankfully emotions rarely (if ever) became heated between colleagues, instead the volunteers were forced to innovate new ways to communicate and share supplies more efficiently. It was great to be able to share our ideas for improving clinic efficiency during rounds at the end of the day—it felt as though we were making veritable contributions to the future of the program!

To my recollection, clinic day 3 was the day our team seemed to crest the metaphorical hill of chaos that we had trudged up the two clinic days prior. We had begun in Leon as a ragtag bunch–a bunch with hearts of gold, sure—but ragtag nonetheless. Out of the seventeen students on the Veterinary Team, the nine of us from UIUC were the only veterinary students. The remaining eight were still Undergraduate students: the majority of who had never trained with surgical instruments or suture before, and had minimal experience with animal handling and medicine administration. Combined with a short orientation covering perhaps 75% of the skills necessary to work in a clinic setting, our team might have unraveled were it not for the gargantuan patience of the VIDA clinicians, and the amazing drive of the student volunteers.

As one might be able to glean from the above paragraphs, the clinic settings inside “La Abejita” were less than ideal: dim, dusty, and exposed to the outside world, no area could truly be considered sterile. The intense summer heat and humidity sapped focus, and generally turned human skin into something more reminiscent of an amphibian. Even while wearing gloves, I couldn’t help but feel that my hands had continued to accumulate a hefty dirt collection. Thankfully, our group had not come to Nicaragua to for a cozy tropical vacation, so these small discomforts did little to deter the group from our goal. For me, one of the strongest motivators to persevere, despite my apparent distaste for the weather conditions of this particular day (see photo—I don’t think I’ve ever quite frowned as serious as that in my life) , was seeing the considerable line of people waiting outside the clinic site as we arrived at 8AM. Dogs and cats were often malnourished, ill, or wounded to a degree that is rarely seen in the US, however the love that the people had for their pets was evidenced by the very fact that they had waited hours in line to be there. I was especially moved by the amount of children who brought their pets to the clinic (admittedly that might be my gringo point of view romanticizing the situation). One young boy approached me while I was washing surgical instruments outside and began asking questions about a wound on the leg of his family’s puppy. With a serious demeanor one would expect of somebody ten years older, he asked very astute questions about the nature of the treatment. I was moved by the depth of his concern and reminded of the powerful human element that fuels the core of veterinary medicine.

Nicaragua2014D3.5While the environment and some of the medications were markedly different from the ones I was familiar with from back in the States, the clinical aspect of the trip maintained the fundamentals of any Small animal practice. The dogs and cats tended demonstrate more fear or aggression during handling than they did in the US–they’re not as much fixtures of the household in Nicaragua. However, the methods for recording their vital signs and performing physical exams remained constant. We took greater precautions to avoid injury by muzzling every patient (with a shoestring, no less!), but restraining techniques were found to be no less effective despite of the change in longitude! We did have our share of fractious cats and snarling dogs, which occasionally required some assistance from the seasoned VIDA technicians and veterinarians–at least one of those occasions resulted in a cat hanging by the teeth from the leg of an aforementioned VIDA vet.

If anything, the experience taught me that pets in the United States are far too prissy about the conditions of their toenails. I had seldom met a dog or cat in the US that had any sliver of affection for a good old fashioned toenail trim, yet in Nicaragua the patients were so calm about it that I could hardly believe that they weren’t sedated beforehand! It was perhaps the most mind-blowing revelation of the trip.

Surgery certainly had its share of novel experiences as well, and probably bolstered my confidence as a clinician more so than any other portion of the clinical setting. Since hauling around several gas anesthesia machines would be cumbersome, expensive, and dangerous (look up a video of a compressed oxygen tank exploding if you don’t believe me), VIDA opted instead for induction by chemical anesthesia. A simple intravenous injection of Ketamine and Diazepam (Dogs) or Acepromazine (Cats) induced an animal into an anesthetized state. Monitoring the patients under chemical anesthesia was a completely different animal from the cushy life of using easily-controlled gas anesthesia, but in doing so I learned to be attentive, methodical, and very effective in maintaining an animal at a safe plane of anesthesia.

Nicaragua2014_D3.7The main reason that I chose to participate in the program was the opportunity to perform surgery, and I must say my expectations were met and subsequently surpassed. Drs. Faran Dometz, Jasson Figueroa, and Emilia Casco demonstrated patience at the surgical table that I never would have expected given the heat, humidity, and frantic pace of the clinic. Even during my two ovariohysterectomies that developed “complications” that afternoon (thereby earning me the nickname of “Mala Suerte Zacharia”, or “Bad Luck Zach”), the doctors never once lost their cool or resorted to snapping at myself or the pre-vet student I was paired with. Performing surgeries on actual patients was made even cooler by the careful yet trusting guidance of the attending veterinarians. I can’t quite express my gratitude for their commitment to ensuring that we constantly strove to refine our technique, as well as helping us break our bad habits. They truly made volunteering for a great cause feel even greater!

Nicaragua2014_D3_7After clinic day 3 the pieces really started to fall into place. After that day, the heat didn’t seem to get to me as much; we stepped up our rate of surgeries per day, and ultimately started working like a beautiful grandfather clock made out of humans (figuratively, of course). My experience in Masaya helped me to realize that even our group of Americans, spoiled though we were with the access to state of the art veterinary resources in the US, were tough enough to slug it out in a minimalist clinic environment. If this experience couldn’t have reinforced my desire to practice veterinary medicine, I don’t know what would have. What really could’ve use some reinforcement is my right ankle, though…
-Zach Kline