Packing the medical kits for our first project away from the MAWS clinic

Now that we were old pros by MAWS standards, we were deemed ready for a few days of work away from the clinic- “trench medicine” by our spoiled brat North American standards. It would be an easy couple of days- Bronwyn, a MAWS supporter, had donated the veranda of a house on her property as the site of our first off-site project. With a packing list and much assistance from Cephas we loaded the truck and the Venture with everything we would need for the next couple of days. It was an easy 20 minute drive to the site on the opposite end of Maun in ‘the ‘burbs’: still in town, but far enough away from the clinic that we could help a lot of people who wouldn’t be able to get there simply because they didn’t have transportation. Providing a couple days of work in this location would provide veterinary assistance to a significant number of people who may not otherwise have made the effort to have their pets seen.

The CAAT crew unpacks and organizes for our first project away from the MAWS clinic

As we would learn over the next two projects, things move slowly in Botswana. We arrived semi-promptly and set up shop in the front yard of what would be considered a swinging bachelor pad in a different part of the world. The home was rented, but the tenant had graciously vacated for a couple days so we could work unencumbered under the shelter of the veranda. A couple of major bonuses, as we would learn, were a bathroom, a fridge, and running water.

A truckload of dogs brought from the surrounding area

We were set up and ready for business by 11, but despite Nation’s ground work announcing the project in the neighborhood, there was not much action. Cephas and Gwen, an ex-pat Coloradan, hopped in the truck and headed off to points unknown. They arrived back a half-hour later with a truck partially full of dogs, collected from the surrounding neighbourhood- enough to keep us plenty busy for the rest of the day, finishing up with 10 surgeries, including a very sloppy spay, and a cryptorchid neuter.

Chris preps and monitors a patient for surgery

Surgery under these conditions is a bit of an adventure at the best of times: outdoors, no surgery lights, no machines that go ‘bing!’. I’m relatively new by by CAAT  standards, but feel I’m game for pretty much anything, but without the amazing assistance provided by Chris and Anette, our super-techs, Jen and I would be lost. There is an art to monitoring anaesthesia with nothing more than a

Leah monitors several dogs post-surgery in the 'recovery ward'

stethoscope, and Chris and Anette perfected these skills while in Botswana. Leah proved herself indispensable drawing up all required medications, and monitoring the dogs through their recovery. Our recovery ward consisted of several blankets spread out at the end of the veranda opposite to the surgery and several leashes/lassos that we’re used to catch escapees as they tried to stagger away.   When the time came to close shop, we still had a handful of sleepy dogs at the clinic with no owners in sight. No problem: we’d drop them off back in the village whence they came. We followed Cephas down a maze of rutted dirt roads to a place your mind might conjure up if someone made reference to the ‘middle of nowhere’: a cluster of cinder block huts

The centre of the village where we, apprehensively, left the remaining dogs at the end of day one.

surrounding an open space, construction rubble piled in a corner, no human inhabitants to be seen awaiting the return of their pets. Cephas picked up one of the patients and I followed suit, carrying another dog to the clearing. We put them down and went back to get the other two. By the time we returned, one of the dogs had managed to get up and stagger away, and the other was doing it’s damnedest to do the same. As we drive away, we we’re all more than a little unsettled about what we’d just done. Our pets receive 5-star care compared to these dogs, but we were told not to worry- the dogs know their way home. A follow-up call the next day confirmed just this.

They were lined up at the gate when we arrived on Day 2

Day 2 on Bronwyn’s veranda broke bright and early. We picked up a few extra supplies and headed directly to the site crossing the ever-so-polite one lane bridge again with perfect manners (unlike the day before). When we arrived, we found two young boys sitting outside the gate with their recently pregnant dog- our first patient. They were followed by a seemingly endless stream of dogs of various shapes and sizes, including an 8-week old Jack

We were busy all day long- pet owners stayed and watched their pets' surgeries from beginning to end

Russell pup that waddled over from the neighbour’s, managing to duck both the electric fence separating the two yards as well as our scalpels (neutering, it seems, knows no age limits).  A well-roasted chameleon we found attached to the fence in a rather crispy manner wasn’t quite as lucky.   Mid-afternoon I found myself preparing to spay a 5 year old English Bull Terrier- the noblest breed known to man, (only because I happen to live with one). Both her markings

Spaying Dolly, the racist English Bull Terrier

and her demeanor reminded me greatly of our dear Olivia apart from one flaw. This dog was racist. She was born and raised in Johannesburg, but the owners maintained she had not undergone any such aversion training. She just didn’t like blacks. Since all of our patrons that day, apart from the lovely women who brought the dog to us, we’re black, this proved to be a wee bit of a problem. We had them back their Bucky into the yard, covered the windows on three sides with blankets to avoid exposing her to any ‘stimulus’, and carried on business as usual. She was a wonderful, thick-headed beast. Full of love for anyone who gave her attention typical of the breed, with obvious exceptions that we did not test. All went well with both the surgery and upon recovery the owners drove her off into the sunset. In circumstances like these, where the owners are obviously not financially strapped, a mandatory ‘donation’ is accepted to support MAWS.

At the end of the school day, the audience grew substantially

We returned to the clinic at the end of a long day, unpacked, and decided this would be a good night to explore Audi Camp (Audi is the owner’s name). This was a

The Main bar at Audi Camp

hostel/hotel/restaurant/campsite, recommended to me by a friend, which turned out to be remarkably close to the clinic, and in a roundabout way (pun firmly intended if you know the geography) directly on the way home for us. We had made arrangements earlier in the day to connect with Dr Rob Jackson, the local veterinarian, and pick his brain about veterinary medicine in Botswana. He was more than happy to connect at Audi Camp. He is one of

The shooter menu at Audi Camp: Croc Fodder, anyone?

about six private practitioners in the entire country, so he’s a busy man. He  deals with both domestic and wildlife species: everything from house cats to elephants, so his work often keeps him away from his home base. In general, he approves of the work MAWS does with regard to population and disease control, but as we’ve learned through other CAAT projects, there are always those who want to take advantage of a good thing- discount veterinary services in this case. We learned there was a fine line between doing good and infringing upon someone’s livelihood.

More Soon!

At Yaletown Pet Hospital, we like to keep on top of current developments that we feel may enhance how we practice veterinary medicine. To that effect, over the past few years we have acquired several new ‘toys’ that we now find indispensible: dental x-rays, digital x-rays, and an in-house blood analyzer, to name a few.

LiteCure Companion Therapy Laser

LiteCure Companion Therapy Laser
To this list we have recently added a Class IV Therapy Laser. This is not the James Bond, cut-sheets-of-metal-in-half variety. And while this type of laser is in the same class as cutting lasers used in surgery, its effects are much more subtle. Therapy lasers are used to enhance or promote tissue healing by using infrared laser energy stimulating tissue at a cellular level.

Think back to High School Biology class- within the nucleus of cells in every tissue are energy-producing bodies called mitochondria. The mitochondria can be stimulated by exposure to light of a variety of wavelengths. The infrared wavelengths produced by therapy lasers not only stimulate the mitochondria very effectively, but can also penetrate well below the skin surface to stimulate cellular activity and tissue repair in deeper tissues- a process known as photobiostimulation.

This enhanced cellular activity produces multiple beneficial effects: pain relief, reduction in inflammation, and accelerated tissue healing. The applications for such a therapy modality are numerous, and we hope to be able to introduce laser therapy to a large number of our patients to enhance our current treatment of various disease conditions.

Several health conditions in your cat may be helped with laser therapy

Almost all inflammatory conditions, chronic and acute, can benefit from laser treatment. Acute diseases like ear infections (those nasty, red, hot painful ears that your dog won’t let you touch), bladder infections and inflammation, and hot spots can benefit. Chronic conditions like arthritis, back pain, and stomatitis (painful inflammation of the gums seen often in cats) are equally likely to benefit.

Many of your pets’ conditions may currently be well controlled medically- non-steroid anti-inflammatory medications for arthritis, for example. Addition of a treatment modality like laser therapy may reduce your pet’s dependence on medication, and in some cases may allow us to stop medications completely as the cumulative effects of laser therapy become more evident.

For acute conditions, your pet may require only one or two treatments to reap the benefits. For more chronic conditions, a series of treatments will likely be recommended, starting with two or three treatments per week (again, the effects are cumulative). Once improvement is noted, we can reduce the frequency of treatments, eventually weaning down to a maintenance dose, which may be as infrequent as once every 4-6 weeks.

A Therapy Laser can help many of your dog's health problems

We will also recommend incorporating a laser treatment in all our elective and non-elective surgeries, as well as with every dental cleaning. The benefits of these treatments are enhanced tissue healing and reduced post-surgical pain and inflammation.

If you’re interested in learning more about how our therapy laser can benefit your pet, feel free to contact us by phone or e-mail, or check out the Companion Therapy Laser website at: www.companiontherapylaser.com

The Internet gods were not smiling upon us. At 256kbps at best, with regular but unpredictable crashes, maintaining a blog from Botswana would have taken the better part of each and every day. Instead, I admitted defeat, kept notes, and took lots of pictures.

Istanbul (not Constantinople)

The Yeni Cami Mosque in Istanbul

The first leg of my journey took me to Istanbul. Traveling on air miles points forces you to follow an itinerary you wouldn’t necessarily have considered. When Istanbul was suggested as a stop before heading south to Johannesburg I decided to take advantage of it and sped some time with a friend there. Baris Sahan worked at the clinic for a couple years as my assistant and was currently living there, so I figured I’d get in a quick visit and a tour of the city by a local.

Looking from Europe towards Asia from Leb-i Derya Restaurant

Istanbul is an ancient, sprawling, beautiful city- a single day there could never do it justice. My day was spent battling a sleep deprived buzz while cramming as much into it as possible: a tour of the spice market, a wander through the maze-like Grand Bazaar,a traditional kebab lunch, a very relaxing Turkish Bath, and finishing with the best baklava on the planet. I was put back on the plane well fed, and nursing a bit of a buzz from a couple shots of Raki- the (vastly superior, I was told) Turkish equivalent to Ouzo. I slept quite well all the way to Johannesburg.

Botswana Bound

Foggy weather greeted us in Jo’burg. My plane managed to land, but my colleagues were diverted to Gabarone and arrived 3 hours late. Having met Chris Robinson and Annette Pecak, the two techs on our team, a year prior I knew vaguely who to look for, but had to pay close attention with arrivals converging from two directions and dumping into the arrival area. Looking between the signs held aloft by the various greeters, I eventually spotted the group- Canadians in Africa seem to stand out. We made our introductions over lunch and made our way to the Air Botswana counter to pick up our boarding passes for the last leg of our flight: Maun via Gabarone.

Rush Hour on the morning drive to work.

An uneventful flight with a brief introduction to Botswana culture in the form of Peolwane in flight magazine, a couple cans of St. Louie light beer- the national brand- and a bag of biltong, the local dried meaty treat. We were met by Ally Lamb, a MAWS volunteer, and Jan Possemiers, who along with his wife Virginia, another volunteer, were our hosts for our stay. Judging by the lights we saw flying in, Maun is a sprawling but sparsely populated community. Our drive to Jan and Virginia’s home proved this: six kilometers outside of town down the tar (paved) road, followed by another two down a bumpy single lane dirt path. ‘Pay attention’, Jan said, ‘You’ll be driving yourselves to the clinic. Tomorrow you’re on your own’.

Chris with Wawa and Lyla

Welcome to Maun

Virginia greeted us warmly, showed us to our respective rooms- me in the house, and the ladies in the cottage- and after meeting the inside dogs (Juanita, Wawa, and Lyla- all Chihuahuas) and Tabby and Mitzi- the only two of seven cats trustworthy enough not to wander off the property and into the mouths of whatever predators might lurk beyond the fence- we sat down to dinner and got the lowdown on Botswana politics, Maun society, and MAWS. Both Jan and Virginia are wonderful cooks, as would be proven time and again. Food was never in short supply and I returned from my trip 5 stubborn pounds heavier!

Goats in the Roundabout

We woke the next morning rested and relatively refreshed. After breakfast, we were escorted to the MAWS clinic several miles away on the property of the founder, Mervyn Palmer. Jan led in the ‘bucky’, a small pickup truck, and we followed in the Venture- a reliable but gutless Toyota van that served us well for the next two weeks. For no apparent reason I took on the role of chauffeur, and followed Jan down the dusty road to the tar, across the Thamalakane River (dry for many years until 2009) on the new bridge, 3/4 way around the roundabout and whatever livestock happened to be resting on the road- an interesting experience for us left-hand drivers, and then a right turn at Exit 10 (someone had stuck a reflective 1 & 0 on the back of a Stop sign) just past the chicken farm. Another twisty, rutted dirt road, a pause while we waited for someone to hop out to open and close the security gate, past the psychotic Border Collie, who pursued the car with a frightening intensity EVERY time we drove past, and then the only marginally less psychotic Malinois, and on to the Palmer compound and the clinic.

Veterinary Medicine African Style

The MAWS Clinic

We made a quick inspection of the clinic and the attached outdoor kennels, already full of dogs, before meeting Mervyn Palmer. The clinic was nowhere near the level of those we practice in back home, but appeared to be very functional and well equipped. Mervyn came down and introduced herself over coffee- she is strong, big- hearted, passionate woman who sounds like Bette Davis with a South African accent. She explained the history of MAWS- its growth from a two person  hobby project (her and her assistant Nation) to its current incarnation- and its objectives. And then it was immediately to work.

Before we left Canada, we were brought up to speed on what medications would be available in order for us to familiarize ourselves with their anaesthetic and surgery protocols. We would not have access to gas anaesthesia, the standard in most North American practices. Instead we would be using injectable medications only. All animals would be sedated with Xylazine- a medication I hadn’t used for over 15 years- then an IV catheter would be put in place (using perhaps the worst adhesive tape known to mankind). The patient would then be anesthetized with a combination of Ketamine and Valium by IV injection. Once we overcame our initial apprehension, mostly brought on by unfamiliarity with the protocol, we became quite comfortable and efficient using the protocol.

The first dog out of the kennel and onto the table was an evil little white Maltese-looking beast- not a good introduction to the next 2 weeks. Added to his ill temper was the fact that he was a bilateral cryptorchid- neither of his testes had dropped into his scrotum- a trait we learned was rather common in the local dogs. The surgery went well, the recovery was smooth, and we learned his attitude was the exception rather than the rule for the dogs we would be dealing with.

Jen does surgery on an evil little Maltese-looking beast

That afternoon and the following day we were able to hone our skills and bring ourselves up to speed using whatever equipment was available. Day 2 went much more smoothly and efficiently, and day 3 even more so with the addition to our team of Leah Burke, a technician from San Diego who is volunteering her services there until the end of June. The additional set of hands improved our efficiency immensely, and after another full day at the clinic, we felt prepared to venture out into the surrounding townships for our first off site project.

Part II- coming soon!

A couple years ago, my colleague, Roxanne Vandermeer, introduced me to CAAT. I was already familiar with the group, but after she went on a CAAT project to help with a spay/neuter clinic in Ucluelet on Vancouver Island I became more interested. I knew of Veterinarians Without Borders, but felt that group was too big for me to really get involved. CAAT seemed to be sufficiently involved at a local that my input could actually make a difference. They also had a reputation internationally that could allow me to combine my career with humanitarian aid and the possibility of travel both within Canada and abroad.

CAAT Ucluelet Project, November 2010

CAAT came together in 2005 under the direction of Donna Lasser, an amazing Animal Health technician based in Vancouver, in response to Hurricane Katrina in New Orleans. As the drama there unfolded, it became obvious that veterinary assistance was going to be a vital part in the rescue efforts. The group took off from there and has been providing veterinary services both in remote Canadian locations and in more exotic locales such as Peru, Fiji and Belize. Wherever they go, their services are greatly appreciated.

I was thrilled when asked to become a board member of the group. It was such a good fit I had to accept. It took a while to take part in my first project (Ucluelet this past November), but the energy and enthusiasm I felt on that weekend was incredible. When I was asked to take part in a project in Botswana, I had no choice but to accept.

Botswana

WHY BOTSWANA?

Botswana is a landlocked country near the southern tip of the African continent. While 70% of the country is covered by the Kalahari Desert, the northwest part of the country is where the Okavango River spreads across the flatlands and creates a huge delta, providing water needed to maintain a lush wetland environment that’s home to a huge and divers wildlife population. The town of Maun is the base for many safari companies located in the delta, and the local economy is dependent to a large extent on the safari industry.

While the human population is generally respectful of the delicate environment, the free roaming dogs and cats of the area don’t necessarily share this respect. They have had a significant impact on the local wildlife, acting both as predators and vectors of disease including rabies and canine distemper (which can affect some feline species like lions, as well). The importance of controlling the dog and cat population has become more evident in recent years.

Elephants have right of way over cars

The Maun Animal Welfare Society, MAWS, was established to address this overpopulation problem. Since the local wildlife and the human population around Maun are so tightly intertwined, an increase in the population of an introduced species can have a devastating effect on a native species. The members of MAWS recognized this and established their non-profit organization to help improve the lives and health of both wild and domesticated animals in the area. By spaying, neutering and vaccinating these animals, with the permission of the people in the villages where the clinic are held, and providing educational programs in and around Maun they are helping control overpopulation and reduce the spread of diseases.

I’ll be away from Vancouver for three weeks. For two of these I’ll be providing veterinary services, spaying and neutering dogs and cats with MAWS. This is a pilot project to see if our group, CAAT, can develop an ongoing relationship with MAWS and potentially be able to provide their group with annual assistance. One benefit for CAAT is increased international awareness of our group. MAWS has set a goal of spaying and neutering 2000 dogs and cats this year. I’m  optimistic that the CAAT team will have a significant impact in reaching this objective and hopefully start an ongoing relationship between our two groups.

Dental care is necessary to promote optimum health and quality of life for our pets.  Diseases of the oral cavity are often painful and can lead to other problems not just in the mouth by in many other parts of the body.

Our pets can have dental issues at all stages of their life.  Young animals can have problems with their baby teeth or the alignment of their teeth.  Adult dogs can break their teeth when chewing hard bones/toys and often suffer from periodontal disease if their oral hygiene is not maintained.  Brushing is the gold standard of oral health care in our pets, just as it is for us, but most pet owners are not aware of this.

Young animals from birth until 9 months of age can have problems with their deciduous (baby) teeth, the most common of which is retained baby teeth.  This occurs if the baby teeth are not shed appropriately when the adult teeth are erupting.  The adult teeth normally erupt between 4-6 months of age.  Most veterinarians recommend spaying/ neutering pets at 6 months of age and their teeth should be assessed at this time.  If they have two teeth where there should be one (ie: 1 baby tooth and the corresponding adult tooth right next to it), the baby tooth should be extracted.  If left in place, tartar and debris tend to accumulate very quickly, which leads to an accelerated onset of periodontal disease.

Periodontal disease is defined as the process that begins with gingivitis and progresses, if left untreated, to periodontitis.  Periodontitis is the destructive process involving the loss the gums, supportive ligaments, tooth structure and the bone that houses the roots of the teeth.  Gums that are swollen and inflamed (gingivitis) combined with chronic infection (periodontal disease) allow bacteria to enter the blood stream where it can seed organs (heart, kidneys, liver etc), which can result in serious infections of these organs.

Periodontal disease can begin as early as 9 months.  The onset of this disease can vary greatly with breed, diet and home care.  Most small dogs have periodontal disease by 3 years of age!! (1).

Dental cleaning

Before any dental procedure is performed a veterinarian should examine your pet and determine their anesthetic risk.

A complete dental cleaning should be performed at a veterinarian hospital because your pet will have to have a general anesthesia.  Anesthesia allows your veterinarian to place an endotracheal tube in the trachea (windpipe) to prevent tartar/bacteria from being inhaled into the lungs and possibly causing a lung infection.  Also, the most important part of a dental cleaning is the removal of tartar and plaque from under the gum line; this can not be done properly in a conscious pet.  Finally the teeth need to be polished, if this step is skipped the microscopic scratches made during the cleaning process will actually provide a rough surface that plaque can more easily adhere to in the future.  It is for these reasons that a “non-anesthetic” cleaning is not recommended.

During a cleaning procedure the animal is placed under anesthesia, at which time they are intubated (endotracheal tube is placed into the trachea) and their heart rate, respiration rate, blood pressure, oxygen saturation, ECG and temperature are closely monitored.  Modern day anesthetics and IV fluids have hugely minimized the risks associated with anesthesia.  The tartar/plaque is removed from the teeth, the area under the gum line is cleaned, the teeth are polished, a detailed chart of the oral cavity is made and further treatments (dental x-rays, local blocks, extractions, root canals, etc) are performed if indicated.  The animal is then allowed to recover and generally can go home the same day as the procedure.

The frequency with which these cleanings are required varies between patients and depends on the anatomy of their mouth, diet and home care (brushing).  There is no treat, diet, water additive or bone that is as good for your pets’ oral health as brushing.  Ideally we should be brushing our pet’s teeth once daily or a minimum of 5 times per week.  Plaque starts to calcified into tartar over a period or 2-3 days.  Plaque can be brushed off, but once it has turned into tartar a professional cleaning is needed to remove it.  Cats and dogs who get their teeth brushed daily will need fewer dental cleanings over the course of their life then pets who do not.  Generally, smaller dogs should have their teeth cleaned earlier and more frequently because their teeth are often crowded and they tend to develop periodontal disease at an accelerated rate.

A healthy mouth makes for a healthy pet and we can extend the length and the quality of our pets lives by keeping their mouths clean and healthy.

Reference:

1. Harvey C, Shofer F, Laster L.  Association of age and body weight with periodontal disease in North American dogs.  J Vet Dent 1993;11:94-105.