They say that travel broadens the mind, and our recent WVS adventure to Chiang Mai in Northern Thailand was most definitely mind-stretching in both a professional and personal sense.
Our destination, ‘Care for Dogs’, was set up in 2003 by Karin Hawelka and Amandine Lecesne next door to Karin’s family home, and currently houses and cares for around 140 dogs, about 50% of whom have medical problems needing attention and/or daily medication.
Unlike animal shelters in the UK, the dogs are housed in large social groups (which from time to time are a bit less sociable), and it is fascinating to observe the dynamics of the groups and their daily routine. Thatched shelters with wooden platforms allow escape from the intense heat and to allow individuals some personal space away from the pack. This mode of housing seems to work well. Karin is ably assisted by her Centre Manager, Ally, and two local Thai helpers plus a Burmese guy. In addition, there is a loose network of volunteers who come in and help to walk, bath, feed and muck out, as well as assisting with various fund-raising activities.
The objectives of the charity are to provide a place of safety for homeless and abandoned dogs especially those threatened with being killed, to educate people, and to reduce the unwanted dog population through sterilisation.
Our mission was to get the new operating facility up and running. We had been permitted by Thai Airways to bring an extra 20kg of luggage – a hard suitcase crammed with drugs, iv catheters, dressings and surgical instruments. I am still astonished at how easy it was to walk through the Customs Hall at Chiang Mai airport, with only a cursory examination of (fortunately) another bag of personal stuff. Presumably the x-ray cameras and sniffer dogs had already passed our suitcase packed with veterinary equipment as ‘uninteresting’.
Twenty four hours after leaving Heathrow, via Bangkok,, we were warmly welcomed at Chiang Mai airport by Karin, who took us to our simple but comfortable hotel a mile or so from the shelter. Our fellow hotel guests were mostly students enrolled on a month’s course to qualify as teachers of ‘English as a foreign language’. I was hoping that the lake around which the accommodation is built would be suitable for a refreshing swim, but discovered the next morning that the loud splash I heard was not a human diver, but a shoal of carnivorous catfish leaping for food!
Next morning, Ally gave us a guided tour of the shelter and briefed us about some of the medical and surgical patients that were awaiting treatment. A local Thai vet, Dr Than, had arrived with her nursing assistant to administer i/v Vincristine to a number of resident dogs suffering from Transmissible Venereal Tumour – a common occurrence in that part of the world. The tumours did indeed appear to regress completely after several weekly injections, after which the affected dog would be neutered. The Thai employees at the shelter were clearly very competent at catching and holding dogs, if necessary using a blow-dart loaded with Zolatil!
We next discussed how best to use the newly-built extension, and agreed that the central room between some holding kennels and the new operating room would serve as an ideal prep room and examination area, and keep the patient flow away from the office and reception area. Ally asked us what basic furniture would be required in the operating room, and we set off to Chiang Mai to search for a couple of dressing trolleys and a drip-stand or equivalent. In the event we found a hat-stand in a furniture warehouse, which actually proved more versatile that a surgical steel drip stand! Extra blankets were also needed for our post-op patients, and we found those in a covered market next to a stall selling a mountain of dried fish and buckets of live eels. By the end of the day we felt that we had a functional operating facility, had reviewed the medical management of several cases and had our ops list ready to go the next morning. We added to our list a kitten (‘rescued’ by a local volunteer) with severe skin deficit wounds on her back and a de-gloving injury to her tail.
We had been warned about the likelihood of intra-operative haemorrhage, and indeed it proved to be the case. Most of the dogs have a low-grade Erlichia infection transmitted by ticks, and concomitant platelet destruction via an auto-immune mechanism. We saw it in its most acute form in a little old collapsed Poodle which bled profusely from a subcutaneous injection site, and sadly did not respond to treatment.
Our surgical patients were pre-medicated with Domitor/Torbugesic, and once sedated, had an i/v line inserted for fluid administration and to top up anaesthesia with Ketamine/Diazepam in equal volumes. Every case had Metacam on board for analgesia, and pre-operative antibiotic, as, although we maintained as aseptic technique as possible, we had to rely on chemical sterilization of instruments. Having said that, we did not encounter any post-operative infection of our cases during the two weeks we were working there.
Typically our surgical case load was a mix of dog castrations and bitch spays, some in oestrus, and some with large cystic ovaries and endometriosis, probably as a result of multiple heat-suppressing injections, that dog owners buy over-the-counter!
One of our patients, Sing-Too, the subject of physical abuse resulting in a depressed fracture of his skull and recent eye enucleation, subsequently needed a scrotal ablation as a result of what looked like infected bite wounds. Poor old Sing-Too also suffered three days post-op from a right-sided neurological deficit of his fore and hind limbs and also his tongue, making ambulation and prehension of food difficult. However, he seemed to respond well to Prednisolone and Baytril, and we are hopeful he will make a full recovery.
Some of our days were constantly interrupted by what seemed like an intensive-care facility in the prep room, with several dogs in cages needing iv fluids, vetergesic and regular monitoring. It meant disruption to the flow of routine ops and curtailed the potential volume of surgical work. Fortunately WVS had sent two vets (Caroline Humphrys and Liz Philo), and we could take turns to be surgeon and surgical nurse when required. It was also helpful to be able to confer on non-elective cases and agree the prognosis and best line of treatment.
Pet ownership is very different in Thailand, where most dogs appear to live on the street or around temples, and have a loose relationship with the people who feed them. Providing that veterinary care is available and sought when necessary (sadly not always the case), one could imagine that the situation is in some ways more ‘natural’ for a social animal than for some of our pets who are confined alone in a tenth floor city apartment whilst the owner is out working.
We were extremely well looked after by our hosts, who made sure that we saw something of the local area and were able to sample some local delicacies. Meals in local restaurants were a welcome change from our hotel, where the set dinner menu was a bit variable to say the least! Chiang Mai is a vibrant and colourful city, most especially the ‘Sunday Walking Street’ (night market) where we bartered for most of our Christmas shopping (Caroline by this stage had a whole empty suitcase!).
A very special highlight of our trip, also organised by WVS and Care for Dogs, was a two-day visit to the Elephant Nature Park, which rescues working (and often abused) elephants. Since logging was banned in 1989, out-of-work elephants have been used by their mahouts for street begging and various tourist attractions. An inspirational Thai woman, Lek, works tirelessly to raise political awareness of the problem and to provide sanctuary for these rescued elephants in a semi-wild 150 acre park (purchased by a Texan millionaire for the purpose). Lek’s aim is to eventually return these elephants to the jungle, where, over the last decade, Asian elephant numbers have declined from 100,000 to an estimated 3,000. We had the opportunity to meet with Lek and see first-hand the amazing bond she develops with these gentle giants. We were also able to deliver some drugs donated by WVS. It was fascinating to see how a very professionally run eco-tourism enterprise can generate serious funding for such a worthwhile project, and a waiting list of volunteers willing to undertake the hard physical work required to care for the elephants.
After our two day ‘holiday’ with the elephants it was good to get back early next morning to the shelter at Care for Dogs and to pick up on our cases and start operating again.
The time went all too quickly – such a fantastic opportunity to experience a radically different culture, learn about a range of diseases hitherto unknown, take up the challenge of setting up and running a functional veterinary surgical unit, and the satisfaction of passing on some of the experience and expertise gained through practising as a vet in the UK.
A big thank you to WVS and Care for Dogs.
Liz Philo November 2009
