Journal

June 3 Sunday

We pack and prepare to leave Managua for our target destination, Sabana Grande, early tomorrow morning. We have spent the last two days in a forest (Reserva National Volcan Mombacho) where we spied on sloths sleeping in the trees, and other native species like frogs, snakes, lizards, insects, and howler monkeys in their daily lives. While in the forest, we trekked around with guides who pointed out indigenous habitats and species, we assisted with mist-netting bats and examining them, and we slept in hammocks. An amazing weekend spent as tourists. But tomorrow we would board a bus to begin our real job, that of asking local Nicaraguans their ideas about if and how One Health could be implemented here. We, ourselves, really didn’t know if or how to ‘practice’ one health here, and we also had no preconceived notions about the information we would elicit from the villages of Nicaragua. 

June 4 Monday

We arrived at the ‘Grupo Fenix Solar Restaurant’ which is barely a ‘spot’ on Pan Am highway 1, one you would certainly miss if you blinked. First, a little information about Sabana Grande. It is a very small village located in the region of Totogalpa which sits in the northern mountainous part of Nicaragua. It is one of the poorest regions in the country following political conflicts, and has been seriously deforested over the past several decades due to recent unsustainable agricultural practices. Wood is collected for cooking and trees are cleared for grazing, rendering the land eroded and the region with severe water shortages. One recently organized group of women, Las Mujeres Solares, has a novel and significant purpose here. Headed up by founder, Susan Kinne, their focus is building and selling solar cookers, teaching renewable energy and operating the Solar Restaurant for volunteers and people passing through the area on Highway 1. But the heart of this story is really the people and animals of Sabana Grande. Today, we spent the morning in the human medical clinic with the medical students from MEDICOS (mentored by Dr.Michael Wilkes, UCD Med School) where we sat with Nicaraguan doctors and witnessed them diagnosing and treating the illnesses of many locals. By the end of the morning, I realized some things that I hadn’t thought about since I was in the International Red Cross treating refugees in the 1980’s. First, the doctors treated lots and lots of people, many more than clinics at home. And they ‘treated’ them with very little. They seemed to take histories and physical exams, diagnose syndromes and diseases, and treat them all, with 5 instruments (stethoscope, sphygmomanometer, thermometer, tongue blade, and penlight) and a basic hematology lab. Next, and the most exciting, was the connections that were made between humans, their animals and their environments. Over and over the questions were asked about where they live, who they live with, what they ate, and what animals were around. My translator told me of cases of ‘worms’ in children, and renal failure in young men (believed to be from pesticides used on crops), bug-bites that cause disease, and widespread malnutrition (in the form of obesity and diabetes). Thoughts were just springing to life in my head about nutrition and healthier food/animals and toxins and pesticides and vector-control and education, and on and on. And now I know that one health connections are already being made, if we can only figure out where to go from here.

June 5 Tuesday

Yesterday while we were at the clinic, one of the physicians mentioned her good friend, Odell, who is known as the local ‘vet’. She contacted him and suggested that we spend time with him. And that is what we did starting at 5 am today. He immediately invited us to go out with him and his assistants on a day of farm-calls. We loaded into the back of an old pickup and rode for a very long time down some very bumpy, dusty roads to get to a ‘spot’. This spot was going to be the clinic for the morning. We soon saw farmers leading their cows to this spot. Within minutes, Dr. Odell was treating sick cows. This seems to be the norm for treating farm animals here, schedule a day at a convenient ‘spot’ and let the word spread. We saw cows with “verrugas” (warts), did pregnancy checks, many assorted other large animal maladies (many are a mystery to me because I have forgotten much of my ‘cow medicine’) and then set out on foot to more remote farms for afternoon calls. I was imagining that the practice of veterinary medicine here seems to be what medicine was like in America early last century. Where diagnostic tools would fit into one bag, house calls were the norm, and making 4 or 5 house calls makes a very long day. All I can say at this point is how amazed I am at the distances they travel by foot, up and down steep inclines, through valleys and peaks, to places with no physical addresses and no roads, just to ‘see’ one or two animals. Wow, are we American veterinarians spoiled. Needless to report that it was incredibly fun and eye-opening to practice medicine this way, but believe me, I was beyond exhausted by the time we were done for the day. In a good way, of course! 

June 6 Wednesday

Today our goal was to continue to meet members of the community by administering our One Health Assessments to households throughout Sabana Grande.  In planning our approach, we needed to consider how the community would perceive our presence and how to collect the most useful information.  Our intention was to establish relationships, explain our purpose, and to gather information to direct future One Health initiatives.  Establishing a good rapport with community members was vital to our success and we were fortunate to have Susan Kinne, Director of the Alternative Energy Program for the Grupo Fenix, as a liaison within Sabana Grande.  Susan arranged a meeting with participating members of the solar initiative that were community leaders, which allowed us to formally meet and explain our presence and to begin our questionnaires. Following this meeting, we were able to visit several households to discuss animal health, human interactions with their animals, and human health.  Susan was very generous with her time and accompanied us on our surveys, which helped lay the foundation of trust with many families.  The people of Sabana Grande were very welcoming and shared many unique and personal stories, which were invaluable in helping us understand how animals are used and regarded.  

June 7 Thursday

With Susan’s assistance, we continued to visit households around Sabana Grande to complete more of our One Health Assessments.  By collecting data from around the entire community, we ensured that the information that we were gathering was not biased and was truly representative of Sabana Grande.  Completing these surveys in this manner ensured that we gathered the appropriate information that would help us tackle some of the important One Health issues.  Following morning surveys, we had scheduled a time to visit the local school to talk with them about animals.  We brought children’s coloring books that addressed basic animal husbandry and health and plenty of crayons to the school, and had the kids draw their favorite animals and share those animals with us.  After the students shared their drawings, we discussed what a veterinarian does and had the kids use stethoscopes to listen to each other while acting like their favorite animals.  Before leaving the school, we gave a soccer ball as a class gift for excellent drawings and full participation.  By interacting with kids, we not only had an opportunity to discuss what it means to be a veterinarian but we also wanted to continue to form relationships for future trips when we will be implementing One Health projects and programs.

June 8 Friday

Today was a sad day. Pretty boy, a dog taken in by our village mentor, Susan Kinne, has been sick for a few weeks. Earlier in the week Susan had quietly asked us what we thought about his lethargy and anorexia. We could not answer that question with any medical certainty because outside of a small first-aid bag, we had no supplies, tests or medical equipment. It was impossible to guess. But this was Susan’s humble way of asking for help, and I strongly felt that it was not an option to do nothing. With the small amount of ‘supplies’ in the first-aid kit, we rigged up some basic sub-q fluids and administered these. But we needed more. We thought of Dr. Freddy Guerrero, a veterinarian whom we had met at his farmacia in the town of Ocotal. We called him and he immediately offered to come to Sabana Grande and make a ‘house-call’. Within an hour or so, Dr. Freddy was treating Pretty Boy. He gave him antibiotics and IV vitamins, and other treatments. He stayed for a long time, treated other village dogs that were brought to Susan’s house while he was there, and eventually left us with treatments for Pretty Boy for the next few days. But Pretty Boy died the next day.

These are the moments when I feel the most helpless and inadequate. And there are never any perfect words or justifications. We will never know why Pretty Boy died. But when you really look closely at life here, this is the reality. We actually witnessed more death and way too much sickness here, in all species. And it does feel hopeless sometimes. And as desperately as I would love to be able to return with a plan to treat all the sick dogs, cats, chickens, and pigs, I don’t believe that is the best use of resources. I will leave here reaffirming my belief that prevention is likely to be a better focus for healthcare than secondary or tertiary efforts. Armed with this reality, we can now strive to make future plans for One Health through preventive lenses.