Mange, Ticks and Maggots, Oh My!

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The island of Koh Samui in Thailand has a vibe unlike anywhere I've visited in Southeast Asia to date. Crass and commercial are the flavours of the day; Shops selling knock-off clothing and cheap watches line the main streets interspersed with a few really posh resorts we can't afford to dine in, never mind spend the night. We're staying at a great little guesthouse on top of a pub that has a very welcoming atmosphere, as well as the misfortune of being located right down the street from McDonalds, Starbucks, Burgerking, and the 7-11, to name a few. Despite all this, what has really made this visit to the Thai islands worthwhile is the work my two classmates and I have been doing at the Dog Rescue Center Samui (DRCS) over the past two weeks... not to mention a couple of days SCUBA diving off nearby Koh Tao!

Controlled chaos, and I use the term "controlled" loosely, is the best way to describe my first impression of the DRCS. The center, which also rescues cats, actually has two facilities on the island. The smaller of the two doubles as the house of the owner/founder, a German woman named Brigitte, and the larger of the two operates as a dedicated shelter complete with a surgical suite for spays, neuters and other minor procedures. A mob of fifty-odd enthusiastically barking dogs greeted us on our first day of volunteering as we approached the front gate of the smaller of the two facilities. The sweet smell of piss and shit whafted through the air as we opened the gate ever so slightly and slipped in, being careful not to let any of the "inmates" escape. Fending off dirty paws left, right and center we made our way to the front door of the house and entered, only to find Brigitte chastizing her Thai staff through way of an interpreter. This would prove to be our first of taste of the politics at the center, but not our last.

There are a total of about 300 dogs that the DRCS cares for, and while most of them are in relatively good shape save some ticks and maybe a little mange, there are others which are in pretty dire straights. The condition of these dogs is not something that a Canadian would be used to seeing, at least not outside of the intensive care unit of a veterinary hospital. Gaping wounds crawling with maggots, encrusted faces, or paralyzed hind ends which have been draged until the skin is raw are not uncommon. All of these animals are under the charge of a single veterinarian, Dr. Sid, and 9-10 Thai staff who are all very nice people, but probably not the hardest workers money can buy. As student veterinarians, we were put straight to use, but have faced a few limitations along the way.

Limitation #1: Our own knowlege, or lack there of. After two years of veterinary school I have learned quite a bit, but the truth is I have probably forgotten even more. Would be nice if I still had the spectrum of activity of all the anti-microbials memorized from my POD course, but somehow that sort of stuff didn't manage to stick much past the exam. There are no textbooks to refer to, and there is no internet on site so we are often left to search out Dr. Sid, or to go with our best guess.
Limitation #2: Lack of diagnostics: There is essentially no diagnostic testing done at the center. No blood tests, no bacterial cultures, no viral antigen tests, etc. Again, we are often left to go on our best guess as to what a particular affliction might be, and as such treatment is usually not as effective as it could be.
Limitation #3: The language barrier. Many of the drugs used at the center have labels written in Thai or German, and some of those written in English don't have all of the information you might expect (who needs to know the concentration of that drug anyway!) Obviously, this causes some problems. In addition, there is a fair bit that gets lost in translation when talking to Dr. Sid. His english is passable (my Thai is more or less non-existent), but we often have to settle for only partial answers to our questions. He is a man in great demand at the center (between us, the other volunteers and his regular duties he gets pulled in seven different directions at the same time) so we try and bother him as little as possible unless we are working directly with him at the time. There is some conflict between him and Brigitte (more later), but thus far he has been nothing but friendly, patient and understanding with us.
Limitation #4:General lack of organization. In all fairness, Brigitte and the rest of the staff are working with limited materials and man-power. There are so many animals at the center, with more arriving every day, that some inevitably fall through the cracks. There are plenty of dogs without records and records without dogs. When you are trying to track down every single one of them to do a physical exam and to administer dewormer and vaccinations this becomes an obvious source of frustration, but such is life.

There have actually been three other veterinary students from Edinburgh University whose time at the center has more or less overlapped with ours. While this means we may have received a little less one-on-one time with the Dr., it's been nice to pick the brains of our European counterparts, and it's also nice to have someone to share a few drinks with in the evening. Despite a few shortcomings, this placement has been a fantastic opportunity. There has been ample chance for us to practice our clinical skills, and I have even managed to get in a few firsts of my veterinary career, namely my first surgery and my first euthanasia.

To date I have spayed two dogs and neutered another, although surgical technique is note quite as rigorous here as they are at the OVC. Asepsis is more or less a foreign concept.... Surgical drapes? Forget about it. Autoclaved instruments? Not here. Sterile gloves? Why bother? How about scrubbing in? Not necessary! In truth, we have actually been doing surgery in our bare feet here as you have to take your shoes off before entering the surgical suite (as you do in many buildings in Asia) to try and keep the room at least remotely clean. The learning curve has been steep, and maybe a little shaky at times, but in the end my first surgical experiences have been very satisfying. Shortly after making the initial incision on my first spay, there arose a commotion outside as a fight broke out between some of the dogs. A few of the other volunteers ran in in a bit of a panic so Dr. Sid rushed out to help, leaving me standing there, quite literally with a uterus in my hand, not entirely sure what to do next. He did come back eventually to offer a little guidance, but he has shown a great faith (perhaps too much) in leaving us to our own devices. On a few occaisions I've asked him what sort of technique he would use in a given situation. Would you use suture pattern A or B? Would you cut here, or there? Inevitably the answer is always "You choose technique"... What he doesn't understand is that at this point I simply don't have a technique! Regardless, I've managed to muddle through all three surgeries some how and I am happy to report that all of my patients are still alive and kicking!

Euthanasia, on the other hand, is more of a touchy subject and seems to be the cause of alot of tension between different factions of the staff. The Thai staff, including Dr. Sit, are Buddhists and the concept of euthanasia is not really something that is easily reconciled with their faith. Because of this, many animals are probably left to suffer longer than necessary as the practice is used only as an extreme last resort. Even though the chance of recovery for a particular animal may be less than zero, they always tend to put off the inevitable. This pisses Brigitte off to no end, and we have been asked to step in and intervene in a few instances. It's a delicate balance. You want to do what is right for the animal, which in these cases are obviously suffering, but have to be careful not to step on the toes of any of the staff at the same time. The technique used is identical to that back home (sedation followed by IV pentobarb overdose), but both of the ones I've carried out personally required direct intracardiac injection as the animals were too dehydrated to hit any veins. It's been emotional putting down some of the animals we've been treating in the days prior, but in the end it's all for the best and good experience for something that I will unfortunately have to deal with throughout my career.

Today we said our sad goodbyes to the dogs and the staff at the DRCS. Maybe I'll come back in a few years time when I feel I will be a little more useful! In the meantime, we're heading out for Lampang (Northern Thailand) early tomorrow morning to save the elephants. More later.... until then feel free to find out more about the DRCS by clicking samuidog.org.

Mike

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Photos

Demodectic Mange
Severe case in a husky cross