A final hello to all! Today marks the end of my Moroccan blog-keeping as Anna and I are leaving the Fondouk tomorrow morning to spend a few days in some of the more southern parts of Morocco before heading home. There is still so much more I could say in this blog, but I am going to keep it short today as to not miss out on any of the eating opportunities that we scheduled for today. Jeremy, Anne, Anna and I already had an elaborate 5-course lunch on the rooftop of the Palais de Fes Dar Tazi, a combination hotel, rug store and top notch restaurant. This food was far superior than the previous 13 days worth of meals combined and the patio was a peaceful and luxurious oasis atop a bustling third world city. Our first course included about 10 little plates of different vegetable salads--a Moroccan anti pasto if you will. We feasted on mashed pumpkins, sweet potatoes, cauliflower salads, lentils and lots of other fun combinations of vegetables that I didn't recognize. Anne had sat us both down ahead of time and given us a serious lecture on the necessity to pace oneself at this meal. We headed her sage advice and were very happy to have enough stomach space for the traditional pigeon pastilla and the chicken tagine that followed. Dessert was a light fruit salad and the final course was coffees and Moroccan tea served with deceptively addicting cookies.
We returned to the Fondouk just a few hours ago to do a final load of laundry and pack our bags which are decidedly heavier than when we arrived. Tonight we're meeting up with the other students, Jeremy and Anne, Dr. Frappier and Houssine, and about 6 other Fondouk employees including several who speak no English or French. We're going out for a farewell dinner and I'm touched that even the maintenance guys want to come with us.
While I hope to have shared the inner workings of large animal veterinary care at the Fondouk, I would remiss not to at least mention the incredible work that is being done on the small animal side. For every two mules we saw, our small animal colleagues were seeing 7-8 small animals. The Fondouk treats everything from cats and dogs to pigeons and peacocks to rabbits and other pocket pets. I saw them do crop surgery on a dove one day and then splint a guinea pig's broken leg the next.
The small animal side has seen a tremendous increase in the number of animals showing up for care. It has gotten to the point where the volume is just too high, largely because people have figured out that the Moroccan veterinarians can't compete with the level of care provided at the Fondouk, not to mention the fact that all care at the Fondouk is free. As you might imagine this hasn't sat well with the local Moroccan veterinarians. Also, the Fondouk was established in the late 1920s, specifically to serve the working animals of Morocco. It's hard to make a case that house cats and pet dogs fall under that category.
The Fondouk has been successful in increasing the number of animals who get vaccinated, but convincing the Moroccan people that they need to spay and neuter their animals has proven to be a much more challenging task. The Fondouk has a policy that it does not treat pitbulls, but it's probably going to have to expand that policy to include German Shepherds as well. I can't tell you how many aggressive un-neutered German Shepherds entered the exam room with a muzzle on and left in the arms of their owners, having had to be completely sedated in order to be examined.
Before I wrap this up, I would like to comment on the incredible hospitality we've been shown since the day we stepped into the Fondouk. From Mohammed tracking down postcard stamps to Dr. Frappier driving us all over Morocco on his day off, we have been welcomed and treated like well-respected colleagues and friends. It makes us want to come back again real soon.
While I loved every moment of work we did here at the Fondouk, I am very much looking forward to coming home to see my family and friends (and "Hayden," of course) for the tail end of the holiday season. I've learned so much about the world, veterinary medicine, and about myself these last few weeks that I'm almost overwhelmed thinking about how I should express it here.
While I tried to mentally prepare myself for the emotional toll that this kind of work would have on me, in truth, basically nothing could have prepared me for the hardship and suffering that I witnessed. Every time someone brought in a half-dead sheep and we couldn't save it, it weighed on me that the animal owner would struggle that much more to make ends meet. There were so many times that I wanted to buy someone a sheep or replace their mule that had just fractured it's leg, but that's just not feasible. I didn't come to Morocco to throw money around buying livestock. I came to Morocco to save the livestock I could, relieve the pain and suffering of whatever animals passed through the Fondouk gates, and therefore improve the quality of the owners' life.
One of the things that completely surprised me was the incredible skill of the staff who worked as "technicians" alongside the veterinarians. Houssine was more competent than some American veterinarians I know and did all the impressive surgeries and procedures despite not having had any sort of formal education. He was clearly well-trained by Dr. Frappier but he taught me that you can do a lot of good for a lot of animals without a hundred-thousand dollar education.
Working at the American Fondouk also put a lot of things in perspective for me and I realize now that good reality check is important once in awhile. Although I have high standards for practicing medicine thanks to my incredible education at Cornell, it turns out that if you practice in a place with sub-standard hygiene and sterility protocols that leave a lot to be desired, animals will survive and the world will go on turning. Although I cringed every time I watched someone reach into an open abdomen without gloves, those animals survived, despite us. Sure, using a new needle each time you stick a new patient is certainly the gold standard. However, it is generally more important to give a patient medication with a possibly-contaminated needle than to not give it at all.
One final thing I learned from my time here in Morocco is that I am cut out for third-world medicine. There were days I wanted to strangle the mule owners for waiting too long to bring in their animals and there were days that I wanted to crawl back into bed and have myself a good cry. However, more often than not, I went to bed knowing that I helped a lot of animals help their owners.
There's no doubt in my mind I'll be back.
Saturday, December 11, 2010
Friday, December 10, 2010
Day 12: Sheep Pox and a Fracture Hunt
Welcome to my penultimate blog post! Today was our final working day here at the American Fondouk and it proved to be a busy one, just as Dr. Frappier promised. I can't believe that our two working weeks are already over. Anna and I are exhausted and maybe that's because time seems to pass differently here in Morocco. I don't know whether it's because we're so far from home and everything here has been very new and stimulating or whether we're just fatigued from the constant drain that this experience has had on our emotions. It's hard to wrap my head around all the unique, challenging and gut-wrenching veterinary cases we've seen. I know one thing is for sure--I am a different veterinarian than I was when I arrived.
This morning we were fortunate enough to do a lot of re-check exams which was very satisfying, especially as we prepare to leave Fez behind this weekend. I was thrilled to see the steady flow of donkeys, horses and mules whose wounds had healed, whose lamenesses had subsided and whose all around attitudes had improved thanks to a good rectal and tubing. The mule whose proud flesh I debrided at least 4 times over the last 2 weeks looked great when his owner came to retrieve him. Our mean mule who came to us with a rope embedded in his leg also looked great. He'll go home as soon as his owner gets around to coming for him. The mutilated mule who had a knife taken to his hind end is mending slowly but surely, largely due to the loving attention and constant care that his been bestowed upon him by our Czech friends. They call him the "We Will Win" mule which is a pretty befitting name. Our piroplasmosis mare with the crippling canker on her hoof got some help today from Azami, the Fondouk's capable farrier, and a hoof wall resection from Jeremy. She's already walking better.
While so many of our patients are doing better, we have many who are not going to win their battle. Our third neurologic donkey has rapidly declined and is not responding to any of the treatments and medications we have given. We had a lengthy discussion about whether or not to euthanize him today since he's not eating and his quality of life is deteriorating. The group finally came to a consensus to euthanize today but Houssine strongly advised against it. Since this donkey is not in pain or facing imminent death, he will have to wait until Monday to be euthanized. We learned that if we euthanized him today, his body would just lay around til Monday anyway. I was fine with this decision for partly selfish reasons--the smell of burning mule meat which wafts directly into our bedroom is enough to make anyone lose her appetite.
We saw a bunch of sheep today, too, including a neurologic lamb who had come in yesterday for significant acute weakness in the hind end. We could find no evidence of trauma or a fracture yesterday but the diffuse ataxia made us wonder about White Muscle Disease, a degenerative muscle wasting disease that is caused by a lack of selenium and/or vitamin E in the diet. Although we treated him for White Muscle Disease yesterday, when he re-presented this morning it became very clear that White Muscle Disease was not this lamb's primary problem. Today he came back with his ewe and both were starting to break out in Sheep Pox. Houssine was fairly confident that the neurologic deficits we saw in the lamb yesterday were due to an early phase of the Sheep Pox infection.
We processed our patient load very rapidly this morning and probably saw at least 30 mules and horses. Friday is the Muslim day of rest so many owners opt to bring their animals in for "control" then so as not to have to give up a day of work. Jeremy and Anna probably floated 6-8 animals this morning. We saw a bunch of colics and some other interesting sheep cases, including a young ewe with a dislocated hip. Because they had waited so long to bring her in, it was not possible for us to "relocate" het femoral head into the hip socket. They decided to take her home and eat her.
The most frustrating case of the day hobbled into the Fondouk on three legs sometime mid-morning. This mule clearly had some kind of fracture in his upper left front leg. The owner was adamant about not euthanizing him (again because it's not Allah's will). We later learned that this mule was seen by a local Moroccan veterinarian yesterday and that vet referred him to us for x-rays. We were very upset by the fact that this mule owner seemed unphased by his mule's excruciating pain--if I didn't know better, it almost seemed as if he were taking some kind of pride in his animal's misery. When Anna walked over to give the mule a shot, the owner went to pick up the mule's good leg so as to force him to stand on the broken leg. After Anna sharply reprimanded him, I was mildly concerned that she was going to punch him in the jaw.
At least several hours was spent trying to locate the fracture through x-rays. The upper limb of a horse or mule is difficult to image under the best of circumstances due to the heavy muscling. Since the x-rays are developed via hand-dipping at the Fondouk it was a very tedious and lengthy process. Finally they got "the money shot" and it was clear that this mule was suffering from a large olecranon fracture (in his elbow). To make matters worse, we learned that this fracture occurred 50 days ago and the owner had waited almost 2 months before seeking medical attention.
After the diagnosis came the difficult decision of what to do with him given that sending him home wasn't an option (for us) and euthanasia wasn't an option (for the owner). After much hemming and hawing (ooh, no pun intended) we decided to try to splint his leg and manage him medically with stall rest. After 1 week, when Anna and I will be long gone, Jeremy and the Fondouk gang will re-evaluate his condition. If they still want to euthanize him (which they likely will, given the duration of the injury) at least they can say they tried everything. Jeremy had to track down some PVC piping and once that was acquired, we set out to immobilize the leg. This mule fought us every step of the way but, as Anna said, he has every right to be angry about everything. With some significant padding and a ton of duct tape, we got this mule's leg splinted. Hopefully he'll be smart about things and not try to lie down.
Our big afternoon procedure featured a rumenotomy on a ewe--they opened up her rumen, removed the plastic bags that were causing her inappetance, sewed her back up and sent her on her way. I was planning to do a C-section on another ewe today but she went into labor before we could open her up. Houssine and I had to work hard to manipulate and re-position the lamb in order to get it out. As expected, it was dead. When I asked Houssine why we were seeing so many dead fetuses rotting in the ewes, he said that it's usually trauma that kills the fetus and that the injury is often induced by the owners. After the unsatisfactory feeling that comes with delivering a dead lamb, I was given the opportunity to open up two abscesses on this ewe's neck. Many of you know that there is little I enjoy more than opening up and draining a good nasty abscess--it turns out that it's just as awesome in Morocco.
Anna and I have elected to lay low for the evening although we're trying to organize a rousing round of charades. That should be extra fun with a crowd of non-native English speakers. We have a full day of eating to look forward to tomorrow between going out for an elaborate multi-course Moroccan lunch followed by a casual dinner out with the staff. We may need to be rolled to our Sunday morning train.
This morning we were fortunate enough to do a lot of re-check exams which was very satisfying, especially as we prepare to leave Fez behind this weekend. I was thrilled to see the steady flow of donkeys, horses and mules whose wounds had healed, whose lamenesses had subsided and whose all around attitudes had improved thanks to a good rectal and tubing. The mule whose proud flesh I debrided at least 4 times over the last 2 weeks looked great when his owner came to retrieve him. Our mean mule who came to us with a rope embedded in his leg also looked great. He'll go home as soon as his owner gets around to coming for him. The mutilated mule who had a knife taken to his hind end is mending slowly but surely, largely due to the loving attention and constant care that his been bestowed upon him by our Czech friends. They call him the "We Will Win" mule which is a pretty befitting name. Our piroplasmosis mare with the crippling canker on her hoof got some help today from Azami, the Fondouk's capable farrier, and a hoof wall resection from Jeremy. She's already walking better.
While so many of our patients are doing better, we have many who are not going to win their battle. Our third neurologic donkey has rapidly declined and is not responding to any of the treatments and medications we have given. We had a lengthy discussion about whether or not to euthanize him today since he's not eating and his quality of life is deteriorating. The group finally came to a consensus to euthanize today but Houssine strongly advised against it. Since this donkey is not in pain or facing imminent death, he will have to wait until Monday to be euthanized. We learned that if we euthanized him today, his body would just lay around til Monday anyway. I was fine with this decision for partly selfish reasons--the smell of burning mule meat which wafts directly into our bedroom is enough to make anyone lose her appetite.
We saw a bunch of sheep today, too, including a neurologic lamb who had come in yesterday for significant acute weakness in the hind end. We could find no evidence of trauma or a fracture yesterday but the diffuse ataxia made us wonder about White Muscle Disease, a degenerative muscle wasting disease that is caused by a lack of selenium and/or vitamin E in the diet. Although we treated him for White Muscle Disease yesterday, when he re-presented this morning it became very clear that White Muscle Disease was not this lamb's primary problem. Today he came back with his ewe and both were starting to break out in Sheep Pox. Houssine was fairly confident that the neurologic deficits we saw in the lamb yesterday were due to an early phase of the Sheep Pox infection.
We processed our patient load very rapidly this morning and probably saw at least 30 mules and horses. Friday is the Muslim day of rest so many owners opt to bring their animals in for "control" then so as not to have to give up a day of work. Jeremy and Anna probably floated 6-8 animals this morning. We saw a bunch of colics and some other interesting sheep cases, including a young ewe with a dislocated hip. Because they had waited so long to bring her in, it was not possible for us to "relocate" het femoral head into the hip socket. They decided to take her home and eat her.
The most frustrating case of the day hobbled into the Fondouk on three legs sometime mid-morning. This mule clearly had some kind of fracture in his upper left front leg. The owner was adamant about not euthanizing him (again because it's not Allah's will). We later learned that this mule was seen by a local Moroccan veterinarian yesterday and that vet referred him to us for x-rays. We were very upset by the fact that this mule owner seemed unphased by his mule's excruciating pain--if I didn't know better, it almost seemed as if he were taking some kind of pride in his animal's misery. When Anna walked over to give the mule a shot, the owner went to pick up the mule's good leg so as to force him to stand on the broken leg. After Anna sharply reprimanded him, I was mildly concerned that she was going to punch him in the jaw.
At least several hours was spent trying to locate the fracture through x-rays. The upper limb of a horse or mule is difficult to image under the best of circumstances due to the heavy muscling. Since the x-rays are developed via hand-dipping at the Fondouk it was a very tedious and lengthy process. Finally they got "the money shot" and it was clear that this mule was suffering from a large olecranon fracture (in his elbow). To make matters worse, we learned that this fracture occurred 50 days ago and the owner had waited almost 2 months before seeking medical attention.
After the diagnosis came the difficult decision of what to do with him given that sending him home wasn't an option (for us) and euthanasia wasn't an option (for the owner). After much hemming and hawing (ooh, no pun intended) we decided to try to splint his leg and manage him medically with stall rest. After 1 week, when Anna and I will be long gone, Jeremy and the Fondouk gang will re-evaluate his condition. If they still want to euthanize him (which they likely will, given the duration of the injury) at least they can say they tried everything. Jeremy had to track down some PVC piping and once that was acquired, we set out to immobilize the leg. This mule fought us every step of the way but, as Anna said, he has every right to be angry about everything. With some significant padding and a ton of duct tape, we got this mule's leg splinted. Hopefully he'll be smart about things and not try to lie down.
Our big afternoon procedure featured a rumenotomy on a ewe--they opened up her rumen, removed the plastic bags that were causing her inappetance, sewed her back up and sent her on her way. I was planning to do a C-section on another ewe today but she went into labor before we could open her up. Houssine and I had to work hard to manipulate and re-position the lamb in order to get it out. As expected, it was dead. When I asked Houssine why we were seeing so many dead fetuses rotting in the ewes, he said that it's usually trauma that kills the fetus and that the injury is often induced by the owners. After the unsatisfactory feeling that comes with delivering a dead lamb, I was given the opportunity to open up two abscesses on this ewe's neck. Many of you know that there is little I enjoy more than opening up and draining a good nasty abscess--it turns out that it's just as awesome in Morocco.
Anna and I have elected to lay low for the evening although we're trying to organize a rousing round of charades. That should be extra fun with a crowd of non-native English speakers. We have a full day of eating to look forward to tomorrow between going out for an elaborate multi-course Moroccan lunch followed by a casual dinner out with the staff. We may need to be rolled to our Sunday morning train.
Thursday, December 9, 2010
Day 11: Stem Cells and the Souk
Greetings to all! This morning started off a little differently from the others. We rendezvoused with Dr. Frappier in the courtyard a couple of minutes after 7. He thought we should see the horse/mule/donkey souk (ie, market) before we left, especially since tomorrow's patient load will certainly include at least several mules purchased at today's souk. The souk is held every Thursday morning from 7-10 am in a large vacant dirt lot, about 20 minutes from the Fondouk. Mule dealers travel from all over to buy and sell working animals. When we walked into the souk, several hundred sets of eyes turned right to us. Anna and I were the only women in the entire place since horsemanship and mule handling is very much a man's job in Morocco. Dr. Frappier told us that since we were clearly foreigners, it was okay. However, if we had been Moroccan women showing up at the souk, everyone would have assumed we were prostitutes. Thank goodness for Anna's blond hair.
We walked around the lot, looking at the different animals for sale. There was the donkey section, complete with a slipper footed donkey and a donkey with a massive intestinal hernia for sale. There was the mule section, complete with a not-so-subtle piece of cloth covering a gaping neck wound on one poor guy. There was also the horse section, split into two parts--one for the mares and youngsters and one for the stallions. The men would periodically whack their mules into a trot if someone showed any interest--every single one of them was lame. For those mules broke to ride, someone would hop on and go for a trot or canter. Interestingly, when the Moroccans ride their mules, they sit very far back on the mule's rump in order to minimize the bouncing. While his may be more comfortable for the man, this has to be very rough on the mules' back and kidneys.
Dr. Frappier knew a lot of the men there and everyone came up to him to say hello. Anna and I even recognized several men who had passed through the Fondouk in the last couple of weeks. As he always is, Dr. Frappier was invited to have mint tea with his buddies. We were offered tea as well, but, given the set up and the sanitation, we politely declined. However, we did try some bread with Moroccan olive oil--to my great chagrin, it actually tasted like olives. I'm not sure exactly why, but we were also offered large pieces of a raw red onion. Given that it was 7:30 in the morning, we passed on that too.
While Dr. Frappier was schmoozing, Anna and I joined a large group of men who were migrating towards an open area at the souk where two horses could go head to head in a gallop. We have seen a number of these "Fantasia horses" at the Fondouk--they are used in traditional Muslim holidays and festivals. The tradition involves galloping while shooting guns (always a good idea!) and the goal is to the shooting in synchrony with other riders. Most of the Fantasia horses have been gray stallions and they are decked out in elaborate tack and dressings. At the souk, there is one man who will hop on any horse (bareback!) and gallop him for a prospective buyer. It was very exciting to watch and involved a lot of hoopla and fanfare from the crowd.
Before we left, Dr. Frappier showed us the farrier section of the souk. All of the working mules, donkeys and horses are "shod" in rubber shoes made from cut up pieces of tires. The walkways in the Medina are sometimes steep and the concrete makes it very slippery. The rubber helps the mules keep their balance, especially when they're carrying a heavy or potentially uneven load. While this type of shoe may be okay in principal, the execution leaves a lot to be desired. We have seen mules come in with nails placed right into the middle of the sole. This is crippling to the mule and immediately sets up a good environment for a foot abscess or a coffin bone infection. Almost every donkey, mule and horse that has come to the Fondouk has had either completely untrimmed feet or dangerously overtrimmed feet. As we watched the farriers work today, I had the horrifying realization that the mule's feet were being trimmed to fit the shoe instead of the shoe being trimmed to fit the mule. Apparently, there have been numerous efforts made in the past to educate the local farriers and teach them how to place shoes in a more humane and productive way. Unfortunately, these programs have failed across the board since the locals want it done how it's always been done, even if it means lost days of work because the mule is too foot-sore to work. I find this notion maddening but I guess if you live in a world where progress is undermined by tradition, this is inevitable.
After our trip to the souk, we returned to the Fondouk to join the working day which was already in progress. Dr. Frappier said that Thursdays are always quiet which makes sense given that we just seen a lot of our clientele across town at the souk. Although our rectal prolapse mule went home today (with his rectum firmly planted where it belonged, I might add) unfortunately, today proved to be a day of tragedy after tragedy. We elected to euthanize another one of the neurologic donkeys, whose condition had progressed to total recumbency and rigidity. Immediately after that euthanasia, a large mule with completely fractured humerus was driven into the courtyard--he too was euthanized since there was nothing we could do for him. The small animal hospital saw more than its fair share of euthanasias today as well.
Late morning, two men rolled in a cart carrying a mostly-dead ewe. Apparently she had been in labor about 20 days ago but never delivered any lambs. 5 days ago she stopped eating and became too weak to stand or walk. Today they decided that this was a problem. I placed a catheter in her and we bolused her some IV fluids. This was the first intravenous fluid therapy I had done since arriving in Morocco. Although we've had a few horses and mules who would have benefitted from fluids (namely "Rolex"), the only type of fluids the Fondouk has been able to get is saline in 1/2-liter bags. This is totally impractical for a horse or mule who requires 20 liters to start with. Hopefully Jeremy and Anne will be able to find some other source for fluids. We wound up doing a C-section on this ewe, too. Even though I won the "guess the number of lambs" game for the second day in a row, I didn't feel much like celebrating. She died on the operating table, which wasn't a surprise to anyone given her precarious and critical state when she arrived. After I removed 3 fetid lambs from her uterus, Houssine did a mini-necropsy to see what had killed her. He opened her rumen (the first of the four stomachs) and pulled out a large pile of plastic bags and other non-digestable plastic.
The other interesting case of the day involved an older donkey who has been seen before for chronically failing suspensory ligaments in both front legs. Today's visit was because of a newer tendon injury. Dr. Frappier had told me that he has done a form of stem cell therapy on some of the fancier horses that have been brought to him over the past few years. In a cutting-edge technology meets third world medicine kind of way, Dr. Frappier harvests stem cells from the bone marrow in the sternum. He mixes them with saline and a bit of antibiotics and then injects them directly into the affected tendon. Apparently he has had great success with this. I thought this donkey might be a good candidate and I was excited to get the go-ahead from Dr. Frappier to try it. With Houssine's help and guidance, we made a valiant effort to retrieve the stem cells. Even Dr. Frappier himself gave it a whirl but no one could hit the bone marrow on this donkey. Who knows if he had some quirky anatomy (admittedly, Dr, Frappier hadn't done this on donkeys before) or maybe we were just a bit off our game today. Sadly, the donkey got no stem cells but some steroid injections and a bit of bute which will hopefully help a bit.
We made a final trip to the grocery store this afternoon but didn't have much to buy since we leave the Fondouk on Sunday morning for a few days of travel in Marrakech before returning home. We're a little nervous how we're going to stuff our newly acquired Moroccan presents into our bags, but we may just have to purchase some extra luggage. This should make the long trek home exciting.
We walked around the lot, looking at the different animals for sale. There was the donkey section, complete with a slipper footed donkey and a donkey with a massive intestinal hernia for sale. There was the mule section, complete with a not-so-subtle piece of cloth covering a gaping neck wound on one poor guy. There was also the horse section, split into two parts--one for the mares and youngsters and one for the stallions. The men would periodically whack their mules into a trot if someone showed any interest--every single one of them was lame. For those mules broke to ride, someone would hop on and go for a trot or canter. Interestingly, when the Moroccans ride their mules, they sit very far back on the mule's rump in order to minimize the bouncing. While his may be more comfortable for the man, this has to be very rough on the mules' back and kidneys.
Dr. Frappier knew a lot of the men there and everyone came up to him to say hello. Anna and I even recognized several men who had passed through the Fondouk in the last couple of weeks. As he always is, Dr. Frappier was invited to have mint tea with his buddies. We were offered tea as well, but, given the set up and the sanitation, we politely declined. However, we did try some bread with Moroccan olive oil--to my great chagrin, it actually tasted like olives. I'm not sure exactly why, but we were also offered large pieces of a raw red onion. Given that it was 7:30 in the morning, we passed on that too.
While Dr. Frappier was schmoozing, Anna and I joined a large group of men who were migrating towards an open area at the souk where two horses could go head to head in a gallop. We have seen a number of these "Fantasia horses" at the Fondouk--they are used in traditional Muslim holidays and festivals. The tradition involves galloping while shooting guns (always a good idea!) and the goal is to the shooting in synchrony with other riders. Most of the Fantasia horses have been gray stallions and they are decked out in elaborate tack and dressings. At the souk, there is one man who will hop on any horse (bareback!) and gallop him for a prospective buyer. It was very exciting to watch and involved a lot of hoopla and fanfare from the crowd.
Before we left, Dr. Frappier showed us the farrier section of the souk. All of the working mules, donkeys and horses are "shod" in rubber shoes made from cut up pieces of tires. The walkways in the Medina are sometimes steep and the concrete makes it very slippery. The rubber helps the mules keep their balance, especially when they're carrying a heavy or potentially uneven load. While this type of shoe may be okay in principal, the execution leaves a lot to be desired. We have seen mules come in with nails placed right into the middle of the sole. This is crippling to the mule and immediately sets up a good environment for a foot abscess or a coffin bone infection. Almost every donkey, mule and horse that has come to the Fondouk has had either completely untrimmed feet or dangerously overtrimmed feet. As we watched the farriers work today, I had the horrifying realization that the mule's feet were being trimmed to fit the shoe instead of the shoe being trimmed to fit the mule. Apparently, there have been numerous efforts made in the past to educate the local farriers and teach them how to place shoes in a more humane and productive way. Unfortunately, these programs have failed across the board since the locals want it done how it's always been done, even if it means lost days of work because the mule is too foot-sore to work. I find this notion maddening but I guess if you live in a world where progress is undermined by tradition, this is inevitable.
After our trip to the souk, we returned to the Fondouk to join the working day which was already in progress. Dr. Frappier said that Thursdays are always quiet which makes sense given that we just seen a lot of our clientele across town at the souk. Although our rectal prolapse mule went home today (with his rectum firmly planted where it belonged, I might add) unfortunately, today proved to be a day of tragedy after tragedy. We elected to euthanize another one of the neurologic donkeys, whose condition had progressed to total recumbency and rigidity. Immediately after that euthanasia, a large mule with completely fractured humerus was driven into the courtyard--he too was euthanized since there was nothing we could do for him. The small animal hospital saw more than its fair share of euthanasias today as well.
Late morning, two men rolled in a cart carrying a mostly-dead ewe. Apparently she had been in labor about 20 days ago but never delivered any lambs. 5 days ago she stopped eating and became too weak to stand or walk. Today they decided that this was a problem. I placed a catheter in her and we bolused her some IV fluids. This was the first intravenous fluid therapy I had done since arriving in Morocco. Although we've had a few horses and mules who would have benefitted from fluids (namely "Rolex"), the only type of fluids the Fondouk has been able to get is saline in 1/2-liter bags. This is totally impractical for a horse or mule who requires 20 liters to start with. Hopefully Jeremy and Anne will be able to find some other source for fluids. We wound up doing a C-section on this ewe, too. Even though I won the "guess the number of lambs" game for the second day in a row, I didn't feel much like celebrating. She died on the operating table, which wasn't a surprise to anyone given her precarious and critical state when she arrived. After I removed 3 fetid lambs from her uterus, Houssine did a mini-necropsy to see what had killed her. He opened her rumen (the first of the four stomachs) and pulled out a large pile of plastic bags and other non-digestable plastic.
The other interesting case of the day involved an older donkey who has been seen before for chronically failing suspensory ligaments in both front legs. Today's visit was because of a newer tendon injury. Dr. Frappier had told me that he has done a form of stem cell therapy on some of the fancier horses that have been brought to him over the past few years. In a cutting-edge technology meets third world medicine kind of way, Dr. Frappier harvests stem cells from the bone marrow in the sternum. He mixes them with saline and a bit of antibiotics and then injects them directly into the affected tendon. Apparently he has had great success with this. I thought this donkey might be a good candidate and I was excited to get the go-ahead from Dr. Frappier to try it. With Houssine's help and guidance, we made a valiant effort to retrieve the stem cells. Even Dr. Frappier himself gave it a whirl but no one could hit the bone marrow on this donkey. Who knows if he had some quirky anatomy (admittedly, Dr, Frappier hadn't done this on donkeys before) or maybe we were just a bit off our game today. Sadly, the donkey got no stem cells but some steroid injections and a bit of bute which will hopefully help a bit.
We made a final trip to the grocery store this afternoon but didn't have much to buy since we leave the Fondouk on Sunday morning for a few days of travel in Marrakech before returning home. We're a little nervous how we're going to stuff our newly acquired Moroccan presents into our bags, but we may just have to purchase some extra luggage. This should make the long trek home exciting.
Wednesday, December 8, 2010
Day 10: C-sections and a Suturing Lesson
Hello all. I'm pleased to report that life went back to normal today and that Anna and I were quite relieved to see the staff ready to work at 7:30 this morning. I was a tiny bit concerned that this whole New Years celebration was actually going to turn out to be a two-day holiday and that our Moroccan friends were looking to have some fun at our expense.
Today was a steady and satisfying day of interesting cases and dramatic surgeries. There were a couple of colics and wounds to treat early on. An older man, whom we have seen at least 4 times since we got here, came in to have us give his mule some bute (an anti-inflammatory). This is one of the few mule owners who has some genuine affection for his animal. We've seen him lovingly pet his mule while he's waiting on multiple occasions. Perhaps more importantly, he seems to recognize discomfort in his animal enough to bring him in on a regular basis. When I went to give his mule the bute IV, he knew that his mule's left jugular vein didn't work well. He was able to communicate that and direct me to the mule's right side.
A man brought in a trio of horses for "control"--deworming and a shot of vitamins. The colt (maybe 6 months old) was covered head to toe in huge prickly burrs. They were in his ears, under his belly and had totally taken over his neck. Some had been there so long they were becoming embedded in the skin. I imagine that that must have been incredibly uncomfortable for the colt, especially when he lay down. I whipped out the clippers and went to town removing hundreds, if not thousands, of burrs. My clip job might not have been up to show horse standards (he did look a bit, um, patchy afterwards) but I imagine he already has to be feeling better. The man who owned the horse was not the most patient client that's come to the Fondouk--he announced (in Arabic) that he had to go before I was done.
Even though I still had about 10 minutes of clipping left, I felt okay about letting him go. I should mention that I was particularly impressed by this colt's manners. He surely hadn't seen clippers before and lots of horses don't like the noise and vibration of them. This guy, however, was very well-behaved and tolerated it well. That's in sharp contrast to the poorly mannered stallions who have come in. Across the board, they've come in snorting, aroused, and jumping all around. Today, we had one come galloping up the cement courtyard (with no handler) and stop only when he got caught up in the rope. Apparently, he just couldn't get enough of our pretty mares and jennies.
While I was clipping the colt, a sad little donkey with a huge gash in his side came into the courtyard. His heart and respiratory rates were high enough that Jeremy was concerned that either the wound communicated with his abdomen, he had a diaphragmatic hernia, or he was possibly dealing with a collapsed lung. The owner of the donkey told us the mule had fallen and that this injury had just happened. This is what they all tell us--that the injury just happened--but that is almost never the case. For example, the uveitic eye that I saw this morning was allegedly new, but I could tell by looking at the changes in the eye that this had been going on for a long time. I'm not sure why the mule owners don't bring their animals in sooner given that the care is free. It seems obvious to me that little problems stay little problems when you address them early but little problems become big problems when you don't. Some of the non-American grooms and farm hands that I work with back home in New York also seem to have trouble recognizing pain and suffering in animals. I don't know if this is a cultural difference, an educational difference or a combination of both, but I find it very frustrating and a problem without an obvious solution. We could do so much more good if we saw these critters 3-4 days before their owners think they need to bring them in.
Anyway, Jeremy ultrasounded the wound on this donkey and determined that, thankfully, there was no communication with the chest or abdominal cavities. He then told Anna this wound was hers if she wanted it. She was elated. Anna clipped and scrubbed up the wound and did her first ring nerve block with lidocaine. I threw a couple of sutures in the muscle since that's not the easiest place to start when you're learning to suture. It took a couple of sutures before she had the hang of it, but after that, Anna was suturing as if she'd been doing it all her life. Once the wound was sewn, Anna sprayed it with an aerosol bandage and the donkey was sent on his way. I joked that Anna has gotten so much hands-on experience in Morocco that she can probably skip college and vet school altogether and just go right into practice.
After lunch, we re-grouped in the courtyard to watch Houssine do a Caesarian-section on a ewe that came in this morning. Her owner told us that she had been in labor for 3-days but that nothing had come out. She was clipped and scrubbed and placed into the sheep cradle on the small animal operating table. Houssine anesthetized her at the last possible second with fears that the lambs inside her would also be anesthetized since they were still sharing a blood supply with their mother. We placed bets on how many lambs she was carrying--I guessed 4 since she was huge. Houssine opened her abdomen very quickly and without gloves, although he did take the time to rinse his hands with betadine. He exteriorized her uterus, made an incision, and removed the first lamb who was dead. The second lamb was also dead. The third lamb was clearly the runt, but Houssine felt a heartbeat on him and handed him off to a student waiting with a towel to rub him awake and get the fluid out of his nose. Those of us watching were so excited that there was a live one. The fourth lamb (I won be bet, by the way) was also alive.
Houssine replaced the uterus and sewed up the ewe's uterus and abdominal wall while the rest of us worked on the lambs outside. Our little runt gave a tiny little bleat but the larger lamb stopped moving soon after we got outside. When his heart stopped beating, Jeremy gave him some Dopram IV and then an intra-cardiac stick with epinephrine. Although his heart started beating again, he never took another breath on his own. Not even Jeremy's loving mouth-to-mouth resuscitation was enough to save the lamb.
The only surviving lamb never stood up but we were able to direct him towards the ewe's teat and he did swallow some colostrum. We'll have no way of knowing whether or not he will survive since his owner took him and the ewe home immediately after the ewe woke up. We can only hope for the best.
Anna and I are headed out now to grab some dinner. The night watchman will tell our taxi where to go since the taxi drivers don't speak French and my Arabic is still not up to snuff. After dinner, we will have a waiter from the restaurant hail us a cab since it's not advisable for women to be out on the streets alone in this city. Never a dull moment here in Morocco.
Today was a steady and satisfying day of interesting cases and dramatic surgeries. There were a couple of colics and wounds to treat early on. An older man, whom we have seen at least 4 times since we got here, came in to have us give his mule some bute (an anti-inflammatory). This is one of the few mule owners who has some genuine affection for his animal. We've seen him lovingly pet his mule while he's waiting on multiple occasions. Perhaps more importantly, he seems to recognize discomfort in his animal enough to bring him in on a regular basis. When I went to give his mule the bute IV, he knew that his mule's left jugular vein didn't work well. He was able to communicate that and direct me to the mule's right side.
A man brought in a trio of horses for "control"--deworming and a shot of vitamins. The colt (maybe 6 months old) was covered head to toe in huge prickly burrs. They were in his ears, under his belly and had totally taken over his neck. Some had been there so long they were becoming embedded in the skin. I imagine that that must have been incredibly uncomfortable for the colt, especially when he lay down. I whipped out the clippers and went to town removing hundreds, if not thousands, of burrs. My clip job might not have been up to show horse standards (he did look a bit, um, patchy afterwards) but I imagine he already has to be feeling better. The man who owned the horse was not the most patient client that's come to the Fondouk--he announced (in Arabic) that he had to go before I was done.
Even though I still had about 10 minutes of clipping left, I felt okay about letting him go. I should mention that I was particularly impressed by this colt's manners. He surely hadn't seen clippers before and lots of horses don't like the noise and vibration of them. This guy, however, was very well-behaved and tolerated it well. That's in sharp contrast to the poorly mannered stallions who have come in. Across the board, they've come in snorting, aroused, and jumping all around. Today, we had one come galloping up the cement courtyard (with no handler) and stop only when he got caught up in the rope. Apparently, he just couldn't get enough of our pretty mares and jennies.
While I was clipping the colt, a sad little donkey with a huge gash in his side came into the courtyard. His heart and respiratory rates were high enough that Jeremy was concerned that either the wound communicated with his abdomen, he had a diaphragmatic hernia, or he was possibly dealing with a collapsed lung. The owner of the donkey told us the mule had fallen and that this injury had just happened. This is what they all tell us--that the injury just happened--but that is almost never the case. For example, the uveitic eye that I saw this morning was allegedly new, but I could tell by looking at the changes in the eye that this had been going on for a long time. I'm not sure why the mule owners don't bring their animals in sooner given that the care is free. It seems obvious to me that little problems stay little problems when you address them early but little problems become big problems when you don't. Some of the non-American grooms and farm hands that I work with back home in New York also seem to have trouble recognizing pain and suffering in animals. I don't know if this is a cultural difference, an educational difference or a combination of both, but I find it very frustrating and a problem without an obvious solution. We could do so much more good if we saw these critters 3-4 days before their owners think they need to bring them in.
Anyway, Jeremy ultrasounded the wound on this donkey and determined that, thankfully, there was no communication with the chest or abdominal cavities. He then told Anna this wound was hers if she wanted it. She was elated. Anna clipped and scrubbed up the wound and did her first ring nerve block with lidocaine. I threw a couple of sutures in the muscle since that's not the easiest place to start when you're learning to suture. It took a couple of sutures before she had the hang of it, but after that, Anna was suturing as if she'd been doing it all her life. Once the wound was sewn, Anna sprayed it with an aerosol bandage and the donkey was sent on his way. I joked that Anna has gotten so much hands-on experience in Morocco that she can probably skip college and vet school altogether and just go right into practice.
After lunch, we re-grouped in the courtyard to watch Houssine do a Caesarian-section on a ewe that came in this morning. Her owner told us that she had been in labor for 3-days but that nothing had come out. She was clipped and scrubbed and placed into the sheep cradle on the small animal operating table. Houssine anesthetized her at the last possible second with fears that the lambs inside her would also be anesthetized since they were still sharing a blood supply with their mother. We placed bets on how many lambs she was carrying--I guessed 4 since she was huge. Houssine opened her abdomen very quickly and without gloves, although he did take the time to rinse his hands with betadine. He exteriorized her uterus, made an incision, and removed the first lamb who was dead. The second lamb was also dead. The third lamb was clearly the runt, but Houssine felt a heartbeat on him and handed him off to a student waiting with a towel to rub him awake and get the fluid out of his nose. Those of us watching were so excited that there was a live one. The fourth lamb (I won be bet, by the way) was also alive.
Houssine replaced the uterus and sewed up the ewe's uterus and abdominal wall while the rest of us worked on the lambs outside. Our little runt gave a tiny little bleat but the larger lamb stopped moving soon after we got outside. When his heart stopped beating, Jeremy gave him some Dopram IV and then an intra-cardiac stick with epinephrine. Although his heart started beating again, he never took another breath on his own. Not even Jeremy's loving mouth-to-mouth resuscitation was enough to save the lamb.
The only surviving lamb never stood up but we were able to direct him towards the ewe's teat and he did swallow some colostrum. We'll have no way of knowing whether or not he will survive since his owner took him and the ewe home immediately after the ewe woke up. We can only hope for the best.
Anna and I are headed out now to grab some dinner. The night watchman will tell our taxi where to go since the taxi drivers don't speak French and my Arabic is still not up to snuff. After dinner, we will have a waiter from the restaurant hail us a cab since it's not advisable for women to be out on the streets alone in this city. Never a dull moment here in Morocco.
Tuesday, December 7, 2010
Day 9: Happy New Year...and a trip to McDonalds
Good afternoon, faithful readers. I have lots to tell you about today but, alas, none of it is veterinary-related. The five students and I awoke at our regular time this morning, ate our regular breakfast and headed down to the Fondouk courtyard at 7:30 like we've been doing every weekday since we got there. The big gates were closed, the rope directing the flow of traffic wasn't up and no one but the night watchman was there. You can imagine how mystified we were given that no one had given us a heads up that something special was happening. It turns out that today was a national holiday--New Years Day, in fact--and it appears that everyone got the memo except for us. Dr. Frappier informed us that the Muslim New Year goes according to the phases of the moon and while all Muslims knew there was going to be a holiday this week, no one knew exactly when it was coming. While we were writing emails, listening to our iPods and hanging out last night in blissful ignorance, the rest of the country was glued to the TV. Apparently, at 9PM last night the national government informed everyone that today would be the observed New Year's holiday. Thus, no one showed up for work today but us.
While there was most likely a bit of last minute debauchery that happened last night, Muslims generally use the New Year's Day holiday to visit family and rest. This fly-by-the-seat-of-your-pants holiday declaration causes problems at the Fondouk every year. Because no one knows when the holiday is coming, no one can plan ahead to have holiday coverage. Poor Mohammed, a very kind and hard-working man who coordinates all aspects of the Fondouk, had to come into work this morning to make sure that someone on the Fondouk staff had shown up to work. Someone had, but it was perfectly understandable why there have been problems in the past.
Since everything was closed today, we used our quiet morning to do some treatments on our patients. Our rectal prolapse mule from yesterday was hanging in there as were two of the remaining neurologic donkeys. Alix, a French vet student, was given a lesson in wound debridement and we watched her close a hole in a donkey's side that had most likely been that way for months. That means we can no longer sing the song "there's a hole in my donkey, dear Liza, dear Liza" but such is life.
Around noon, Jeremy and Anne came to the Fondouk to join us for a lunchtime adventure. Anna had picked out a restaurant in a hotel known for its spectacular city view--Jeremy was all for it as was Emmy. It was not until Jeremy turned on the car that we realized that everyone had been thinking of a different restaurant and no one had any idea how to get any one of them. In a true comedy of errors, we all piled back out of the cramped little car to try to figure out where we were going and the best route to take. Once the directions were established we got back into the car to try again, only to have Dr. Frappier point out that we had a flat tire. We just couldn't win today.
We did finally make it to Anna's intended lunch spot where we were the only people in the entire restaurant and maybe even the entire hotel. It's been 70 degrees for the past few days and we enjoyed a long leisurely lunch out on the terrace. Anna and I each ordered the poulet grille au crapodine. We had absolutely no idea what grilled crapodine chicken was, but the name was too intriguing not to find out. We asked what crapodine was to which the waiter responded "mustard." We all had a bit of a laugh when the meal arrived--I'm not sure where the communication broke down, but there were definitely no mustard seeds harmed in the process of making grilled chicken crapodine.
We extended our afternoon festivities by walking around parts of New Fez (the nicer, newer area). After our walk, we all decided that the time had come to check out the McDonald's that was about 1-mile down the road from the Fondouk. Our little Moroccan fast food detour was fascinating. First of all, this was the cleanest restaurant we'd been in so far. The menu was significantly more limited than back in the States and the Moroccans have gone all out exploiting the McDonald's brand. For instance, if we hadn't wanted to sit down at a table, we could have driven through the "McDrive." Jeremy ordered a sundae and mozzarella sticks (note: why can't we get mozzarella sticks at our McDonalds' back at home?) and the rest of us ordered McFlurries. I guess because we're so close to Europe, the candy options for the McFlurry were different. We didn't have the option of adding Reeses Peanut Butter cups or heath bars to our McFlurries but we did get to add Toblerone chocolate which was a perfectly acceptable substitute. Anne was quick to point out that even though there was, in fact, a McFlurry machine behind the counter, it was broken and thus our McFlurries didn't differ in any way from Jeremy's sundae.
Interestingly, although the price of the McDonalds food was by no means expensive, it was not nearly as comparatively inexpensive as it is in the States. A couple of other things worth mentioning: we didn't have the option to "supersize" our meal in Morocco which is probably a good thing. Also, because knowing about the quality of the meat you put in your mouth is a respected Islamic rite, the paper placemat that came on our trays had graphic pictures following the idyllic and immaculate cows from their freedom in a grass field all the way to the abattoir. I think that if the McDonalds' in the States displayed comparable pictures of hanging carcasses on their placemats, no one would ever ask to supersize anything again.
After our McFlurries, we returned to the Fondouk to play a bit with Moushkil. Moushkil is the Fondouk's resident donkey and he is a ridiculous bundle of joy. Moushkil showed up at the Fondouk about 4 years ago. He was half in his mother and half out of his mother and his mother had a broken leg. Moushkil (which means "trouble" in Arabic) was delivered by Dr. frappier and the students and his dam was then euthanized. The owner did not want to keep Moushkil because orphan foals are a ton of work and require round-the-clock care and feeding. As the story goes, the students at the Fondouk (which included Jeremy when he was a vet student) pleaded with and begged Dr. Frappier not to euthanize him. When he gave in (Dr. Frappier definitely has a soft spot in his heart for orphan and homeless animals) the students organized themselves and took turns getting up to feed the baby. Unlike every single other one of his donkey counterparts, Moushkil has led a life of leisure and comfort in Morocco. He's fat and happy, has his teeth floated and his feet trimmed on a regular basis. Because he was raised by humans and spends afternoons strutting around the courtyard while we do our surgeries, his behavior is thoroughly un-donkeylike. He cavorts with the dogs and would happily sit in our laps if we let him. He's a breath of fresh air in a dark and grim donkey world.
Hopefully all will be back to normal tomorrow when we show up to work at 7:30. However, this is Morocco and clearly, anything goes.
While there was most likely a bit of last minute debauchery that happened last night, Muslims generally use the New Year's Day holiday to visit family and rest. This fly-by-the-seat-of-your-pants holiday declaration causes problems at the Fondouk every year. Because no one knows when the holiday is coming, no one can plan ahead to have holiday coverage. Poor Mohammed, a very kind and hard-working man who coordinates all aspects of the Fondouk, had to come into work this morning to make sure that someone on the Fondouk staff had shown up to work. Someone had, but it was perfectly understandable why there have been problems in the past.
Since everything was closed today, we used our quiet morning to do some treatments on our patients. Our rectal prolapse mule from yesterday was hanging in there as were two of the remaining neurologic donkeys. Alix, a French vet student, was given a lesson in wound debridement and we watched her close a hole in a donkey's side that had most likely been that way for months. That means we can no longer sing the song "there's a hole in my donkey, dear Liza, dear Liza" but such is life.
Around noon, Jeremy and Anne came to the Fondouk to join us for a lunchtime adventure. Anna had picked out a restaurant in a hotel known for its spectacular city view--Jeremy was all for it as was Emmy. It was not until Jeremy turned on the car that we realized that everyone had been thinking of a different restaurant and no one had any idea how to get any one of them. In a true comedy of errors, we all piled back out of the cramped little car to try to figure out where we were going and the best route to take. Once the directions were established we got back into the car to try again, only to have Dr. Frappier point out that we had a flat tire. We just couldn't win today.
We did finally make it to Anna's intended lunch spot where we were the only people in the entire restaurant and maybe even the entire hotel. It's been 70 degrees for the past few days and we enjoyed a long leisurely lunch out on the terrace. Anna and I each ordered the poulet grille au crapodine. We had absolutely no idea what grilled crapodine chicken was, but the name was too intriguing not to find out. We asked what crapodine was to which the waiter responded "mustard." We all had a bit of a laugh when the meal arrived--I'm not sure where the communication broke down, but there were definitely no mustard seeds harmed in the process of making grilled chicken crapodine.
We extended our afternoon festivities by walking around parts of New Fez (the nicer, newer area). After our walk, we all decided that the time had come to check out the McDonald's that was about 1-mile down the road from the Fondouk. Our little Moroccan fast food detour was fascinating. First of all, this was the cleanest restaurant we'd been in so far. The menu was significantly more limited than back in the States and the Moroccans have gone all out exploiting the McDonald's brand. For instance, if we hadn't wanted to sit down at a table, we could have driven through the "McDrive." Jeremy ordered a sundae and mozzarella sticks (note: why can't we get mozzarella sticks at our McDonalds' back at home?) and the rest of us ordered McFlurries. I guess because we're so close to Europe, the candy options for the McFlurry were different. We didn't have the option of adding Reeses Peanut Butter cups or heath bars to our McFlurries but we did get to add Toblerone chocolate which was a perfectly acceptable substitute. Anne was quick to point out that even though there was, in fact, a McFlurry machine behind the counter, it was broken and thus our McFlurries didn't differ in any way from Jeremy's sundae.
Interestingly, although the price of the McDonalds food was by no means expensive, it was not nearly as comparatively inexpensive as it is in the States. A couple of other things worth mentioning: we didn't have the option to "supersize" our meal in Morocco which is probably a good thing. Also, because knowing about the quality of the meat you put in your mouth is a respected Islamic rite, the paper placemat that came on our trays had graphic pictures following the idyllic and immaculate cows from their freedom in a grass field all the way to the abattoir. I think that if the McDonalds' in the States displayed comparable pictures of hanging carcasses on their placemats, no one would ever ask to supersize anything again.
After our McFlurries, we returned to the Fondouk to play a bit with Moushkil. Moushkil is the Fondouk's resident donkey and he is a ridiculous bundle of joy. Moushkil showed up at the Fondouk about 4 years ago. He was half in his mother and half out of his mother and his mother had a broken leg. Moushkil (which means "trouble" in Arabic) was delivered by Dr. frappier and the students and his dam was then euthanized. The owner did not want to keep Moushkil because orphan foals are a ton of work and require round-the-clock care and feeding. As the story goes, the students at the Fondouk (which included Jeremy when he was a vet student) pleaded with and begged Dr. Frappier not to euthanize him. When he gave in (Dr. Frappier definitely has a soft spot in his heart for orphan and homeless animals) the students organized themselves and took turns getting up to feed the baby. Unlike every single other one of his donkey counterparts, Moushkil has led a life of leisure and comfort in Morocco. He's fat and happy, has his teeth floated and his feet trimmed on a regular basis. Because he was raised by humans and spends afternoons strutting around the courtyard while we do our surgeries, his behavior is thoroughly un-donkeylike. He cavorts with the dogs and would happily sit in our laps if we let him. He's a breath of fresh air in a dark and grim donkey world.
Hopefully all will be back to normal tomorrow when we show up to work at 7:30. However, this is Morocco and clearly, anything goes.
Monday, December 6, 2010
Day 8: A Trio Of Neurologic Donkeys and Some Pretty Fancy Warmbloods
Good evening blog friends. Anna and I have just had a fascinating but emotionally draining day at the American Fondouk as we started our second week of work. The day started out with a case that really wore on our souls. A beleaguered woman came in with an infant strapped to her back and a young boy at her side. The boy was pulling a cart that carried a half-dead sheep inside. They had clearly walked quite a distance to get here. The ewe had such a severe anemia that her blood was like water when I took a sample. The woman pleaded for us to help the sheep. Jeremy casually said to me "hey, have you ever done a blood transfusion on a sheep?" and I was proudly able to respond "sure...I did one last summer." (Insert shout-out to Dr. Enger here). We were perfectly well equipped to try a blood transfusion at the Fondouk but we needed another sheep to act as a blood donor. Houssine told the woman that if she came back with another sheep, we could try the blood transfusion. She agreed. Not 10 minutes after this woman left with her two children, the sheep passed away on her own. The woman returned with a donor sheep several hours later--clearly exhausted--only to find out that her second trip was for nought. As the tears flooded down her cheeks, I wanted nothing more than to give her the several dollars it would have required to buy a new sheep. My heart broke in half as I listened to Houssine say there was nothing left that we could do for her.
We saw a bunch of mildly colicky mules this morning, all of which required rectals and tubing. This hospital is providing invaluable hands-on experience to the vet students (and Anna), all of whom are becoming increasingly proficient at tubing. One interesting thing I'd love to mention is the curious fact that about 85% of the mules who are tubed here develop a bloody nose during or immediately after the tubing. Because only 1 out of every 100 horses I tube at home develops a bloody nose, I assumed that this significant difference was largely due to the inexperience of the students passing the tube. When I commented on this to Dr. Frappier, he said that even when there aren't any students around, the mules still bleed. He told me that he passed an endoscope on a couple of them soon after he arrived in Fez to see if there was some anatomical explanation for their increased bleeding tendency. He never found one and no one at the Fondouk bats an eye when blood comes pouring out of the mule's nose during a tubing.
Mid-morning, we had an unexpected meeting of two worlds. While the Fondouk's courtyard was filled with overworked and over-burdened pack animals, two enormous and regal warmblood horses were marched in. They were jumpers owned by a wealthy person in Casablanca. One had come in for lameness and one was there for a pre-purchase exam. I found the dichotomy of today's patient load to be almost too great to wrap my head around. While we watched the very expensive horses jog up and down the concrete walkway next to the Fondouk as part of their lameness exams, a whole group of dumbfounded and bewildered Moroccan men watched as they dragged their own lame animals into our clinic. Dr. Frappier is very highly regarded in the world of fancy show horses and I must say that I did learn a bunch of interesting and new lameness tips from him while we worked on these two horses. We did an incredibly thorough exam for the pre-purchase horse and since they had driven 400 km to get here, we blistered her stifles while we were at it so as to save them another round-trip drive. There were also x-rays taken and hocks injected.
There was so much going on this morning, that I felt like I was being pulled in a thousand directions. There was drama with every case and we were spread pretty thin. When we were finishing up with the fancy horses outside, a small green van pulled up alongside the Fondouk. Inside was one standing donkey and one recumbent donkey. We were told that the recumbent donkey started acting neurologic 10 days ago. 2 days ago he became unable to rise, eat or drink. We had the van pull rightinto the Fondouk and between Jeremy, Houssine and the men who brought the donkeys in, they were able to lift the down donkey out of the van. He was unable to lift even his head and due to the rapid progression of the disease and the degree of paralysis, we decided that euthanasia would be the most humane option. We discussed possible differential diagnoses for this donkey. I suggested botulism. Dr. Frappier said that was certainly a possibility but that West Nile Virus (a devastating disease that we vaccinate for at MHVP) was just as likely. We told the donkey's owners that we would try our best but that he would likely die. As most Muslims are against euthanasia (because it is not Allah's will), we could not be up front with these men. We euthanized the donkey this afternoon but the men will not learn of his fate until they come back on Friday. Interestingly we had a different man bring in two other neurologic donkeys today. They will likely also decline to the point where euthanasia is necessary. There was no connection between the first donkey and the second two--they live on opposite sides of the city--but those of us in veterinary medicine know that bad things come in threes.
One of the other more interesting cases of the day was an old emaciated mule who came in with a prolapsed rectum. Other than the sheep with the prolapsed uterus last week, I'd never seen any animal with a prolapsed anything--neither had Jeremy. Now we've seen two prolapses in the last few days. This mule's prolapse most likely occurred because his diet it too coarse and his bad teeth don't allow him to chew the straw enough for proper digestion. This poor mule had probably been colicky in the last couple of days because of an impaction he was trying to pass. We surmise that he strained and strained and strained until he passed his own rectum.
After we tubed and oiled the mule, Houssine, who is truly an incredible man, went to work fixing this prolapse. I will spare you the details--it was too gross, even for me--but this mule wound up with all body parts where they belonged. We treated him to some dental work, gave him some more pain meds, and we'll see how he's doing in the morning.
You can imagine how such an emotionally tumultuous day can wear on a person. Anna and I opted to stay in and have a quiet evening tonight even though our friends were headed out for dinner. We need to decompress a bit and maybe we'll even try some of that famous Moroccan wine we bought at the grocery store.
We saw a bunch of mildly colicky mules this morning, all of which required rectals and tubing. This hospital is providing invaluable hands-on experience to the vet students (and Anna), all of whom are becoming increasingly proficient at tubing. One interesting thing I'd love to mention is the curious fact that about 85% of the mules who are tubed here develop a bloody nose during or immediately after the tubing. Because only 1 out of every 100 horses I tube at home develops a bloody nose, I assumed that this significant difference was largely due to the inexperience of the students passing the tube. When I commented on this to Dr. Frappier, he said that even when there aren't any students around, the mules still bleed. He told me that he passed an endoscope on a couple of them soon after he arrived in Fez to see if there was some anatomical explanation for their increased bleeding tendency. He never found one and no one at the Fondouk bats an eye when blood comes pouring out of the mule's nose during a tubing.
Mid-morning, we had an unexpected meeting of two worlds. While the Fondouk's courtyard was filled with overworked and over-burdened pack animals, two enormous and regal warmblood horses were marched in. They were jumpers owned by a wealthy person in Casablanca. One had come in for lameness and one was there for a pre-purchase exam. I found the dichotomy of today's patient load to be almost too great to wrap my head around. While we watched the very expensive horses jog up and down the concrete walkway next to the Fondouk as part of their lameness exams, a whole group of dumbfounded and bewildered Moroccan men watched as they dragged their own lame animals into our clinic. Dr. Frappier is very highly regarded in the world of fancy show horses and I must say that I did learn a bunch of interesting and new lameness tips from him while we worked on these two horses. We did an incredibly thorough exam for the pre-purchase horse and since they had driven 400 km to get here, we blistered her stifles while we were at it so as to save them another round-trip drive. There were also x-rays taken and hocks injected.
There was so much going on this morning, that I felt like I was being pulled in a thousand directions. There was drama with every case and we were spread pretty thin. When we were finishing up with the fancy horses outside, a small green van pulled up alongside the Fondouk. Inside was one standing donkey and one recumbent donkey. We were told that the recumbent donkey started acting neurologic 10 days ago. 2 days ago he became unable to rise, eat or drink. We had the van pull rightinto the Fondouk and between Jeremy, Houssine and the men who brought the donkeys in, they were able to lift the down donkey out of the van. He was unable to lift even his head and due to the rapid progression of the disease and the degree of paralysis, we decided that euthanasia would be the most humane option. We discussed possible differential diagnoses for this donkey. I suggested botulism. Dr. Frappier said that was certainly a possibility but that West Nile Virus (a devastating disease that we vaccinate for at MHVP) was just as likely. We told the donkey's owners that we would try our best but that he would likely die. As most Muslims are against euthanasia (because it is not Allah's will), we could not be up front with these men. We euthanized the donkey this afternoon but the men will not learn of his fate until they come back on Friday. Interestingly we had a different man bring in two other neurologic donkeys today. They will likely also decline to the point where euthanasia is necessary. There was no connection between the first donkey and the second two--they live on opposite sides of the city--but those of us in veterinary medicine know that bad things come in threes.
One of the other more interesting cases of the day was an old emaciated mule who came in with a prolapsed rectum. Other than the sheep with the prolapsed uterus last week, I'd never seen any animal with a prolapsed anything--neither had Jeremy. Now we've seen two prolapses in the last few days. This mule's prolapse most likely occurred because his diet it too coarse and his bad teeth don't allow him to chew the straw enough for proper digestion. This poor mule had probably been colicky in the last couple of days because of an impaction he was trying to pass. We surmise that he strained and strained and strained until he passed his own rectum.
After we tubed and oiled the mule, Houssine, who is truly an incredible man, went to work fixing this prolapse. I will spare you the details--it was too gross, even for me--but this mule wound up with all body parts where they belonged. We treated him to some dental work, gave him some more pain meds, and we'll see how he's doing in the morning.
You can imagine how such an emotionally tumultuous day can wear on a person. Anna and I opted to stay in and have a quiet evening tonight even though our friends were headed out for dinner. We need to decompress a bit and maybe we'll even try some of that famous Moroccan wine we bought at the grocery store.
Sunday, December 5, 2010
Day 7: A Couple of Cool Macaques
Bonsoir, mes amis americains (good evening, American friends). I thought I'd sneak in a quick post again tonight, even though today was another non-veterinary day. Anna and I treated ourselves to a couple extra hours of sleep this morning since there weren't any mules knocking down our door for help. After breakfast, we took a "petit taxi" about five minutes to a street where the "grands taxis" were waiting. Then, through a very confusing series of events, we wound up in a taxi cab with 5 other people in it! I found it a bit absurd that the "petits taxis" won't take more than 3 passengers total (ie, the middle seat in the back is always empty) but you can stuff as many people as physically possible into the "grands taxis." Our goal was to get to Azrou, a city that some of the other vet students had visited previously and liked. The cab fare was only 30 dirhams apiece (roughly $3.50) which seemed really low for a 2-hr taxi ride. We had absolutely no idea that they were going to pack us in like sardines to make up the difference. Two men sat in the front next to the driver and two other men joined Anna and me in the back. We couldn't wear seat-belts for obvious reasons but never fear--we were so tightly squished together in the back seat, that there's no way we would have budged in the event of a car accident.
I think I'll take a moment here to talk about the concept of time here in Morocco. Basically, there isn't any. We've seen evidence of this at the Fondouk (to the great frustration of the directors, old and new) and it is certainly evident in everyday life outside the confines of the Fondouk walls. Anna and I sought out our 2-hr taxi ride when we were ready to go to Azrou. We didn't expect to have to sit in the
taxi for 45 minutes while it filled up. When the 7th and final guy put his suitcase in the trunk of our cab, we thought we'd be on our way imminently. But no--we had to wait another 10 minutes while the guy walked away and bought something to drink for the cab ride. You clearly can't plan to arrive anywhere at a certain time unless you are physically driving yourself there. At the Fondouk, this "relaxed" concept of time translates into work projects and repairs taking days instead of hours. Sure, the tools aren't state-of-the-art and sometimes the repairs are complicated. The handymen who work at the Fondouk are anything but lazy, but there's a pervasive attitude of "I'll get to it when I get to it."
The countryside that we drove through today was totally different from yesterday's landscape. While yesterday's ride was through lush olive tree groves, today we drove through much more mountainous terrain and the land was very dry and rocky. We didn't see anything being grown in the rocky fields along the road but we did see bottles of a honey-looking substance for sale perched on a cinder-blocks every 200-300 yards for miles. Our cab driver said it wasn't honey (they don't have honeybees in that region) but instead, some sugar-like substance that apparently doesn't taste very good.
When we arrived in Azrou, there was more chaos as I tried to find a cab driver who would take us to see the monkeys we had heard about and wait for us there to ensure we had a way to get back to the city. Fortunately, we wound up with a very nice young cab driver who spoke fluent French. I'm not sure how you could navigate the countryside without at least a little French since no one there spoke English.
We were driven about 15 minutes outside of town to a national forest known for it's Macaque monkeys. We saw tons of monkeys who were happily eating trash and whatever the tourists offered them. Anna squeezed in a short horseback ride while I walked beside her. Our cab driver really wanted me to hand feed the monkeys, but I informed him (in French, of course) that if the monkey bit me, I'd be in pretty big trouble.
There were various crafts for sale at the monkey forest so I got to practice my bargaining skills after we were done with the Macaques. Anna is a bit overwhelmed by the whole bargaining thing (plus, she doesn't speak French) so I've been doing the bargaining for both of us. Bargaining is part of the Moroccan culture and the locals fully expect for there to be some back and forth negotiations. Because we don't have anything like this in our culture, it's been hard telling a local vendor what we think his products are worth. We watched some Australian folks get totally ripped off at the tanneries last week but I've been pretty successful in my transactions. Either that or there are a bunch of Moroccans having a good laugh at my expense.
We decided to splurge and have our cab driver take us back to Fez without an additional 4 people packed in the car. We've been here long enough that I was able to give the driver directions on how to get us back to the Fondouk. There's a big McDonald's right up the road from the Fondouk, so that serves as a good landmark.
As much as traveling outside the city has been exciting, I always breathe a big sigh of relief when the Fondouk's guard opens the big doors for us and lets us in.
Anna and I cooked ourselves dinner this evening and I think we'll turn in early so we're well rested for tomorrow's critters.
I think I'll take a moment here to talk about the concept of time here in Morocco. Basically, there isn't any. We've seen evidence of this at the Fondouk (to the great frustration of the directors, old and new) and it is certainly evident in everyday life outside the confines of the Fondouk walls. Anna and I sought out our 2-hr taxi ride when we were ready to go to Azrou. We didn't expect to have to sit in the
taxi for 45 minutes while it filled up. When the 7th and final guy put his suitcase in the trunk of our cab, we thought we'd be on our way imminently. But no--we had to wait another 10 minutes while the guy walked away and bought something to drink for the cab ride. You clearly can't plan to arrive anywhere at a certain time unless you are physically driving yourself there. At the Fondouk, this "relaxed" concept of time translates into work projects and repairs taking days instead of hours. Sure, the tools aren't state-of-the-art and sometimes the repairs are complicated. The handymen who work at the Fondouk are anything but lazy, but there's a pervasive attitude of "I'll get to it when I get to it."
The countryside that we drove through today was totally different from yesterday's landscape. While yesterday's ride was through lush olive tree groves, today we drove through much more mountainous terrain and the land was very dry and rocky. We didn't see anything being grown in the rocky fields along the road but we did see bottles of a honey-looking substance for sale perched on a cinder-blocks every 200-300 yards for miles. Our cab driver said it wasn't honey (they don't have honeybees in that region) but instead, some sugar-like substance that apparently doesn't taste very good.
When we arrived in Azrou, there was more chaos as I tried to find a cab driver who would take us to see the monkeys we had heard about and wait for us there to ensure we had a way to get back to the city. Fortunately, we wound up with a very nice young cab driver who spoke fluent French. I'm not sure how you could navigate the countryside without at least a little French since no one there spoke English.
We were driven about 15 minutes outside of town to a national forest known for it's Macaque monkeys. We saw tons of monkeys who were happily eating trash and whatever the tourists offered them. Anna squeezed in a short horseback ride while I walked beside her. Our cab driver really wanted me to hand feed the monkeys, but I informed him (in French, of course) that if the monkey bit me, I'd be in pretty big trouble.
There were various crafts for sale at the monkey forest so I got to practice my bargaining skills after we were done with the Macaques. Anna is a bit overwhelmed by the whole bargaining thing (plus, she doesn't speak French) so I've been doing the bargaining for both of us. Bargaining is part of the Moroccan culture and the locals fully expect for there to be some back and forth negotiations. Because we don't have anything like this in our culture, it's been hard telling a local vendor what we think his products are worth. We watched some Australian folks get totally ripped off at the tanneries last week but I've been pretty successful in my transactions. Either that or there are a bunch of Moroccans having a good laugh at my expense.
We decided to splurge and have our cab driver take us back to Fez without an additional 4 people packed in the car. We've been here long enough that I was able to give the driver directions on how to get us back to the Fondouk. There's a big McDonald's right up the road from the Fondouk, so that serves as a good landmark.
As much as traveling outside the city has been exciting, I always breathe a big sigh of relief when the Fondouk's guard opens the big doors for us and lets us in.
Anna and I cooked ourselves dinner this evening and I think we'll turn in early so we're well rested for tomorrow's critters.
Saturday, December 4, 2010
Day 6: Studs, Ruins, and Pigeon, oh my
Good evening blog followers. I don't have anything particularly veterinary-related to report today but since we did have ourselves an exciting outing this afternoon, I thought I'd tell you a little about it. Because Dr. Frappier seems to know everyone who's anyone here in Morocco, with a single phone call, he was able to arrange for us to get inside the National Stud Farm. Even better, he agreed to drive us there himself. This government-run facility in Meknes (about a 45 minute drive from Fez) is home to about 40 Arab and Arab-Barb stallions in addition to at least 60 broodmares and youngsters. The studs were magnificent and the dichotomy between these well-kept horses versus the ones we treat during the week just seemed unfair. We learned that during the breeding season, the stallions are brought into the cities to breed (ie, they go to the mares) which is precisely the opposite of how it works in the United States. Interestingly, even though this is a government-run farm, Dr. Frappier still battles the management in trying to get the horses properly dewormed even though they are valuable animals and their bloodlines are highly sought after.
After our stop in Meknes, we continued on to Volubilis which, although it might sound like a communicable disease, is actually an ancient Roman ruins site. We had to stop and ask directions multiple times because maps don't really help you out in Morocco and I haven't seen anyone use a GPS. Apparently, city maps don't include street names because the names of the streets change periodically as new political and powerful families move into the neighborhood. You can imagine how difficult this makes navigation. We drove for another 45 minutes, winding our way up some frighteningly narrow roads. We passed pack mules carrying so much shrubbery that all you could see were explosions of green branches with four spindly legs beneath. Volubilis lies on a hillside atop a very lush valley. This is an area known for its olives groves and we passed thousands of rows of olive trees, methodically planted in perfectly even increments. I don't like olives under any circumstance, but we did learn that the olives that you eat are different from the olives that go into olive oil. Apparently the olive oil here is delicious, but I'll have to get back to you on that one.
When we finally arrived at Volubilis, the first thing that I was struck by was how silent the area was. Yes, we were there in the off-season, but there was almost no one at the ruins. Other than the occasional chirp of an insect, our footsteps were the only sound. Dr. Frappier conferred with the man whose job it is to direct the non-existent traffic. He asked whether we'd be able to get a cab back to Meknes since he was leaving us to go back to the Fondouk. The man assured him that yes, he could call us a cab and that it would cost 150 dirhams (roughly $18). Dr. Frappier bade us farewell and we were on our own. After a quick bite to eat at their mildly shady "restaurant" we got a good tour of the ruins (in English!). Volubilis was built in 3rd century BC and served as an important administrative center for the Roman presence in Africa. There has been extensive excavations over the last 100 years and it is still an active archaeological site. The mosaic floors were beautifully detailed and it was pretty darn cool to walk on stones that had been there for thousands of years.
When it was time to go, we found our parking guy who told us he was going to call us a taxi. I think he was hoping that we didn't notice that the "taxi" driver was really just his buddy. We really had no alternative (the ruins were smack dab in the middle of nowhere) so we took the guy on faith that he could get us to the train station. Thankfully he could and he did. A 45 minute train ride from Meknes to Fez was uneventful, other than the fact that there were no announcements made on the train. Therefore, we had no idea when we were nearing Fez or when we were supposed to get off the train. It's just dumb luck that I happened to inquire about this dilemma 2 minutes before we pulled into the train station in Fez. Our Swedish friend Emmy wasn't so lucky a few weeks back when she made the same trip. She completely missed the stop in Fez and wound up in Tangier at 3 AM by herself.
For our evening activity, Anna read our guide book for restaurant recommendations and we decided to try one that we knew was relatively close to the Fondouk. Jeremy, Anne, and Emmy joined us and the 5 of us spent a really long time trying to figure out where the restaurant was. Finally, with just an inkling of where this restaurant was located, we got in the car and started driving. I find the street parking process in Fez to be rather remarkable. There's a company that Jeremy calls "Mr. Dirham" and I can't tell whether that's a legitimate company or whether that's just his funny name for it. Anyway, when you find street parking, a man in a reflector vest helps you parallel park. When you get back to your car at the end of the evening, you pay him him 2 dirhams (roughly 25 cents) as a courtesy for making sure your car didn't get stolen. I asked Dr. Frappier whether you still have to pay the 2 dirhams if your car isn't there when you get back, but I never did get an answer.
The five of us had a lovely dinner out where I ate the best pigeon I've ever had. Sure, it may be the only pigeon I've ever had, but baked in a "pastilla" with some other vague meat and cinnamon, it was pretty darn tasty. The hubcaps were still on Jeremy's car when we returned so it was a successful evening all around. Anna and are working on a game plan for tomorrow, but we're hoping it involves monkeys.
After our stop in Meknes, we continued on to Volubilis which, although it might sound like a communicable disease, is actually an ancient Roman ruins site. We had to stop and ask directions multiple times because maps don't really help you out in Morocco and I haven't seen anyone use a GPS. Apparently, city maps don't include street names because the names of the streets change periodically as new political and powerful families move into the neighborhood. You can imagine how difficult this makes navigation. We drove for another 45 minutes, winding our way up some frighteningly narrow roads. We passed pack mules carrying so much shrubbery that all you could see were explosions of green branches with four spindly legs beneath. Volubilis lies on a hillside atop a very lush valley. This is an area known for its olives groves and we passed thousands of rows of olive trees, methodically planted in perfectly even increments. I don't like olives under any circumstance, but we did learn that the olives that you eat are different from the olives that go into olive oil. Apparently the olive oil here is delicious, but I'll have to get back to you on that one.
When we finally arrived at Volubilis, the first thing that I was struck by was how silent the area was. Yes, we were there in the off-season, but there was almost no one at the ruins. Other than the occasional chirp of an insect, our footsteps were the only sound. Dr. Frappier conferred with the man whose job it is to direct the non-existent traffic. He asked whether we'd be able to get a cab back to Meknes since he was leaving us to go back to the Fondouk. The man assured him that yes, he could call us a cab and that it would cost 150 dirhams (roughly $18). Dr. Frappier bade us farewell and we were on our own. After a quick bite to eat at their mildly shady "restaurant" we got a good tour of the ruins (in English!). Volubilis was built in 3rd century BC and served as an important administrative center for the Roman presence in Africa. There has been extensive excavations over the last 100 years and it is still an active archaeological site. The mosaic floors were beautifully detailed and it was pretty darn cool to walk on stones that had been there for thousands of years.
When it was time to go, we found our parking guy who told us he was going to call us a taxi. I think he was hoping that we didn't notice that the "taxi" driver was really just his buddy. We really had no alternative (the ruins were smack dab in the middle of nowhere) so we took the guy on faith that he could get us to the train station. Thankfully he could and he did. A 45 minute train ride from Meknes to Fez was uneventful, other than the fact that there were no announcements made on the train. Therefore, we had no idea when we were nearing Fez or when we were supposed to get off the train. It's just dumb luck that I happened to inquire about this dilemma 2 minutes before we pulled into the train station in Fez. Our Swedish friend Emmy wasn't so lucky a few weeks back when she made the same trip. She completely missed the stop in Fez and wound up in Tangier at 3 AM by herself.
For our evening activity, Anna read our guide book for restaurant recommendations and we decided to try one that we knew was relatively close to the Fondouk. Jeremy, Anne, and Emmy joined us and the 5 of us spent a really long time trying to figure out where the restaurant was. Finally, with just an inkling of where this restaurant was located, we got in the car and started driving. I find the street parking process in Fez to be rather remarkable. There's a company that Jeremy calls "Mr. Dirham" and I can't tell whether that's a legitimate company or whether that's just his funny name for it. Anyway, when you find street parking, a man in a reflector vest helps you parallel park. When you get back to your car at the end of the evening, you pay him him 2 dirhams (roughly 25 cents) as a courtesy for making sure your car didn't get stolen. I asked Dr. Frappier whether you still have to pay the 2 dirhams if your car isn't there when you get back, but I never did get an answer.
The five of us had a lovely dinner out where I ate the best pigeon I've ever had. Sure, it may be the only pigeon I've ever had, but baked in a "pastilla" with some other vague meat and cinnamon, it was pretty darn tasty. The hubcaps were still on Jeremy's car when we returned so it was a successful evening all around. Anna and are working on a game plan for tomorrow, but we're hoping it involves monkeys.
Friday, December 3, 2010
Day 5: Vulvoplasties and a Trip to the Grocery Store
So, I was not expecting to get a new post in today, but our travel plans changed unexpectedly, so here I am. Anna and I were supposed to leave for Tangier early this afternoon but when we went to get our train tickets, we were informed that all trains to Tangier had been cancelled due to flooding of the train tracks. We looked into other ways to possibly get there but the 7-hr bus ride and the $200/5-hr cab ride made that sub-ideal given that we were only going to be there for the weekend. So, we're staying in Fez for the weekend.
Today marked the end of our first week of work at the Fondouk. We know the drill and are much more efficient about getting things done. At least 20-25 horses, donkeys and mules passed through the Fondouk gates today, a significant increase over the last few days. Apparently, the waxing and waning of patients seen is fairly predictable. For example, right before we arrived, the Muslim world celebrated Eid al-Adha, a festival commemorating when Abraham offered to sacrifice his son, Ishmael, as an act of God. As the story goes, God intervened and offered him a ram to sacrifice instead. In the weeks leading up to Eid al-Adha, Moroccan Muslims fatten up their lambs to be slaughtered for the festival. This is done by excessive feeding which, unfortunately, results in the formation of urinary stones. Thus, for the couple of weeks before the holiday, the Fondouk sees blocked lamb after blocked lamb after blocked lamb. In the weeks immediately after the holiday, the Fondouk is inexplicably quiet.
Because of the increased volume of equines seen today, we were all torn in different directions. Anna was put in charge of making sure everyone got dewormed while waiting to be examined. I got to spend a fair bit of time tending to a mule with a large fluctuant swelling in her hind end, certainly the result of a kick from another mule. As many of you know that I love sticking needles into things and draining them, you can imagine how much pleasure I got from this case. I pulled off a huge volume of serum, injected some steroids and antibiotics and sent her on her way.
One of the other interesting cases I saw today was a ewe who was dragged in with her uterus dragging on the ground behind her. A prolapsed uterus in a ewe is something that we do see in the States, and although I hadn't actually ever fixed one myself before today, I wasn't too surprised when Houssine whipped out a jar of honey. Honey, like granulated sugar, has the power to reduce inflammation quickly. After washing the uterus and dousing it in honey for 15 minutes, Houssine was able to return the uterus to it's normal position inside the mule. I then placed an intra-uterine antibiotic tablet and set out to restore her anatomy and ensure that the uterus could not re-prolapse. Houssine told us that this ewe had already had the prolapse repaired once by a Moroccan veterinarian, but that her sutures had been way too tight and now a large portion of the uterus and vulva was necrotic. I spent the first 15-20 minutes of the surgery basically doing plastic surgery on her vulva, piecing her back together one stitch at a time. Finally, Houssine showed me a purse-string-like suture pattern to hopefully keep the uterus in place. We gave her pain medication and antibiotics. Houssine also introduced me to the concept of using a commonly-used bronchodilator (Ventipulmin, just in cars you were wondering) to stop uterine contractions. We asked the ewe's owner to bring her back early next week for a re-check exam. Hopefully he will.
Since we didn't have any surgeries for the afternoon, Dr. Frappier arranged for Anna and some of the vet students to go for a ride at a nice nearby stable. He is a pretty popular guy in Morocco, as you might imagine, and people appear to bend over backwards to accommodate him and those who are associated with him. Every policeman we passed on the street waved at him while we were en route to the stable. Although the stable was only 6 miles from the Fondouk, it took 30 minutes to get there and even longer to get back. The traffic in Fez in crazy and, as I learned from Dr. Frappier today, Morocco has more car accidents than any other country. That is a pretty scary statistic but a totally believable one nonetheless. Lanes appear to be optional as is listening to the policeman directing traffic. The roundabouts are definitely a free for all with some roundabouts giving cross-traffic the right of way and others giving cars already in the roundabout the right of way. The pedestrians are fearless and there are people and motorbikes meandering through the cars every time traffic slows down. However, we made it there and back and the girls apparently had a nice ride through the olive tree groves.
We made a stop at a big grocery store on the way back from the stables. It actually reminds me of a Super Target we see at home. You can buy cheese, a dishwasher, clothes and vegetables all under the same huge roof. It is very modern and clean. Anna and I have been eating breakfast and lunch at the Fondouk and our dinners have been either out or cooked in our living quarters. We have taken endless amusement by the names of some of our food, most of which is labeled in French and Arabic. Our favorite so far is definitely our breakfast cereal, "Tropical Crunchy."
For those of you wondering about "Rolex," our rockstar mule from earlier in the week, I'm pleased to report that his owner came to take him home just minutes before we returned from the market. That's a good thing, not only because it is a happy ending, but because I had fallen in love with him and was already pondering ways to bring him back to New York with me.
Now that we're back at the Fondouk for the evening, I'm sure we'll buckle down and come up with a plan for tomorrow. For now, good night.
Today marked the end of our first week of work at the Fondouk. We know the drill and are much more efficient about getting things done. At least 20-25 horses, donkeys and mules passed through the Fondouk gates today, a significant increase over the last few days. Apparently, the waxing and waning of patients seen is fairly predictable. For example, right before we arrived, the Muslim world celebrated Eid al-Adha, a festival commemorating when Abraham offered to sacrifice his son, Ishmael, as an act of God. As the story goes, God intervened and offered him a ram to sacrifice instead. In the weeks leading up to Eid al-Adha, Moroccan Muslims fatten up their lambs to be slaughtered for the festival. This is done by excessive feeding which, unfortunately, results in the formation of urinary stones. Thus, for the couple of weeks before the holiday, the Fondouk sees blocked lamb after blocked lamb after blocked lamb. In the weeks immediately after the holiday, the Fondouk is inexplicably quiet.
Because of the increased volume of equines seen today, we were all torn in different directions. Anna was put in charge of making sure everyone got dewormed while waiting to be examined. I got to spend a fair bit of time tending to a mule with a large fluctuant swelling in her hind end, certainly the result of a kick from another mule. As many of you know that I love sticking needles into things and draining them, you can imagine how much pleasure I got from this case. I pulled off a huge volume of serum, injected some steroids and antibiotics and sent her on her way.
One of the other interesting cases I saw today was a ewe who was dragged in with her uterus dragging on the ground behind her. A prolapsed uterus in a ewe is something that we do see in the States, and although I hadn't actually ever fixed one myself before today, I wasn't too surprised when Houssine whipped out a jar of honey. Honey, like granulated sugar, has the power to reduce inflammation quickly. After washing the uterus and dousing it in honey for 15 minutes, Houssine was able to return the uterus to it's normal position inside the mule. I then placed an intra-uterine antibiotic tablet and set out to restore her anatomy and ensure that the uterus could not re-prolapse. Houssine told us that this ewe had already had the prolapse repaired once by a Moroccan veterinarian, but that her sutures had been way too tight and now a large portion of the uterus and vulva was necrotic. I spent the first 15-20 minutes of the surgery basically doing plastic surgery on her vulva, piecing her back together one stitch at a time. Finally, Houssine showed me a purse-string-like suture pattern to hopefully keep the uterus in place. We gave her pain medication and antibiotics. Houssine also introduced me to the concept of using a commonly-used bronchodilator (Ventipulmin, just in cars you were wondering) to stop uterine contractions. We asked the ewe's owner to bring her back early next week for a re-check exam. Hopefully he will.
Since we didn't have any surgeries for the afternoon, Dr. Frappier arranged for Anna and some of the vet students to go for a ride at a nice nearby stable. He is a pretty popular guy in Morocco, as you might imagine, and people appear to bend over backwards to accommodate him and those who are associated with him. Every policeman we passed on the street waved at him while we were en route to the stable. Although the stable was only 6 miles from the Fondouk, it took 30 minutes to get there and even longer to get back. The traffic in Fez in crazy and, as I learned from Dr. Frappier today, Morocco has more car accidents than any other country. That is a pretty scary statistic but a totally believable one nonetheless. Lanes appear to be optional as is listening to the policeman directing traffic. The roundabouts are definitely a free for all with some roundabouts giving cross-traffic the right of way and others giving cars already in the roundabout the right of way. The pedestrians are fearless and there are people and motorbikes meandering through the cars every time traffic slows down. However, we made it there and back and the girls apparently had a nice ride through the olive tree groves.
We made a stop at a big grocery store on the way back from the stables. It actually reminds me of a Super Target we see at home. You can buy cheese, a dishwasher, clothes and vegetables all under the same huge roof. It is very modern and clean. Anna and I have been eating breakfast and lunch at the Fondouk and our dinners have been either out or cooked in our living quarters. We have taken endless amusement by the names of some of our food, most of which is labeled in French and Arabic. Our favorite so far is definitely our breakfast cereal, "Tropical Crunchy."
For those of you wondering about "Rolex," our rockstar mule from earlier in the week, I'm pleased to report that his owner came to take him home just minutes before we returned from the market. That's a good thing, not only because it is a happy ending, but because I had fallen in love with him and was already pondering ways to bring him back to New York with me.
Now that we're back at the Fondouk for the evening, I'm sure we'll buckle down and come up with a plan for tomorrow. For now, good night.
Thursday, December 2, 2010
Day 4: Rolex and the Medina
Hello loyal blog followers! The last twenty-four hours have been one heck of a professional and emotional roller coaster. When I last signed off, I was headed out to dinner with Anna, Jeremy (one of two new directors), Mohammmed (the "foreman" of the Fondouk) and four European vet students who are here volunteering. We had a lively meal out and then continued our evening like any other local would do--by going out for the special Moroccan mint tea. Because this is a Muslim country, there is very little alcohol consumption. Drinking sickly sweet and piping hot tea with fresh mint leaves instead of beer and wine definitely limits the amount of trouble that one can get into.
We were all jazzed up from an evening out so when we returned to the Fondouk to find our previously-colicky gray mule down and rolling from abdominal pain, the mood instantly got more somber. We got him up, gave him some sedation and then I stuck an arm in him (yup, that's the most glamorous part of job). However, it was really only a hand that I could get into him because his intestines were so severely distended with gas. We passed a naso-gastric tube on him and, not surprisingly, got back a bucket of fairly fetid reflux. This told us that things were backing up in his GI track enough that his stomach was starting to become stretched out. Combined with everything else going on, this changed his prognosis from fair to grave. We discussed whether or not to pull the plug and euthanize him then and there whether to see if we could keep him comfortable enough to wait it out a little longer.
This mule was gas-distended to the naked eye. Although I had never done this or even seen this done before, I proposed trocarizing the mule in an effort to relieve the gas. This would involve placing a trocar (a large-bored catheter-like instrument) through the body wall and hoping it would pierce the colon and serve as an exit route for accumulated gas. The best outcome would be resolution of the colic if a sufficient amount of gas could exit the colon. The worst outcome would be necessary euthanasia if the trocarization seeded a septic peritonitis. After a brief pow-wow, Jeremy and I decided that we had nothing to lose. This mule was very close to death and if he did die, at least we'd know we had tried everything. With our entire dinner gang present, we clipped and prepped the site and then I stuck a trocar into this mule's colon. The gas poured out. That puncture was so successful that I suggested we do it on the other side, too. Again the gas poured out as we all watched with amazement.
I re-rectaled the mule after the trocarization and I could now get my entire arm into him. Jeremy had been kind enough to buy the Moroccan tea for everyone that night. I announced that if this mule pulled through, the next round of tea was on me. We all went to bed shortly thereafter and, interestingly, not one of us was able to fall asleep last night. We individually tossed and turned and some of us rendezvoused in the kitchen at 3 AM for a snack. This mule's unknown fate was clearly wearing on all of us.
Well, I am pleased to report that our tough little gray mule was standing in his stall bright-eyed and bushy-tailed this morning. Our mule, whom Anna and I have named "Rolex," is going to make it. Some of you may think we named him "Rolex" after the famous 3-day event held in Lexington, KY every year. He was, after all, covered with a sheet overnight bearing the Rolex insignia. But no--we consider this mule to be the best of the best, the Rolex of mules. We took our Rolex out for grass this morning and he ate ravenously. He passed manure like a champ and even gave us a cliched little hee-haw when we approached his stall. When his owner came to check on him this morning I gave him the thumb's up. It turns out that that's a universal sign for "everything's going to be okay." If all continues to go well, he'll go home tomorrow. I've never been so excited by the prospect of buying a round of tea.
We saw a whole bunch of other colics today (weather change?), although none were as severe as Rolex's. They were all examined, medicated, rectaled, tubed, and sent on their way. We also saw a few small herds of emaciated sheep who came in mostly for "control," as Houssine puts it. A shot of vitamins and dewormer for all. I find this shot of "vitamins" sort of interesting. Even if there's no intramuscular injection indicated, the Moroccan people who bring us their animals want them to get a shot because a "shot" fixes everything. While it sounds ridiculous, I've had numerous clients back in the United States ask me "why can't [I] just give him a shot, Doc?"
Anna and I bowed out of our afternoon work a hair early in order to be given private tour of the Medina, the walled city-within-a-city that is home to 250,000 Moroccans. This is not a place you would ever want to explore without someone who definitely knew the way out. It's a claustrophobia-inducing maze of incredibly crowded cobblestone pathways and narrow alleyways. There are no street names, there is no order, and every ounce of our bodies was overstimulated. Between the hurried bustle of the foot traffic, the bright colors of the weavers' threads, and the remarkably pungent odor of the tanneries, we were thoroughly exhausted by the time our tour was over. Interestingly, our guide introduced us to everyone by our association to The American Fondouk. Even people who don't own animals know of the Fondouk and respect the work that goes on there. We were even treated to some special discounts--it's like being one of the "in crowd"--Moroccan style.
We are heading to Tangier tomorrow afternoon for a weekend of exploration since the Fondouk is closed on the weekend. We are being hosted by a man who was introduced to me by one of my MHVP clients. We will stay with him and his family on Saturday, stay at the hotel belonging to a Fondouk employee's friend on Friday, and dine at a supposedly excellent restaurant owned by one of Dr. Frappier's friends. We sure do know how to travel in style.
I don't expect an Internet connection this weekend so you, my faithful blog followers, may just have to wait until Monday for my next post.
We were all jazzed up from an evening out so when we returned to the Fondouk to find our previously-colicky gray mule down and rolling from abdominal pain, the mood instantly got more somber. We got him up, gave him some sedation and then I stuck an arm in him (yup, that's the most glamorous part of job). However, it was really only a hand that I could get into him because his intestines were so severely distended with gas. We passed a naso-gastric tube on him and, not surprisingly, got back a bucket of fairly fetid reflux. This told us that things were backing up in his GI track enough that his stomach was starting to become stretched out. Combined with everything else going on, this changed his prognosis from fair to grave. We discussed whether or not to pull the plug and euthanize him then and there whether to see if we could keep him comfortable enough to wait it out a little longer.
This mule was gas-distended to the naked eye. Although I had never done this or even seen this done before, I proposed trocarizing the mule in an effort to relieve the gas. This would involve placing a trocar (a large-bored catheter-like instrument) through the body wall and hoping it would pierce the colon and serve as an exit route for accumulated gas. The best outcome would be resolution of the colic if a sufficient amount of gas could exit the colon. The worst outcome would be necessary euthanasia if the trocarization seeded a septic peritonitis. After a brief pow-wow, Jeremy and I decided that we had nothing to lose. This mule was very close to death and if he did die, at least we'd know we had tried everything. With our entire dinner gang present, we clipped and prepped the site and then I stuck a trocar into this mule's colon. The gas poured out. That puncture was so successful that I suggested we do it on the other side, too. Again the gas poured out as we all watched with amazement.
I re-rectaled the mule after the trocarization and I could now get my entire arm into him. Jeremy had been kind enough to buy the Moroccan tea for everyone that night. I announced that if this mule pulled through, the next round of tea was on me. We all went to bed shortly thereafter and, interestingly, not one of us was able to fall asleep last night. We individually tossed and turned and some of us rendezvoused in the kitchen at 3 AM for a snack. This mule's unknown fate was clearly wearing on all of us.
Well, I am pleased to report that our tough little gray mule was standing in his stall bright-eyed and bushy-tailed this morning. Our mule, whom Anna and I have named "Rolex," is going to make it. Some of you may think we named him "Rolex" after the famous 3-day event held in Lexington, KY every year. He was, after all, covered with a sheet overnight bearing the Rolex insignia. But no--we consider this mule to be the best of the best, the Rolex of mules. We took our Rolex out for grass this morning and he ate ravenously. He passed manure like a champ and even gave us a cliched little hee-haw when we approached his stall. When his owner came to check on him this morning I gave him the thumb's up. It turns out that that's a universal sign for "everything's going to be okay." If all continues to go well, he'll go home tomorrow. I've never been so excited by the prospect of buying a round of tea.
We saw a whole bunch of other colics today (weather change?), although none were as severe as Rolex's. They were all examined, medicated, rectaled, tubed, and sent on their way. We also saw a few small herds of emaciated sheep who came in mostly for "control," as Houssine puts it. A shot of vitamins and dewormer for all. I find this shot of "vitamins" sort of interesting. Even if there's no intramuscular injection indicated, the Moroccan people who bring us their animals want them to get a shot because a "shot" fixes everything. While it sounds ridiculous, I've had numerous clients back in the United States ask me "why can't [I] just give him a shot, Doc?"
Anna and I bowed out of our afternoon work a hair early in order to be given private tour of the Medina, the walled city-within-a-city that is home to 250,000 Moroccans. This is not a place you would ever want to explore without someone who definitely knew the way out. It's a claustrophobia-inducing maze of incredibly crowded cobblestone pathways and narrow alleyways. There are no street names, there is no order, and every ounce of our bodies was overstimulated. Between the hurried bustle of the foot traffic, the bright colors of the weavers' threads, and the remarkably pungent odor of the tanneries, we were thoroughly exhausted by the time our tour was over. Interestingly, our guide introduced us to everyone by our association to The American Fondouk. Even people who don't own animals know of the Fondouk and respect the work that goes on there. We were even treated to some special discounts--it's like being one of the "in crowd"--Moroccan style.
We are heading to Tangier tomorrow afternoon for a weekend of exploration since the Fondouk is closed on the weekend. We are being hosted by a man who was introduced to me by one of my MHVP clients. We will stay with him and his family on Saturday, stay at the hotel belonging to a Fondouk employee's friend on Friday, and dine at a supposedly excellent restaurant owned by one of Dr. Frappier's friends. We sure do know how to travel in style.
I don't expect an Internet connection this weekend so you, my faithful blog followers, may just have to wait until Monday for my next post.
Wednesday, December 1, 2010
Day 3: We're Down With the Mules
Good evening to my blog readers. Anna and I have just finished day three of work here at the American Fondouk. We've got the drill down pat and are operating smoothly in the large animal hospital. It finally stopped raining for the first time since we arrived. Right off the bat, this meant a greater flow of patients. We're happy to report that both of our rope-in-the-leg horses are doing well. The one we saw on Monday needs just another day or two of antibiotics and then we'll be able to send him on his way. Another post-op mule whose case we inherited when we arrived also looks great. His owner drove him 100 km to get him here so next time he calls to check in, we'll be able to tell him that the mule is ready to go home. Our piroplasmosis/colicky mare from yesterday was bright-eyed this morning as well.
My first case of the day was a ewe who was dragged in because her owner didn't know if she had already given birth, was about to give birth, or whether something else was going on. Half of a fetid placenta hung out of her. Through a 2-finger exam, Houssine and I were able to determine that she was in the process of aborting. Houssine was able to scoop out her fetus and membranes. I placed an intra-uterine antibiotic tablet while Houssine gave her a shot of antibiotics--then we sent her on her way. Because I was clearly running a special on small ruminants today, a ram who was off his feed was my next patient. With Houssine's guidance, we passed a surprisingly large naso-gastric tube and administered some kind of concotion for rumen health and a dewormer. He, too, was sent on his way.
Many of our other cases today were types of illnesses and problems that we see at home. One man brought in a large gray mule who was quite lame in the front end. He had an obvious carpal hygroma (fluid pocket on the knee) and the other leg was so upright that he had developed remarkable arthritis. I was all set to drain the carpal hygroma and inject some steroids into it, something I do routinely in practice at home. However, the mule's owner did not want his mule to be clipped on the knee (which is necessary for the procedure) because he hoped to sell the mule at the souk (market) tomorrow. That may sound harsh, but it's actually a very similar situation that I'm presented with at home--people don't want their horses clipped because they don't want anyone to know that their horse has a problem. This mule received a shot of bute and we bid him adieu.
We tended to a few other mules with wounds and abrasions, including one emaciated mule who comes in regularly for bute (an anti-inflammatory). One of the first things that was mentioned by the staff vets at the Fondouk was that he needed his tear ducts flushed. This is the second time in two days where flushing the tear ducts has been requested. I find this fascinating--the mule is wasting away, has minimally trimmed feet and a sore back from carrying too much weight, but the people are most bothered by the small amount of eye "crusties." We went ahead and flushed the tear ducts, but then also treated him to dental work and a hoof trim. It was a big day for Anna, partly because she was handed the powerfloat and told to "go for it."
Later in the morning, a man brought a terribly depressed mule completely caked in mud and manure. We were told he had been colicking but we didn't know for how long. While the students were trying to do a physical exam, the mule went down to the ground and we couldn't get him up. I had a debate with Houssine about the merits of his pain-killing drug of choice versus my pain-killing drug of choice. He wanted to give dipyrone, an anti-spasmodic drug that my practice doesn't even carry and I wanted to give banamine. We compromised amicably and gave both intravenously.
The needle policy here is an interesting one. Because supplies are extremely limited, needles are conserved and reused. There is no form of sterilization here but they are washed in a chlohexidine rinse between uses. A new needle is used, however, for intravenous drug administration and then that needle becomes an intramuscular needle. With this in mind, you can imagine how curious I find it that Houssine always hands me a cotton ball with alcohol on it "for sterilization" before an injection. I passed a naso-gastric tube on the mule on the ground and we gave him water and oil through the tube. The mule got up when I was done tubing him and looked mildly more comfortable. Our work was only getting started with this mule, however. At least 4 of us (including the mule's owner) went to work to clean this poor guy up a bit. I joked that we were white-washing the mule as the layers and layers of muck poured off of him. His owner talked very emphatically to me in Arabic while I was working with him--he kept pointing at the sky, pointing at me, and smiling. I couldn't help but think he was expressing some kind of gratitude. Either that or he thinks I'm a crazy American. After his rejuvenating bath, we ask his owner if we could hang onto the mule for the day and he agreed.
Later, when we reassessed the mule, we sedated him for a rectal exam and our findings were not encouraging. As this was a perfect teaching environment, Anna and one of the other students also got to stick their arm in the mule to learn what "abnormal" felt like. And as if that weren't exciting enough, Anna also got to pass the naso-gastric tube when we re-tubed him. She did a fantastic job and I'm sure the mule appreciated the hydration. There was a discussion of intravenous fluid therapy, but given that there are no sterile fluids in large quantity here and the pH of the distilled water isn't necessarily compatible with horse blood, instead we opted to "first, do no harm." We'll monitor the mule closely overnight, each taking turns to wake up in the middle of the night and poke our heads in stall, and hopefully a good night's rest will do him some good.
In about 10 minutes, we're all meeting up to head out to dinner in the Medina. Last night was our first adventure outside the confines of the Fondouk. The Medina is a walled city-within-a-city and is a wild maze of narrow streets and winding alleyways. The Medina is closed to cars and trucks and the mules that we treat are the only way to get goods and merchandise into the market areas. Anna was the bravest of all at the restaurant we chose. She ate a camel burger which, interestingly, tasted very similar to our dessert. Go figure. Until tomorrow...
My first case of the day was a ewe who was dragged in because her owner didn't know if she had already given birth, was about to give birth, or whether something else was going on. Half of a fetid placenta hung out of her. Through a 2-finger exam, Houssine and I were able to determine that she was in the process of aborting. Houssine was able to scoop out her fetus and membranes. I placed an intra-uterine antibiotic tablet while Houssine gave her a shot of antibiotics--then we sent her on her way. Because I was clearly running a special on small ruminants today, a ram who was off his feed was my next patient. With Houssine's guidance, we passed a surprisingly large naso-gastric tube and administered some kind of concotion for rumen health and a dewormer. He, too, was sent on his way.
Many of our other cases today were types of illnesses and problems that we see at home. One man brought in a large gray mule who was quite lame in the front end. He had an obvious carpal hygroma (fluid pocket on the knee) and the other leg was so upright that he had developed remarkable arthritis. I was all set to drain the carpal hygroma and inject some steroids into it, something I do routinely in practice at home. However, the mule's owner did not want his mule to be clipped on the knee (which is necessary for the procedure) because he hoped to sell the mule at the souk (market) tomorrow. That may sound harsh, but it's actually a very similar situation that I'm presented with at home--people don't want their horses clipped because they don't want anyone to know that their horse has a problem. This mule received a shot of bute and we bid him adieu.
We tended to a few other mules with wounds and abrasions, including one emaciated mule who comes in regularly for bute (an anti-inflammatory). One of the first things that was mentioned by the staff vets at the Fondouk was that he needed his tear ducts flushed. This is the second time in two days where flushing the tear ducts has been requested. I find this fascinating--the mule is wasting away, has minimally trimmed feet and a sore back from carrying too much weight, but the people are most bothered by the small amount of eye "crusties." We went ahead and flushed the tear ducts, but then also treated him to dental work and a hoof trim. It was a big day for Anna, partly because she was handed the powerfloat and told to "go for it."
Later in the morning, a man brought a terribly depressed mule completely caked in mud and manure. We were told he had been colicking but we didn't know for how long. While the students were trying to do a physical exam, the mule went down to the ground and we couldn't get him up. I had a debate with Houssine about the merits of his pain-killing drug of choice versus my pain-killing drug of choice. He wanted to give dipyrone, an anti-spasmodic drug that my practice doesn't even carry and I wanted to give banamine. We compromised amicably and gave both intravenously.
The needle policy here is an interesting one. Because supplies are extremely limited, needles are conserved and reused. There is no form of sterilization here but they are washed in a chlohexidine rinse between uses. A new needle is used, however, for intravenous drug administration and then that needle becomes an intramuscular needle. With this in mind, you can imagine how curious I find it that Houssine always hands me a cotton ball with alcohol on it "for sterilization" before an injection. I passed a naso-gastric tube on the mule on the ground and we gave him water and oil through the tube. The mule got up when I was done tubing him and looked mildly more comfortable. Our work was only getting started with this mule, however. At least 4 of us (including the mule's owner) went to work to clean this poor guy up a bit. I joked that we were white-washing the mule as the layers and layers of muck poured off of him. His owner talked very emphatically to me in Arabic while I was working with him--he kept pointing at the sky, pointing at me, and smiling. I couldn't help but think he was expressing some kind of gratitude. Either that or he thinks I'm a crazy American. After his rejuvenating bath, we ask his owner if we could hang onto the mule for the day and he agreed.
Later, when we reassessed the mule, we sedated him for a rectal exam and our findings were not encouraging. As this was a perfect teaching environment, Anna and one of the other students also got to stick their arm in the mule to learn what "abnormal" felt like. And as if that weren't exciting enough, Anna also got to pass the naso-gastric tube when we re-tubed him. She did a fantastic job and I'm sure the mule appreciated the hydration. There was a discussion of intravenous fluid therapy, but given that there are no sterile fluids in large quantity here and the pH of the distilled water isn't necessarily compatible with horse blood, instead we opted to "first, do no harm." We'll monitor the mule closely overnight, each taking turns to wake up in the middle of the night and poke our heads in stall, and hopefully a good night's rest will do him some good.
In about 10 minutes, we're all meeting up to head out to dinner in the Medina. Last night was our first adventure outside the confines of the Fondouk. The Medina is a walled city-within-a-city and is a wild maze of narrow streets and winding alleyways. The Medina is closed to cars and trucks and the mules that we treat are the only way to get goods and merchandise into the market areas. Anna was the bravest of all at the restaurant we chose. She ate a camel burger which, interestingly, tasted very similar to our dessert. Go figure. Until tomorrow...
Monday, November 29, 2010
Day1: Intro to life at the Fondouk
Greetings to all my blog followers from here at The American Fondouk in Fez, Morocco! Anna and I arrived in Fez yesterday (Sunday) after 24 hours straight of smooth traveling. We were met at the airport by one of the Fondouk staff and then given a tour of the Fondouk. The Fondouk is a large, walled compound consisting of large and small animal treatment areas and a central courtyard surrounded by stalls for inpatients. There are living quarters for the visiting vets and students and a house for the director. For the last 16 years, the Fondouk has been run by the legendary Dr. Denys Frappier, a Canadian former FEI veterinarian. As Dr. Frappier's tenure at the Fondouk comes to an end the start of the new year, the vacant position is going to be filled by two young American veterinarians (Jeremy and Anne...didn't catch their last name). They are an impressive and gutsy couple with great aspirations for the Fondouk. They treated us to a welcome lunch out and then we parted ways for the day.
Anna and I were both awoken out of deep sleep when the alarm clock rang after 13 hours. We weren't even disturbed by the calls to prayer that are blasted by the mosques at all hours of the day and night. I guess that's what happens when you miss out on a night's sleep somewhere along the way. Work at the Fondouk begins at 7:30 AM when the huge gates are opened and the crowds flood in and line up around the courtyard. Since it was rainy and cold, there were significantly fewer animals seen today...only around 50 instead of The usual 100+. There is
very little order in the Fondouk but everything manages to get done. In addition to the staff veterinarians and Anna and myself, there are 4 European vet students, a small animal, technician, a farrier, a groundsman, and a wonderfully capable Moroccan veterinarian named Houssine who, I'm told, has barely a high school education. There are a large number of small animals that come through the door such as dogs with mange, cats with pneumonia, pigeons with ruptured crops, and even a bunny or two. I poked my head into the small animal room a couple of times but am much happier outside with the donkeys, mules, horses and sheep.
We did so much today and the work is emotionally draining. I'll tell you about a few cases but will try to spare you the gory gory details. Unfortunately, I just discovered that I cannot post my pictures onto the blog because something is incompatible with the iPad that I'm using to type. However, I will ask my office to post some of the pictures that I email them and hopefully I'll remember to put a link to the office site at the end of this post.
One case that gave me a lot to think about was a little gray mule that was dragged in, unable to bear weight on his right hind leg. He had been like this for at least several days, although the history that we get has passed through several people and has been translated from Arabic to French and then French to English. I'm glad I paid attention in French class all those years since I'm able to follow a fair bit of the French conversations and even participate in a few. The femoral fracture in this poor soul is obvious as we take turns manipulating it in the courtyard. The mule's condition is far past the point where we could do anything to help him. We recommend euthanasia to his owner who is torn because he feels that we should not necessarily intervene--"if Allah wills it" the mule will die on his own. Eventually, we convince him to let us euthanize the mule, but only if we agree to pay him 300 dirhams (roughly $40) so he can buy a new one. I have never been so comforted by performing a euthanasia. The only thing made me a bit nervous was learning afterwards that the dead donkey meat would be used to feed the dogs and cats at the Fondouk. If the donkey had died on his own, the meat would have been fed to the man's family.
Another interesting case that I wound up taking involved another lame mule who came in with what looked like rope burn around his pastern. I did not follow all the rationale of taking x-rays right away but two were taken anyway since they're processed the "old-fashioned" way (by getting dipped in chemicals) and development takes 20 minutes. While we were waiting, I clipped the wound and scrubbed it. Once all the debris was cleared, I realized that I was looking at a piece of rope firmly embedded within the wound. It turns out that the Moroccans "hobble" their mules--ie, tie their legs together with rope--to keep them from escaping. This rope had essentially grown into the mule's leg and was so deep that it was down to the bone and mostly covered over by regrowth of skin. The purpose of the x-rays was to see if there was anything else trapped in there since, apparently it's not uncommon to finds pieces of metal in there too. Although this mule did not have any metal identified on xray, the xray was horrifying nonetheless. The degree of arthritis and the evidence of old injuries was staggering. Also, because there is essentially no corrective foot trimming done, the angle of the bones in the distal limb was significantly different from what it should have been. Anyway, a simple nerve block (just like we do at home) numbed the leg. With Houssine digging for the rope with a special hooked instrument I was able to cut the entire rope out. The mule got some IV bute, a shot of long-acting penicillin, and a tetanus anti-toxin. He'll stay for at least a few days. If he doesn't improve overnight, I'll try some regional limb perfusion on him if I can find some amikacin kicking around.
I have so much more to share but I'll spare you the details of the tail amputation I did on a ram this afternoon. Anna and I are responsible for cooking our own meals so it's time for us to get creative in the kitchen. Goodbye for now.
Anna and I were both awoken out of deep sleep when the alarm clock rang after 13 hours. We weren't even disturbed by the calls to prayer that are blasted by the mosques at all hours of the day and night. I guess that's what happens when you miss out on a night's sleep somewhere along the way. Work at the Fondouk begins at 7:30 AM when the huge gates are opened and the crowds flood in and line up around the courtyard. Since it was rainy and cold, there were significantly fewer animals seen today...only around 50 instead of The usual 100+. There is
very little order in the Fondouk but everything manages to get done. In addition to the staff veterinarians and Anna and myself, there are 4 European vet students, a small animal, technician, a farrier, a groundsman, and a wonderfully capable Moroccan veterinarian named Houssine who, I'm told, has barely a high school education. There are a large number of small animals that come through the door such as dogs with mange, cats with pneumonia, pigeons with ruptured crops, and even a bunny or two. I poked my head into the small animal room a couple of times but am much happier outside with the donkeys, mules, horses and sheep.
We did so much today and the work is emotionally draining. I'll tell you about a few cases but will try to spare you the gory gory details. Unfortunately, I just discovered that I cannot post my pictures onto the blog because something is incompatible with the iPad that I'm using to type. However, I will ask my office to post some of the pictures that I email them and hopefully I'll remember to put a link to the office site at the end of this post.
One case that gave me a lot to think about was a little gray mule that was dragged in, unable to bear weight on his right hind leg. He had been like this for at least several days, although the history that we get has passed through several people and has been translated from Arabic to French and then French to English. I'm glad I paid attention in French class all those years since I'm able to follow a fair bit of the French conversations and even participate in a few. The femoral fracture in this poor soul is obvious as we take turns manipulating it in the courtyard. The mule's condition is far past the point where we could do anything to help him. We recommend euthanasia to his owner who is torn because he feels that we should not necessarily intervene--"if Allah wills it" the mule will die on his own. Eventually, we convince him to let us euthanize the mule, but only if we agree to pay him 300 dirhams (roughly $40) so he can buy a new one. I have never been so comforted by performing a euthanasia. The only thing made me a bit nervous was learning afterwards that the dead donkey meat would be used to feed the dogs and cats at the Fondouk. If the donkey had died on his own, the meat would have been fed to the man's family.
Another interesting case that I wound up taking involved another lame mule who came in with what looked like rope burn around his pastern. I did not follow all the rationale of taking x-rays right away but two were taken anyway since they're processed the "old-fashioned" way (by getting dipped in chemicals) and development takes 20 minutes. While we were waiting, I clipped the wound and scrubbed it. Once all the debris was cleared, I realized that I was looking at a piece of rope firmly embedded within the wound. It turns out that the Moroccans "hobble" their mules--ie, tie their legs together with rope--to keep them from escaping. This rope had essentially grown into the mule's leg and was so deep that it was down to the bone and mostly covered over by regrowth of skin. The purpose of the x-rays was to see if there was anything else trapped in there since, apparently it's not uncommon to finds pieces of metal in there too. Although this mule did not have any metal identified on xray, the xray was horrifying nonetheless. The degree of arthritis and the evidence of old injuries was staggering. Also, because there is essentially no corrective foot trimming done, the angle of the bones in the distal limb was significantly different from what it should have been. Anyway, a simple nerve block (just like we do at home) numbed the leg. With Houssine digging for the rope with a special hooked instrument I was able to cut the entire rope out. The mule got some IV bute, a shot of long-acting penicillin, and a tetanus anti-toxin. He'll stay for at least a few days. If he doesn't improve overnight, I'll try some regional limb perfusion on him if I can find some amikacin kicking around.
I have so much more to share but I'll spare you the details of the tail amputation I did on a ram this afternoon. Anna and I are responsible for cooking our own meals so it's time for us to get creative in the kitchen. Goodbye for now.
Saturday, November 27, 2010
And we're off...
Well, it's been one year in the works, but now this trip is finally happening. Along with my faithful and trusty student extraordinaire, Anna Carroll, I am sitting in JFK, about to embark on the adventure of a lifetime. Although I have no Moroccan news to report yet and I'm new to this whole blogging business, I did want to share one piece of great news. Together, Anna and I have raised over $10,000 in the last few months on behalf of The American Fondouk. This is an extraordinary amount of money that will go a long long way to help the animals of Morocco. I have been greatly humbled by the generosity of our friends, family, and clients and have great confidence that the money will be put to good use. This fundraising effort certainly would not have been as successful as it was without some help from the inside. I am indebted to my tireless office manager, Debbie, for her creativity and clever fundraising ideas. Our corporate support from Millburn and Wedgewood Pharmacy advanced our fundraising campaign significantly. I would also be remiss not to be thankful for the support of my colleagues who will be stepping up to cover my calls while I'm gone. I am truly lucky to be part of such an incredible team. And with that, it's time to board our flight and get this show on the road.
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