April 21, 2009
Having arrived in Morocco several days ago and orienting ourselves to the American Fondouk hospital we began seeing patients Monday in earnest (however this is my first opportunity to write). Aside from a pesky sore throat and the death of my computer charger, we are faring very well. We have been documenting our work through photographs and have posted those as well.
The morning began with a direct introduction to the limitations that veterinarians must work with at the American Fondouk. Resources are scarce here. Surgeries are performed only under injectable anesthesia which had been replaced by the safer gas anesthesia stateside a few decades ago. We do not have surgical monitoring equipment for anesthesia other than your eyes and ears with the aid of a stethoscope. There is also a clear lack of many things that we take for granted as Angell [Animal Medical Center] veterinary specialists including pain medication and sterile surgery (there is no autoclave here ‑ only cold sterilization). Needles, syringes and drip-sets are all reused. Regarding surgical wear, caps, masks and gloves are not consistently available. This is a complete return to basic veterinary care as we fight to save the lives of animals each day.
Today’s first patient was a cat found earlier in the morning by a woman in her garden. Noticing something was wrong with the cat the woman brought the animal to the American Fondouk to receive free care. It was immediately apparent that the cat was in labor with dystocia – she had one dead kitten in her birth canal and presumably more of the litter in her body. A Caesarean-section was required immediately if the mother and any of her litter were to survive.
The American Fondouk veterinary staff wasted no time preparing the patient for surgery. Amber, a veterinary student from Purdue [visiting the Fondouk], performed the surgery and successfully delivered two healthy kittens. The mother remains in critical, yet stable condition and she must regain her strength quickly to feed her kittens. Even in the face of a PCV of 12 and a total solids of 2.5 we have no crystalloids and can only hope that the mother gains an appetite soon as her kittens may have to eat goat’s milk if she cannot produce her own. A blood transfusion from another cat may also be a possibility to bring the mother around.
As I told Amber following the surgery, "This may be your first C-section, but it is one more than I have done."
We saw one Ophthalmology case today when we (myself and Angell technicians Alicia and Bob) were presented with a Rottweiler with severe dry eye in both eyes and a significant firm facial swelling on the right side. It is not a simple task to obtain significant historical information from the Moroccan pet owners however with the help of the American Fondouk staff as translators we uncover enough information to care for our patients.
In this particular case our diagnostics were limited to a tear production and check for corneal ulcers. Cytology of the non-painful but firm swelling showed some chronic inflammation but no organisms. As with many things, the options here are to wait and see if the wound heals with medication, or further investigate with surgical biopsy. The Rottweiler was not painful so we opted to take the wait and see approach. We also delivered some eye ointment to the owner and asked him to return to the American Fondouk in a week or so to re-evaluate the swelling.
As we do not have the financial resources to maintain medical records here, visits are very 'of the moment' and the future is not at all certain for the ongoing medical care of our patients. The only constant we know is that we will be here if the pets’ owners decide to come back.
As luck would have it, one of our patients from yesterday’s surgeries did return ‑ an ancient Poodle with an eyelid tumor that was healing nicely. The Poodle’s advanced age made her survival a bit more unpredictable, however, the Fasi [Persian-speaking] owners seem to fully understand the possibilities of mortality.
The other cases from yesterday will hopefully return later in the week including a keratectomy of a dermoid in a Pekingese and an entropion repair in a young Labrador Retriever. Mind you, all of these surgeries were performed under injectable anesthesia and cold sterilization which is a first for me ‑ especially with the corneal surgery. Fortunately all of the procedures were fairly straightforward. Tomorrow we plan to remove a painful infected eye from a kitten.
Alicia is in heaven with about 80% of the canine caseload being German Shepherds, however our patients have varied. We have evaluated a few horses and donkeys with either eyelid swelling or non-specific ocular pain. Bob took tonometry* in a horse for the first time in his life, he told me today. I think he is relishing a bit on the large animal side here if my observations are correct.
All nine dogs currently living here at the Fondouk also received bright, new, colorful collars courtesy of the MSPCA-Boston Animal Care and Adoption Center and Alicia who brought them here. All of these permanent canine residents have been adopted by the Fondouk after being abandoned on the property.
As the day closed, we were told that the weather has been unusually cool for Fez in April, but if sunny and 75 degrees is unusually cool, I'll take it. The sun is now just setting over the wall of our American Fondouk and we will rest a bit before dinner later, thankful that we are enjoying our time and in reality learning more than we are teaching.
Dr. Dan Biros
* In ophthalmology, tonometry is the procedure eye care professionals perform to determine the intraocular pressure (IOP), the fluid pressure inside the eye. It is an important test in the evaluation of patients with glaucoma.