Nicaragua Experience

This experience piece was submitted by Kristy Herman from Michigan State University College of Veterinary Medicine.

In 2009 I was a Junior at St. Thomas Aquinas College, still coming to grips with what my future career would be. I was majoring in Biology and had hopes of becoming a veterinarian but still wasn’t sure that would be the most fulfilling path for me. I enrolled in a course that focused on the history and culture of Nicaragua, an honors course that included 10 days service trip to help build houses with Bridges to Community. Choosing this class was one of the best experiences of my life.

My classmates and I met once a week to learn about the geography and history of Nicaragua and discuss our travel plans and itinerary for our alternative Spring Break. We would be spending 10 days helping to build houses in impoverished communities, teaching children English and basic math (and playing soccer and baseball!), while connecting with students from Hobart and William Smith College. As much as we prepared for the trip, I was not aware of just how much of an impact Nicaragua would have on me.

My classmates and I were housed in a small church in Nindiri, within the larger department of Masaya and home to 48,000 people. The area we were staying in was incredibly rural, complete with dirt roads and fields that seemed to go on forever. Modest huts were composed of corrugated metal and families of 5-6 would fit in one room. Even at the church, toilet paper was considered a luxury in the outhouses and showers were limited to cold water that was on the warmer side due to the hot and humid climate. Cots were setup with mosquito netting to help reduce the risk of contracting blood-borne diseases from insects.

It was in Nicaragua that I learned to love coffee. Even to this day, there is nothing that can compare to the strong, invigorating, delicious taste of the café that was brewed fresh daily. Breakfast was the most important meal of the day in order to provide everyone with the strength and energy to help build houses out of cinderblock or work with the children on their language and math classes. Fresh fruit, eggs and bread were served by smiling members of the community. Mornings started around 6 am but the roosters started to crow closer to 5 am. For those that were scheduled to help build in the first half of the day, everyone loaded into the old but well-maintained pick-up truck to head over to the construction site around 7 am. Water and sunblock were imperative for reducing the risk of heatstroke and sunburn; those that felt tired were encouraged to rest until they felt well enough to continue working. I am happy to say there were no injuries while we were there! By 11:30, it was time to head back to base camp to eat lunch, relax, and prepare for the second portion of the day.

While I enjoyed the fulfilling experience of helping to build houses, working with the children gave me the most joy. They seemed to have more energy after lunch rather than after breakfast and loved to play soccer. I was amazed at their knowledge of pop culture, particularly when it came to Disney characters and musical celebrities. They might not have known where New York is on a map, but they could sing every word from Michael Jackson’s “Thriller” or Lady Gaga’s “Just Dance”. They were well behaved and aimed to please, visibly proud whenever they answered a question correctly. We encouraged them all to work hard, focus on their studies, and never give up on their dreams.

While the majority of the service trip revolved around supporting the community, there was also opportunity to explore Managua on the weekends. Half a day was spent at the Laguna de Apoyo in Managua and a jungle hike that ended with jumping into the cool water after working up a sweat. These were welcome treats that made me hope to return in the future. There was also a visit to El Coyotepe Fortress where I learned about the Sandinistas and political tension throughout the late 1800’s into most of the 20^th century. It was sobering to imagine being imprisoned in this fortress and the horrible conditions the inmates must have endured. This made me feel privileged to live in a country where we are considered innocent until proven guilty and have the opportunity to be bailed out of jail in most conditions.

While this class and service trip did not stir me to change my major to social science, it did make me consider what was important to me and how I would like to help support my community. Volunteering and giving back to my community have always been an important component of my identity and I hope to continue to find time and energy to give back even when I feel burned out from the rigmarole of daily life. I continue to love the Spanish language and will continue to practice reading, listening and speaking when the opportunities arise. I also hope to return to Central America to volunteer as a veterinarian when the time is right. I thank St. Thomas Aquinas College and Bridges to Community for making this memory possible.

Global Veterinary Alliance Experience

Winner of the Underserved Populations Externship Stipend

from the SAVMA Public Health and Community Outreach Committee

Neda Othman, University of California Davis

Ten days, six communities, seven clinics, 347 patients, and 88 surgeries. Last summer I was immersed in the long, hard, rewarding days of running a rural field clinic in another country. I participated in the Global Veterinary Alliance (GVA) trip to Nicaragua last June soon after completing my first year of veterinary school at UC Davis. GVA is an independent 501(c)(3) non-profit that was founded by UC Davis veterinary students only a few years older than me. For the past several years, GVA has organized two Nicaragua voluntourism (volunteer-tourism) trips per year (one in December and one in June) with a team of Nicaraguan veterinarians, American RVTs, and around twenty UC Davis veterinary students, providing much-needed veterinary care to rural communities in northwestern Nicaragua.

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A typical clinic day started with a Nicaraguan breakfast at our hostel, Monty’s Beach Lodge in Jiquilillo. Right after breakfast, while we’d all be spraying ourselves down with bug spray and filling up water bottles, we’d get a briefing on the plan for the day- which town; who was assigned to which station. Then we’d pile into the bus and soon be setting up the clinic (we set up at a different community each day), locals spotting us and lining up with their pets before we even had the intake station ready.

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We saw dogs, cats, pigs, donkeys, cattle, and chickens, from 70-100 patients per day. Some popular dog names were “Canela” (cinnamon) and “Princesa” (princess), though my favorite one, though, was “Pelusa” (dust bunny). Our canine patients were typically covered in ticks and had a BCS less than 4. I was grateful for the four years of paying attention in high school Spanish, for I was able to investigate the history of a female dog who seemed to be hematuric from the history but who we actually found to have a transmissible venereal tumor (TVT) on physical exam. My Spanish skills also helped me investigate the source of pain in the angry hunk of a dog suitably named “Killer”. Another memorable patient was the tiny puppy who’s poorly-docked tail was infected and necrotic; one of our veterinarians gave it a cleaner amputation in surgery. And of course (because I literally can’t forget) the shriek-like squealing of the pig patients still has my ears ringing—we hadn’t even touched them and they were wailing!

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Our clinics were held rain or shine. As much as possible, we reserved the limited space under the roof for surgery, but on the two rainy days, the sky poured, rumbled, and lit up with streaks of lightning! And all the clients waiting in line ran for cover under the roof, packing into the limited space until the rain let up. Other than the crazy rain days, another hard-to-forget thing is the American pop music playing every night the hostel, turning Despacito and Thunder into theme songs for our trip. And there was the memorable night when the three fruit bats flapped into my room and tangled themselves in my mosquito net, making me and my bunkmates shriek like pigs getting subcutaneous ivermectin!

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The people who lined up for our clinics ranged from age five to 75. Some people had brought their pets every time to our clinics since the very first clinic; for others, it was their first time. It brought us immense joy when a client every so often would bring the little paper booklet from the clinic six months prior containing the vaccination and deworming record. At one clinic, there was a woman who arrived at the end of the day just as we had stopped accepting more surgeries and were about to start breaking down the intake station. We almost turned her away...until we learned that she had walked five miles carrying her young female dog in her arms to get her spayed by us. Of course, we fit her in.

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Kids ran around at every clinic, some sent by their parents to bring pets, others just enjoying the novelty of our group’s presence. One young girl around the age 10 or so was especially curious of what I was doing and followed me around all day. She asked a lot of questions. I could tell she was bright, compassionate, and loved animals. What bothers me to this day is that I could not comfortably or with any certainty tell her that she, too, could become a veterinarian one day if she just “got good grades and a lot of experience with animals”. That is something I have told American children without a second thought. But realizing that Nicaragua is the second poorest country in Latin America, where only 7% of Nicaraguans aged 15-24 continued on to post- secondary education, and almost 50% of the country’s population live in the poor rural regions where it is hardest to ascend to higher education reminded me of the privilege it is to be an American with access to high-quality public education and a relatively easy path to a Bachelor’s degree. That little girl is an important part of my memory of Nicaragua and is integrated into my interest in completing an MPH, working internationally down the road, and being involved in public education both domestically and abroad.

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I am grateful for both the SAVMA Public Health and Community Outreach Committee Underserved Population Externship Stipend and the SAVMA Professional Development Fund, funding that has helped me significantly with the costs associated with the trip. I would like to encourage readers to look into international veterinary voluntourism as a way to travel while honing your clinical skills, broaden your world view, help others in an extremely meaningful way, and discover new life goals or avenues for applying your DVM training in the future. While Global Veterinary Alliance hopes to grow chapters at other veterinary schools, consider volunteer trips with World Vets, Mission Rabies, Darwin Animal Doctors, and Vida Volunteers. Your life, both personal and professional, will benefit deeply, and you will be providing an enormous service to those in areas with fewer resources.

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“Todo Esta Bien”~ All is well.

Meredith Gumash

Ross University School of Veterinary Medicine

“Todo esta bien” quickly became a Spanish phrase that myself and the 16 other Rossies employed whenever we were feeling like something wasn’t going exactly as planned or when we needed a small reality check to “go with the flow” on our VIDA (Volunteers for Intercultural and Definitive Adventures) trip this past April.  Feeling too hot and sweaty? Todo esta bien.  Driving on a bus for hours on end? Todo esta bien.  And what was on the menu for breakfast, lunch, and dinner every day during our two weeks in Central America? Rice and beans. Todo esta bien.  This phrase brought me back to reality and reminded me that well, yes I am feeling hot and am sweating in places that I didn’t know you could sweat but I’m currently spaying a dog and am practicing veterinary medicine. WOW! As in, me- a veterinary student that has never once been allowed to get that close to a surgery let alone be in control of the fate of this creature’s uterus- is currently wielding the spay hook, scissors, sutures, and needle holders to perform the procedure.  It was an incredible experience that I will be forever grateful for.  This phrase reminded me that even though we spent a lot of time on a bus, at least the scenery was beautiful and there was SO much to see.  In Costa Rica there were rolling hills, mountains, birds of every color combination imaginable, and small and large towns that were bustling with people all seemingly going in different directions. And you know what? I don’t really mind rice and beans that much- they were actually delicious and at least we were fed hearty fuel to give us the strength we needed for the clinic days (and for the fun days too when we had the chance to relax a little bit). Todo esta bien.

The 17 of us Rossies along with our VIDA trip leader spent 2 weeks in Costa Rica and Nicaragua traveling to different sites to set up clinic days for the community members.  We set up our clinics in one home, one school-yard, two different churches, and set up for the one large animal day in a field surrounded by community members’ homes.  One thing that I learned from this trip is that with proper planning, the correct supplies, and a big, open space, you can set up a vet clinic just about anywhere. Todo esta bien.  For each of the five small animal days, we set up three stations: intake, surgery, and recovery.  We worked in pairs and rotated working with each other, which was one of my favorite aspects of the trip.  I had decided to sign up for this trip somewhat on a whim, and not knowing anyone prior to that first night in Costa Rica when we went around and introduced ourselves (with the exception of a tutor I had been to several times). Todo esta bien.  I truly enjoyed getting to know my fellow Rossies on this trip, and learning about their experiences in vet med and and at Ross.  Most of them are in the semester above me, so it was helpful to pick their brains about what to expect in the coming semester.  I had worked in a clinic prior to vet school but was the “poop scooper” and cage cleaner, and did not have much hands-on clinical experience other than what I had taken away from observing.  In that regard I was able to learn from my classmates different tricks of the trade to place difficult IV catheters and give injections to nervous patients.  

In addition to working with my classmates, it was such a great experience to work under the VIDA doctors on both the Costa Rican and Nicaraguan team.  They were extremely patient, especially when it came to the surgeries and allowing us to perform most of the steps, and were excellent teachers.  They were encouraging and instilled a real sense of confidence in me and my abilities- even though I was still learning and was somewhat operating under the “fake it, ‘til you make it” mindset. Todo esta bien.  This trip and the people that I learned from taught me to go for it with confidence and a positive attitude, especially when it comes to the hands-on aspects of vet med, and see what happens.  If it doesn’t work out, you try again but remain confident.  If it does work out, that small victory fuels that confidence for next time.  Todo esta bien.

Experiencing this VIDA trip has been one of the highlights of my vet school career thus far, and probably will remain a highlight as I move forward and begin practicing.  The trip reminded me to be thankful for my own family and friends, and for the luxuries that I have at home that many people around the world do not.  I hope that I am able to return to Costa Rica or Nicaragua as a practicing veterinarian and participate in clinic days such as the one that VIDA hosts.  These clinic days are not only important for population control, but to educate community members on the importance of proper pet care and spaying and neutering their animals.  The experiences in Costa Rica and Nicaragua are ones that I will carry with me as I progress through my veterinary education and into my career, and I hope to continue learning to become a more confident, experienced, and “go with the flow” member of this profession.  Todo esta bien.

Mission Impossible: Fighting Zoonotic Infections in Nicaragua

Brandon Woods, Iowa State University

Honorable Mention, Experiences  

A Dangerous Paradise 

From jungles with jaguars to crystal blue lakes with freshwater sharks, Nicaragua is one of the most beautiful and dangerous countries in Central America. The brilliant biodiversity attracts millions of tourists each year and the looming volcanoes that pepper the landscape can be an exciting yet unsettling sight. However, in reality much of the danger in Nicaragua comes from the risk of infectious diseases. For example, if you’re planning to travel to this tropical paradise anytime soon, the Center for Disease Control (CDC) states that international travelers are at risk of contracting Typhoid fever, hepatitis A, hepatitis B, Leishmaniasis, malaria, dengue, rabies, and more! As a dual degree veterinary medicaland public health student, I am fascinated by these infectious diseases and want to learn how they interact with the environment, people and animals. Many of the diseases that the CDC listed are called zoonotic diseases, or diseases that are transmissible between animals and humans. Whether you own a pet, like to travel, or simply enjoy spending time outdoors, you are at risk of infection because these zoonotic diseases are increasingly emerging worldwide and are becoming a serious public health threat. During the spring break of my first year of veterinary school, I traveled to Nicaragua on a mission trip and got first-hand experiences of some frightening infectious diseases. 

Bed Nets and Bug Spray 

Planning for this trip was time-intensive and reminded me of planning for my semester study abroad adventure to Tasmania, Australia. However, unlike my semester Down Under, this trip was coordinated through the national non-profit Christian (CVM) whose goal has been to help veterinarians serve others and live out their Christian faith for more than 30 years. Out of all the fundraising and logistics meetings we had, the meeting that stands out the most was when the Iowa State University travel nurse described the laundry list of potential pathogens we could encounter. Our team of 8 veterinary students, 3 veterinarians, and 1 pharmacist would be treating animals in a remote village called Espavel in the jungles of eastern Nicaragua. When I saw that my destination was in the middle of the red zone for malaria on the CDC map, my eyebrows escalated and my stomach dropped. 

I was going to fly to an unstable, earthquake-prone country of approximately 5.7 million Spanish-speaking people where malaria was endemic. My Spanish was scarce, but my drive to serve was strong. After I heard that malaria was essentially eliminated from Nicaragua, my blood pressure dropped a few millimeters of mercury. Approximately 84% of the Nicaraguan population is at risk of contracting malaria, according to a UCLA study. However, Nicaragua has experienced a 97% decrease in reported malaria cases between 2000 and 2010. This significant decrease in prevalence was a result of Nicaragua partnering with the Pan American Health Organization (PAHO) in 2006 which heavily implemented stronger surveillance, prevention, vector control, and treatment. Despite this progress, I learned from my undergraduate Lyme disease Honors project that there are always numerous challenges to completely eliminate vector-borne diseases like malaria. For instance, controlling mosquito breeding populations is particularly vexing due to the complex ecology of the parasite life-cycle. In addition, you may have heard about the controversy surrounding toxic pesticides like DDT. My colleagues and I were fortunate for our DEET bug spray and Permethrin treated clothes and bed nets that we brought after skyping our host-country missionaries. I was also relieved that our trip in March 2013 was during the dry season and not during the September-to-January rainy season, when disease transmission is highest. 

Rambunctious Rabies 

Escaping the endless hours in the frigid, formaldehyde laden anatomy lab and flying to a third-world tropical country to practice preventative medicine was slightly shocking, but totally worth it. On our first day, we drove through the littered streets of Catarina to an outdoor shelter where we set up a temporary clinic. The local children brought their pet dogs and we treated them with Ivermectin and other anti-parasitic medication. Many animals were very thin and infested with fleas and ticks. However, it was rewarding to interact with the children and walk them through a brochure that described healthy animal care. Then suddenly one of my colleagues was bitten by a dog! He was trying to give a rambunctious mixed-breed a pill to protect against heartworm disease and the next thing he knew, the dog bit him in the hand. He quickly washed the wound with soap and water and bandaged it. Fortunately, everyone on our veterinary team was already vaccinated for rabies prior to the trip because it’s a requirement to enter veterinary school. He also followed up with post-exposure rabies prophylaxis when he returned home. 

 Rabies is one of the deadliest and most notorious zoonotic diseases in the world. Rabies is endemic to Nicaragua, often occurs in poor rural communities, and the most common source of transmission is when a dog bites a human and delivers the fatal RNA virus. According to the World Health Organization, potentially any mammal can contract rabies, and common reservoirs in the USA include skunks, foxes, raccoons, and bats. Although rabies cases can be successfully treated, it still persists worldwide killing more than 55, 000 people each year. The Center for Food Security and Public Health (CFSPH) at Iowa State University is an excellent resource that provides more information on rabies and preventing zoonotic diseases. 

Tasting Iguana and Tackling Typhoid 

It’s a good thing I like rice and beans, because that was the bread and butter of most of my meals every day. Hiking to farms builds an appetite and one day we had to traverse across a narrow blank that stretched precariously over a ravine. After we arrived, we vaccinated over 100 head of cattle for clostridium, anthrax, and Dectomax. Dectomax is an injectable drug used to control parasites like hookworms, round worms, grubs and mites. When we returned to the main village and got out of the blazing 90+ degree sun, the crispy, plantain chips with a glass of freshly squeezed tamarind juice was an irresistible snack. However, the most memorable meal of all was the morning the villagers surprised us with two 5 foot long iguanas! A few hours later, I was savoring some delicious iguana meat seasoned with local spices and vegetables. Cooking wild reptiles is foreign to us in the developed world; likewise, the way many Nicaraguans prepare their food is also different. 

Sayings like, “Don’t drink the water,” or ‘Boil it, cook it, peel it or forget it,” come to mind when traveling abroad, and they couldn’t ring more true for my experience. Food-borne illnesses are another great example of how veterinary medicine and public health overlap. I’m enrolled in the dual DVM-MPH degree program at the University of Iowa’s College of Public Health and learned that food-borne epidemics are a major focus of research in epidemiology. From mild cases of spoiled potato salad on romantic picnics to church dinner outbreaks from contaminated home-made ice cream, food-borne illnesses can range in their severity depending on your pre-existing health and the dose and type of microorganism ingested. One of the Nicaraguan diseases that I was vaccinated for before my trip was a food-borne illness known as Typhoid fever. Thankfully I avoided this illness; however, I couldn’t escape the wrath of Montezuma's revenge, or traveler’s diarrhea, most commonly caused by enterotoxigenic Escherichia coli. 

Typhoid fever is transmitted through contaminated food or water and is unique among food-borne pathogens because it only affects humans. In fact, some individuals can unwittingly become carriers of the bacterium and transmit the disease to others through improperly prepared food, like the infamous Typhoid Mary. This disease is caused by the bacterium Salmonella typhi, which is one of over 2,300 serotypes of Salmonella and can be treated with antibiotics, according to the USDA. Other Salmonella species are also common among household, cold-blooded critters like turtles, frogs, iguanas, and snakes, so it’s important to always wash your hands after handling these pets. Like malaria and rabies, Typhoid fever presents challenges for eradication in developing countries where poverty limits accessibility to clean water, pasteurization, and proper sanitation and hygiene. For example, I had never taken a well-water bucket shower before, and although the murky water felt refreshing after a long days’ work, I came to more deeply appreciate the luxuries of everyday plumbing and electricity.

From Davis to Nicaragua: Forging Partnership in Veterinary Care

David Kim
UC Davis, '14

About a year ago, Eric Eisenman, a fellow classmate, approached a few students, including myself, about forming a student-run project to provide free veterinary care to a developing country.  We had just attended a lunch talk given by Dr. Richard Bachman, who spoke of his experience with Oregon State’s IVSA program that organized international veterinary trips.  It seemed strange that UC Davis did not have a similar program, and we were all eager at the idea of starting something new.  The amount of work for our group, which we named International Veterinary Outreach (IVO), seemed daunting as we began the long process of becoming a 501(c)(3) as well as planning inventory, permits, and fundraising, but slowly, things started to fall into place.  Through a mutual connection, we were able to make some contacts in Jiquillio, a small fishing village on the northwest coast of Nicaragua, the second poorest country in the western hemisphere. 

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