Veterinarians help the working equids of the developing world and their owners
Like most equine veterinarians, my passion is horse health and welfare. In my day-to-day life I enjoy mobile equine practice in rural New England, but the world’s working horses hold a special place in my heart. In January 2016 I joined a team of 30 volunteers, including veterinarians, vet techs, vet students, undergraduate students, PhDs, a saddler, and a farrier, on the Osa Peninsula, in southwestern Costa Rica, to perform a week of equitarian work.
Equitarians are veterinarians or other caregivers who assist a community by providing veterinary care to working equids and education to their owners. Throughout the developing world working equids are an essential part of the local economy and family life. Unfortunately, only a very small percentage of the world’s veterinarians serve these areas. Equitarian work trips to remote developing regions are important to help correct this disparity. By helping the horses, donkeys, and mules in underserved areas, we help not only the animals but also the families who rely on them for income, transportation, water, and so much more.
So, what’s a “typical” day like on one of these trips? Here’s a taste.
5:30 a.m. Rise and shine! We have been sleeping on the floor of a senior center in the small town of Puerto Jimenez. It’s time to dust ourselves off and get ready for our last clinic day. We take turns applying DEET and sunscreen, tuck our pants carefully into our socks, and wrap a layer of duct tape around our ankles. The chiggers are bad here, and we’ve learned to take abundant caution to prevent their itchy bites.
6:00 a.m. Breakfast. Our lovely Costa Rican hostess, Mariana Mobley, arrives with trays of hot coffee, breakfast burritos, and bananas. We eat quickly but spend a few minutes savoring the coffee; this is Costa Rica, after all, and the coffee is excellent.
6:30 a.m. Our transportation—a large cattle truck—arrives. We load our bins of gear, then hop in. It’s an hour drive on bumpy roads to our work site today, so we make ourselves as comfortable as possible and embark.
7:30 a.m. We arrive at a farm in the community of Venegas, in the northern part of the peninsula. Horses line the road waiting for us, which is a good sign. Mariana has gotten the word out that we’re here, and the local community has decided to trust us with the care of their horses. We begin unloading our bins, setting up at the foot of a large shade tree. We quickly divide the work site into five sections: patient intake, dentistry, surgery, farriery, and central pharmacy.
My primary job on this trip is intake, and my team is made up of my husband (Matt Kornatowski, DVM, also an equine veterinarian) and me; Kim Thabault, DVM, MVZ, an equine veterinarian working in Costa Rica; and Maria Jose Zuniga, a veterinary student from Honduras. Our job is to perform initial evaluations on the equids presented to the clinic, including a full physical exam and body condition scoring. We’ll assess the need for dentistry, surgery, and farrier care and address the owners’ specific concerns. We will vaccinate every animal for rabies, Eastern/Western equine encephalomyelitis, and tetanus. We’ll deworm them with oral ivermectin and treat for ticks topically with a broad-spectrum insecticide.
Each intake team includes at least one member who speaks Spanish. Matt and I are lucky to have two team members fluent in the language, and Maria is especially invaluable as a native speaker. Client communication is essential to a successful clinic. We need to not only ask these horse owners questions about their animals’ care but also relay to them our findings, concerns, and treatment recommendations.
Before we even get set up, however, it’s obvious which patient we’re treating first: a 4-day-old filly that’s unable to stand. Upon consulting with the owners, we find that this foal has not nursed normally or stood well since birth. We hypothesize that she’s a “dummy foal.” Deprived of oxygen during birth, these foals usually are neurologically abnormal. A team gets to work on her immediately, starting with intravenous fluids, a stomach tube to administer mare’s milk, and a combination of antibiotics from our limited stock. The prognosis is very poor—sick foals need to be treated aggressively and immediately, and time is not on our side. The foal will need constant care throughout the day, so two of our team members—Hal Schott, DVM, Dipl. ACVIM, of Michigan State University, in East Lansing, and Brianna Leahy, a veterinary assistant with Orange County Equine Veterinary Services, in Santa Ana, California—dedicate themselves her. The rest of us prepare to tackle the remaining horses lining up for care.
8:30 a.m. Horses begin to filter through the intake stations, and overall we’re pleased with most patients’ body condition. These animals are used for cattle ranching, fruit gathering, or tourism, and many live out on the range. Costa Rica has a tropical climate and, so, abundant lush grass, and most equids that have access to free-choice pasture hold their condition well. Hoof care, on the other hand, is a huge issue. It’s very difficult to get a qualified farrier to tend to these horses. Many have shoes that are several sizes too small and tacked on poorly, with hooves overgrown by about six months. Large chronic hoof cracks are abundant. Dr. Thabault and Maria spend a few minutes convincing owners to let us pull the shoes—they are doing these horses no favors—and have our farrier trim the feet. By early morning, a line of horses awaits our farrier’s expert attention.
In general, these horse owners have good intentions and want to do what’s best for their horses. Horsemanship skills get passed down through families and villages with little formal or organized education in horse management. So there’s a wide range of abilities and knowledge when it comes to horse care. Most owners are receptive to learning a different way of doing things, but we do have to tread lightly—it does no good to come in as “the experts” and tell these people they must do things our way. We do our best to educate on proper diet, access to fresh water, how to prevent tack rubs, the importance of tick removal, wound care, and more.
11:00 a.m. I venture down to surgery, where Tracy Turner, DVM, Dipl. ACVS, ACVSMR, of Turner Equine Sports Medicine and Surgery, in Big Lake, Minnesota, is overseeing castrations. We’re pleased with the number of stallions brought in for gelding; sometimes it’s difficult to convince these owners to allow us to do it. Castration is important to make these horses easier to handle, train, and ride. It’s a valuable service, and the owners are typically very interested in having their stallions gelded. However, these owners also know that surgical procedures carry risk, and their horses are important sources of income and transportation. They might have witnessed castrations performed by nonveterinarians, typically with a machete. As you can imagine, removing testicles with a machete is gruesome to watch, and the horses do not tend to recover well. We often have to convince owners that our methods are much safer. Here, however, word seems to have gotten out.
I jump in to castrate a well-built and well-mannered gray 2-year-old. We induce anesthesia and guide the colt to the ground. I get to work scrubbing, rinsing, and injecting lidocaine into both testicles. We remove the testicles quickly, with minimal bleeding, and before the owners know it we are done with the surgery and administering an antibiotic injection into the new gelding’s hindquarters. As we wait for the anesthesia to wear off, we chat briefly with the owners. They are relieved and pleased at how smooth the procedure went and seem more than a little impressed at how little bleeding there is. Once their horse is awake and steady on his feet, we walk them back to the main intake area, where they receive paperwork detailing the horses’ postoperative care in Spanish. They are all smiles, and we hope they will tell their friends how well a castration can go with modern surgical techniques.
12:00 p.m. Time for lunch. Our host farm has prepared a nourishing meal of yellow rice with beans and vegetables and, of course, coffee. I’m still not used to the Costa Rican habit of drinking hot coffee in the middle of a 95-degree day, so I pass, but the rice and beans are delicious as usual.
12:30 p.m. Our next intake patient is a small gelding that the owner rode into the clinic. The horse is overheated—he is blowing hard and lathered up. We work on cooling him down while gathering a history from the owner. He says he bought this horse a few days ago, as a supposedly 5-year-old riding mount. He’d ridden him for the first time today, several miles to the clinic. An examination of the incisors reveals that this “small” gelding is actually not even 2. None of his permanent incisors have erupted yet. The owner is understandably upset that his new horse is so much younger than he was told. He doesn’t have another mount; he needs this one for transport. We explain that if he can wait to ride this youngster until he is more grown, the horse will last much longer and ultimately be much stronger. He says he might be able to borrow a horse for six months, maybe a year, which should be long enough. By the end of the conversation, the horse has cooled down enough to have his vaccines and deworming. His owner promises to lead him back home instead of riding him.
1:30 p.m. A man presents his horse for examination and vaccinations and points out some rubs along the animal’s topline. He’d like advice on how to avoid these injuries in the future. He harvests palm fruit, and his horse must wear large metal baskets on either side of a saddle to help him do this work. He brought these baskets with him, as well as the felt pad he places underneath to try to cushion the metal. We alert our saddler, Omar, who examines the equipment and makes padding modification recommendations. Omar offers additional ideas on how to craft a type of basket that would fit this horse properly. He takes some measurements, as well as the man’s phone number, and promises to get in touch with him as soon as he has devised a solution.
2:30 p.m. There’s a lull in intake but dentistry is backed up, so I head over to help out. My first patient there is an older gelding, reportedly 30 years old. “Thirty?” I think, knowing that most of our patients are younger than 15. With the lack of veterinary care in the region, horses just don’t live to be seniors. I take a quick peek at his incisors, which look more appropriate for a horse in his early 20s. But still, he’s not a spring chicken, especially for this area.
I give the horse an intravenous sedative and pop a speculum in to examine his cheek teeth. I am pleasantly surprised by their condition. They are certainly worn, but fairly level, and he’s got a good amount of grinding surface left. His enamel points are very sharp, however, causing deep ulcerations in his cheeks. I take care of those quickly using our motorized float, checking for loose teeth as I go and finding no other issues. I pass along to his owner that it’s unlikely he’s 30 (if so, he has a great mouth for his age!). He’s probably just “really old” by Costa Rican standards.
3:30 p.m. I swing over to see how Dr. Schott and Brianna are doing with the 4-day-old filly. They report some progress: She has received 3.5 liters of fluids through an intravenous catheter and, with their help, stood a few times. She’s been receiving her mare’s milk via nasogastric tube every two hours. We discuss what to do with her as the end of the day draws near. We might be able to bring her back with us to the senior center and continue treatment overnight, but we don’t have anywhere to put her dam. As we consider options, the foal declines suddenly, first having a seizure and then going into respiratory arrest. Dr. Schott attempts resuscitation but is unable to revive her, and before we know it she is gone.
We all take a moment to mourn this little life that was cut so short. Dummy foals can be hard to treat even at referral hospitals, never mind under a tree on a farm in remote Costa Rica. The owners are understandably upset but very grateful that we tried as hard as we could to save her.
4:00 p.m. Back at intake, our team is receiving the last horses for exams and vaccines. We get word of a horse so lame with a chronic hoof issue that it can’t come to the clinic. A group of three veterinarians and our farrier load up into a truck with one of the local horsemen and head down the road to see the animal. The rest of us tend to the stragglers, trying to finish before we lose light.
5:30 p.m. Done for the day, it’s time to pack the gear, load the truck, and head back to Puerto Jimenez. But first our hosts offer to take us to a local bar for a few thank-you beers and to discuss how we might all work together to make sure these kinds of trips happen on a routine basis. That is exactly what we are hoping for: to build a relationship within a community where we are counted-upon for regular veterinary service. Julia Wilson, DVM, Dipl. ACVIM, spends time discussing details with the farm owners to see how we might continue the relationship. The rest of us celebrate a week of hard work with a few drinks. We board the cattle truck as night settles in and make our way back to Puerto Jimenez.
I take a moment to reflect on the day. We saw around 100 horses, bringing the trip total up to about 300. The loss of the young filly weighs heavy on all of us but, overall, the day was a success. We performed castrations on stallions that now will not have to face the machete. We treated wounds, respiratory disease, and dental issues on horses that will now be healthier for our efforts. We gave our patients a chance to do their jobs more comfortably by trimming their feet and reducing saddle and harness pressure. And we established relationships that will allow us to continue doing this work in the future.
In addition to the direct client education we performed on this trip, our farrier trained a local man, Melvin, to perform hoof trims. Melvin took a strong interest in our work and followed us from site to site, soaking up as much knowledge as he could. His education will continue with future equitarian trips to the region. Mariana also stayed behind as a point of contact for the local horse people. She, in consultation with Dr. Thabault, can help them through problems when no veterinarian is available. These are small steps, but they can have a large influence.
This trip is just a start for me, and it’s already proven to have deep impacts on the way I practice and see the world. The problems facing equids in developing countries and their owners are many, but we have the tools to help. I’m exhausted, sore, and more than a little overwhelmed by all I have learned and seen. But I can’t wait to do it again.