Monday, 7 November 2011

Dogs Trust Veterinary Director visits ITC India to help vet training

Who needs Captain’s Log when you can have Director’s Blog?

Paula Boyden, Dogs Trust Veterinary Director has swapped rainy London for a week in Southern India at the International Training Centre to help train vets, animal handlers and shelter workers from all over the country how to run

cost effective and safe neutering and vaccination programmes.
The Centre’s long term aim is to help reduce the number of rabies related deaths in India. The ITC needs more UK vets like Paula to give up their time and support the centre for a week or six months. Over to you Paula…

Saturday 2
9 / Sunday 30 October 2011

After a 10 hour flight we arrive in Bangalore at 4.30am, temperature around 25oC with a 7 hour car journey in front of us. Destination: Ooty, a small town in Tamil Nadu. Our car drivers await us, my fellow travellers being John Gaye (Vice Chairman of Dogs Trust trustees), James Florence from Worldwide Veterinary Service and Gabriela, a Spanish vet working in Yorkshire (!) who is volunteering at the ITC for a couple of weeks.

If there are any rules on the Indian roads it can only be described as anything goes, namely:
  • Any vehicle/person permissible; car, lorry, bus, tictic, oxen, sheep, goats, dogs, pedestrians, carts (ox drawn and wooden wheels) all vying for the same space
  • Use of the horn is mandatory in any and every situation
  • Overtaking, particularly in the face of oncoming traffic is a national sport. I’m not sure our driver understood what a gearbox is for, but it clearly wasn’t his day to die. Corners merely add a new dimension
  • Windscreen wipers are optional; we had the uni-wiper variety, thankfully on the driver side
We pass through Mysore and then onto Bandipur National Park – a baby elephant and her protective mother are sighted! Bandipur is in the Karnataka region of India; as we pass into Tamil Nadu it becomes Mudumalai national park. Plenty of monkeys also seen and tiger safaris are available. Sadly no time to stop and spot.

Our first destination is IPAN (India Project for Animals and Nature) where we meet Nigel and Ilona Otter. Nigel runs IPAN; which, like many animal welfare organisations, is run on a shoestring with totally dedicated staff. IThe organisation co-ordinates and runs field neutering projects.

Local animals requiring veterinary attention are also seen at IPAN; to ensure dogs get the right treatment, they are kept in until the course is complete. This is in part due to many dogs being ‘community’ dogs and not kept inside, and also difficulties associated with dosing. IPAN has around 30 dogs that live quite happily at the centre, many of them ending up there by default. There are also several donkeys left over from working in local brick kilns.

Our final destination is Ooty itself, just 500m climb and 36 hairpin bends (they are numbered so easy to count!). We finally arrive around 4.30pm, some 30 hours after I last saw a bed. No point in peaking too early; so time for rest and recuperation, an evening meal and then the most wonderful night’s sleep. Welcome to India!

Monday 31 October 2011

The first day on the Animal Birth Control [ABC] course; the ITC not only train vets but also run courses for managers, veterinary assistants and dog catching, essential to be able to run an ABC programme.

The first half of the day is introductions as well as an overview of the course. The course leader is Dr Ilona, helped by Dr Maiju, Dr Arnand and Dr Gabriela, with me Dr Paula in the wings. The course overview explains that the primary objective is to contain rabies and humanely control the dog population (via ABC programmes). Killing dogs or locking them up will not solve the problem.

The variety of experience of the vets is staggering; many have done no surgery at all or the numbers are in single figures despite graduating some years ago. This in itself shows how important the ITC is.

I was delighted to see a (human) GP on the course. He’s here because in his community rabies is on the increase and he wants to know how to manage it.

The afternoon consisted of demonstration surgery; a dog castrate and bitch spay.

Tuesday 1st November

An interesting start to the day; the waiters in the hotel restaurant had clearly decided that I needed help with my breakfast choice and brought, unprompted, rice pancakes and green curry for me. Now I am a fan of green curry, but not at 7.30am; toast and marmalade is truly fine!

First day of operating today; the students start the day by doing rounds and wound scoring on the dogs operated on the previous day which provides some healthy rivalry and a sense of pride among the delegates. Today’s scoring was from the two demo ops from yesterday afternoon only so it was more or less straight in to operating. Each delegate is expected to perform two surgeries each day; doesn’t sound much but try and imagine yourself as a 3rd year student again.
The thing I find staggering is the lack of practical skills amongst these vets through no fault of their own. Even basics such as scrubbing up, putting on surgical gloves and having everything to hand before inserting an i/v catheter are completely alien. I spoke with Dr Neghna over lunch; despite graduating in 2009, he has not performed any neutering ops. He is a government vet (as most are – with a good income and a pension). He gets involved with AI, vaccinating against pasteurella and clostridial diseases in cattle and sheep. The 5 year vet course consists of 4.5 years at university followed by 6 month placements, 3 in agricultural establishments (equivalent to animal husbandry placements in years 1 and 2 in the UK) and 3 months with a government vet where they get no practical experience. With a culture of not questioning senior colleagues bad habits just perpetuate.

I joined in the supervision of surgery today; this is quite scary as you cannot take your eyes off them for a minute. They are simply, through no fault of their own, not used to handling tissues, ligation, suturing. Again, a reminder of how vital the work of the ITC is.

Lectures are held each afternoon; today’s was late as the first day of operating is always long. Perhaps not ideal, however given that we are at around 2500m above sea level, it is important that the dogs are given maximum time to come round from the anaesthetic. Today was asepsis and antibiotics. All dogs are kept in for 2 days post operatively to ensure that they are well before being returned to their own environment (note the change from TNR, trap-neuter-release to CNR, collect-neuter-return).

Finished the day with a Chinese meal (as one does in India); this was definitely the Indian adaptation with Indian level of spices – hot!

Wednesday 2nd November

Started the day with more surgery; this time a challenging spay even by UK proportions. The bitch was of good condition score, plenty of fat and tortuous blood vessels. Dr Krishna coped very well, although it’s quite difficult not to step in and take over. I’m so pleased I’m not a 3rd year student again!

Took the opportunity to have a look in Ooty over lunch; there are still some of the old colonial buildings left, including one which is a bookshop, Higginbothams! We were left in no doubt about it being the monsoon season; the heavens opened and continued for much of the afternoon.

Back for afternoon lectures, anaesthetics and analgesia. The good thing about this course is that the delegates are eager to learn and want to know more. There is one, slightly older vet on the course who, when discussing chronic osteoarthritic pain advocated the use of ‘bad leg tablets’ – it transpired these contain omega 3 and chondroitin. This is the same vet that suggested that the ITC should ask the vaccine companies to reduce the antigens in vaccines to make them less expensive; the ITC only receive 445 Rs, around £50, to collect, neuter, vaccinate and return the dogs – this not only includes the surgery and vaccination costs but has to cover the cost of transport and the salaries of the dog catchers as well!

Thursday 3rd November

A morning of completely mixed emotions today. Nigel took us to Coonoor (on the other side of the hill to the way we came up) where they have been very successful in running the ABC programme. We stopped at a local government veterinary ‘hospital’ which left me feeling completely downhearted. The building were erected in 1914 and little appears to have been done to them since. The practice room were frankly, a mess. Tables covered in used syringes, and tin pots containing treatment powders, magnesium sulphate and sodium bicarbonate. There was a lady waiting with her sick dog to see the vet who had disappeared off. A farmer arrived and shouted at the (unskilled) veterinary assistant who just handed over some medicines to pacify the individual. Seeing an environment such as this emphasises what an uphill battle is being faced; whereas in the UK, much of what we do is to educate pet owners, here in India it has to start with the vets. Ilona mentioned seeing the course notes for a postgraduate course in orthopaedics which suggested that peri-operative pain relief is not always necessary, and if so, paracetamol should suffice! It is still common practice to administer dexamethasone at the time of neutering to reduce post-operative swelling!

We then went on to visit one of the slum areas in Coonoor; even having visited developing countries before I still found this upsetting. The slum was alongside a fast flowing and dirty water course where people just dispose of their rubbish. Apparently it is much improved from when WVS first visited in that a toilet block has been built to improve the sanitation. The gypsy inhabitants live under tarpaulins with their animals in sheer squalor. There were lots of puppies which they try to sell to visiting tourists; the area is a holiday destination for Indians who come up to the hills to escape the heat of the summer.

There is a train that goes up the hill towards Ooty which we decided to take rather than drive back. I have to say, the best 50p spent in a long while. Stunning scenery and a fabulous feat of engineering. The carriages were something to behold, although we did have the best seats in the house – rights at the front of the train (the engine was pushing, not pulling) in the direction of travel!

This evening’s lecture was on ethics and euthanasia; we discussed amputation and the ethics of amputating more than one leg, but what about amputating the leg of a cow? Allegedly one of the (older) attendees had – interestingly the same one that prescribed bad leg tablets.

We ate with Ilona and Nigel this evening; these folks who give and do so much really have so little by Western standards – it is clear that while they give and do so much, being materialistic isn’t on their agenda.

Friday 4th November

The skills and confidence of the course participants is growing. One of them, Dr Prasad is fired up to set up an ABC programme in Andhra Pradesh where he is from. Sadly, like most things, bureaucratic red tape gets in the way. If he wants to set up the programme and apply for funding he has to run it himself for 2 years, gain approval from the AWBI (Animal Welfare Board of India) and then become an NGO. I just hope their enthusiasm lasts.

This afternoon was spent out with the dog catchers; there is a definite skill to this – it is not just about speed and, as with everything, a right and a wrong way! These guys most definitely do it the ‘right’ way. Therefore while the vets are neutering their assistants, apart from learning to assist in theatre, also gain the skills of dog catching. The main tool of the trade is a large net; once the dog is caught, it is then carried, in the net to the back of the truck. Nigel is the only one that handles the biting end whilst putting the dogs in the truck. Our travels again took us to parts of India that the average visitor would not see. Rubbish tips are a great source of food – if only the pictures could transmit the smell as well. One sadness was seeing cattle rifling through the rubbish while there is lush grass nearby; plastic is a huge problem for ruminants – they will eat disused packets with the plastic ultimately impacting in the rumen causing great distress. We saw a TV clip of Luke on the first day removing 14kg of plastic from a cow’s rumen. Although immediate relief, only palliating the problem until the cause – discarding plastic – can be resolved.

Today’s ‘catch’ is 11 dogs; they are taken back to the ITC and kept overnight. Bizarrely, despite being kept in a group, they never fight.

Tonight was the group meal, held at a local hotel (dinner for 29, £75). A great chance to chat and find out more about veterinary education and the profession in India. It was also a night for dancing; as I discovered, they don’t really listen to western music and the dancing is primarily by the men – I can’t see that taking off in the UK!

Saturday 5th November

Time to head back to Bangalore for our flight home tomorrow – via the 36 hairpin bends. We first visit the ITC to attend the final lecture (trauma and amputation) and to say our goodbyes. There is a festival on Monday so lots of traffic on the road. Thankfully our transport was better than on the way here – James and I had the (circa 1980) Chevrolet that was most definitely not built for comfort on the way to Ooty; the Toyota cruiser was a much more comfortable return journey. A trip that is a couple of hundred miles literally takes all day. We stop at Mysore for a break and to have a look around the palace. Not being used to westerners we found that we were the tourist attraction and will be turning up in many a photo album across the region! Bangalore is just one massive conurbation that spreads for miles – we finally arrive at the hotel around 9pm, Basco our driver relieved that James could tap into sat nav via his i-phone. If not, I fear we could still have been there.

Sunday 6th November

Finally back to Heathrow around lunchtime after a 10 hour flight. Sadly (not!) the Thai meal that I should have been taking the current Mr Boyden for (it was his birthday yesterday) couldn’t happen as the restaurant does not serve Thai on a Sunday night. A good roast was just fine!

So, was it worth it? Absolutely yes. These guys so need our help. The way they're taught is not their fault and their culture dictates that they do not challenge senior colleagues. I’m proud that Dogs Trust is involved with this project and the good that is so clearly being achieved, not only in terms of the skills of the veterinary profession, but in controlling the Tamil Nadu dog population.

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