Wednesday, 17 April 2013

Surgery in flip flops

A month as a Cook Islands vet at the Esther Honey Foundation

I was apprehensive as I left Auckland for the island of Rarotonga, one of the Cook Islands in the midst of the bright blue South Pacific. It wasn't because I was on my own or because I was heading to a new country- it was because I was about to be a vet again. I tried to reassure myself that all the veterinary knowledge and skills I'd left behind when I gave up my job in small animal practice 18 months ago must still be there...somewhere. I hoped that they were just very dusty, and that I'd be able to brush them off and feel like a vet again, but there was a real fear that I had genuinely forgotten it all.

In Rarotonga airport a man with a floral shirt and straw hat was playing a Ukelele and singing to welcome the newcomers to the island. It made for a nice chilled out arrival to a country, and Rebecca, a vet nurse and fellow volunteer, was waiting to meet me. Even at midnight it felt very hot and sticky as we drove the short trip in the dog-hair covered car, and I wondered how I'd cope with working in this humid 32 degrees.

Ginger kittens- my favourite!
Arriving at the clinic immediately brought back that long forgotten but distinctive smell of all vet practices, a mixture of medical cleanliness and animals. It was a messy little bungalow situated in a garden full of barking dogs attached to trees. This would be where I would live and work for the next month. 
There may have been palm trees, but this was no tropical haven. Next to the island road, close to the runway, and surrounded by a yard full of barking dogs and crowing cockerels with no sense of dawn timing. I asked Rebecca, 'How do you sleep?'. The answer came 'You don't'. I was at least relieved to be able to hear the waves on the reef- a welcome addition to the cacophony. Having the sea so close would prove to be a real blessing!

Posing with some of our patients
The Esther Honey Foundation is a charity animal clinic, the only veterinary practice in the Cook Islands. Treatment is provided free and the place is run by a constantly changing group of volunteer animal lovers, mainly vets and vet nurses. Most of the fund raising is carried out overseas, and volunteers come primarily from Australia, New Zealand, and particularly the UK. I was taking up a 'Senior Vet' position, which felt a bit of a joke given how long it was since I'd held a scalpel blade, and added to my first day nerves. 

The current set of volunteers were Michelle, an Australian vet of my age, here for 6 months, a Danish vet student Julie, and 4 vet nurses- Kiwi Tracey, and British Rebecca, Angela and Rachel. All girls apart from Gregg, the clinic director, and all working hard together in the heat to care for, feed, clean and treat the large collection of dogs and cats.

The outdoor hospital
The patients lived in the yard- in a set of hospital pens under the shade of a corrugated iron roof, a few kennels and cages scattered around the garden, and on a number of chains attached to palm trees. 
Among the animals here were two dogs with gunshot wounds, RTAs hit by cars and scooters, anaemic little kittens mewing mournfully, and three cases of fish poisoning. 
Then there were all the strays- adult cats with one eye (always hard to rehome), gangs of kittens, and dogs dumped here when their owners left the island for overseas. They were all desperate for attention, wagging tails and whining hopefully if it looked like you might be coming their way.

Are you quite sure you want to castrate me?
It was clear from my first rounds, talking through the cases in the clinic, that there was plenty of work to be done here. I tried to imagine what would happen without Esther Honey, and I knew a lot of these animals would be dead or dying painfully in some corner of the island. 
I may have been nervous about my own role here, but I was really glad to be part of this team, doing the good work we were doing. It was also fantastic to be back working with animals! The reason I'm a vet in the first place of course, but I've hardly even handled a dog or cat for months. Without exception the animals were gorgeous and deserving of all the help we could give them. Unlike some pets back home, they were incredibly accepting of anything we needed to do. It was like Mr Miagi the dog was saying 'Pick pellets out of the massive gunshot wound that's blown away half my neck? Okay then, if that's how you want to play with me, go right ahead'.

Lucy, a suspected fish poisoning case
Fish poisoning dominated the medical cases, and was something I'd never heard of before I applied to come here. I had been helpfully educated about it and given information and protocols for treatment before I arrived. Properly called Cigatuera toxicosis, this is a poisoning caused by eating certain fish from the coral reef that surrounds the island. It can happen to people too and is found in various tropical regions of the world, but dogs and cats are particularly susceptible. The effects are horrible, and can include a paralysis of the whole body. It isn't fatal and almost all cases will eventually recover, but only with weeks and even months of treatment and dedicated nursing. If we weren't here, without doubt many of these animals would die. At the moment we had Jango the dog, and the badly affected cats Vicky and Shrek.

Vicky having hydrotherapy
These three patients took a lot of time, requiring syringe feeding, regular turning, washing and grooming, physio and hydrotherapy. They were sorry sights, but despite being unable to move more than their heads, the cats would still purr quietly as you handled them. Jango the dog wasn't quite as badly affected, and he would attempt to get up, wobbling and bashing himself against something before he tried to rise again. It was hard to see animals like this but I kept the words that I had been sent in my head; 'Try not to give up on these cases, even if they seem to be going nowhere, as almost all will eventually turn the corner and start to improve'. I just hoped that would happen during my month here.

Hydrotherapy, South Pacific style

Tracey and I took Jango down to the sea for his first session of hydrotherapy. He was a dead weight in Tracey's arms and his heart was beating fast as we lowered him into the water, his eyes showing his trust in us, but tinged with apprehension. I worried he might think we'd taken him down there to drown him, and we gently reassured him. Carefully supporting his body we immersed him in the water, gently swaying his legs. There was no movement at all. We flexed and extended his limbs for him, willing life back into his muscles, but to no avail. It was much the same for Vicky the cat- we gently held her in a bowl of water, swishing the water over her skinny little legs.

Kisses from the 3 legged pup Boston
But as the days went by, things started to change with these fish poisoning cases. The cats raced each other to lap at food rather than have it syringed, then eat mush while their heads were supported, and then hold their own heads up for proper meals. They began to turn their necks and try pathetic attempts at grooming. Yesterday Vicky overtook Shrek's recover, and walked for the first time. Her forelimbs are slower to improve than her hindlimbs which gives her a comical Bambi like stance on rigid splayed legs. She falls over a lot, but she has quite clearly turned the corner, and sits in her cage looking almost like a normal cat. Meanwhile Shrek has started to use his forelimbs to pull himself up the cage bars. I think he's doing his own pull ups to speed the returning strength and function of his limbs, and to avoid the hydrotherapy pool.

Jango starts to swim for himself

On Jango's second hydrotherapy session in the sea he started to kick his legs, and then all of a sudden, over just a couple of days, he was walking, swimming, barking, wagging his tail. His owners came to pick him up and his excitement at seeing them, yapping like a puppy and tail wagging at full speed as he ran to the car, was ample reward for our time caring for him. In these cases it's not medicine that saves the animals, but TLC, and we have plentiful supplies of that!

Getting back into surgery
As for my own role, I needn't have worried so much. It helped enormously with my initial confidence crisis to have such patient and brilliant nurses for my first couple of ops, but within a few days I was feeling like a vet again. It turns out that even 18 months away isn't enough to make you forget! 

There's a real sense of team spirit here, with everyone working together to make sure all the animals are cleaned, fed, medicated and cared for. Consults and surgeries occur on a fairly ad-hoc basis, with people sometimes turning up at 2pm with no appointment and 5 cats they want neutering. This afternoon please. Esther Honey is obviously keen to neuter as many island animals as possible so we try to fit in as much surgery as we can.

Consultations can be interesting. Normal strategies don't always work too well, with questions as simple as the animal's name and age often drawing blanks ('Oh, this one might be Blackie. Or maybe Snow White', when the dog in question is neither black nor white!). There's sometimes not a lot of point trying to go into details of how much it's drinking or how long it's been ill.

Dinner time!
Some owners are very loving and come to visit pets who are clearly part of the family, but others leave us wondering. It is quite common to have ill animals left here, seemingly forgotten. We get them better and then ring the owners with the good news that their pet is ready to go home. Maybe a few days later they turn up. Perhaps it's 'island time'. 
We worked hard to save little Jessica the puppy, who came in critically ill, weak and anaemic. When she'd turned the corner we phoned her owners every day to come and get her, only to eventually discover they'd moved to Australia!

Jessica feeling poorly
I've had some memorable cases in my month here, like 'Tintin' the cat, a stray found with his whole head wedged firmly inside a tin can. To make matters worse he'd also been caught by a dog while in this state and shaken, causing fractured ribs and emphysema. He must have been petrified, and was well on his way to dying of dehydration and starvation, so it was very rewarding to free him, treat him and watch as he went from having a huge swollen, distorted and bruised purple face to looking like a cat again. There have also been some funny moments, like the call out to an attacked dog that turned out to be a perfectly happy goat! I've stopped expecting people to come in with a cat basket, most animals arrive here cradled in one arm, the other hand driving the scooter!

The clinic runs entirely on donations, and we try to be as efficient and inventive as possible with the resources we have. It has been an opportunity for me to get to know many alternative drugs and try to work around problems using what we have available. Many of the medical supplies are donated, often less commonly selected drugs in bizarre concentrations, given to us as they have expired and would no longer be used in practice. This creates an eclectic array of medicines to choose from, although there's always something appropriate. It will feel like luxury to go home to a well stocked practice with, among other things, more than one anaesthetic circuit, paper towel and different size needles, catheters and syringes! We always have a long wish list, and anyone in practice reading this may be able to help - please visit

After work drinks!
I have loved my month here as a 'honey'- it's been hard work at times but often very rewarding, and I always feel proud to tell people I meet around the island that I volunteer at the animal clinic. Locals and tourists alike are very grateful that we're here and it's nice to feel part of the island community. Although I did get one comment, 'Is that why there are so many dogs with 3 legs on Rarotonga? Do you vets come here to practise surgery on them?'!!

It's definitely going to be hard to leave, and I've even started to sleep through the nightly chorus of whining, meowing, barking and cock-a-doodle-doos!


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