Costa Rica 2015

Costa Rica Equitarian Project 2015: February 24 – March 5

Submitted by Adrienne Otto, DVM

This Equitarian Project was our 5th on the Osa Peninsula. Again, we teamed up with the University of Costa Rica (UCR) ‘zootecnia’ (animal science/technician) students. At dawn, Profesora Catalina Salas Duran, her equine-savvy husband, Jason, and students Ana, Andrea, Astrid, Karolina, Mariana, and Margarita had loaded the bus with our ‘Action Packers’ full of Equitarian supplies they had generously stored for a year.

The loaded UCR bus swung by Margarita’s Guest House near the airport and collected Veteran Equitarian veterinarians. This year’s team included Drs. Fernanda Castro, Sara Gomez, Adrienne Otto, David Turoff, Kim Thabault, and Julie Wilson, and all together we started our 7 to 8 hour journey to the South Pacific coast’s spectacular Osa peninsula. Along the way, we delightfully happened upon Costa Rican farrier Marvin Chavez, who, having lost his cell phone (seemingly a world wide phenomenon), had been mysteriously out of touch. He seemed delighted to be found, and agreed at once to again join our team. Working with clients and community members regarding good trimming and hoof health has been an ongoing Equitarian priority.

In Puerto Jimenez, the Osa’s principal city, we met up with our Osa organizer, Argentinean native and Costa Rica resident, Mariana Dialeva Mobley. She had done a spectacular job organizing our work venues, including excellent meals and places to literally ‘hang’ our hammocks and mosquito nets.

After a quick stop for supplies, we continued deeper into the Osa, past ranches, forests, and tiny trails into the mountains. Several river crossings later we arrived at Hacienda Rio Oro. This working hacienda, currently managed by the late founders’ daughter, Dona Cira Sanchez Sibaja, produces organic cheeses, made from both water buffalo and cow’s milk, as well as meat, vegetables, and fruit. There are guest cabinas and volunteer opportunities.  We were treated to a magnificent sunset, via kayak, and a traditional and festive meal. Most equids in this area work on subsistence farms, and due to remoteness and lack of resources, this area is under-served by veterinarians. Hacienda Rio Oro is aware of the important role Equids have here, and the ‘welcome to the Osa’ evening represented Dona Cira’s commitment to helping this community.

After dinner we pounded down the road to our first worksite, the farm of Don Trinidad Bellanaro. He gifted our night in breezy hillside bungalows, including an incredibility beautiful 5” frog in the toilet tank! The next morning we were fed and ready to go to work.

‘Don Trino’ uses about 25 horses to work this very ‘tipico’ cattle ranch, which has been in his family for over 60 years.  Campesino families brought their working horses down from the surrounding mountains, but we couldn’t examine many of Don Trinos own horses, as he needed to work cattle in the corrals (our work space) early in the afternoon.  This was the team’s first day as well as well as Equitarians’ first venue in this area of the Osa, but we addressed the needs of 19 horses that day, including many skin infections. We suspect these animals may be grazing on plants that contribute to photosensitivity, an interesting future project.

The UCR Zootecnia students, had had little horse experience, but with some coaching, they quickly developed basic skills to assist the veterinarians in examining each horse that was seen, and we became a well-oiled team. Their enthusiasm and eagerness to learn made the work go quickly, and their English language skills came in handy. We were reminded that Equitarian field work provides educational opportunities to students, owners and veterinarians alike.

The next day we worked at La Balsa, high in the mountains above Puerto Jimenez. This was our 5th visit to this farm and it was wonderful to see Don Javier Garcia’s family and the campesinos from the surrounding valleys again. The kids are growing up, as are the horses. We castrated three that were only ‘potrillos’, or ‘caballitos’ on previous visits. Unfortunately, the past prevalence of EIA at La Balsa appears to be among the highest of those communities tested in Costa Rica. On the bright side, the equids receiving annual Equitarian visits are doing remarkably well, with decreased tick loads, higher body condition scores (BCS) and overall better usability. Sadly, the local pit viper, the Fer de Lance or ‘terciopelo’ (velvet skin) is likely responsible for several recent acute hemorrhagic equine deaths in La Balsa. Overall we addressed the needs of 21 equids.

That evening we enjoyed another exceptional meal and family gathering at the request of important Osa rancher, Don Pedro Sanchez. Don Pedro’s father founded nearby Puerto Jimenez, and developed this ranch, more than 100 years ago. Theirs is another vast finca invested in cattle and, more recently, African Palm Oil trees, and, being very close to Puerto Jimenez, his ’Pura raza’ non-working horses receive routine care from veterinarians outside the Osa.  Don Pedro and his son Chaco, generously included the Equitarians in the family dinner, and provided a camping accommodation to support our efforts to care for the equids of isolated subsistence farmers and small ranchers. They saddled a couple of horses and the students enjoyed a sunset ride. We did examine one of his “pura raza’ horse, a mare with a significant ongoing skin issue, and were able to recommend some collaborative treatment options.

Shortly after dawn the following morning, we boarded a ‘panga’, and crossed the Golfo Dulce.  After a dramatic beach landing, and carrying much of our personal gear through the crashing waves, we were joined by Dr. Julie Wilson, and World Horse Welfare/Costa Rica Equine Welfare (CREW) personnel. Unfortunately, CREW’s in-country coordinator, Debbie Warboys was unable to join us; a big disappointment after all of her efforts to make this part of the Equitarian project a reality. CREW team members included organizer Tiffany Morse; her husband Cristian Martinez; Dr. German Cifuentes, a Colombian veterinarian working with CREW; saddler Omar Salvador as well as two Spanish speaking, Guyami to Spanish translators, Griselda and Santo. Veteran Equitarian farrier, Jerry Rapp had been unable to join us on the Osa this year, but joined us as part of the CREW team.

After breakfast, we drove to our first Guyami/Ngabe Indigenous Reserve venue, Alta Mira. The community is high above the beach town of Pavones via an extremely rough road. We were very grateful for the expertise of our drivers! Julie, Adrienne, Sara and Fernanda did most of the initial physicals with help from the UCR students. All of the horses were vaccinated against rabies, tetanus and Eastern, Western and Venezuelan encephalitis. Most of the horses were thin and many had saddle sores on their withers and girth galls. Omar Salvador was in much demand, looking at their saddles and girths as well as counseling the owner on how to remedy the cause of the sore(s). Some had already had input from the CREW team, sporting thick felt saddle pads and signs of early healing of the withers sores. The ubiquitous plastic rope “gamarras” (hackamores) were responsible for lesions on the bridge of the nose. Many needed to be loosened, adjusted and raised to resolve the issue. A lovely young chestnut mare that looked like she might be part Saddlebred, was tentatively diagnosed as a wobbler based on neurologic deficits in all four limbs and abnormal neck conformation.

indiginous women are often very involved in equid care, as are the children, but are reserved with outsiders until they get to know you.      Surprisingly, a number of horses were also dehydrated based on prolonged skin tents. Summer is the dry season here and forage and water are scant near the homes where most are traditionally kept. This proximity to homes may be responsible for the high number of horses that had a history of cough that began when the weather became dry and the roads dusty. Dr. Cifuentes and the UCR students counseled owners about other options for forage that might be nearby. Photosensitization was a common problem on many of the white faced horses, prompting a recommendation to use sunblock and to provide shade wherever possible. Dave and Kim addressed dental issues, hanging the dental halter from a tree branch. Sara and Fernanda did the single castration of the day, with the Equitwister, a hand crank adaptation of the Henderson castration tool, which does not require a drill or recharging of a battery. Although WHW had scheduled a hoof care workshop for next week, we could not stop Jerry from putting on his apron and going to work. Fecal samples were taken, and Dr. Cifuentes’ subsequent analysis showed unexpectedly high counts of ascarids and strongyles as well as some coccidia, even among adult equids. In all, health services were provided to 28 horses.

The Equitarians and UCR team spent that night under mosquito nets on the floor of the school buildings. Dave and Sara opted to string their hammocks from trees, while Catalina and Jason slept in their tent. We were surprised and delighted to find both electricity, and satellite dish internet. In contrast, the only bathing option was cold water scooped up in a bowl.

The next morning, we once again boarded the ‘taxis’ (4×4 pickups) with standing room only and headed back down the rough mountain road to the community of Progresso. Our work venue was excellent: a soccer field with plenty of shade. We treated 26 horses that day, including a heavily parasitized, febrile yearling with signs of pneumonia. Otherwise, medical issues were similar to the day before. The UCR students had the opportunity to discuss nutrition with many horse owners and provided them with several brochures that they had developed to address that topic and others pertaining to horse welfare.

After the last horse, a number of the team ventured down to the adjacent river to splash off the day’s dust and sweat, as there was no water to be had at the school and surrounding homes due to a broken siphon system, too many families on the well, or and or an exceptionally dry winter, depending on who you asked. The cook’s resourceful five-year old son, Hansel, volunteered to become our guide to a possible water source. With his help, several team members, including the ever-helpful Jason, walked a half kilometer down the road to the one house that had water. With two full buckets and two big kitchen cauldrons, this provided enough water to make dinner and refill our water bottles, but river water had to be fetched to keep at least one toilet functional.

Sara, who had led the team in 4 castrations that day, did one more procedure, this time on Kim’s foot. She utilized a new spray that contains lidocaine, a local anesthetic, to reduce the pain. A huge thorn was removed from a sore spot that Kim had been ignoring for a number of days.

After yet another dinner of rice, beans and some “mystery meat”, we hung our nets on the school house veranda overlooking the soccer field. The happy chatter at the end of the day made it seem like a slumber party. With over a dozen mosquito nets strung along the school porch, it looked very much like a scene from a tropical hospital. The night sounds were a blend of birds, lizards, occasional snoring, and in the early hours, serenades by both the roosters and howler monkeys.

The following morning we were driven further up into the mountains to Alta Conte. We were amazed by the young dog  galloping alongside us for almost 5 kilometers, through several water crossings. This was our second visit to this community, and we handled two castrations. However our patients numbered only 9 this year, perhaps because of a soccer game in a nearby community. Dr. Cifuentes constructively used the time to talk to us about alternative forage sources for horses as well as the medicinal uses for some of the plants in the area. We held informal rounds seated under a tree, where we discussed some of the interesting cases we had seen so far on the trip, and the evidence supporting a link to a new form of Ehrlichial disease that a number of the veterinarians had seen in horses in Central America. A skeletal, small, fearful, mange-covered dog was captured by Andrea and her classmates to bring to the horse vets for help. She was carefully dewormed, bathed and fed. Before long, she became sociable, prompting a decision to adopt her. We wrapped up early to return to Progresso. The Progresso community’s water system was still sketchy, so Equitarians once again had to haul water from a home further up the road for cooking, drinking, and from the river for dashing down the toilet. Between the river and buckets, we managed to cool off and clean up enough to sleep.

Early the following morning, a Monday, a large number of curious, uniformed students came to school. Some were barefoot, and some had walked over an hour to get there. We dispensed some coloring books, designed by Equitarian Angie Gebhart, along with crayons.  After hastily packing up, transforming our sleeping quarters back into classrooms, we participated in the school’s traditional morning assembly. Under the watchful eyes of their teachers, by age group, they formed 4 lines on the veranda, and sang multiple verses of the Costa Rican national anthem. Julie and Catalina were asked to briefly explain why we were there, and thanked them for sharing their school with us and for keeping their lovely grounds so clean. ‘Crocs’ seem to be the standard footwear, so perhaps next year the team can round some up as a thank you.

Our taxis, one of which was equipped with boards for us to sit on, ferried us high up into the beautiful mountains to the community of Santa Rosa. The little street dog nestled into a cardboard box and did not seem to mind the ride. We often saw parrots overhead, and heard at least one toucan. The winding and hilly road was smoother than others we had travelled and passed through both a teak forest and palm oil plantation before emerging into an area of vast vistas of steep hills and rain forest. Last year we saw only 15 horses here, and were delighted to treat almost 70 equids this day, many arriving via mountain trails from villages several hours away. There was plenty of room for surgery and dentistry, but at times, there were too many owners eager to have their horses looked at all at the same time. A number of foals were amongst them, some of which had never been handled. Kim and Julie were not daunted and successfully caught several of them to enable treatment. One of the youngest foals was found to have a draining skin wound on its chest. After cleaning the wound, Sara found a small foreign body which she removed.

This day’s caseload included a number of interesting cancer cases. An eight-year-old gray mare had bilateral, very firm parotid masses, most likely melanomas. A young palomino stallion was presented for castration but had a swollen prepuce and testicle. Upon further assessment, significantly enlarged pectoral and prefemoral lymph nodes were found, prompting a tentative diagnosis of lymphoma. As the young horse seemed otherwise healthy, the owner opted to go ahead with the castration. As the sun was setting, a speckled grey stallion appeared with a large protruding nasal tumor as well as several small melanomas under the tail. The large tumor on his nostril had been burned off with a hot iron a couple of times, without anesthesia, the only previous option in this area. He was a gentle animal with a kind owner, and, after careful deliberation, the veterinarians decided that this nasal tumor should be resected or at least debulked. The 10 cm mass was removed under headlamp, but probably not completely, as the underlying tissue had been infiltrated.  The long term prognosis is poor, but he will benefit from significant relief from the irritating, infected nasal sarcoid/sarcoma, and be comfortably useful to his grateful owner for as long as possible.

This community is extremely hospitable and provided the best rice and beans we had eaten to date. One of the cooks, probably in her mid-forties, proudly told us she was going to school, and was now in 10th grade. Running water, a cold water shower and 2 functional toilets were greatly appreciated, and a nice counterpoint to the multiple chigger bites most of us had acquired by that point. Adrienne provided ‘Zepol’, a product like Vick’s Vapor Rub, and remarkably effective at relieving the itching.

After breakfast and packing up, one of our friendly cooks asked us to join hands to say a prayer of gratitude and wish us well. Many goodbyes and hugs were exchanged before we boarded our ‘taxis’ to leave the mountains and return to the coast once again, driving this time to Punta Banco, south of our starting point of Pavones.

We set up our work stations at Jerry’s home across the road from the beach. The sea breeze was very welcome as were the sounds of the waves on the beach. It was an intermittently busy day with dentals and castrations, as well as our routine services. Unfortunately, the supply of vaccines had been used up, so only deworming could be provided. A number of the local expats came by to watch. Catalina and Jason scrounged to find enough food in Jerry’s kitchen to make us all sandwiches during a busy stretch midday.  A ‘calle’ (loose on the street) pinto stallion, with a fever of 105 F and a swollen, open, oozing chest wound, was presented. His history proved he was a danger to himself and others, as he had recently been kicked in the area of the swelling and wound. The kick(s), which had been observed on multiple occasions, were payment for attempting to mount uninterested mares that were being ridden by locals and tourists alike. Shade, Banamine and sponge baths were used to bring down his fever, and antibiotic therapy was initiated. The chest wound was cleaned and probed. Sara found a likely chip fracture of the sternum as well as a deep purulent abscess above the wound. The abscess was drained but we felt that he was too ill to anesthetize for castration. However, the owner insisted that the stallion be castrated to prevent further kicks and said that he did not care if the horse died from the surgery. So the ‘Equitwister’ was used by Sara to castrate him standing, with sedation and local anesthetic. This was, to our knowledge, the second standing castration with the Equitwister, and the first to be performed in Central America.

Kim and Sara headed out to Guanacaste, as Kim’s solo practice needed attending. Sara continued on to Nicaragua via public bus. Our final project patient was treated well after dark, on her way up the beach with sacks of beans and rice for an isolated community.

That night, one of Jerry’s friends, Harry, kindly lent us use of a nearby hillside home he manages. This beautiful home has a full veranda, a great view of the beach and actual beds for those so inclined. Jerry’s brakes are in great need of repair, and we had a bit of a scare on the steep drive, crashing through a “guard rail” of spindly poles above the steep precipice, as he tried to brake. Most of us chose to abandon the pickup, but Jerry was able to carefully regain the road. Regardless, all of us but Adrienne chose to walk back to Jerry’s in the dark. Jerry promised to get his brakes fixed soon.

We were treated to a barbeque cooked in banana leaves, over a wood fire by Freddie, another of Jerry’s friends. Post dinner, Dave and Fernanda stayed behind to sleep at Jerry’s, only steps from the beach, while the rest of us walked back up to the beckoning house on the hill. The crashing waves had an especially soporific effect and all were soon asleep. Julie opted to sleep in a veranda hammock for the first time in her life and was treated to an unforgettable view of the full moon on the ocean, surrounded by sounds of many night creatures including the howler monkeys.

The following morning, the pinto stallion looked much better. Jerry agreed to provide ongoing wound care and will continue antibiotic therapy. Our intrepid UCR bus driver arrived, and after a quick stop to pick up Omar, we headed out for the eight hour return drive to San Jose, allowing for our traditional stop at the Tarcoles ‘crocodile bridge’. The ride gave us time to recap our trip and banter with the now familiar students, and to discuss what they had learned. They were all enthusiastic and several expressed an interest in going on to become veterinarians. Their rapid progression in both skills and confidence, as well as their great work ethic, were certainly one of the project’s highlights. Fernanda and David said goodbye to the students and Catalina and Jason, with heart felt hugs, at Margarita’s guest house where the remaining veterinarians spend that night.

Friday morning, Dave and Fernanda left for California while Julie and Adrienne took a taxi to UCR in San Jose. They joined Professor Catalina and the students at UCR to go over the inventory and run the informal EIA tests. Parting with the students and Catalina was bittersweet, but tempered by plans to work with UCR when Adrienne’s team returns to the Osa in 2016. All in all, it was a very successful trip with health services provided to 202 horses. The fantastic support from the UCR team and CREW made the work days efficient and gave the team time to spend on owner education. Support from the AAEP Foundation, and Zoetis’ donation of vaccines, Excede, Dormosedan and other very expensive supplies, went a long way towards making this program possible. We’re hopeful that the 6th Equitarian Workshop, scheduled for the reserve region in January, 2016, will train more veterinarians interested in becoming Equitarians in the “Reserva” region, will be as successful, interesting and enjoyable.
CastrationsCastrations always gather a large crowd. The ‘Equitwister’ was used on all our castrations including this one, standing, with Dr. Sara.

Nasal tumor This painful nasal tumor was resected, giving this patients relief and a better quality of life.

MelanomasUnfortunately he also suffered from perianal melanoms.

HoofHoof issues are a constant challenge to our farriers Jerry Rapp and Melvin Chavez.

Low BCSBody condition scores were especially low on the Reserve.

MuleMules and donkeys are very expensive in Costa Rica. Most of our horse patients were fairly tractable, but mules can be touchy.

SchoolThis two-room school veranda served as our camping area at night. These students, some barefoot, started their lessons at 7 am sharp.

Child with coloring bookWomen and children are often very involved in the care of working equids, however the cultural issues can make it difficult to communicate until we know each other better.The Equitarian Initiative coloring books help bridge this gap.

Indiginous womenLocal women from the indigenous Reservation
tabanid trapStudents and owners building a Tabanid trap. Controlling the Tabanid vector for EIA is a critical issue, but the traps are not yet readily accepted on the Reserve.

TicksHundred of ticks, like the ones in this horses ear, are very common on working equids. On the Osa, owners are using tick control, however more work needs to be done on the Reserve side of the Gulfo Dulce.

Last patientOur last patient of this project–a mare on her way to an isolated community was treated well after dark.

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