Blog by Dr. Julie Wilson
Day 1 Saturday, January 21, 2017
This year’s Equitarian team of 24 people includes veterinarians, veterinary students and a farrier coming from 5 countries. We are united by our passion to improve the health and welfare of working horses, donkeys and mules. We have come to the Workshop to learn more about the plight of the working equid and their critical contributions to the livelihood of their owners. Equitarian Initiative’s leaders, our teammates, the horses, donkeys, mules and their owners will be our instructors. Lessons gleaned from decades of experience providing health care to working equids will be shared by Drs. Julie Wilson (Honduras), Jay Merriam (Dominican Republic and Morocco), Dave Turoff (Guatemala, Nicaragua, Peru), Judy Batker (Haiti, Pine Ridge SD), and Stacy Tinkler (Peru, Morocco). Dr. Dennis Benavidez has been part of the Honduras team and is now the veterinarian for World Horse Welfare in Honduras. Two days in the classroom and four days in the rural communities of the Osa and Corcovado National Park will introduce our participants to Equitarian work and models of care delivery and education. Our participants include veterinarians Steven Edsall, Katarina Purich, Leah Knox, Ela Misuno, Elaine Klemmensen, Megan Rioux and Alisa Alden from Australia. There are 5 veterinary students: Brianna Bradford, Natalie Lord, Dan Mordarski, Fabian Jimenez and Daniela Ramirez. Fabian and Daniela are Costa Rican. ANSE Foster and Deb Whitten are the team’s veterinary technicians. Paul Dorris is our farrier. Lucy Bartlett is our registrar for the incoming horses, and Annie Henderson is our new fundraiser coming for an immersion experience. Mariana Mobley is our indefatigable local organizer.
We left San Jose midmorning on a very comfortable bus where many took advantage of the lengthy journey to nap or get to know their teammates. After winding down the hills to the Pacific coastal plain, we stopped to admire the 30+ crocodiles under the Tarcoles bridge.
The chance to stretch was welcome as were treats and beverages from the adjacent shop. When our bus driver, Luis, admitted that he knew very little about crocodiles, the shop’s manager gave us a great summary of crocodile facts and biology, including the impact of global warming on sex determination of crocodiles. The current warming trend supports more male embryos, leading to more fighting amongst adult male rivals.
Our next stop along the coastal road was Uvita, where we had a quick, cafeteria style lunch. Mariana Mobley, our incredible local organizer, was waiting for us when we reached Puerto Jimenez, our base for the Workshop. We were soon settled into the Hogar de Ancianos, the same senior daycare center, where we stayed in 2016. This lovely facility has a large meeting space, great bathrooms, and ample floor space to sleep. Most chose the indoor floor area but still put up mosquito nets in a variety of novel configurations. Four chose to set up tents outdoors.
Dinner was a short walk away, with a surprise engineered by Mariana. We were greeted by two beaming young girls (~6 years old), dressed in typical dancing dresses with very full, colorful and ruffled skirts, white tops and beautiful combs in their hair. The restaurant owner, Doña Angela, chose special decorations typical of Costa Rica to welcome us. Her famous fish stew was served to our hungry crowd. The lovely young ladies danced for us, pirouetting, raising and swishing the full skirts, to great applause.
Day 2 Sunday, January 22, 2017
Blog by Dr. Julie Wilson
The early morning began with a Costa Rican “alarm clock”: The long rolling growls of howler monkeys in the woods just beyond the walls of the Hogar compound as well as flights of chattering and screeching parrots of varying sizes zooming across the sky, We were all awake soon and ready for the class sessions to begin. The topics provided an overview of many aspects of Equitarian work: World hunger and the role of working equids; ethical challenges encountered in Equitarian work, tropical diseases and their manifestations, and strengths of differing projects in Haiti, Dominican Republic, Guatemala, 
Nicaragua, Honduras, and Peru. The unique history and incredible work at the American Fondouk in Morocco included a number of case examples of donkeys, mules and horses that would have had little chance of survival without the excellent free care that is available there. Emphasis on education of veterinarians and veterinary students was clear in all of these models and valued as a strategy to encourage more individuals to effectively engage and support Equitarian work. The afternoon concluded with presentations and discussions of anesthetic and surgical techniques and accompanying challenges in remote areas. Options for safe euthanasia, when warranted, were debated as euthanasia solution is not an option. All viable choices included induction of general anesthesia first.
On a lighter note, Mariana spoiled us again with a night at the Opi Opi. After a very tasty dinner, the family’s dance school pupils put on an incredible series of folk dances with beautiful choreography, accuracy, energy and smiles. This is the first such school in Puerto Jimenez, and just opened last year. The students range in age from 3 to 23. After an invitation to perform in the national competition for this dance form and a strong performance there, the troupe has been invited to perform in Mexico. This wonderful opportunity and pride in their accomplishment will have a strong positive impact on these young people who might otherwise go astray without a focus in a quiet beach town. The evening ended with many of the Equitarians dancing with members of the troupe. What a great way to end the day!
Day 3 Monday, January 23, 2017
Blog by Dr. Stacy Tinkler
Today was our first day in the field with the eager EI participant veterinarians, veterinary technicians, farriers, and student in the fantastic village of Gallardo. We and all of our gear were bundled into the back of a local truck and became very sympathetic of the cows or horses that are the usual cargo.
We arrived to find several of our equine friends all lined up and ready to go. A few mares with foals by their side and a yearling colt that was not halter broke. The colt was having a hard time understanding what his owner wanted from him. Dr. Julie Wilson came to the rescue and had the little guy moving forward in moments with a plastic bag on a stick shaken behind him as opposed to a hard log beating on his butt. What a great teaching moment to show the owner and bystanders a different, less stressful way. After about 15 minutes, our amazing teammate, Dr. Dennis Benavidez, had the colt ready to be examined, vaccinated and dewormed. Our 4 teams made light work of the 44 horses we saw in this village: 3 castrations, 12 dentals, 20 some odd foot trims that almost heat-stressed our valiant farrier, Paul Dorris.
All equids presented for a full physical examination were vaccinated for rabies and tetanus and received oral ivermectin. Most of the horses in this community are used for harvesting palms to make palm kernel oil, and for some transportation. Our wonderful hosts provided us with some delicious Costa Rican fare and snacks of home-made savory cream and corn tortillas served on banana leaves and some of their locally grown coffee (unbelievably smooth!).
The dental team led by Dr. Dave Turoff had a few cases of particularly bad malocclusions and overgrowths that were easily correctable and could have been detrimental to the horses if left unattended along with numerous other more routine floats.
The two triage internal medicine teams saw several suspect cases of a fungal rhinitis that we have seen fairly often in Central America. It is thought to be conidiobolomycosis. Clinical presentation is characterized by a combination of thickened nasal septum, hemorrhagic or serous nasal discharge, dyspnea and /or pink-red plaques on the septum. Dr. Eric Davis with R-Vets is investigating these lesions by collecting tissue samples for histopathology. Systemic antifungal drugs are cost-prohibitive here and at this point there is not a good treatment option without more regular veterinary care. The growths will continue, eventually resulting in obstruction of the nasal passage. Lastly, an 18 year old horse presented with bilateral poll swelling. The local horsemen call this syndrome, “raton”, which means rat. The soft- tissue swellings were non-painful and cool to the touch except upon deep palpation of the atlas. One of the most likely causes of the swelling is Brucellosis and therefore, the swellings were left alone and untreated, as opening them or draining them could put people and other animals at risk of infection.
The horse appeared to be completely unbothered by them at this point in time and was in good body condition. These situations are always difficult as you wish there was more you could do for these animals.
Tracy and Jay enjoyed showing team members how to use the Equitwister for castration. This simple device works on the same principle as the Henderson clamp but requires no power source.
Everyone had a great first day and returned to the senior center in good spirits, with a much better idea of how the whole process works. After our boxes were restocked for tomorrow’s work day, we ended our busy first day with a picnic dinner and a night swim on the peach. Pura Vida!
Day 4 Tuesday, January 24, 2017
Blog by Dr Ela Misuno
After about a 30 minute drive in the truck, we arrived to our workspace for the day, Guadalupe de la Palma. We were stationed in a cattle pasture with the owner’s herd of Brahma cattle grazing all around us. Chickens and dogs were freely roaming. The hosts supplied our team with an endless supply of coconut water and a red fruit known as a water apple.
As soon as we arrived, a man approached Mariana (our guide) about a very old sick donkey. She explained that this man could no longer farm and made his living breeding and selling donkeys and mules. The man had explained to her that he owned a very old donkey who could no longer walk. He believed his donkey had cancer and he wished to have euthanized. The team decided to examine this animal at the end of the day and euthanize it if necessary. This animal ended up having a large necrotic mass on his mid-neck and was euthanized using lidocaine in the spinal fluid after the donkey was anesthetized.
Many horses were lined up waiting for us when we arrived including a handful that belonged to the Guaymi which are the local indigenous people. The Guaymi’s matriarch was wearing one of the colorful traditional dresses in a lovely pink. These people are very shy and reserved and Mariana explained that she was very pleased to see them at the clinic as they will spread the word amongst their village.
The day brought us several interesting cases. In triage, a 14-year-old gelding presented for routine health check who was blind in his right eye. The owner explained this horse had been kicked in the face. On further examination, this animal had a prominent scar on the caudal aspect of the cornea with iris adhesions, miosis, and a cataract. Otherwise, this animal was healthy and functional.
Another interesting triage case was a 4yo mare used as a pack animal with no presenting complaints. However, during the physical exam, we discovered a grade 3/6 diastolic heart murmur with PMI over the aortic valve. With further questioning, the owner divulged that this mare had once collapsed while working. We explained to him that the mare was otherwise normal on physical and should be able to continue as a pack horse but should not be ridden aggressively at speed.
One of the most interesting cases of the day was a neurological case in a very old gelding (est. 26 years old) who presented for anorexia and lack of drinking. He showed signs of ataxia, nystagmus and progressed through the day to showcase some facial nerve deficits. He was treated with fluids, anti- inflammatories, and antibiotics. His owners from the indigenous community were kind enough to leave him overnight on the property we held the clinic. Thankfully, he showed marked improvement in the next 24 hours.
We also met an unusual horse family, where single mom took care of her 3-week old mule, and was a “stepmom” for a yearling mule who decided to stick by her side. The yearling was a curious kind and even decided to read its mom’s health record.
The kids were very interested in our work and one 4-year-old boy brought his dog over for us to examine. This rapidly progressed to us examining a handful of dogs. We were very happy to see such involvement and empathy in the children of the community.
Sunburnt around the face and ears is a common problem in grays, paints, and horses with blazes in tropical climates and fortunately, we could offer some solution on the spot: fly masks donated by horse owners in the U.S.
The lunch provided by the property owners was amazing. The fresh fruit and vegetables added a lot of interesting flavors. The hosts also walked us out to their butterfly farm at the end of the work day where they farm many native species of butterflies with the help of a local biologist. Mariana explained that the owners do not make any money from their farm animals, their farming is only done to feed their family. The owner’s dream is to develop a butterfly farm that tourists may visit to see the many stages of metamorphosis. The butterflies were stunning and in a wide array of amazing colors. Mariana also described that the butterflies are used to make jewelry after their natural lives are over. The community is currently fundraising with this jewelry to help develop an insect museum.
The day ended with a change in lodging. Mariana persuaded her friend Maria to let us rent her beach house that sleeps 24 people for a bargain price. Hammochs! Real beds! Washing machines! This seemed like the Ritz.
Day 5 Wednesday, January 25, 2017
Blog by Dr. Julie Wilson
Today was the second classroom day, beginning very early back at the Hogar (senior center). Many topics were covered and generated great discussion. We finished up early to take advantage of the chance to go out on the Golfo Dulce on a boat belonging to Mariana’s friend. As one might expect the scenery was gorgeous, with shades of blue in the water, sandy beaches with palms, and the mountains on either side of the gulf. An array of sea birds overhead soared and dove for fish. Most impressive amongst them were the frigate birds with forked tails that closed and spread like ailerons as the swooped down to the water. The boat anchored just a way of the shore and just about everyone jumped in to swim. Alas, a strong current from the outgoing tide quickly swept Julie and Elaine far from the boat. Both of us were good swimmers but not good enough. We tried swimming strongly back to the boat to no avail, as our marker bush on the shoreline clearly showed we were not any closer to the boat. After we realized our predicament, we headed to the shore. Phew, we made it! We headed up the beach well past the boat, then successfully swam back to it. The only other blot on the adventure was Kat’s encounter with a jelly fish.
As we headed back towards the pier, a pod of dolphins was sighted, to everyone’s delight. Out came all of the cameras and cell phones. The dolphins put on quite a show for us, frequently surfacing in groups of 3 or more as we cruised along. Several of us were lucky enough to sit on the edge of the very front of the boat where the dolphins took turns swimming rapidly forward and rolling over just a few feet ahead of us. We learned that dolphins love to do this, and often choose to come to a boat, especially one with music playing. Both dolphins and whales are frequently spotted in the Golfo, in part because fishing is limited by an interesting strategy: A billionaire who loves the Golfo bought up the majority of the fishing licenses. What a great memory this was for all of us to bring home.
Day 6 Thursday, January 26, 2017
Blog by Dr. Megan Rioux and Dr. Leah Knox
Thursday at the Equitarian workshop started off with a bang…literally! Fellow workshop attendee Dan Mordarski elected to sleep in a hammock on the beautiful balcony of our rental house to get the true Costa Rican experience. Waking up to the sounds of the jungle – howler monkeys hooting and macaws squawking through the trees is truly a special experience. Unfortunately for Dan, he woke up early this morning to a friendly visitor sharing his hammock.
We’re not sure who was more frightened by the encounter but reports have it that both Dan and the possum-like creature bailed out of the hammock in rapid fashion. Not to worry though, our nocturnal friend emerged from the encounter unscathed. Dan, on the other hand, is being watched closely for signs of lice or the equine disease transmitted by possums, equine protozoal myeloencephalopathy (EPM). He blames the possum or kinkajou or whatever it was.
Those of us not engaging in extra-curricular wildlife experiences were up before the sun, drinking copious amounts of coffee and lacquering on insect repellent like it was going out of style. We had Costa Rican pizzas for breakfast before piling into the local cattle truck for the drive to today’s farm. If you’ve never ridden in a cattle truck, it’s an experience – hot, windy, a great way to get friendly with your fellow passengers and an exercise in balance for the clumsy amongst us – shifting your weight to stay balanced on bumpy, windy roads. Luckily nobody on the trip kicks or bites…although the week isn’t over and Dr. Tracy Turner was a walking zombie (not a morning person). Stay tuned! It is certainly a colorful way to get around and fitting that the veterinarians and some of the horses arrived by the same mode of transportation.
After an exhilarating ride through the Osa peninsula in our trusty cattle truck and crunching the back bumper, we arrived at Rony Picado Mora’s private farm in the Agujas community. The property was stunning with lush palms, tropical flowers and an incredible 20-year-old Banyan tree with its tortuous labyrinth of above ground roots providing a focal point to the property, as well as much needed shade. The horses started to arrive quickly, and within a few minutes, we saw our first case. This was a 10 year- old chestnut tobiano (pinto) gelding who presented for a growth on his lower lip. The gelding was obviously well loved, with his rider enthusiastically describing his prowess at herding, calling him his favorite horse. The growth had developed over a 4 month period and had not responded to any of the treatments applied. Upon closer examination, the gelding had a large mass affecting his lower lip and extending full thickness through the mucosa, dermis, and epidermis (into the mouth) as well as involving the mandible (lower jaw). The mass was malodorous, necrotic and obviously causing the horse distress and pain, as he was having difficulty chewing. Another sign of pain was that he consistently tossed his head in irritation. After further evaluation, it was determined that there was cancerous with secondary osteomyelitis (infection of the bone) of the lower mandible with pending loss of the very loose lower incisors.
Unfortunately, the top differential for a tumor of this sort in the Central American tropics is squamous cell carcinoma, although an aggressive form of sarcoids cannot be ruled out without histopathology. Unfortunately, the tumor was too exstensive and likely too aggressive to be treated successfully at this point, even in the best of conditions. Euthanasia was recommended for the pinto gelding, although permission had to be obtained from his out of town owner. It should be noted that while euthanasia is commonly accepted cultural norm in many parts of the western world, that isn’t always the case in the developing world. It is a difficult decision for an owner which goes against their deeply ingrained values.
Behind the scenes, Dennis, Brianna, Steve and Julie were tackling a myriad of horses belonging to the farm owner. Very few were halter broke so guess what – they had to be roped. The owner ha a shed with two pens and a small catch pen in between. Without Dennis, there is no way these animals would have been examined, vaccinated or dewormed. His patience and gentleness were outstanding, and left the horses’ owner in total awe of him. Steve had a similar quiet grace working on the wild ones, managing to get eyes looked at as their heads tossed, and sliding ivermectin in their mouths before they knew what had happened.
As the evening light faded, we visited Mariana’s store by the airport. She stocked so many different things, most made by local tradesmen, that we had a hard time choosing a special memento of our Equitarian week. Most beautiful of all were the earrings and necklaces made from the wings of local butterflies which several of us could not resist. The income from their sale supports the family with the butterfly garden, Daniel, the Spanish butterfly specialist we met, and a hoped for butterfly educational museum in Puerto Jimenez. A quick dinner at Lilly’s soda (local café), a big thank you for all the “on the go” meals she prepared, and we were done for. Certainly, this was another great day of learning and team building.
Day 7 Friday, January 27, 2017
Blog by Dr. Judy Batker
The morning began with a farewell to Julie and Tracy. They reluctantly departed to Grand Cayman where Tracy had to be for a conference the next day.
Our first stop of the day was the farm on the edge of town to euthanize the horse with the severe cancer of his lower jaw. A few of us walked with his caretaker down a long pasture and near a big tree. As we approached the horse to sedate him, the caretaker’s phone rang. It was the owner, saying don’t do it. He said his other employees couldn’t be there to help dig the hole and he didn’t want the one man to do it by himself. This seemed unbelievable. The owner said he would have the horse shot later in the day. Mariana said more likely a friend had told him, “Don’t do it. I put something on a horse once with the same problem and it went away “. We all walked back up to the truck in silence, knowing the horse would likely continue to suffer now. With his constant head movements, shooting would be difficult. This is one of the huge disadvantages of only being in a community for a short time.
Our work destination today was the community of Rincon. We provided health care to 55 horses. Most of the horses were in very good shape. Several true working horses came that needed a little more care. Our work included 2-3 castrations, several dentals, and many farrier cases. Melvin, the local farrier that had received training and equipment from previous Equitarian visits, came over and worked with Paul and Dennis.
One horse was ataxic (uncoordinated) but also dull and thin. His history suggested that he had not been “right” for two years. The horse was also lame in his right hind limb. After discovering that the owner was willing to try some form of treatment, Jay and I discussed trying to ship in “Elevate”, an effective vitamin E supplement that can be given orally, an option that might be economically feasible. The option of a trial course of phenylbutazone, a nonsteroidal anti-inflammatory medication, was also an option to determine if neck arthritis may be the cause of incoordination. If so, the horse might improve.
On this last community day, the students very clearly could take charge and had a very good idea of what to look for.
On arrival in Rincon, a very poor man with obvious skin cancer approached Mariana about coming to his home, about 20 minutes away by truck. We told him depending what time we got done, we would try to. The man said that with his neighbors, he would have 15-20 horses that needed health care. This sounded like a very good idea.
As we were packing up, a truck pulled in with two horses. One horse was very thin. After the owner unloaded him we found that the thin horse was aged and needed dentistry. While this last patient was being attended to, a local news station pulled in. They interviewed Dr. Dave Turoff and one of our two Costa Rican veterinary students, Fabian Jimenez. Dr. Stacy Tinkler also contributed to the interview.
They got good footage of dental care and the thin horse. Fabian was a rock star on camera!
Finally, we all loaded up and decided to try to go to the next community. There was disagreement amongst the local men as to how rough the roads would be. Marvin, our truck driver, finally said he would not take his large truck with 20 foreigners on that road. At that point, all the local guys concurred that going would not be a good idea. We said, “Whatever Marvin thinks, we will listen to him.” He has taken very good care of us this year and last year without charging us for his time, so his opinion is very important. Disappointed, we headed back to PJ where a large group of us did inventory of the remaining supplies.
Day 7 Saturday, January 28, 2017
Blog by Dr. Judy Batker
The Workshop’s last day began with the final classroom session. The instructors finished up their didactic presentations on multiple topics: The importance of targeting equine husbandry lessons for children; challenges and benefits of Equitarian work with American Indians on the Pine Ridge reservation in South Dakota; logistics and components of starting a project and providing services; and the impact of including the Equitarian veterinarian’s family in the projects. This was followed by a lively discussion of not only the lectures but also the entire Workshop. Many great ideas arose as well as suggestions for the next workshop. Dr. Tinkler made a great closing statement about the almost euthanasia that wasn’t. As bothersome as that was to many of us, we need to remember we are only there for a moment in their lives. This kind of thing happens all the time. We just happened to see and know about this one. We can’t feel responsible or carry it with us. We just need to keep trying to educate and do what we can.
The Workshop benefitted hugely from Dennis’ horse handling expertise and many hours trimming hooves. He received a veterinary care package with several surgical instruments and a stomach tube for his practice back in Honduras. Many, many words of gratitude were expressed to Mariana, Lucy, Paul, and all of the leaders. All were very sincere and heartfelt, including some that were quite emotional.
Mariana’s daughter, Carolina, was incredibly helpful throughout, not only because she is bilingual but because she is truly interested in veterinary medicine. To thank her for all the many little things she did to help us, she was given a stethoscope. We hope we can steer her towards our profession as she would be a terrific asset.
Goodbyes amongst this amazing group of altruistic volunteers were difficult. Six stayed on to dedicate another week to the Equitarian work led by Dr. Neil Gray on the other side of the Golfo. Paul and Steve, both with chronic back issues, chose to fly back to San Jose. The rest of us headed back on the bus.
Ironically, as we headed out, we saw the squamous cell carcinoma horse grazing in his pasture.
Epilogue
By Dr. Julie Wilson
No tale of the Workshop would be complete without acknowledgement of the terrific students and young veterinarians that were integral to the team effort. What a mature, talented and hardworking group they were! The “less recently graduated” veterinarians loved watching their skills grow as the Workshop progressed. Two of our American students, Brianna Bradford (Tuskegee) and Natalie Lord (Ross University), were thankfully Spanish speakers and great workers. Both were able to participate through scholarships provided by the American Association of Equine Practitioners Foundation.
Australian Dr. Alisa Alden, who had graduated just two weeks prior to the Workshop, was supported by this Foundation as well, and also brought her great Aussie sense of humor. Dr. Katarina Purich came with the support of the Delta Society composed of equine veterinarians in western Canada. Funds for Dr. Dennis Benavidez’s travel costs were donated by instructor Dave Turoff. Dan Mordarski joined us from Tufts University, bringing additional insight from his MPH program. Daniela Ramirez and Fabian Jimenez from Costa Rica were tremendous help, playing multiple roles with the horses, translation for the gringos, and help recognizing flora, fauna, and cultural differences.
Our hats are off to Paul Dorris, our expert and often hilarious farrier. Paul joined us at the last minute when we learned that Costa Rica Equine Welfare could provide neither a farrier nor a saddler. Paul kept us all smiling and clearly loves teaching. We hope that his enthusiasm will lead to greater North American farrier partnership in the future.
Unsung heroines of our workshop were Sandra Foster and Deb Whitten, both veterinary technicians. They made our days go so much more smoothly, keeping our central supplies in order, have vaccines at the ready, and never letting us run out of anything. Even though Deb was nursing a sprained ankle, it didn’t slow her down at all. Sandra’s childhood Spanish awakened in this immersion environment, letting her enjoy the interchanges with the horsemen and their families even more. Best of all, they took charge of the final inventory, a very trying task when everyone is tired. Many, many thank you’s to you both.
Although the community days did not reach as many horses as anticipated, or the horses high up in the hills that had even greater needs, the Workshop met its objective of providing an excellent learning opportunity. Many of the participants will choose to continue altruistic work to help provide health care to underserved animals. We look forward to their progress within their careers.