November 2, 2009: 5 am
The alarm clock rings before sunrise. I dress
quickly in our dimly lit, unheated room where
it is just bright enough to see my own breath hanging in
the frigid air. There’s little time for restful sleep between
the noise of late night musical festivities, dogs fighting in
the streets, and the crowing of roosters at dawn. Mornings
are uncomfortably rushed. The building we are using
for surgery today is a half-hour hike away, and we need
to get an early start to make the most of the few hours
of midday warmth and sunshine, so breakfast is a brief
10-minute pit stop at the local tienda for hot coffee and
pan frances (white breadrolls).

The veterinary team I joined here two days ago has
almost completed the vaccine and neuter clinics for this
visit and has just started spaying the females. My jaw
drops as I enter our makeshift surgery room—it looks like
something out of a war movie: tin-covered walls, a dusty
floor, poor lighting, and no central heat. Benita, a local villager
who has been hired to translate for us, takes patient
histories and helps the villagers sign consent forms.

My first patient of the day is Chaquira, a small, slightly
foxy-looking mixed breed. “You are a lucky little perra
(dog),” I tell her, feeling a healthy layer of muscle and fat
over her ribcage. Without veterinary care or regular meals,
most of the dogs in this mountain village are thin, flearidden,
and carry a host of greedy, calorie-robbing internal
parasites. Chaquira looks remarkably well cared-for—her
body weight is normal, her coat is shiny, and her eyes
sparkle. I am secretly relieved at her apparent good health;
the work environment looks like enough of a challenge
for today.

Surgery in a rustic, high-altitude setting is an exercise in
creativity, to say the least. In place of multi-beam surgical
lighting, we have simple headlamps; instead of fully adjustable
surgical tables, we have wooden desks propped up
with bricks, and with no fluid pumps on site, we hang the
bags by rope or nail, and our diligent
technicians count drip rates manually.
A little pressure cooker serves as our
autoclave for sterilizing instruments,
and a butane camping stove boils
water for scrubbing, filling hot water
bottles, and warming IV fluids. I take
a long look around while scrubbing in
and realize what a feat it is to be running
a very basic yet functional operating
room in such a remote area. I dry
my hands and glove up; Chaquira is
on the table and ready for surgery.

Not long into her spay, I am disturbed by the amount of
bleeding. Small vessels that should be clotting quickly on
their own aren’t, and I’m spending precious time clamping
them all off. Dr. Kuzminsky, who led the first team
here in January, explains that the oozing I am seeing is not
unusual and there is suspicion that either blood parasites
or chronic malnutrition are causing mild clotting problems.
I sigh at this unwelcome news—surgery and anesthesia
reduce body temperature quickly, so with no central heating
and only hot water bottles to keep our patients warm,
we need to work quickly to prevent hypothermia. I carry
on, juggling the need to control bleeding while minimizing
surgical time.

I find myself unusually deep in concentration performing
a procedure that is normally effortless.
I notice the strange silence between me
and my technician, a blunt reminder
that monitoring a patient in these conditions
leaves no room for the leisurely
chit-chat that routine surgery typically
allows. At home, the dogs are kept
under general anesthesia by gas, and
their vital signs are tracked with sophisticated
monitoring equipment, much
like in a human hospital. Alarms ring
if breathing or heart rates go beyond
the normal range—a terrific safety
measure to back up skilled observation and direct patient
monitoring—and gas levels can be adjusted quickly and
easily as needed. Anne-Marie, my technician, has none of
these luxuries. She is keeping Chaquira under general anesthesia
with IV drugs instead of inhaled gas, and adjusting
her drug rate based on continuous monitoring. Not a minute
goes by without an evaluation of heart rate, breathing,
muscle tone, and other indicators of how deeply “asleep”
her patient is. Even with meticulous monitoring, Chaquira gets a bit too deep about halfway through the spay, and
Anne-Marie has to assist her breathing for five minutes
and administer a special drug to increase her heart rate.
Nonetheless, I am able to carry on with the surgery virtually
uninterrupted; Veterinarians without Borders (VWB) only
takes on technicians who are highly skilled and very experienced,
and I have full confidence in Anne-Marie.

In just over an hour, the spay is done and we move
Chaquira to the recovery area where she is bundled in
blankets and hot water bottles in front of the propane space
heater. I sit with her as the anesthetic drugs slowly wear off,
my back sore from hunching and my stomach grumbling for
lunch. Before the sense of deprivation gets the better of me,
I stroke Chaquira gently,
and appease myself with a
reminder of why I am here
on this difficult but compelling
project.

In 2007, when VWB
was first contacted, the dog
population in this remote
Mayan village was out
of control. Pet dogs, kept
mostly for protection from intruders, other dogs, and wildlife,
were breeding with each other and with strays. Dogs
had become the main reservoir of rabies and some of the
strays were aggressive towards people. Tourists were afraid
to walk the streets and the community was living in fear.
Efforts to reduce the stray dog population by mass poisoning
had been unsuccessful. Pet dogs were inadvertently
baited, strays were not reliably targeted, and poisoned dogs
died a slow and excruciating death. The people of Todos
Santos wanted a humane and sustainable solution, and
VWB was eager to help them build a culturally suitable program
to reduce the risk of rabies and keep their dog population
in check. The first phase of the project focused on rabies vaccination,
neutering, and establishing whether females could be safely spayed in such
challenging conditions. Surgery proved to be rigorous, but feasible, so a key
goal of this second phase was to sterilize as many female dogs as possible.
Lunch arrives, and we alternate between filling our bellies with rice,
beans, and soothingly warm tortillas, and keeping a close eye on our
patients in the recovery area.
We are 8,000 feet high in the

We are 8,000 feet high in the mountains, nestled in a steep valley
between two towering mountain ranges. Weather changes dramatically
throughout the day, and by mid-afternoon, when the western mountains
suddenly cast cool shadows upon us, we want our patients settled in at
home by a warm kitchen fire.

At 2 pm, the Mendozas, Chaquira’s family, return and Benita talks to
them about the special care she will need. In this indigenous Mayan culture,
dog ownership does not mean what it does in Canada or the United States.
Pet dogs sleep outdoors, and aren’t fed much more than the occasional tortilla.
They roam the village freely and scavenge most of their food. Without
specific homecare instructions, many of our patients would succumb to
hypothermia and malnutrition, so Benita gently explains how important it is that Chaquira stay indoors overnight on a thick blanket near the
warm kitchen fire, and that she be fed some protein for the first few
days. Most families can afford to provide eggs but, for some, providing
chicken is a struggle—it means less for themselves that week.
Benita is able to acknowledge and empathize with the hardships of
her fellow villagers, and she is able to encourage owners to do the
best they can for their dogs without appearing insensitive or culturally
inappropriate.

Mrs. Mendoza says she can provide Chaquira with eggs and
chicken, as they have done well with their crops this season, and
she thanks us for our help. Tia, her youngest, shyly hands me a
picture she has drawn of all the animals at home. She points out the
dogs: Chaquira, Mecca, and Princessa, and tells me how she especially
loves them.

Just as the Mendozas head off with Chaquira securely in their
arms, three children arrive to pick up another patient, Paloma.
Roberto, Paloma’s surgeon, glances over their heads for a moment,
then turns back to them looking concerned. “Donde estan tus
padres?” he asks. The eldest replies matter-of-factly that their parents
are busy drying the corn. It is a struggle for some of the villagers
to take time off to come to our clinic. The Todosanteros are quite
poor, and work very hard to support themselves. A trickle of tourists,
many seeking the intricately hand-woven garments the village
women are renowned for, brings some money into the community,
but the villagers sustain themselves mostly by growing crops and
maintaining a small number of chickens and pigs for eggs and meat.
Paloma’s family lives a 45-minute hike up the mountains, much too
far for her to walk so soon after surgery, and the children are not
strong enough to carry her all that way themselves.

It is tempting to call a tuk-tuk (threewheeled
taxi), just as it is tempting to send
dogs home with nutritious food and bring in
more sophisticated drugs and equipment that
would make surgery easier and safer, but we
don’t; the short-term heroics would come
at the cost of long-term success. We have
stepped in to help solve a crisis, but with the firm intention of stepping aside as soon
as we are able to leave a culturally suitable
and sustainable solution in our place.
With the dog population now under temporary
control, it will be easier to secure
government help to maintain the program,
but we must be careful to do our work
in a way that the Guatemalan veterinarians
who will eventually replace us can
sustain.

Roberto furrows his brow, adding
“adults at discharge” to the daily debriefing
agenda, then smiles warmly at the
children as he laces his hiking boots and
bundles Paloma in a warm blanket. He
grabs a cell phone in case he has trouble
finding his way back and tells us he’ll see
us at dinner.

Most of the team stays on site for a few
more hours doing discharges, cleaning
instruments, and preparing kits for the
next day, while a couple of us run though
the list of housecalls for patients who are
recovering slowly and need a bit of extra
TLC or medication. Despite the remote
location and the poverty, cell phones are
ubiquitous and allow clients
to get in touch with
us easily if they have any
concerns. We pack a small
drug kit, stethoscope, and
thermometer, and go over
the call list with Andres,
our guide. There are no
addresses in Todos Santos,
so housecalls are typically
long, adventurous hikes
with our trusty tri-lingual
translator (English-Spanish-Mam), who
asks for directions from villagers to locate
our patients and helps us communicate
once we find them.

Walking through the village and visiting
homes provides a fascinating glimpse
into Mayan culture. This community is
one of the few places in Guatemala where
traditional clothing is still worn. Men dress
in striped red pants, dark blue chaps, and
shirts with large, elaborately embroidered
collars, and women wear long, dark skirts
with strikingly vibrant, ornately woven
blouses, often carrying babies swaddled
snuggly in a huipil over their backs.

We turn onto a narrow path between
two fields of mixed crops where tall cornstalks
act as scaffolding for beans, and the foliage of both provide shade for the
thriving squash below them. At the end of
the pathway, we reach the Duarte home,
where I see two women weaving busily
on backstrap looms and enjoy the faint
smell of burned wood coming from the
chuj (sweatbath).

We have come to check on Luna, who
has been lethargic and refusing food since
surgery two days ago. Luna is resting
comfortably in the kitchen. She is a bit
quiet, but her incision looks good and her
gums are moist and pink—I am happy
with her overall appearance. The family
says that she has been turning her nose
up at tortillas and demonstrate her disinterest
with a fresh one off the stove, but
quickly point out that she perked up this
morning with a warm bowl of sopa de
pollo (chicken soup) and is actually doing
much better now.

The rest of our housecalls are equally
uneventful; the occasional dog needs
some additional pain medication or incision
bandaging, but most just need a little
extra food and warmth, something that
villagers are not accustomed
to providing for them.

With rounds done and kits
packed, we have an hour or
so to spare for a cold shower
and laundry before suppertime.
Normally we congregate
at a local restaurant for
supper, but this evening is
a special occasion: we have
been invited to dinner by
the mayor’s office. When we
arrive, I am relieved to see that we have
not come under-dressed. Back home, such
an invitation would surely call for formal
attire, but here, clean, warm clothes were
the right pick—no one raises an eyebrow.
The mayor’s representatives, all wearing
dark half-length chaps atop their trousers
and black leather jackets, clothing worn
only by certain men in the community
who are of distinguished rank, welcome
us as their honoured guests.

“Salud!” one of the officials belts out
soon after we are seated, holding his glass
in the air. We join in his toast: “To the
people and dogs of Todos Santos!” and
are treated to a simple but hearty meal of
tamales, potatoes, frijoles, and, of course,
corn tortillas, while we review where we stand with this daring and vital project.

The community is very pleased with our help so far. Villagers have noticed a big drop
in the number of aggressive dogs roaming the streets since the project began, and there
is hope that, over time, this will help with tourism and economic development, especially
once other aspects of this complex problem are addressed. The mayor is impressed with
the results of our work and has committed to even greater support of the project next
year: a driver and truck for transporting equipment and some patients, storage facilities,
and a suitable central location for clinics.

The positive feedback is tremendously reinforcing and well-timed, given the hard work
still ahead; there are several underlying problems that will need to be addressed for longterm
success.

Poor waste management is sustaining a stray dog population that will not go away until
their food source does. Strays are drawn to the slaughterhouse, the market, and the dump
where they scavenge leftovers. The mayor is ready to work on these problems and would
like us to assist him in developing a responsible pet ownership
program, one of our past recommendations for this
community, so that pet dogs will not need to scavenge for
survival. He and our team leader agree that resolving these
fundamental problems will require involvement beyond
those of us at the table, including cooperation with government,
Guatemalan veterinarians, and nongovernmental
organizations.

This is a tall order—but it looks like help and support is on the way. A University of
Guelph engineering professor who is a member of Engineers Without Borders, has offered
to help troubleshoot the complex waste management issues, and the Guatemalan veterinarian
in charge of rabies control who visited us on site expressed great interest in helping
support the project. In fact, she has already begun networking to stimulate participation
from the Guatemalan veterinary community.

The welfare of both the strays and the owned dogs will need to be taken into consideration
when waste becomes unavailable as a food source, so a fair amount of planning and
coordination between these various organizations and the community will be needed. The
solutions will be complex, yet there is a sense of optimism brewing among us. We are
energized by the air of accomplishment, and tempted to continue socializing late into the evening. But with an early morning ahead
of us, we wish our kind hosts a buenas
noches and hike back up to Las Ruinas,
our rented home, to call it a night.

Despite exhaustion I cannot sleep. My
bed feels empty—I’m used to cuddling
up with my two dogs. I lay awake thinking
of my girls back home, snoozing on
the sofa by the warm fireplace, with full
bellies and no worries in the world. It is
hard for each of us here to accept the vast
cultural differences in pet ownership, to
reconcile how someone can care about a
dog yet leave her to scavenge her meals.
Then I think of Tia’s drawing, of the worried
faces of villagers when they leave
their dogs for surgery, and the affection
they display when reunited, and wonder
if despite our very different ways of caring,
our love for our dogs might, in fact,
be much the same.

It will still be a few years before we
outsiders can step away from Todos
Santos knowing that the local people are
in charge of their own solutions, and the
road to success will probably be much
like the village roads themselves: rugged
and steep. But I know that we will get
there. With continued hard work and
careful planning, the wish for improved
health and wellbeing of this charming
community will surely come true.

VWB is a not-for-profit organization whose mission is “To
work for, and with, communities in need to foster the health
of animals, people, and the environments that sustain us.”
Visit www.vwb-vsf.ca for information on their remarkable
projects and guiding principles.