Sunday, June 23, 2013

(Un)attainable Goals

Without a doubt I can say that this trip changed me, as traveling always seems to do. The neat part about this experience is that, because I get credit for class, I was required to have a list of goals prior to my travels. This was done in order to see what I truly gained from the opportunity compared to my expectations. These were my goals:

Veterinary Goals
o   I am looking forward to all of the veterinary experience I will gain on my trip, especially that which puts me out of my comfort zone.
o   I hope to observe how veterinarians in Brazil practice medicine in similar situations as those I have observed here and how their protocols differ from ours.
o   I hope to increase my knowledge in clinical areas while working and observing in the hospital there.
o   I would like to see how medicine is practiced in rural areas and what supplies they have at their disposal.
o   I am looking forward to seeing how the cultural differences of Brazil effect how veterinary medicine is practiced there.
o   I hope to get more hand on experience with animals that I have not yet encountered while working at the wildlife facilities.
o   I also hope to get more hand on experience while at the university in both clinical and surgical settings.
o   I look forward to seeing how language barriers affect learning veterinary medicine in a foreign environment.

Cultural Goals
o   I hope to learn some Portuguese. I feel that nothing shows respect or appreciation for another culture more than trying to understand and speak some of the language.
o   I hope to form long-lasting relationships with my host family, students and the veterinarians I meet and work with along this journey.
o   I hope to truly experience the culture, but taking advantage of every opportunity that is presented to me!

Looking back at these goals, I realize how blessed I really was on this trip. I gained an incredible amount of veterinary experience. I was able to view the differences in how clinicians and surgeons practice in another country and was proud that I could make my own valid opinions on these techniques. It is wonderful to realize how much I did know prior to the internships, even as a first year.  It was interesting to me to see how they seemed to understand the importance of every move they made while working, which I found a valuable observation. Veterinary medicine is constantly changing and growing in the United States but this experience showed me that every country has something to teach us and global understanding is truly important and relevant to our career.
While I believe that the trip was focused with personal veterinary goals, I am grateful that I was able to grow in the knowledge of a new culture as well. I definitely saw how language barriers affect learning veterinary medicine in a foreign country. I feel that this will help me relate more to those visiting Purdue from other universities around the world. I hope that I will be as helpful and encouraging as those were to me in Brazil. That being said, I am beyond thankful for the relationships I gained and friendships I made during the four weeks. I hope to return one day, but with a greater Portuguese vocabulary!

Saturday, June 15, 2013

Goodbye For Now

The last two days of Curitiba came and went in a blink of an eye. Thursday morning we woke up and arrived early morning to head back to the farm with Dr. Ferrari. He took us to the dairy cattle and presented us with a row of about 20 plus cows. This is when the questioning began and he quizzed us on the signs of pregnancy and different stages. It turned out we remembered quite a bit from Dr. Hill and Husbandry because Dr. Ferrari was impressed when we identified the cow about to give birth. We spent the morning practicing rectal palpations on all of them while he taught us the different stages in pregnancy and what we should be feeling. Some were incredibly difficult and in others, you could "see" so much! For someone like me who has no experience in large animal medicine, it was amazing how much I learned and, even more, enjoyed. As a special treat, he let us perform a vaginal palpation on the cow that was less than 10 hours from birthing. This was one of the most incredible experiences of my trip. I couldn't believe how much I could feel, the calf's legs were right there! I am so thankful for him and his incite into such an unknown field for me. It was a wonderful morning and was sad when it ended.
(I am performing a vaginal palpation on the left. To the right we are with Dr. Ferrari.)

That afternoon I hung out in radiography. This is not my favorite area but the residents and technicians were grateful to have time with us. We talked a lot and learned a lot, including how to place/hold an owl to get an image of a broken wing. Leaving that afternoon was bittersweet knowing that the following day we would use our time to explore Curitiba rather than enjoy the company of those at the hospital.

(The Imaging and Exotic Residents placing an owl for radiographs)

It turned out to be the perfect ending to our trip though. We explored the Opera House, several parks and finally went to a local Churrasco restaurant for my fellow classmates. I'm going to be honest, as a vegetarian, an "all you can eat" Brazilian BBQ joint is not my idea of a good time. However, everyone else seemed to love every second of it. It was an experience but one that helped ease me into the inevitable departure the next day. Clearly, I was ready to return stateside; well after our last stop...Rio de Janiero, get ready!

 (Left: Sara and Rica loving life and Brazilian BBQ. Right: Last night with my wonderful host, Carol.)

Wednesday, June 12, 2013

Back to Work

We returned from our weekend fully satisfied with our travels. We eased into Monday and enjoyed the morning off from work. We took off to the Botanical Gardens for a couple of hours. Brazil, for being such a poor country with rundown buildings and homes, has the most beautiful gardens scattered throughout the cities. We took it all in, along with several photos and then headed to lunch before returning to the University. I spent my afternoon in cardiology and was shocked to find out how much I loved it. I remember leaving the cardio section of physio last semester with more questions than answers, but the cardiologist in Brazil helped answer many of those. When a sweet German Shepherd showed up, I was able to hear my first Atrial Fibrilliation and will never forget it. The brazilians like to joke that it sounds like "an American playing Samba" but I prefer the "shoe in a dryer" description for personal reasons! She talked us through EKGs and Echocardiograms. We saw a pleural effusion and learned about a rare case called Chagas Disease. It is caused by Trypanosoma cruzi and results in sudden death in many cases, mostly because it is poorly diagnosed. I was even able to help edit her post in English on VIN so she could get more information on the case herself! I think this was the day I appreciated most so far in Brazil. I can only imagine how frustrating it could be to have two American first year veterinary students following you, but she went above and beyond the role which meant more than she will ever know.

(Here I am learning how to properly ID during an ECHO)

Tuesday was a whole new adventure, per usual. We began in my favorite department: surgery. A canine came in with a bullet lodged in it's metatarsals. The resident was to take lead on the procedure but it ended up being messier than originally thought so the ortho surgeon came and saved the day. Something that took all of us off guard was the fact the this patient was covered in fleas. They continued after discovering this news as if it was no big deal. Certainly, that would never be the case in a sterile surgical suite in the States. Again, one of the many differences in practicing within a different country.
That afternoon we went to the University Farm with the exotics department. We saw more avian species than I could believe. Every building had a different type and the buildings never ended! We were taught proper bird handling again but with several parrots and species that I had not worked with prior. The exotic residents taught us how to quickly examine all of them and properly, making sure to check wings, beaks, and of course complete physical exams. It was a long afternoon but time flies by quickly when working with beautiful animals of vibrant colors!
(This was my favorite bird, a hybrid Macaw. 
Seriously beautiful but sadly not easy to handle at all and thus, slightly dangerous) 

The following morning we spent with an Agriculture class. The professor was the large animal veterinarian that we had met before at the gym. He was lecturing on ultrasonography and pregnancy in goats. We met a man who began a project called "urban goats" in order to help third world countries. The thought is that if he can create an urban environment in which goats can thrive without being dangerous (ie the males) and yet still get pregnant, then a society can benefit from their milk and other dairy products. They eat anything so it would be ideal and low upkeep, the problem is keeping the male away from the females until they are in heat and then bringing them together in the hopes of natural fertilization. I loved the conversation and learned so much from both of these men. I hope to hear about the project and it's success in the future.
(When performing a rectal ultrasound, the individual can "see" the image in the goggles and freeze the frame to show others.) 

That afternoon I returned to cardio but with a different partner, Rica. Since I had been there before she had me try and teach the different parts of an Echo instead. I needed some help, but was proud of how much I had retained. All in all a wonderful end to another wonderful day. Beginning to dread the arrival Friday when it all comes to an end.

Monday, June 10, 2013

Weekend getaway

Friday went by quickly. We spent the morning working on the same dear from the day before. However, this time in surgery! We joined the surgeon and the wildlife veterinarian for their consultation on how to proceed. It was determined that he will attempt to repair the fractures but amputation may be necessary. Deers are very high stress animals so regardless of the procedure, the outcome may be poor. It turned out that the leg had become slightly necrotic overnight with the bandaging so that made the decision quite simple...amputation. He quizzed us on muscles and explained pros and cons to prosthetics, etc. Clearly, this animals won't be able to return to the wild and survive so a zoo is the best bet for recovery. Bruno (anesthesia resident) said he was going to sleep with the deer while it recovered all weekend. SPOILER ALERT: regardless of all the preventive measures and amazing post of care provided, the deer passed away on Monday. Sadly, that is the reality of veterinary medicine, and especially wildlife veterinary medicine. 

That afternoon we joined in on a mastectomy. Not going to lie, it was a bit of a shocker. They hacked away the skin and removed everything in a very dramatic way. The whole time I just kept thinking that Dr. P (the vet I learned from before school) would be cringing at the sight. What was most interesting was that it was a teaching surgery so 4 students were scrubbed in at once, all practicing suturing techniques. I was very confused as they used curved hemostats as opposed to needleholders when they were available for use on the table next to them? Even more confusing was how much difficulty they were having...clearly, very different techniques than I am used to in the States and Purdue especially. Again, the lesson of this trip is that every place and person has their own preferences, there is no right way or wrong way to do something (well, I suppose there is a wrong way...but rather multiple right ways). 
Driving the surgery a couple of the male residents gained some courage and started talking to me. I have never been so thankful to be wearing a surgery mask. I was literally in a room where everyone was talking about me and I knew it but didn't know what was being said exactly. Until one of them asked "some of the guys here want to know if you have a boyfriend." Umm...really? I said no and they all started laughing shocked apparently that I actully answered the question! Of course, this made me even more self-conscious. Once the laughing stopped, they asked us to a bar that night. Surprisingly, it was the bar we were alrewdy going to with Carol, so we said we would see them there. Best part of the story, that night at the bar, not one of the guys came up to talk to me! Must have scared them off, typical.
 (Carol and I at the bar Friday night)

That weekend we took a "vacation" while already on vacation. Simone offered us their family's beach house in Itapema. So we went to Florianopolis for the day and then stayed in Itapema that night and the next day. Florianopolis (or Floripa as the locals call it) is an island about 5 hours south of Curitba. it is touristy but beautiful. We spent the morning on the beach, afternoon shopping and all day sampling local "beverages". I even finally got to have true Brazilian Açaí on the beach, even better than my favorite kind in San Diego. It was a perfect day.
 (Açaí and surf shop on Floripa beach)

 Sunday we stayed in Itapema, a small beach town in between Floripa and Curitba. This was my favorite place, it reminded me of Waikiki Beach in Hawaii but without a single person present. No joke, there were 20 people on the entire mile plus strip of beach. The day was gorgeous and just what we needed. The restaraunts on the "boardwalk" had waiters deliver buckets of beer to you on the sand and I ended my day enjoying the most amazing frozen yogurt of my life, açaí and passionfruit twist. Everyone needs to taste this at some point. Hopefully you are more graceful than yours truly because half of it ended up on clothes; my white shorts have seen better days. All in all, a great vaca from "work" but we were excited to see what Monday had in store for us at the university so we made the trip back willingly. 
(Itapema beach, surrounded by gorgeous lush strips of jungle)

Note. I hate bus rides. Someone really needs to invent teleporting. 

Thursday, June 6, 2013

Don't worry, I'm a doctor!

Meet Carol. Things were getting a tad crowded at Simone's so Rica and I got shipped off to a new home. Carol is working on her PhD in Optho and is quite the person. Her apartment is tiny but her 2 cats make us feel at home right away. When we arrived, she immediately started rattling off her plans for us; there were a lot of plans. We stayed up late talking and getting to know each other and then woke up exhausted , but ready for our first day at the veterinary hospital.

The university is quite different than ours as made obvious by our tour first thing Wednesday morning. After that we split up into 2 groups; I was sent to work in Optho for the morning. It would have been incredibly awkward if it had not been for Daniel, a 3rd year with wonderful English. He explained everything that was going on and made sure the resident let us examine the patients as well. I think it was weird at first for the clients when they heard English in the background but once it was explained who we were they were just as interested in us as they were in discovering the problem with their dog! One thing that is worth mentioning is how neat their TonoPen was compared to what I am used to in the States. It is very high tech and exciting to use. (FYI -TonoPen measures ocular pressure). We saw many cases, including entropions, ulcers, etc but the most interesting was a case of non-perforated ulcer which required microsurgery the following day. The globe of the eye looked entirely misshaped, something I had not seen before but was happy to observe! 
 (Helping with an Optho case)

That afternoon was my favorite; surgery. We spent the entire afternoon observing orthopedic surgeries, a love of mine. I am pretty sure if I wasn't wearing a surgery mask you would have been able to see me drooling. Weird, perhaps? But I truly love ortho. The veterinarian was very kind and made sure to explain everything he was doing and encouraged questions along the way. The first procedure was IVDD of L1-L2. He did a did a dorsal approach, which I was not used to seeing. The doctor I worked with before veterinary school always went in laterally and always fenestrated/excavated the adjacent discs as well. This surgeon does not agree with that plan of action and only removes the nucleus of the injured disc. One thing I have learned here is that there are pros and cons to everything and that there are numerous methods in order to gain the same outcome. I love hearing different perspectives and can't wait until the day where I have one of my own. The second procedure was a a fractured scapula from a head on collision between two dogs. In order to cause that damage, the other dog must have been on quite a mission. Needless to say, the fracture was impressive. The supraglenoid tubercle had fractured off, so he repaired it with a single screw and then a second fracture off of the process was repaired with K wire. It was quick, no more than an hour. But very interesting to observe. I am used to typical procedures; CCL, spine, OCD, etc thus it was very excited to see a rare fracture. 
 (Post op X-rays of the scapula)

That evening was a rare blessing. We joined the local gym where carol works out. Thanks her brilliant communication, we were able to pay only $25 for 2 weeks of membership; including spin classes! We did the spin class and then worked out, it was much needed after the amount of desserts we have consumed since our arrival!

Thursday was a whole new day. In the morning I was assigned to work with exotics. One benefit to going to veterinary school in Brazil vs the US, the female to male ratio. It was us and 4 attractive males all day, something common here at the university! Two spoke English and the other tried and failed, but tried nonetheless! We spent the morning working on a chinchilla (severely dehydrated and in shock) and a deer. The deer had been hit by a car and fractured its rear right limb. The tibia was sticking out completely and the metatarsals were shattered, giving the limb a flimsy appearance. We gave heavy sedatives, analgesics, fluids, radiographs and bandaged the limb. We learned how to place IO catheters and what they should feel like and the different drugs they use and why. We also awkwardly found out that the hospital has been talking about us because Bruno (the anesthesia resident) kept mentioning information about us that we had not told him yet. Then the others would just start laughing and talk in Portuguese. It is very odd being the subject of a topic and not understanding exactly what is being said. 
 (Ouch, quite the injury)

That afternoon we had the opportunity to be in a horse necropsy. It was one of the most fascinating things I have watched. The head cut off and sitting in the corner, blood covering the ground and then taking an ax to the skull to examine the brain. Veterinary medicine is not something for the weak stomached. Rica said how interesting it is that we were "bred" for this. It never made us gag or queasy, only interested. 

That night we headed to the gym again and then went to a pub to listen twosome live music. It is funny because at the university we look Brazilian. Many professors and residents say that with our white coats and tans, they cannot tell we are American (obviously until we open up our mouths and the its a dead giveaway). White coats give you a sense a confidence, I feel like I could run around the hospital and just say "Don't worry I'm a doctor!"  But apparently when we are out, it is completely obvious that we are not from here (and more specifically from USA) because of our clothes. Let's just say that my style is slightly different. Red pants and jean vests aren't exactly trending here. But I am rocking them nonetheless of course. I love my style and I have learned that even in Indiana at Purdue my clothes are given second glances. However, in Brazil I even feel out of place and plus, once they hear me speak, that feeling is exaggerated times one hundred! 
 (So professional)

Regardless, I love it here and every day comes with a new story and more knowledge. 

Tuesday, June 4, 2013

New City, New Adventures

Goodbye to the beautiful Iguassu Falls. Hello to the very different Curitiba.
We arrived in Curitiba Saturday night, picked up by our host family. Dr. Simone and her husband were very generous. They cooked us an amazing meal and truly made us feel at home. We spent Saturday at a farmers market (well kind of a farmers market). There were tons and tons of booths all selling very random items, sadly nothing caught my eye except for the food...of course. They had stands selling a variety of Brazilian foods and they all spelt enticing! I bought a cheese empanada and a chocolate/banana empanada for dessert. Amazing.

The next morning was our first day of work. We went to the Paseo Público (a miniature Central Park) and met Biondo. Biondo is how we were able to get to come to Brazil in the first place. He has a relationship with two of the veterinarians at Purdue and helped us arrange everything (well sort of). He speaks wonderful English and is a delight to be around. He sent us to the the zoo for the day and there we met Manuel. Oh man was this guy a sight. He is the veterinarian at the Curitiba Zoo; let me paint you a picture. His lab coat (that every vet where's here) was camouflage not white, it went all the way down to his knees. He had a long grey pony tail half way down his back and a pair of cracked eye glasses. I was so excited to spend the day with him. Similar to everyone we meet, he was timid with his English at first and passed us off to a Biologist who specializes in avian repopulation. He told us all about the successful breeding program they had there and showed us all the endangered species (not on display for the rest of the park). I should mention that on Mondays the zoo is closed to visitors; staff only. We had the place to ourselves and it was fantastic. Eventually, Manuel picked up some courage and spoke more English to us, which is way better than he thinks. He gave us a private tour during feeding time, so all of the animals came out and put a show on for us! My favorite were the hippos. There is a baby hippo, 3 months old that they only Just brought into the public enclosure the day before, we got to feed the mighty beasts, which turns out the best way to examine their teeth! 
(Hungry hungry hippo; holding food to examine teeth)

After lunch, we went into the veterinary hospital portion of the zoo and he explained his work. It turns out that he does not have legal access to any sedate/anesthetic for wild animals, like we use in Africa (M99 for example), so he never truly examines the biggest species, hippo, giraffe, etc. That was a shocker for me to hear. In the US we preach that a full exam involves actually getting your hands on the animal. I can't see how that is possible without drugs at least once a year? Every place is different, that is what traveling teaches me daily. We were able to watch while Manuel and the keepers captured a very large Caiman alligator for transport. It was quite a show and we learned interesting handling techniques, including pushing the eyes to stimulate the vagus nerve which relaxes and calms them down. The rest of the day was low key, we learned about the program for school children that the zoo puts on in order to educate the youth. I loved this. They taught about the environment, science, animals, etc. It reminded me of when I was young and spent a night at the zoo; every kid should get the opportunity! 
 (Playing cowboy with a Caiman)

Tuesday was an eye opener. Again, no one knew what to do with us. We had planned to split up but ended up remaining in our wolf pack of five. We spent the day with the equivalent of the SPCA, animal cruelty response team. Like I said it was an eye opening day. You have heard of hoarders I am sure, and even animal hoarders, but it is a whole new world seeing it first hand. This organization is only 3 years old and doesn't have anywhere to put the dogs so sadly they can't confiscate the animals. They visit the owners every month and make sure the animals are being fed and also give the owners some psych therapy. We went and visited a lady in the favela (slums) with 70 dogs. She said that she doesn't go pick up dogs anymore but people drop them off at her house. She had dog feces on her and could barely get out of her house without allowing any of them to escape. The second house was emotionally devastating. It was in the nicest area I have seen since being in Brazil. The lady used to be rich with a beautiful home, but then her mother died and everything went downhill. The current number is 160 dogs. They have completely destroyed her house. They took over the front years, back yard, home, car, piano, everything you can imagine, there are feces everywhere and just as many dogs. The saddest part is that she is running out of money and food so the dogs are very thin. The experience made me appreciate what organizations like animal control and SPCA do but I know it is not my calling. 
 (This used to be a nice car. Now all the windows were shattered, no cloth on the sets, everything was eaten. There are 130 more dogs in the house and back yard because she tries to keep them out of the front yard...Very heartbreaking sight)

The end of the day we went to visit a community dog. Brazil has a problem with stray dogs however every time they try to adopt them out, the dogs run and return to the bus stations where they were before. So this program for Community Dogs was established. Each of these dogs are castrated/spayed, vaccinated, fed and cared for by an individual. However, they live and stay at the station. It is actually beneficial because they are people friendly but territorial so that they keep other dogs away from these crowded public areas. It was a very interesting concept but after visiting, you can see how we'll cared for these dogs are, in better condition than many living in a home with their owners. It was a great couple of days, very different than Foz but wonderful nonetheless. The next days will be at the hospital and university, hoping they are just as exciting!

Sunday, June 2, 2013

Iguaçu Falls: My Playground

Have you ever had one of those days where it goes from terrible to perfect in a snap of the fingers? Well that is the best way to describe Friday. We were very excited because Zalmir set up a day for us at the Brazilian National Park (where the falls are) but with the veterinarian/wildlife biologist, Apollonio, who specializes in jaguars but works on all the wild animals in the park when necessary. So we woke up, bright-eyed and bushy-tailed and set out for the park. When we got there we asked for Apollonio, everyone was very confused because we are a group of young Americans who don't understand anything anyone says and they don't understand us either. Eventually after about 45 minutes of waiting in a freezing room, where I felt like I was trapped in a holding room at an airport for suspicious behavior, finally someone from Apollonio's office came to get us. She said he didn't know we were coming and that he couldn't meet with us. Oh great. It turns out, she felt really bad for us. We might as well have "pathetic foreigners" stamped on our foreheads. 

Apparently that stamp isn't so awful to have associated with yourself. This was the day that Iguaću Falls became my playground. We were allowed to do whatever we wanted, for free. Well actually, at first she asked if we would like to hike and bike, but the day before I had seen a sign for zip-lining and repelling and I was too interested to resist. So I smiled and asked if we could possibly do that too? She said she would see what she could do and let us know. 

The morning began with a 2 hour "mountain" (or "jungle") biking to get to the Paraná River (the river of the falls). Once we got there we went on a safari boat ride and saw alligators, turtles and tropical birds of all kinds. The boat took us to an area with kayaks and we got to kayak up and down the river, it was quite a work out on such a strong river. Rica used to do outrigger canoeing and I think she was ready to kill me because I was clearly a failure at the whole steering concept. After that, we went to the canyons overlooking the falls. 
 (The kayaks on the giant river)

Here is where the outdoors course existed and we received a free pass. Ropes course in the jungle canopy, zip line, cat jump, rock climbing, repelling and rafting. We started with the ropes course and it was terrifying and incredible at the same time. Walking along rolling logs at 11 meters above ground only attached to a harness definitely gets your blood pumping. After you survived the endless obstacles, you made it back to the start on a zip line; one of my favorite things. However, I found a new favorite thing; the cat jump. This was insane. You climb up a pole, 40ft high, and somehow stand at the top of it on a 2 foot stand. Then you leap. You have to leap 7 feet to a hanging/swinging bar and grab on tight. Did I mention the platform only gave you room to bend your knees, no steps allowed. Rica went first, it took her a while once she got up top but finally mustered up courage and leapt. She missed. But she was so close! I was next and thought, the quicker the better; less time to think. And somehow, I actually grabbed it and held on! I have never been so proud of myself! It was so fun and every one else eventually got it too (2 attempts were allowed). The day ended with some rock climbing and repelling. We opted out of the rafting due to time constraints, but it was still a perfect day.
 (One of the several "free" passes were blessed to have received. By the way, that structure to the right is where you repelled off.)
 (Goodbye falls)

We walked, hiked, swam, rowed, climbed and worked about every muscle on our bodies. We returned to the hostel on a high. Such a great goodbye to one of the best 2 weeks of my life. I will miss the friends I made and replay the memories over and over. Time for the next chapter, Curitiba where work starts on Monday at the Veterinary University. They have heavy boots to fill, but I'm excited to see them try!