In MY day, we didn’t HAVE personal surgical mentorship in Central America

I remember my first spay out of vet school. It was my third dog spay ever, after two done in junior surgery lab and a couple of rabbit spays during my lab animal rotation. I was alone, my mentor literally and figuratively out to lunch. On the table before me, a ten pound Maltese with pristine white fur and pearlescent skin. The owner had plastered her face to the window leading into the treatment area, craning her neck to try and see into the surgical suite, wide eyes making me no less nervous about the incision I was about to make.

It went fine, but it was slow and the incision was large, two common occurrences with newly minted vets. The owner, apparently expecting a 1 cm horizontal bikini line incision, was furious and complained loudly to my mentor about turning her dog into a Frankenpup. His response was, “Yes, she’s new, that’s why it looks so terrible. You should have had me do it.”

My point here is this: learning surgery is scary, and it helps a whole awful lot to have a supportive mentor to walk you through the early stages. I would have killed for that. Instead, I spent the first year out terrified of surgery and never living up to the unrealistic expectations of someone who, instead of helping me get better, simply persisted in pointing out that I wasn’t as good as he was.

I’m not alone in having this experience. Many new vets graduate with just a couple of surgeries under their belt, and depending on who they wind up working for, they either learn through guidance, or learn through trial and error. Both roads usually lead to the same place, but guess which one is more stressful.

Granada, Nicaragua is a city of surprises. When you look up and down the street, you are flanked on both sides by solid walls that cover the entire block, with only changes in paint color to demarcate one residence from the next. You just never know what is going to be behind each door. Behind one, a farmacia selling Kleenex, albendazole, and Levitra. Behind another, a ramshackle cement abode. Next door, an immaculate Spanish casita surrounding a lush green courtyard.

On one quiet street corner, a group of men and women from North America sit in one such courtyard, fanning themselves in the equatorial humidity, and wait for instructions from Dr. Sarah Seitz. Dr. Seitz is a calm and capable veterinarian, one of three World Vets interns charged with teaching sixteen veterinary, pre-vet, and veterinary tech students all she can over an 11 day period, which has been repeated now nine times over. This is the last group of students for the summer, and despite her exhaustion, Dr. Seitz doesn’t miss a beat getting the team on task.

Dr. Sarah Seitz from World Vets preps the International Veterinary Medicine program students on their work for the day in Granada.

Shepherding sixteen people, many of whom are young, some of whom have never left their home country, through an intensive project in a foreign country is no small feat, but Dr. Seitz, along with vet students and World Vet interns Val Akin and Shawn Flottmeyer, run the show like a well oiled machine. It’s telling that they make it look so effortless, as if such a complicated project with so many variables that must fall into place just, you know, kind of works itself out. Did I mention this is the inaugural summer for the International Veterinary Medical Program? You’d never have known.

Some of you might think this looks creepy, but those who have been in their school's path lab at midnight would find this positively cheerful.

Earlier in the session, students practiced important skills such as intubation, catheter placement, and suture technique using sophisticated models. Yes, the mood lighting makes it look a bit creepy, but trust me, it’s less creepy than practicing on cadavers like the rest of us old schoolers. After perfecting these skills, they headed off into Granada for multiple tasks:

  • Patient medical consultations at Casa Lupita, which provides veterinary medical services for the community;
  • Field work on horses and neighborhood domestic pets;
  • One on one spay and neuter training at the World Vets Latin American Veterinary Training Center, the first of its kind in the region.

More on that later, but for now, let’s return to my discussion of what a tense time I had as a new vet getting comfortable with surgery.

During the training session, the students are split into two groups. While one group is out in the field, the second group is at the surgical training center, an unassuming, cheery yellow building in the middle of a quiet residential area.

Overseeing the operations at the center were Dr. Don Hanna and his wife Lisa, who came down to Granada with their two Goldens for the summer in order to walk the instructors and the students through everything from tracheostomies to fracture repairs, enucleations, and feeding tubes. They were joined by Nicaraguan staff veterinarians Dr. Jasson Figueroa, Dr. Jose Antonio Gomez Campos, and Claudio Mayorga. This community has never had consistent access to veterinary surgeons. There was a lot of work to be done.

Dr. Hanna reviews suture technique with World Vets intern and student Val Aiken at the Latin American Veterinary Training Center in Granda, Nicaragua

Along with the sixteen students, each session also saw the arrival of four experienced veterinarians, who volunteered their time to come down and teach the veterinary students one on one in the art and science of surgery (pre-vet and tech students learned other tasks appropriate for their experience). The students rotated through instructors, learning different tips and techniques under the patient tutelage of someone who, you know, wanted to help. The instructors were calm, zen-like, founts of practical spay advice nuggets and Millers knot demonstrations.

Tech, student, teacher. Repeat times four.

By the day I arrived to observe, the students were on their last day of surgery. Day one was, I imagine, a little nerve wracking, a little shaky. By now, though, the students were zipping through about six surgeries each, the mentors hanging back and offering help only when needed. Students who, two weeks prior, had never held a scalpel or thrown a knot were confidently tying off ovarian pedicles and swiftly suturing up incisions like pros.

“Oh, did ya drop a pedicle?” I heard someone drawl from the far side of the room. Dropping a pedicle, for those not in the know, is probably the most terrifying thing that can happen to you when you are learning how to spay a dog. Dr. Brian Arneson, who I can only describe as a cross between Obi Wan and the Fonz, nodded sagely to the petrified student in front of him. “That’s good,” he said. “It happened here with me, and we’re going to fix it, and now you’ll know how to handle it.” And she did.

These students are going into their second year of veterinary school with more surgical experience than I had a month and a half after graduation.

I think they know how lucky they are to have this learning experience; at least, I hope they do. And it never would have happened without every single person on that World Vets team in Granada busting their rear day in, day out over three months to make it happen. Dr. Seitz’s phone never stopped ringing- everything from payroll questions to staffing to student concerns to airport pickups to after hours emergency calls all funneled to her. She answered every single call.

I talked to most of the veterinary students, many of whom showed up not knowing what to expect. The World Vets leadership, taking the conservative approach during this inaugural summer and not wanting to overpromise the experience, had been deliberately demure about what students might get to do. Much like the city itself, what lay behind Door Number One was a pleasant shock: no, you’re not watching surgery or helping out on a few neuters. You are going to leave here a surgeon. They were, to a one, blown away by what they learned here in the little pink room at the foot of a volcano.

And here’s the coolest part: The students who left now have an amazing skill set to take back to school. The people of Granada were able to provide much needed care for their animals. And, now that the summer has ended, the center will transition to a training facility for Nicaraguan veterinarians, whose veterinary school lacks a surgical training facility. So in addition to helping the foreign students who came for the summer, this facility will train resident vets in a much needed and marketable skill to benefit their career as well as their surrounding communities in perpetuity. This doesn’t compete with the local community veterinarians, it helps them. Everyone wins.

Unsurprisingly, this kitty went home with one of the program students.

This is everything an international veterinary program should be.

I sure do love what World Vets is doing (and by extension, the Fondation Brigitte Bardot, who has been tireless in their support of this and many World Vets projects). But you already knew that.

I know I have a few vet readers out there- how much surgical experience did you graduate with? And how helpful would this have been?

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  • Cathey

    Tremendous story about a real gift – the question is, who is really getting the gift!? It’s sad that vet students need to leave the country to get this kind of guidance, but how wonderful for the World Vets that they can do so much good for the local vets and pet population.
    World Vets has moved up ANOTHER notch on my discretionary giving list!! Thanks so much for sharing, Dr. V!!!

    • Yes, they are pretty incredible. The biggest gift has been to me, at least IMO- because I get to witness it firsthand. 😀

  • Tamara

    What a fantastic example World Vets is making, and the instructors really sound committed to teaching. Amazing, amazing, amazing…

    • It was so nice to see colleagues genuinely interested in mentoring the future crop of vets. 🙂

  • I went on two RAVS (rural area veterinary services) trips when I was a student. I entered my surgical didactic lab with more experience than most of my classmates. RAVS taught me two very important skills: How to perform surgery, and how to deal with the loss of a patient. One of the dogs I spayed died later in the evening after her surgery. While I don’t think we know whose knot it was that wasn’t tight enough or slipped (I did half of the surgery guiding a less experienced student), I still felt entirely responsible because I was the more senior student. Having something like that happen to me before I was out on my own was very helpful and has made me an even more vigilant surgeon. I can now do all but the largest and fattest of dogs in about 20 minutes or so. Programs like this are so good for students to learn those incredibly important fundamental surgery skills. They are a great help to needy communities as well.

    • I remember you talking about what a valuable experience RAVS was for you. 20 minutes- you’re good!