A contribution to veterinary medicine in Tajikistan

When I had a puppy spayed in Nepal, the doctor showed up at the door with a bag full of supplies.  He cleared off my coffee table, laid out a little green sterile (or almost sterile) cloth and proceeded to sedate the puppy and tie her four legs to the four legs of the coffee table.  With no fanfare, he removed her uterus and ovaries and stitched her back up.  An injection for pain and another for antibiotics and, in a flash, he was gone.  The surgery itself couldn’t have taken more than 30″ if that, but I didn’t time it.    So imagine my surprise when I arrived at the clinic to have a dog spayed here to find not one, not two, but THREE veterinarians and three assistants all lined up and waiting to spay my dog.   The main surgeon was dressed in green scrubs, everyone else in white (or almost white) lab coats.

And the saga began.   First, they gave the dog some injection and then told me to walk her around for ten minutes.  I have no idea what that injection was for.   Then they gave her another and told me to take her outside?      Two assistants dutifully followed me.    We took her into the parking and then to a small patch of grass and waited until she collapsed on her feet like a drunken doll in the grass.  The two student-assistants then removed her collar and her leash and carried her back into the clinic, down the flight of stairs, and into the surgical room and placed her on a table, stained with purple — potassium permangate — their choice over iodine for sterilizing surgical areas and operation sites.

They didn’t want me to stay while they did it and had a TV monitor outside for me to watch.  But I told my vet that the next time we did this, I was going to watch in the surgery room.  I wanted to know what the heck they were doing.   I probably should have been more insistant, but didn’t realize that they would all be standing in front of the camera so I wouldn’t be able ot see anything anyway.

The surgery probably took an hour, the man in green was obviously in charge, everyone else was observing and handing him things when he needed them.  When they were finished, everything was covered in a cloud of purple powder and the dog had what appeared to be a tube sewn lengthwise along what I presumed was the incision in her belly.   They had laid out the uterus and ovaries in a single triangle like a necklace and proudly gestured for me to admire them.

Did they  think that they would have left them in?

But the drama was not over.  The proceeded to bring out a T-shirt and place her in it and then tie it up the middle by cutting holes and putting pieces of cloth through them to make little ties.  It was knotted across her hind end like a lumpy one-piece infant suit with a diaper in it.  But there was no diaper, and there were no snaps.

How was she supposed to pee or poo?

I decided to take her home with me rather than leave her alone in a cage there for the first night.  After all, I had taken care of the other pups after they had been spayed and neutered in Kathmandu and I was, after all, a physician.    But as the afternoon wore on, her little T-shirt began to stink due to being wet with urine.   I decided that I was not going to wait until the next day and I called my vet.

He arrived within 20 minutes and produced, from a square piece of gauze cotton, about the length of the dog and wide enough to wrap around her, the most amazing bandage I had ever seen.   Four holes in four corners for each leg, the middle of the cloth covered her wound and across the bag, he cut the sides of the cloth into strips and proceeded to tie little knots to snug the cloth against her tummy by tying it tight across her back.  When he was done, she looked like she was wearing a white French braid down her back and he even left an opening through which she could pee.

So what was going on with that surgery?

Well, when I went to see my neighbor, a cardiologist doubling as a Tajik tutor in the evening, all was revealed.  First of all, I reported with some glee that I had been able to read the signs on the doors at the clinic (surgery, recovery, diagnostics) because through the course of her teaching me vocabulary related to her job so that we could talk about what she did each day, I had learned the words that I needed to know to do this.  That was very exciting for me, and I was quite proud of myself.

It’s these few  little moments of comprehension when one is out in the real world that gives the novice language learner hope for a better future, no matter how far off in the future it might be.

But then I told her about how strange it had all been.  So many doctors and so many assistants although I had, by the time I left, figured out that they might be students and had my suspicions confirmed.   But it took so long!    Even she wrinkled her brow at the length of time it took.  But then she explained to me — being able to witness a spaying (called a “sterilization” here) is a rare occasion in veterinary medicine here.   Perhaps there is only one every six months, if that.  People don’t spay their pets.   The two vets who were observing  probably could not do the surgery themselves just as, presumably, my vet could not.   The doctor whom they brought in to do it, perhaps from the veterinary medical school, may have been the only person in the country who could do the surgery.  Certainly, if not, he was one of only a handful of vets who could do it but, since there are only a handful of vets to begin with, my guess is that the handful of vets who can do the surgery is more like a thimbleful, if that.

Of course, that explained why I had had so much difficulty scheduling it, with a couple of date changes along the way.   My $75 had provided a much coveted event in veterinary education to five clinicians.

Aren’t they going to be excited to hear that I will have them spay another one in a month?

What about the purple stick tied to her incision?  Well, with the help of her telephone, translating from Russian to English, I learned that it is apparently a drain, which they do as a matter of course for such surgery.      And because of this, they can’t glue a bandage to her middle as it needs to drain.  I have no idea what it is going to look like when all is said and done, or how long she needs to stay with me until it can be removed,  but the news that spaying is so rare that no one knows how to do it was sobering, to say the least.    All those puppies born and left to die and then later, if they make it to adulthood, euthanized when people in town start complaining about them,  instead of simply spaying the females and neutering the males.  Where is the sense in this?

The international world of animals continues to educate me about things that, in my ideal world, I would have preferred to know nothing about.  Perhaps this is why this has been happening to me.   Perhaps the world decided that I had lived in ignorance long enough.  Certainly, seeing patients at the clinic in Putney for nearly ten years opened my eyes to the lives of a much wider variety of people than those with whom I had been previously in contact as a faculty member in a graduate program.    It’s not that I didn’t work with animals then; those years were the same years I worked with dozens of different cats, with varying degrees of socialization.    But there are lots of people in the U.S. who concern themselves with strays, in one fashion or another.  And vets galore who spay and neuter several animals every day.   I am  embarrassed to say that I would have never imagined that spaying a dog would be a momentous occasion for a veterinarian anywhere in the world.

How naive can I be?

I thought I came here to teach English teachers, but find  that, instead, I am providing educational opportunities for veterinarians and veterinary students.   I guess it is worthwhile to note that, at least, I am still doing something in the field of education!