Update from Sikkim

This a journal email from Dr. Alan Sherlock. When not performing Vets Beyond Borders work in Sikkim, Dr. Alan works at Central Vet Hospital Sandringham, 9598 7848.

Sikkim – still Gangtok – April 2013

(The capital of Sikkim State)

It is late afternoon Tuesday 2nd April. Yesterday, Monday the first, was of course April fool’s day. Various staff members were sent on ‘wild goose chases’ at strange times of the day and Dr Alan was asked to watch out for the black leach that was crawling up his leg (a not uncommon occurrence I must add).

Dr Dicky was arranging the roster for the coming weeks.

“Dr Alan, please take rest tomorrow and Wednesday” she said.

On reflection I reckoned that apart from travel, I hadn’t ‘taken rest’ since arrival, so I agreed on Tuesday, but said I would be OK for Wednesday.

Dr Helen is due here tonight and I have spent the day cleaning up and ‘taking rest’. I went up to MG Marg in the afternoon, renewed my Inner Line Permit, which will now see out my time in Sikkim. I also had a haircut in one of the tiny booths that flank either side of the steps as you come up from Lal Bazaar to MG Marg. Great value at 50 rupees ($1.00). I take great delight in telling my barber in Hampton about the reasonable price I pay in India, including a head massage, and why can’t he match it? Various market stalls line the steps selling hundreds of items, basic necessities such as clothing, shoes, tacky souvenirs or the more exotic Buddhist statues and prayer flags, even gold plated plastic solar powered prayer wheels that many local cars sport on their dashboards.

vegetable-sellers-at-lal-bazaar

Vegetable sellers at Lal Bazaar

Bronwyn and Noelia are both gone Sunday. Noelia left early (6am) and was to meet a taxi at the clinic. We left her at the steps that lead down past the girl’s school. Bronwyn left after a farewell lunch at ‘Porky’s’. Dr Alan brought home a ‘doggy bag’ which was more than adequate for his dinner. We then headed for the taxi / jeep terminus below the flat where amidst noise and hustle and bustle; travellers jostle to purchase tickets for places with exotic sounding names such as Siliguri, Kalimpong or maybe Darjeeling in West Bengal.

Bronwyn managed to secure a ride to Siliguri, just about 10 km short of NJP, the train station she wanted. She would spend the night there and on to the train early next morning for her trip to Kolkata and her flight ‘home’ to Singapore. For some reason Bronwyn prefers train travel to flying. Her seat number on the jeep was 7, so we figured she would be in the very back of the jeep in one of the seats facing fore and aft, rather than cross ways like the front and middle seats. We reckoned she had a pretty good deal until we realized she would be sharing her little 80cm seat with someone else – 4 people altogether in the back section plus hand luggage; large cases on the rack up top. It may have been better to purchase two tickets as Noelia did on the way up. At 200 rupees each ($4), a bargain for the 100 km odd trip. Dr Alan inspected the tyres – reasonable re-treads and with a toot and a roar of diesel engine they were away.

A typical ‘jeep’ – in this case a little ‘overloaded’.

 

The ‘girls’ experimenting with new hair designs.

Vettrain wound up Saturday night with presentation of certificates, awards and speeches (not too long from Thinley).

Dr Alan presented certificates to the Paravets, Bronwyn the Vets.

Then we, the volunteers were thanked and presented with the traditional white scarf and a present. Dr Alan scored a little Buddha statue and a lovely traditional Sikkimese grey jacket – see below, and is now officially referred to as Dr Alan Bhuttia. (The most common surname in Sikkim)

As a special honour we also received a lovely hand woven, patterned scarf from the Assamese students.

 

Thinley asked me what he might project on the lecture screen, as a final farewell message to the graduates. I suggested the following; which are basic points I had been drumming into the Vets for the past two weeks.

Think first

Pick up with forceps once only

(Causes less tissue damage)

Don’t let go!

(Refers to when you have found something important you want, like the uterine horn)

Look for the fibrous tissue on the Linea alba

(This is the only tissue in the midline that will really hold sutures well)

And most of all – Don’t poke!

(This refers to student’s nervous habit of constantly dabbing at the tiniest drop of blood with a swab – wastes time and also probably leads to tissue damage)

Farewell, take care and hopefully we will all meet again!

 

Finally a couple of the Vets performed a ‘rap dance’ titled ‘How to do a spay’ which incorporated all the above points, and more, accompanied by the various frustrated hand gestures that Dr Alan used!

A great way to end the evening and everybody was in stitches.

 

Bishnu (red pants), chief cook and caterer for the two weeks, with her sister (assistant caterer), Namgal and his wife (opposite) and son in the middle.

 

And so back to business.

Remember the little dog with the anal tumour back in Jorethang. His wound opened up a bit, so he came up to Gangtok. We redid a couple of sutures and he is healing well. I asked one of the boys if he thought the dog was continent as we had inflicted a fair amount of damage to the nerves and muscles of his backside. They felt he was OK However he is a ‘nasty piece of works’ and barks violently at me. Next day I was observing and noted that with every bark, a pellet of poo was ejected from the rear end. It was rather comical, almost like you would see in a cartoon. Perhaps he was not as ‘continent’ as we thought! He seems good the last few days however. A before and now shot.

 

Friday – he has gone home!

 

Transmissible Venereal Tumour (TVT) 

This is a sexually transmitted tumour, in many ways resembling the recently discovered Facial Tumour in Tasmanian Tigers. (In this case the tumour is spread by fighting and bites) It is seen reasonably commonly in the street dogs – maybe two dogs in a hundred. Below are two pictures of about the worst case I have ever seen. The tumour is affecting penis and anus. Some readers may want to skip this section! Also in this shot it is difficult to see the maggots inhabiting all those nooks and crannies.

One of the extra advantages of desexings dogs is that the incidence of the disease drops markedly as sexual activity is reduced.The disease is not seen at all in Gangtok now as nearly all dogs are ‘done’. What a great thing for the dogs!

This also reminds me that we may only be able to do one more Vettrain class in Gangtok. Why… because we don’t have a supply of entire dogs for the surgery classes any more. The boys are running more or less constant trips of a hundred kilometres or more to find surgical candidates. So, in one way it is a shame, but in another way it is an outstanding success.

 

This dog and two others were brought over from West Sikkim for treatment here.

It’s a wonder this dog can even defecate or urinate. It is difficult to find the ‘openings’ where these functions happen. Standard treatment is first to desex (males and females). I think there is a sex hormone effect that enhances tumour growth? If the tumour is not too extensive, as much as is practical of the growth is removed surgically at the same time. Then the dog is given three days rest before starting chemotherapy. Weekly doses of Vincristin are given intravenously and most dogs respond well receiving generally three plus treatments, depending on response. We will see how this fellow goes. The vets are confident he will do well, believe it or not. They have had success with other cases like him. I have seen the pictures!!

 

Perhaps I am a bit tough, but common sense tells me this fellow would be better ‘sent on his way’ as even if he does recover, the time and resources spent on him are enormous and of course our finances are limited. However the philosophy here is that we are here for the dogs and all deserve the best we can do for them. I can’t argue with that.

 

We learnt about this tumour in Vet School but were told it wasn’t in Australia. I have never seen it in practice in Sandringham. But guess what… When Vets started to do work with dogs in aboriginal communities – there it was. You don’t know what you’ve got until you look for it.

 

Well it is fourteen days since this fellow was desexed, so that makes him about ten days after the first chemo and I have some new photos of him below. I would like to think there is significant improvement – what do you think?

He is still a pretty sick looking dog – his general health is poor which is not helped by the chemotherapy. I have another ten days or so in Sikkim. I will try for an update photo then.

 

 

.

 

Sikkimese honesty and goodwill

The Money Changer.

One afternoon I was visiting MG Marg, doing some shopping and errands. One ‘job’ I seem to do every year on arrival in Sikkim is to visit the hardware store and purchase maybe 20 metres of light chord, which I cut into 50 or 70 cm lengths, tie a bowline on one end and then tie them to the 4 corners of the operating tables. They are leg ropes, used to position the dogs for surgery. The ropes deteriorate over time or a ‘stolen’ and used for other jobs, so that by the time I return the following year they are all looking pretty sorry or more likely have been replaced with bits of knotted string, gauze bandage or whatever scrap of fibre comes to hand.

 

I needed a top up of money and having not really moved into the electronic banking era very well, sought out a money changer who could cash my old fashioned traveller’s cheque. I saw a sign for Western Union Money Change, pointing upstairs. A steep narrow flight of stairs led to a tiny office with a little cubicle with a glass window with a small round hole in it where the cheque was passed in and hopefully the money came out. A young boy was in the cubicle. The cheque was signed, the passport inspected and photocopied as per usual, then the boy brought the cheque out of the cubicle and handed it to a man who was chatting to two younger women. He was about my age, obviously the boss and was seated on a bench on the opposite side of the tiny room, about a metre away from the ‘official cubicle’. He inspected the cheque, rang a number as is normal, read out the cheque number and details, must have got the required response and authorized the assistant to release the money.

The young man spent time with a calculator and then rummaged in a draw to gather together the required cash which in a very nervous fashion he meticulously counted out as he gave it to me.

All was well and I thanked him. Then as I was about to leave, the boss said, “Young man, is there anything else we can do for you”?

I replied “Well I’m not sure what else you may have to offer?”.

“We could change some more money. We could wish you well or safe journey and we could include you in our prayers at night” was the response.

I said “Well, I think I would like all of that”. We all had a good laugh and exchanged further thoughts on age not being a problem and he told me about the seventy year old Indian man who had just married a twenty year old girl! With much laughter I cautiously descended the steps back to the street and was on my way.

A couple of days later I returned and had barely entered the room before I was greeted with “Well young man, good to see you back again” and the boss rose from his seat to serve me. This time the cheque was taken, glanced at and a bundle of money was thrust at me. I somehow knew that it would be the correct amount. This time no formality, no passport and no phone call. I said “I must now be a reputable customer”. “Reputable and reliable” was the answer. Then came the question, “I’m thinking you must be returning from the Vietnam War?”

I said “Well fortunately not, but I could well have been” explaining how conscripts were selected by ballot of birthday and I was ‘lucky’ not to be drawn. “Lucky indeed” said the boss, “Many young lives destroyed in that debacle and Reagen really made a big mistake getting involved in that country’s affairs”. And so another friendly and interesting conversation was had with an obviously learned and intelligent man. I look forward to our next encounter!

 

The ‘lost’ computer

Last week the ‘girls’ and I were returning from the clinic. A very full day and it was 7pm. We called into Mr Rahi’s grocery shop to purchase provisions for dinner and then anxiously searched up and down the street for one of those shops that sell drinks ‘to calm the nerves’. I think you know what I mean! Well we weren’t having any luck; it appeared the two or three shops we knew about were all closed. In desperation we went down to Porky’s Restaurant to see if they would sell us a bottle of the ‘tonic’ we needed. They were about to close, but the disturbing news was that it was ‘Dry Day’ and no alcohol is to be sold. Sikkim has the odd dry day and I am not quite sure of the significance.

So we trudged off home and resigned ourselves to tea or coffee. I remembered I had a part bottle of very cheap Sikkimese red wine which comes in a about a 700 ml plastic bottle. That would do me fine, but of course the ‘girls’ wouldn’t go near it!

Some time after returning home I went to find my computer – no where to be seen; not even outside the front door where I sometimes put it down to unlock the door. I had brought it from the clinic. After much thinking and panic we reckoned Mr Rahi’s store was the likely spot where it might be. So Noelia and I rushed of to the shop about 400 metres down the road. I glanced in to where I had stood at the counter; no sign of it! But… almost immediately one of the shopkeeper boys held it up from behind the counter with a very big smile on his face. Mr Rahi received a big hand shake and a hug around the shoulders and all was well with life again.

 

Interestingly, the same thing happened to Dr Helen the next week. We had been shopping for a new phone and some tourist items and then headed to The Tashi Delak Hotel (means good luck in Nepali) for a ‘lemonade’. This hotel has a restaurant and large outdoor balcony area that has a fabulous view over the valley and even though the weather was stormy the valley and mountain ridges looked fabulous.

We got up to leave after about an enjoyable hour and a half, only to find, horror of horrors, Helen’s computer not there! Where oh where could it be? Maybe the tourist shop and Helen took off at a rate of knots to look for it and left me to pay the bill! As she ran the following thoughts were racing through her mind. “All my life’s work is there!” No, no, its OK I did a big backup before I left home. All is not lost. Life will go on”

By the time I exited the hotel, Dr Helen was there with a big smile on her face and computer in hand. The same outcome as my episode in the grocery shop. Just to be nasty I said “they’ve probably raided it and filled it up with viruses!” But of course we knew that would not be the case.

 

Dr Helen had arrived late on Tuesday night. She is the project manager for SARAH and has been coming to Sikkim several times a year. She is here for a month this time and says her visits are now down to twice yearly.

Most of the flights come into Bagdogra in the early afternoon. That means if you have a good drive ‘up the mountain’ you are usually here by 6 or 7pm. Well not Helen. At 8pm I gave up, thinking she must have been delayed somewhere. Her phone wasn’t answering (she had a new number). The rain was pouring down and I was settled in for the night. At about 8.15 there was a knock at the door and a wet and bedraggled Helen was there. She had come in a shared taxi with some German tourists who had made numerous stops along the way. Firstly they needed passport photos and photocopies of their visas to qualify for Inner Line Permits. Then they stopped for dinner and drinks. She had been dropped off at the corner of Deorali School Rd and the highway; about a 400 metre walk to the flat. She left part of her luggage at the grocery store for collection in the morning when I could help.

 

Here is Dr Helen in 2010 yak riding (on the left). We are at the Sacred Lake Tsomgo in East Sikkim. Also present is Chrissie, another volunteer from Germany who specializes in viral diseases; valuable for our work with rabies.

 

 

Tsomgo is at an elevation of about 10,000 feet. It is really above the tree line; only rhododendrons and tough shrubs surviving there. Some of the Vettrain people took a trip here this week and I was interested to see some of their photos on Face book.  The whole area was still covered with snow (now well into spring).

On the map, Tsomgo is to the right of Gangtok heading towards the Tibet border near the Rangpo River. It requires a special entry permit as it a military sensitive area.

 


Field Camp

Good news! We are off to a field camp in East Sikkim. Leaving Sunday to start work on Monday and returning the next Saturday. Somewhere over near Nathang on the map above; getting close to the Bhutan Border.

Its new territory for me and I am looking forward to it; cold and high I believe.

 

You may remember Dr Kinchokla, the young female Vet who came down from Namchi to especially visit me at Joretheng at the field camp. She came twice and helped with the desexings. I have got together a set of instruments for her here in Gangtok and Phurba collected them today and will take them down to her. I really hope she will use them and hopefully spread the word of ABC surgery in her area. I’m sure she will!

 

I will finish as usual with a few words of wisdom; Buddhist of course! From the notice board at SARAH.

 

When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help.

Thich Naht Hanh

 

The Mount Kanchenjunga Range, seen from Tashi View Point, above Gangtok

 

Cheers!     Dr Alan.

 

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