Course Allows UF Veterinary Students to Participate in Rabies Vaccination Campaign in Mexico

Imagine a Mexican village where a loudspeaker awakens residents at 5 a.m. each day to announce where poultry and meat can be purchased.

Forget sleeping in: no food will be left for anyone who arrives more than a few hours later. In this town, people sleep in hammocks. One public health clinic and one doctor serve the entire community of about 2800 people. Finally, imagine dogs, everywhere.

In the village of Tunkas, located about 65 miles east of the city of Merida in the Yucatan peninsula, veterinary services are not readily available and no animal control organization exists to monitor or offset the threat of disease.

“It’s a bomb waiting to go off,” said Dr. Jorge Hernandez, an epidemiologist and assistant professor at the University of Florida College of Veterinary Medicine. Hernandez recently led a team of veterinary students on a rabies vaccination campaign in Yucatan as part of an elective course known as International Veterinary Medicine, now in its third year. A native of Mexico, Hernandez sees the threat of rabies as daunting in this village, which he feels is not unusual in many rural areas of Mexico.

“There are just way too many dogs,” he said, adding that his team, including senior Julia Alvarez and sophomores Tara Creel, Amanda Jezek, Sara-Louise Roberts and Lisa Hinder, together with students from the University of Yucatan, vaccinated close to 300 dogs and 100 cats over a three-day period. An unknown number of dogs and cats remain unvaccinated.

“There’s never been a good count, using reliable methods to predict the dog-to-human ratio. It’s an epidemiologist’s dream.” During the three-day visit, the team conducted a study in order to describe the dog population in Tunkas. Preliminary results indicated that most dogs were males (68 percent), less than 2 years old (75 percent), allowed to roam freely in streets (89 percent) and were not neutered or spayed (93 percent.)

For about three hours each day, the student teams, accompanied by public health workers and young “promoters” – children who had been given the day off from school to ride ahead on their bicycles distributing flyers throughout the neighborhoods – walked door to door. “Buenas! Buenas!” the health workers would call out at each stop, prompting children and their parents outside to investigate their visitors. Most were more than willing to help round up their animals – many obviously not used to being handled – with a tortilla, on occasion, or whatever it took to tempt them closer to the obligatory confining rope.

Things were going well; students got used to vaccinating cats in bags (seemingly the preferred means of restraint) and to saying no when owners would present puppies under three months of age for vaccination. However, on the third day, someone was bitten. A health care worker, previously unvaccinated against rabies, now must undergo the entire series of painful rabies vaccination shots. The male worker, in his early 20s, had attempted to restrain an animal while working with a team of Yucatecan veterinary students. No UF students were at risk in the incident, but it could have happened to anyone.

“It’s a sensitive position for us to be in,” Hernandez admitted. “We come in and we tell our own teams what to do, and how to do it, in terms of restraining an animal. We won’t vaccinate until that animal is totally restrained, period. But we can’t exactly tell the teams from another veterinary school what to do because they have their own system and it has worked in the past. This is their country, and technically we are their guests.”

We are their guests. It’s something Hernandez and the UF team were constantly reminded of during their stay, in subtle and not so subtle ways. There was the unplanned but apparently mandatory visit to the director of public health’s office following a morning of rabies-related presentations – one by UF veterinary student Alvarez - given at the University of Yucatan. The visit, proposed by one of the presenters, a public health veterinarian, ostensibly was arranged for the team to “state its business.” The public health director then determined which village the UF group would visit, and assigned a medical doctor who was from that village to accompany them.

That woman, Dr. Nelda Nunez, who spoke not a word of English, proved invaluable both professionally and personally.

“Dr. Nunez was instrumental in the organization of the vaccination campaign, helping make this international experience a success,” Hernandez said. Nunez’ father, a baker, provided team members with mouth-watering cheese-and-butter-filled pastries, hot out of the oven, on the afternoon of their second day in Tunkas. An offer to use her family’s bathroom for showers was much appreciated, given that water didn’t work in the house where the UF team stayed. Some team members learned to mix boiling hot water with cool water in vat-sized buckets, dipping to wash their hair or rinse soap from their bodies.

We are their guests. So when the Yucatecan veterinary students wished to vaccinate in the morning before the heat was too intense, UF’s group went along, even though Hernandez was sure the likelihood of catching people at home with the dogs was greater in the afternoons when children were home from school and parents had returned from work.

Still, Hernandez felt the group accomplished its goals. As an instructor and epidemiologist, his goal is to foster collaboration between UF veterinary students and people in the veterinary and health care field from foreign countries. A key part of this is fostering in the group the understanding that when traveling abroad, an individual’s perspective is only that.

Earlier courses, held both in Yucatan and Chile during previous years, were heavier on the observational aspect, with students exploring swine and cattle production facilities, slaughter plants, small animal clinics, equine racetracks and meeting with state, national and international veterinarians. Evaluations from students led to this year’s implementation of the hands-on component, Hernandez said, and UF’s spring break this year coincided with National Rabies Eradication week in Mexico.

“I’d like to bring students here again every year,” he said. “While rabies in domestic animals is not the main threat in the United States anymore, dogs are the main source of rabies infection for humans in Mexico. There are reasons for this, and they have to do with social and economic conditions. Students need to understand canine ecology; why things like the ratio of humans to dogs is important, and how many dogs there are in a household, whether they’ve been vaccinated, and whether they’ve been spayed or neutered.”

The visit to Tunkas was an eye-opening experience for everyone who went.

“I felt our experiences in Tunkas captured the successes and the challenges of international work,” said sophomore veterinary student Creel, who said the course went above and beyond her expectations.

“It is very important to know what you are trying to accomplish before you begin, but you also have to be flexible and respectful of your hosts.”

Hernandez said he hopes another UF team can return to the same place next year to take up where this year’s group left off, providing assistance to the local public health community.

“In Tunkas, people do not take their pets to veterinary clinics to be vaccinated,” Hernandez said. “They use government public health services to protect their pets against rabies. Yet not all pet-owners vaccinate their pets. Why? Because of social, cultural and educational reasons.”

Public education is very important, he added.

“It takes adequate funding to run an effective and efficient program, and there are budget limitations both at the governmental level and within individual families,” Hernandez said. “Rabies is not a controversial issue; nobody wants the disease. But there are priorities and funding is limited.”

Still, he commends public health workers in the Yucatan for their efforts toward controlling rabies; there have been no rabies cases reported or confirmed either in humans or in domestic animals for the past two years.

“The public health officials in Yucatan are making very difficult and important decisions in order to deliver the best public health services to their people,” Hernandez said. “I am very proud of our students who went to Tunkas. Every dog and cat they vaccinated counts.”