2/22/14
Mending Kids International (MKI) was starting our second day of medical clinics with Floating Doctors (FD) in Salt Creek Panama, a remote island in the Bora Del Toro archipelago. The first arrival was seen at intake by Dr. Kate Porter a phenomenal volunteer tropical medicine doctor working with the Floating Doctors this year.
The first arrival, a young Ngäbe-Bugle man explains that he is here for a problem in both his eyes – or so Dr. Kate hears it, but shortly after commencing his history, he says “Tengo un tiernito en casa.” Having limited Spanish, Dr. Kate asks a fluent Spanish speaking Mending Kids volunteer, Juan Ramirez, to interpret ‘Tiernito.’ Juan interprets – the Ngäbe man has a newborn, a ‘tender child’ at his home. Its eyes are white and it is blind. The mother pushed him away and won’t feed him.
Dr. Kate marks the intake form with a big star and bold letters, “House call, new born – Chi chi – 5 days old, mother refuses to feed, possible blindness.” The Tiernito is growing perilously weak, would the doctor be able to come see it in his home? Juan says ‘this is quickly becoming high drama’ ….a slight understatement!
Due to high infant mortality, Ngäbe babies are all named chi-chi (baby) until their second birthday. Quickly a medical team coalesces to make the emergency house call. Running to the home, our MKI volunteer leader, Isabel Fox, stumbles and falls deep into mud, then shortly thereafter spots her patient, lying moribund in the hot sun and mud.
Chi-chi, – as Dr. Kate, Allie, and Isabel are about to find out – is a 5 day old calf. So, regroup – there was a slight error in translation as the ‘father’ whose native language is Ngäbe spoke his second language, Spanish, to the English speaking Dr. Kate, also using Spanish as her second language.
By sheer coincidence, Drs. Dan Evers – veterinarian ex-patriot, and I – Renee Kaswan, retired veterinary ophthalmology professor – are tangentially participating in this mission and evaluating a baby Howler monkey affected with bot fly granulomas. The baby monkey – Jasmine – was acquired by a family from Memphis, who were relieved Jasmine was not very ill, and most surprised to learn that Jasmine would need a new name, she was a he…. Dr. Dan and I finish that delightful adventure and move onward to the neonatal calf.
Having not eaten for 5 days Chi-chi was severely dehydrated.
In the most primitive possible conditions, Dr. Dan and I assessed a dire situation while a family of 8, a sizable film crew from MKI, 3 impressionable 15 year old MKI student volunteers all waited to see if this first born calf – hopefully the Ngäbe family’s second cow – would live. Although the farmer assumed Chi-chi was rejected due to blindness, Chi-chi was actually only blind in his left eye, further evaluations were needed.
The diagnosis: Chi-chi had a relatively common bovine congenital ocular defect – persistent pupillary membranes (PPMs). In all species, the embryological pupil first forms like a spider web of blood vessels from the iris that bridge the future pupillary hole; these prenatal vessels should atrophy and desist prior to and or shortly after birth. However, sometimes these vessels inadvertently touch the lens and/or inside of the cornea – as they did in Chi-chi, and they persist. Persistent pupillary membranes can adhere to the lens, disrupt its growth causing cataracts and also adhere to the innermost layer (endothelium) of the cornea. These capillary attachments lead fibroblasts to follow the vascular path, the fibroblasts proliferate leading to a deep white fibrous corneal scar – which is what the Ngäbe farmer observed.
What were the chances that a calf – born in a primitive village in Panama – no electricity or running water – would be attended by a retired veterinary ophthalmologist seeking meaning and purpose on an MKI/Floating Doctors mission? 
For further irony, in August 1985, I was sweating in similar subtropical conditions in Evanston, GA, 8 months pregnant. The University of GA Veterinary Hospital where I was on faculty as an ophthalmologist, was called to attend a herd of cattle with ocular problems in Deep South GA. We diagnosed that the herd had multiple congenital defects, the most common being PPMs. Based on those observations – made at great effort by myself and 2 female colleagues – who would catch over 20 free roaming beef cattle (the farmer chided he couldn’t believe UGA didn’t send even one man), sweat ridden in the GA heat, I wrote the first case study of purportedly heritable PPMs in cattle. Our female senior student and large animal intern who did the hard work of catching and restraining the cows did not get authorship on the case report – physical labor being poorly remunerated as usual. As my academic curiosity has diminished over the years, I did not seek to examine other cattle in Salt Lake Island to determine if Chi-chi represented an isolated or herd problem.
Chi-chi – should he live, will have non-painful, unilateral blindness. The other eye was simply so deeply sunk in the socket from dehydration that it was covered by the third eyelid…until rehydrated. The assumption that the baby didn’t nurse due to blindness was erroneous, more likely just a naive mother cow, a newborn, a naive farmer, all fumbling with a new situation for everyone.
With a large audience watching and assisting, we used the limited supplies we had, 2 liters of lactated ringers solution, a couple of 50 ml syringes with 18 gauge needles to blow tennis ball sized bubbles of fluids under Chi chi’s skin all over both sides of his body (photo) while the MKI boys – sheepishly looking like they might be participating in torture – held the calf down. Chi-chi absorbed the fluids like a sponge within 20 minutes, and we were all amazed as Chi-chi stood up and began stumbling around! So we asked the farmer to fetch mom, tied her to the house, tied her rear feet so she wouldn’t kick, and low and behold we taught Chi-chi to nurse.
Fate, MKI, Floating Doctors came together, intervened and the Ngäbe family wouldn’t eat veal tonight…..Such a gratifying crazy adventure.
Written by Renee Kaswan