Bali to Singapore September 2013
Report by
Drh. Anak Agung Ngurah Oka Pujawan
Drh. I Bagus Made Bhaskara
Bali Veterinary Clinic, Indonesia

Our names are Drh. Anak Agung Oka Pujawan and Drh. I Bagus Made Bhaskara. We are veterinarians working at Bali Veterinary Clinic in Denpasar Bali.  We understand that Bali island is a growing tourist industry in Indonesia in which affecting the demand of veterinary service in the region. Dr. Shane Ryan and Dr. Made Restiati put an idea to broaden experience for 6 young Veterinarians at Bali Veterinary Clinics to gain one week “Visiting Program” to gain experience at Companion Animal Surgery (Companion) in Singapore. We are the first group to visit Companion & we are expecting the program would be beneficial for us to have better view of proper veterinary services. At Companion, we have a supervisor, Dr. Miles McNickle who leads us during the visit.

We stayed at Fragrant Hotel Classic just next to the clinic.  The first day of our visit, in the morning we met the Companion Managing Director, Ms Jean Lee. First time to step into Companion, we felt little bit nervous but she is a very warm lady and made us to feel much comfortable in foreign country. She introduced us to all of the Companion members then took us to Dr. Miles McNickle.  Dr. Miles McNickle I considered a very good and a happy friendly person. He made us to feel more confident to stay there. Dr McNickle asked us to stay in the room where he was doing the consultation and examine the dog with a bladder stone problem.

We listened and watch what Dr. Miles consulting the owner about their dog’s problem. The dog with bladder stone must be operated to remove the stone in the bladder. Before the operation, blood test is needed to evaluate the dog condition status. The second client was a dog with canine heart failure problem. Third client, we met with a cat owner that Dr. Miles only opened the stitches after ovario-hysterectomy surgery.
 
At noon, Dr. Miles allowed us to come to surgery room, treatment room and x-ray room. In the x-ray room we accompanied Dr. Miles do the x-rays and discuss the result about patient with non-union fracture in left of back legs of a tiny dog. The patient has done the first surgery by inserted the pin. The next surgery was Dr. Miles doing is to take out the pin and inserting a plate. In surgery room, Dr. Miles introduce us to Ms. Miko Sugawara. She is a nurse for surgery in Companion.

At 12.30 pm, we were lucky to see Dr. Miles perform the surgery to insert the plate in a tiny dog. It took one and half hours for surgery and it was a successful surgery. After surgery, we allowed to visit and see the next surgery. The dog with bladder stone problem will be operated at 4.30 pm. We were allowed to watch the surgery.

The second day, we arrived around 10.00 & we accompanied Dr. Miles for ear cleaning patient.  Not long after, we met Dr. Nicholas Woo. Dr. Nicholas is our supervisor who we can follow and learn. The first patient with Dr. Nicholas was a dog with vaginitis problem. We learned from Dr. Nicholas about helping owner to make good decision on the proper treatment for their dog. After that, we back to the surgery room to see Dr. Miles perform lumpectomy in golden retriever dog. Dr. Miles teach us about how to decide a proper suture after surgery, especially in lumpectomy surgery. Dr. Miles also teach us on how to manage the time during the surgery, make a schedule for surgery and prepare 100% sterile.

The next surgery is the cat with infection of anaerobe bacteria in the left of back leg. There is pus between muscle and skin. During the surgery, Dr. Miles teach us about standard surgery for this case. In our clinic, we faced lots of anaerobe infection in cats. We really thankful can learn the surgery protocol and make the proper surgery in our clinic in Bali.

Around 4.30 pm, we are helping Dr. Nicholas for emergency case, a golden retriever dog with fluid in Chest. We helped for restrain the dog and saw Dr. Nicholas doing the USG exam. The veterinary assistant did a “tap” to remove the fluid from the body. Dr Bhaskara is given the permission by Dr. Nicholas to insert IV Catheter to take blood sample. The last surgery in our second day is operation for anal gland infection.

male cat sterilisation
Dr. Joanne Ho, Dr. Bhaskara, Dr. Pujawan & Veterinary Technician Geovanni Solis

In third day, we met Dr. Miles in hospital room at 10.20 am. Dr. Miles was doing examination on a dog Wally with canine heart failure. Dr. Miles allowed to us do the examination with auscultation of lung and heart. Dr. Miles asked about our exam result and discuss the result. After that, for make sure the result Dr. Miles asked to us to accompany him do the x-ray and do the discussion.

Around 11.00 am, we accompanied Dr. Nicholas in consultation room 2. There is a dog with tick fever (blood parasite). The tentative diagnosis supported by a comprehensive blood test and tick fever test by PCR machine. There is positive Babesiosis infection.

Around 12.00 pm Dr. Nicholas allowed us to accompany him do the laparotomy surgery. Drh Oka Pujawan allow to be his assistant of Dr. Nicholas Woo to do the laparotomy. There is foreign body inside of intestine and Dr. Nicholas incised the intestine. The result is a dog ate the underwear! During the surgery Dr. Nicholas teach us the knowledge about enterotomy and perform a quick and secure stitches. 





ultrasound at Companion
Veterinary Technician Mark Canturna, Dr. Bhaskara, Dr. Pujawan & Dr. Nick Woo

In the fourth day, we follow Yongzhi Cong the veterinarian assistant. Yongzhi Cong teach us on how to run hematologic routine machine, comprehensive blood test machine and pancreatitis test with a sample taken by Dr. Chua Ying Ying. In the same time, Yongzhi Cong also saw to us how to test quick test of blood parasite test.

In the afternoon, we met Dr. Shane Ryan the owner of Companion and Dr. Made Restiati the owner of Bali Veterinary Clinic. The rest of time in fourth day we use for observation for patient status, reading some book and see a treating a patient as the order from Dr. Miles McNicle.

In the fifth day, in the morning we meet Dr. Lee See Yang. He asked for discussion about spinal fracture in consultation room 2. He asked the question and we answer it. Then Dr. Lee teach us on how to deal with spinal fracture and what he has been doing for it. During the day, Dr. Lee allowed us to help each other with veterinarian student in Companion. In the afternoon, we met Dr. Joanne Ho in surgery room. We discussed about anesthetic drugs that she used. In our clinic normally we used atropine as pre-medication, xylazine as sedative and ketamine as anesthetic drug. In Companion, they also use acepromazine as pre-medication, diazepam as sedative and methadone as analgesic drug. Around 12.30 pm Dr. Joanne allowed us to visit and see her to perform close castration in cat.

reviewing xrays
Dr. Lee See Yang, Dr. Bhaskara, Dr. Pujawan

Dr. Lee See Yang also showed us a new result of comprehensive and hematologic routine blood test and asked to us to interpretation and make diagnosis. Dr. Lee agreed about our interpretation and he taught the rest of on how to interpret the comprehensive blood test result.
 
We met with Dr. Nicholas after 12.00 pm to do the monitor patient for electrocardiogram in dog with heart problem. Dr. Nicholas asked us to do the interpretation with electrocardiogram lead II. We could describe the problem with monitor patient but we still could not make a diagnosis. After that, Dr. Nicholas told us the diagnosis and we learn more about interpretation the electrocardiogram only with lead II.

In the last day, we did blood glucose test in the cat with Dr. Eugene Ong. There is patient with diabetic problem. Dr. Eugene gave the information about the patient with diabetic problem. Our activity after discussion with Dr. Eugene, we helped the other doctor and nurse to give a medicine, special diet food, took a blood a sample and restrain the patients. At 1.30 pm, Dr. Lee See Yang asked for do a comprehensive blood test and hematologic routine test. After that, we did a discussion about Chinese herbal medicine in general.

We met with Dr. Miles around 2.00 pm in treatment room. Dr. Miles allowed us to visited clinic library in pharmacology room and then he recommended reading a Merck 8th edition book. During a day we read a book and helped to monitoring patient with diabetic problem. At 4.00 pm Dr Nicholas Woo allowed us to visit and see him to perform the pelvic surgery. There was a three fracture in pelvic (right ilium, left ilium and right ischium). He used a plate and screw to fix the bone and it needed a two and half hours for surgery.

During a 6 (six) days in Companion, there was a lot of things that we learned because we realized that we are fresh graduated veterinarian and still have to learn a lot about veterinarian medicine in the future. Companion Animal Surgery is a good clinic for us to learn because this clinic has a complete facilities and the doctor is very professional and qualified in International licence. All staff in Companion Animal Surgery it will be a good example for us to follow and copy because all of them have a good responsibility and dedication for their jobs. On this good opportunity, we feel grateful because we allowed to visit and learn in Companion.

We want to say thank you very much to Dr. Shane Ryan, Ms. Jean Lee, Dr. Miles McNickle, Dr. Nicholas Woo, Dr. Lee See Yang, Dr. Eugene and all staff in the Companion Animal Surgery Singapore.
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