Dr. Susan Chadima stands with medical team members at Kabul Small Animal Rescue in Kabul, Afghanistan. Courtesy of Dr. Susan Chadima

Coco, a 10- to 12-week-old street dog, arrived at Kabul Small Animal Rescue with what the organization’s Facebook page describes as “a shocking injury.” According to the post, someone had deliberately smashed her paw and then either kicked or beat her with something hard enough to snap her humerus and shatter her wrist.

But the dog was among Afghanistan’s fortunate few. Instead of letting her die an agonizing death on the street from her injuries, a Good Samaritan drove Coco through the night to the KSAR clinic for help. Most dogs would be left to suffer, given the country’s general perspective on animals.

“It’s about life and death and values and the role of animals in an agrarian culture, which is vastly different than ours,” says Maine veterinarian Dr. Susan Chadima.

Chadima, who has traveled to Kabul to work with animal organizations for almost 20 years, says however that amid the animal cruelty and neglect she has seen, she has also witnessed unexpected acts of kindness as she continues to work to better the futures of animals in a culture so unlike ours.

FROM A LOCAL TO A GLOBAL PERSPECTIVE

Chadima’s work in Afghanistan began many years earlier with a move from Cedar Rapids, Iowa, to New England, where her doctor of veterinary medicine degree from Iowa State University led to an externship in Vermont in 1979. Instantly sold on the region, she later landed a job with Bath Brunswick Veterinary Hospital.

Chadima and her architect husband, Michael Steitzer, who now focuses on designing veterinary clinics and animal shelters throughout New England, later purchased 11 acres in Topsham. She filled in at area vet clinics, even treating animals at their home. “We turned the basement into a one-room vet clinic and then took over the entire basement,” she says.

The birth of a second child warranted more space for the couple’s growing family, so they built a clinic next door, which became Androscoggin Animal Hospital. After years of practice, she “retired” in 2016, selling the practice to a junior partner. “I started going overseas more at that time. Running a local vet hospital with so much time away wasn’t the right combination.”

Having acquired a master’s degree in veterinary preventative medicine from Iowa State in 2019, Chadima also did a stint as medical director of VCA Lewiston Animal Hospital, which she relinquished in favor of her growing work in Afghanistan, though she maintains a presence at VCA seeing patients and performing surgery whenever she can.

It was in 2005, Chadima recalls, when she became aware of the needs in Afghanistan. Active with the Maine Veterinary Medical Association, on which she currently serves as a board member, Chadima recalls then-Executive Director Bill Bell being tapped to go to Afghanistan, consulting on three trips to help establish the framework for an Afghan Veterinary Association.

Part of the U.S. rebuilding effort in Afghanistan at that time to create a stable democracy included establishing a veterinary organization, recalls Chadima. The organization would support animal health services “in a country overly dependent on animal agriculture and husbandry, but in the realm of growing crops — not caring for animals.”

Chadima says she was more than intrigued by Bell’s work, and was encouraged by him to introduce herself to Dr. David Sherman, adjunct faculty at Cummings School of Veterinary Medicine at Tufts University who worked with the Dutch Committee for Afghanistan, a nonprofit humanitarian and livelihoods organization. “I convinced him I wasn’t crazy” wanting to go into a country at war, she says.

At the time, the existing university veterinary faculty in Kabul had a building that had been almost completely destroyed, being used as a weapons storehouse. The faculty members were operating in a tiny clinic on the outskirts of town. British-based Mayhew Animal Health had worked continuously in Afghanistan and donated funding for a new clinic, but no one with a significant veterinary background was treating the animals. A Dutch Committee for Afghanistan veterinary paraprofessional with six months of training was at the helm, so Sherman sent Chadima over for six weeks.

“I went. It was fascinating! I really, really liked it,” she says. “I was by myself. People were open and welcoming. I had the opportunity to see a completely different part of the world through a lens in a much broader context: culturally and religiously.”

CULTURAL, MEDICAL CHALLENGES

Chadima vividly recalls a meeting that spoke to the culture she was entering and, to some extent, the way they viewed animals. She had been in Afghanistan only two weeks when the dean of the veterinary school invited her to tea at his home. Electricity was rationed, and he expressed concern that he could not offer music so his daughters could dance for her. They subsequently drove quite far to his brother’s home in a village on the outskirts of Kabul.

“It looked biblical,” Chadima says, “all mud and brick homes and walls — no furniture — just carpets and toshaks (big cushions).” It was the time of the second Eid — Eid al-Adha — commemorating the “feast of the sacrifice.” There were at least 50 family members in attendance and everyone was served tea and sweets. A sheep or cow is traditionally slaughtered in the backyard, which she got to observe.

Eid al-Adha commemorates the historic event when God commanded Abraham to prove his faith by sacrificing his son, Isaac, and rewarded his willingness by having the Angel Gabriel substitute a ram for the boy. Mentioned in Chapter 37 of the Qur’an, the event is also noted in Jewish and Christian texts. Chadima and the dean had a conversation about fundamental religious beliefs that would alter Chadima’s perspective about working in Afghanistan.

Dr. Susan Chadima, left, at work In the Kabul Small Animal Rescue operating room in Kabul, Afghanistan. Courtesy of Dr. Susan Chadima

“It was clear he wanted to talk to me,” she says of the dean, because he took her to a quiet room. In the course of conversation, the differences in how the religions tell the story of Abraham’s other son, Ishmael, became apparent. The dean stated that Ishmael, who is considered the father of the Muslim faith, was born to Abraham and Hagar and his birth is considered legitimate, which runs contrary to Christian and Jewish beliefs. Also, the dean told her, Christ was not a godlike or divine figure in Muslim eyes. “The power in this was that here I was, sitting in this home in a remote village, having a profound discussion of religion that has divided the world all these years.”

His emphasis on the differences in their beliefs had a great impact on Chadima. It showed her she was now working in a part of the world that sees things very differently. She knew she wasn’t in Kansas anymore, so to speak, and anything she did toward her mission of “education, exposure and medical treatment” of animals would need to respect the fundamental viewpoints of the culture, starting with religion.

That awareness took hold on a professional and a personal level. For instance, over her time spent in Afghanistan she has been careful to follow the cultural expectations and, since the Taliban’s takeover in 2021, is sure to wear a headscarf, even indoors in a clinical setting. She found a Kabul tailor to transform her routine scrubs shirt and pants into a long scrubs garment falling well below her knees. Three-quarter-length sleeves cover her arms. She wears a long black coat out in public, doing what she can to ensure nothing gets in the way of doing her job.

The Taliban banned the women who had been working at Kabul Small Animal Rescue, except for foreigners like Chadima. “Still,” she says, “KSAR has done a really good job building bridges and relationships with the Taliban in order to continue this work.”

The personal differences Chadima discovered in the Afghan culture are as stark as the differences in how animals are treated there and the services for treating them.

For instance, Chadima said, in Afghanistan, animals are considered unclean and disease-ridden. “When they are loaded with contagious diseases, parasites, and carrying rabies — and there is no rabies vaccine — that is probably pretty good public health advice,” she acknowledged.

She tells a story from the nine months she spent with the Afghan Veterinary Association. A dog had been hanging around the area with an apparent broken leg. The leg had healed on its own, but part of the bone was sticking out, something vets removed. “The dog was doing amazingly well, but we needed to give him something to eat. After (feeding the dog), they made me throw away the plate because a dog licked it and no one would ever eat from it again.”

Such fundamental views of animals, she said, mean that unless a dog is a guard dog or has some other relationship with a family, mistreatment and disinterest are commonplace.

Other differences include views on euthanasia, even for animals, because the Muslim faith teaches that life is sacred. “In Afghanistan, despite pain and suffering, the idea of euthanasia is almost impossible to accept because it’s taking a life,” Chadima says. “Though something we consider an act of loving kindness, it is not viewed that way.”

The more basic nature of Afghanistan’s medical services is even more primitive for animals, Chadima says, with no gas anesthesia. If an animal needs to be sedated, as are all animals prior to surgery in the United States, the only means in Afghanistan is injectable medication. Because it is difficult to know when the effects of injectable medication will wear off, in the United States it is only given as a brief sedative prior to administering gas anesthesia, which is constantly monitored.

“The first time I had to do it (use only injectable anesthesia in Afghanistan), I sweated buckets,” Chadima admitted.

Further, there is no X-ray equipment for veterinary clinics in Afghanistan. “If a dog or cat needs an X-ray, you have to load them into a car and drive across the city to one of the few human clinics with X-ray machines that will allow an animal, because of the culture,” Chadima says.

And corrective orthopedic surgery is nonexistent in the country, which, in light of the number of trauma cases that come in including dogs being hit by cars, limits what can be done.

‘IT’S ALL ABOUT TRAINING, TRAINING, TRAINING’

Despite the many challenges, Chadima says she is happy she has been able to make a difference through her training of medical staff and caring for animals, starting with her first assignment working with the Dutch Committee for Afghanistan.

Prior to KSAR, with whom she began working only a couple of years ago, Chadima notes there were two other Afghanistan-based animal care groups founded by foreigners — both still operational — that she worked with. She says one wants to stay out of the media, and she doesn’t mention its name. The other is Nowzad, caring for animals in Afghanistan and Ukraine.

Dr. Susan Chadima with one of the Kabul Small Animal Rescue dogs, who was named Norman. Courtesy of Dr. Susan Chadima

She learned of KSAR, founded in 2018, from Nowzad, whose leaders asked Chadima to volunteer her services to that group as well. KSAR founder Charlotte Maxwell-Jones remained when the government fell to the Taliban, her rescue growing from a small source of vet care and long-term care to the primary source for vet care in Kabul.

KSAR works with other rescues in the U.S., Canada and more to place rescued animals, but also leases 14 houses to permanently care for 250 dogs and 70 cats. Given the ravages of war, real estate is inexpensive, providing ample space for rescued animals to live cage-free with caretakers, something Chadima says improves their spirits. In fact, unlike shelter animals in the U.S. that are isolated and confined to small kennels and runs, rescued animals in Afghanistan don’t experience as much anxiety, depression and lack of socialization for that reason.

Chadima has two Afghan street dogs of her own, but she says her focus is not on rescuing dogs and sending them to the West, but rather on improving the care in Afghanistan. “The government fell in the summer of 2021 and I went in late spring/early summer 2022 to assist KSAR. Charlotte’s previous staff was trying to get to the West, so she’d hired new vets — university graduates with no experience because that’s all that was available. I went to help train them. . . . How to improve Afghan veterinary care so they can do it themselves is the goal.”

Chadima noted that the country’s university education in veterinary care is extremely limited in terms of clinical exposure. The curriculum is largely focused on agriculture — cows, sheep, goats and poultry — which is natural because it is critical for survival in Afghanistan.

So her work with KSAR is “all about training, training, training. What’s rewarding for me is that some of these veterinarians are really smart and committed, but they just don’t know. I see my role as providing exposure, format, protocols and hands-on teaching. A few months ago, nobody could even castrate a cat, which is a pretty straight-forward surgical procedure. Now they’ve amputated a leg without me. That’s the success.”

Coco, the young street dog that came to KSAR after being abused, was given antibiotics and pain meds, along with frequent feedings to strengthen the starving pup. Amputation of her shattered limb was imminent, something Chadima says was not possible even a few short months ago as the veterinarians she was training were not experienced enough to do it.

She was not in Kabul when Coco arrived at KSAR, though thanks in part to her training, veterinarians there were able to successfully perform the surgery.

Chadima acknowledges the substantial help she’s gotten from a lot of people to do what she does in Afghanistan, including a veterinary anesthesiologist in the United Kingdom and one in Maine, offering help on crucial issues that come up all the time, such as how to keep a dog anesthetized without gas for two hours.

Even when home in Maine, Chadima receives between 30 and 80 WhatsApp communications a day from Kabul veterinarians, a translator or higher ups. Set to return to KSAR in September, she has no plans of slowing down.

In fact, while Chadima has focused primarily on Afghanistan after her first visit in 2005, her work recently took her to South Africa with ECOLIFE Conservation, which organizes trips for veterinarians and veterinary students. The goal was learning about wildlife conservation medicine and management and endangered species, including rhino poaching. The group also had a one-day hands-on community service clinic through The HALO Trust, vaccinating between 100 and 150 village dogs, scheduling neutering for a later time.

But she acknowledges a part of her heart is always in Afghanistan. In the last year she has logged three trips to work with the organization, staying four to six weeks at a time. “Charlotte (Maxwell-Jones, KSAR founder) has done a pretty amazing job of putting everything together, against all odds, getting funding and more. This is her life. I do what I can do to support her.”

To read more about the work at Kabul Small Animal Rescue or to donate, go to: www.kabulsmallanimalrescue.com/ and www.facebook.com/kabulsmallanimalrescue/