Veterinary care where it’s needed

For each of the past eight years, the Community Outreach Club at the University of Guelph’s Ontario Veterinary College (OVC) has organized and hosted animal wellness clinics at Kettle and Stony Point First Nation in southwestern Ontario. OVC student and staff volunteers have also offered the program at nearby Walpole Island First Nation for the past four years. Early in 2020, the group was preparing for its annual outreach visits. Then came the worldwide COVID-19 pandemic and associated lockdowns and other public health restrictions.

Prof. Shane Bateman
Prof. Shane Bateman

“We were gearing up for our largest clinics when COVID-19 struck and it became very apparent that in-person clinics would not be safe or possible this year,” says clinical studies professor Shane Bateman, who helps run the program in collaboration with the First Nations as well as local veterinarians and pharmaceutical companies. “We elected to proceed with offering some services virtually, including parasite prevention. We used telemedicine to ensure members of the community – humans and animals – would be protected.” Noting that internal parasites, as well as fleas and ticks, can transmit disease from animals to people, he adds, “Parasite prevention was deemed to be a public health priority this year.”

Partnering with Indigenous communities is one example of a growing movement to widen veterinary care for underserviced regions.

Partnering with Indigenous communities is just one example of a growing movement to widen veterinary care and community practice for underserved animals – and often overlooked clients – in Ontario and across Canada. Over the past decade, the cost of providing gold-standard veterinary care has risen significantly, as practitioners looked to apply medical research and technological advances for their patients. Those increasing costs have prevented large swaths of people and their pets from receiving even basic veterinary care – often creating a moral dilemma for practitioners looking to provide care for clients while ensuring a thriving practice for themselves (see accompanying story).

A 2018 study in the United States found that one out of four households with pets experienced a barrier to veterinary services, mainly financial. The “money gulf” is what one Florida practitioner called it in a 2017 article listing the top challenges for veterinarians. In a follow-up article two years ago in the Canadian Veterinary Journal, U of G pathobiology professor emeritus Carlton Gyles found that a similar divide exists in Canada. Says Bateman, “Veterinary medicine is very focused currently on supporting the usual clientele, but we’ve neglected a whole segment of our community and population who in some ways depend on that human-animal bond even more than the average citizen does.”

Dean Jeff Wichtel
Dean Jeff Wichtel

That’s all changing, says OVC dean Jeff Wichtel. An $11-million gift announced in fall 2019 is intended to effectively reinvent veterinary education. As the largest single donation in the college’s history, the funding comes from longtime U of G and OVC benefactors Kim and Stu Lang through their Angel Gabriel Foundation. With its connections to top-flight academics performing clinical trials and benchtop research on everything from cancer treatment to heart health to infectious diseases, the college always provides gold-standard health care through the college’s Health Sciences Centre, says Wichtel. But he and others want to train tomorrow’s grads to meet the growing need for affordable care for all animals, including societal sectors that have traditionally been underserved. “We want our graduates to leave veterinary college understanding, ‘This is what vets do,’” he says. “This shift is a real moment of transformation in veterinary medicine and probably the biggest reframing of our curriculum in 20 years.”

For the first time in Canada, graduate students will have a chance to focus their studies on community or shelter medicine.

Named the Kim and Stu Lang Community Healthcare Partnership Program (CHPP) – the first of its kind in Canada – this initiative will refocus teaching, research and animal health care to include that neglected sector. To do that, the college will develop partnerships with humane societies, veterinary outreach organizations and social service agencies working in community health care. Students will gain broader experiential learning opportunities, including a clinical rotation in Northern Indigenous communities. For the first time in Canada, graduate students will have a chance to focus their studies on community or shelter medicine. The gift has also led to the creation of Remy’s Fund – named for one of the Langs’ numerous rescue dogs – that will help subsidize medical expenses for underserved owners with animals in need. The Lang gift will also support capital improvements on campus as well as new positions, including a full-time veterinary director and an academic professorship or chair in the field, both to be appointed by early 2021.

illustration of man with animalsFor Bateman, the project makes sense for many reasons, not least the blend of expertise on campus, from the Health Sciences Centre and related services, to the college’s “one health” focus that encompasses well-being of humans and animals, to the University’s strengths in interdisciplinary research and learning. “We have the right expertise here,” says Bateman, now serving as the program’s interim director. “A lot of features make OVC the right place for this to happen.”

Indeed, it’s already happening – including through those annual wellness clinics to First Nations communities in southwestern Ontario. Working mostly with dogs – several hundred in all – and supervised by Bateman as faculty adviser, about 15 student and professional volunteers normally visit to provide an overall health check, as well as vaccination, microchipping and protection against various parasites. Clients obtain those services for less than one-quarter of what they might pay in a regular veterinary clinic – no small consideration, says club president Taylor Morris, a third-year doctor of veterinary medicine (DVM) student. “It’s not that the people living in these communities don’t want to care for their pets or don’t understand the need,” says Morris, who has also volunteered at pop-up clinics in Guatemala. “They lack access to veterinary care and money is tight, so they can’t afford it.” The club raises money to buy supplies and medications and relies on support from pharmaceutical companies to keep costs at a minimum for families.

Tracy Bressette, a resident of Walpole Island First Nation, says the virtual care helps ensure the continued health of her dogs. “They were able to provide medicine for my pets, which they desperately need because we have lots and lots of mosquitoes and wood ticks in this area,” she says. “So they really needed the heartworm prevention and so on.” Bressette says the service helps area clients, few of whom can transport their pets to the veterinary clinic in nearby Wallaceburg. Even the reduced service due to COVID-19 was a big help to many pet owners, she adds: “The fees are great compared to what a veterinarian would charge, and I think that’s where a lot of people really benefit.”

illustration of dogs and peopleAfter the virtual appointments, medications were labelled and packaged for individual animals. They were then bundled together and shipped to the health centres in both communities, where they were distributed by local teams. Regulations preventing veterinarians from prescribing medications through telemedicine have been relaxed during the pandemic, says Bateman. “Our pharmaceutical partners – Boehringer Ingelheim, Elanco and Merck – all stepped up and allowed us to deliver this important care in a unique way. It allowed our students the opportunity to learn so much about not only telemedicine but also how to work with First Nations people in providing health care for their companions.”

“There’s a significant lack of access to veterinary care in many remote communities. Some communities have zero access.”

Since it began, the program has seen 1,000 pets from 665 families. This year’s telemedicine effort served more than 170 pets. Christina Jobson, entering her third year at OVC, worked on the project this year from her home in Guelph. “It’s very different than the clinics we’ve run in the past,” Jobson says. “Not being able to run the clinics in the First Nations this year, but still being able to find a way to provide support to the communities, has been a really great experience.” The medications and preventive care provided remotely will help until the team can get back into the communities, she adds.

Supported through the CHPP, the program not only provides care to animals in First Nations but also ensures OVC students have the specific knowledge and skills to extend animal health care to these communities, says Bateman. “Going forward, this type of work will be a core activity of the CHPP, and we will be expanding our impact in other communities.”

“For many people facing socioeconomic barriers to care, animals are incredibly important in their lives.”

Prof. Katie Clow
Prof. Katie Clow

This year, under a grant from PetSmart Charities of Canada, OVC will offer similar services through a new fourth-year rotation in Aroland First Nation, about four hours’ drive northeast of Thunder Bay. Currently, the closest veterinary service is provided by a practitioner from Sault Ste. Marie who runs a mobile clinic once every two months in Geraldton, about an hour away from Aroland. “There’s a significant lack of access to veterinary care in many remote communities. Some communities have zero access,” says population medicine professor Katie Clow. Beginning in spring 2021, about eight students will spend a week there with Clow, Bateman and other OVC members, learning from the community and providing programs including youth education and scholarships to enable youngsters to visit U of G.

Prof. Gordon Kirby
Prof. Gordon Kirby

Biomedical sciences professor Gord Kirby says the program partly reflects growing student interest in serving wider communities. “They are very plugged in,” he says. “A lot of this is being driven by students’ desire to explore alternative career paths.” Bateman says the program will likely benefit community members, too. “Veterinarians impact human health because of the human-animal bond,” he says. Beyond that, caring for animals may enable the veterinary team members, along with practitioners from other disciplines, to address human health concerns from smoking cessation to vaccinations: “This is an opportunity to influence human health care decisions and behaviour through relationships with their pets.”

Linda Bolton
DVM Linda Bolton

In 2019, Kirby and Clow took part in another northern clinic program run by U of G grad Linda Bolton, DVM ’84 and owner of Mullen Small Animal Clinic in Walkerton, Ont. Under the Grey Bruce Aboriginal Qimmiq Team, she leads twice-yearly volunteer groups of veterinarians and technicians to semi-remote First Nations communities in Northern Ontario to provide humane dog population control through spaying and neutering, vaccination, parasite control and microchipping. Running since 2012, the program has spayed and neutered more than 850 dogs and performed wellness treatments on more than 1,300. Bolton says the communities help to partially fund visits, and veterinary care is offered pro bono to owners. “By helping the dogs, we will be helping the community members,” she says. “Each community has different resources, cultural priorities and socioeconomic issues such as isolation and poverty. I wanted to see the North and help in my backyard. I have thought about rabies clinics in Africa, but why do that when there’s a need in Ontario?”

Meagan Wellon, a veterinary technician in OVC’s large-animal clinic, has accompanied Bolton on three week-long trips to two First Nations communities. She says the project fits with her long-time interest in advocating for animals through their owners. “Education is important for the one health aspect,” she says. “Teaching owners about population control and helping them learn to interact with their dogs in a safe way helps make the community safer.”

Treat a pet and treat the person: That might be the mantra for Michelle Lem, a 2001 DVM grad who runs Community Veterinary Outreach from Ottawa. Now offered in several Canadian communities as well as Kansas City, Missouri, the program provides accessible care for people and their pets who are experiencing homelessness and housing vulnerability. Clinics are offered every other month for clients referred through community agencies.

DVM Michelle Lem
DVM Michelle Lem

In an unusual twist, those pet owners can also obtain health-care services for themselves, ranging from smoking cessation to oral and dental consultations to immunizations. “What makes the program unique is that human health services provided by collaborating practitioners from other disciplines are paired with veterinary services,” says Lem, who studied social work at Carleton University and completed a master’s degree at U of G on effects of pet ownership on young people who are homeless or at risk. She says many clients worry more about their animals’ health than their own. “For many clients, just getting out of bed in the morning is a huge challenge, and pets are huge motivators, so we work with that in a non-judgmental way.” She’s been working on animal care guidelines for shelters for people who are homeless or victims of domestic violence; those guidelines were released earlier this year.

“It’s about the simple act of caring and providing dignity and respect to another human being who has an animal.”

“For many people facing socioeconomic barriers to care, animals are incredibly important in their lives,” says Karen Ward, chief veterinary officer with the Toronto Humane Society (THS). Far from merely sheltering animals, the agency provides subsidized procedures, notably spay and neuter procedures, and has delivered outreach services to First Nations. The THS has partnered with Meals on Wheels and other organizations delivering food to households, including dog food for pets. In 2019, the agency began offering access to free veterinary care for people in the city’s homeless shelters. Partnered with the People with AIDS Foundation, it provides temporary fostering of animals while their owners get treatment.

DVM karen ward
DVM Karen Ward

From diagnostic tools to treatment options, veterinary care has improved since Ward completed her DVM in 1990. Those advances are double-edged, she adds. “There’s such a focus on technological advancement to the detriment of some folks of offering accessible care. Veterinary medicine doesn’t always have to function at that standard. You leave so many behind and that’s not right, not just and not fair. We are doing a disservice to the profession and the community at large when we chase that gold standard. The value that life has should not be reliant on your financial resources.”

Back at OVC, that sentiment resonates with Bateman. For its nearly 160 years, the college’s clinical training has focused on providing excellent veterinary care and equipping graduates to succeed in practice. The new community healthcare program is about widening access to veterinary care, he says, and growing practitioners’ hearts at the same time: “It’s about the simple act of caring and providing dignity and respect to another human being who has an animal.”

Story by Andrew Vowles and illustrations by Jeff Kulak

Kim and Stu Lang Community Healthcare Partnership Program