Recently, a Finnish veterinary colleague and Chairman of the Commission of the Finnish Veterinary Association shared on social media how she had operated a GDV surgery in her very basic primary care practice far up north in the Finnish Lapland with her 17-year-old daughter and the owner assisting in anesthesia monitoring as per her instructions. The reason she shared this was to encourage young veterinarians to try and do their best in critical cases even when the facilities and circumstances are far from the ideal scenario, and to question the view that is sometimes shared in the veterinary circles that attempting GDV without proper hospital facilities, including a trained anesthetist, would equal professional suicide. I was very happy to see this post.

When ‘somewhere else’ is simply too far away

GDV is an emergency where the time that would take to travel from rural and remote places to an emergency care veterinary hospital would often mean that the window of opportunity to save the animal would be lost. It is important that vets working in primary care / general practice clinics maintain adequate surgical and anesthesia routines to be able to handle emergency cases such as GDVs as well. For that, veterinary students need to be taught to practice the ‘Spectrum of Care’ instead of only getting to see the most advanced referral-hospital level specialist care while in their clinical rotation.

What is Spectrum of Care?

I covered briefly a bit about Spectrum of Care in my earlier blog post. The term Spectrum of Care (SoC), was first introduced by Jason W. Stull and his team in an article, “Barriers and next step to providing a spectrum of effective health care to companion animals”, published in 2018.   The article acknowledges how veterinarians have a wide spectrum of diagnostic and treatment options, ranging from technologically advanced and usually more expensive to less advanced and usually also less costly options. The decision on what specific treatment plan is chosen depends on factors such as the knowledge and skills of the veterinarian, the scientific evidence of the safety and efficiency of the available treatments, practice-specific goals, culture, available resources, as well as the owner’s goals, values, and resources. 

The article recognizes that navigating the different care options is particularly challenging for young veterinary graduates whose clinical training is often based on highly sophisticated procedures performed in university teaching hospitals that, in essence, are referral centers. The article then proposes an initiative for improving accessible veterinary healthcare by facilitating discussion within the veterinary profession to promote the expansion of what is considered effective and affordable veterinary care for companion animals.

A key aspect of Spectrum of Care is to create positive-language messaging that supports collaboration between different veterinary care providers and helps owners to find the treatment provider that best meets their specific needs with their pet.

 What If?

Sheena Warman and her team suggest in the 2023 article, “Preparing Vets to Practice Across the Spectrum of Care“, to provide veterinary students with ‘What if?’ questions in a problem-based learning activity. What if – scenarios are so common for us working as vets in countries or regions where a large proportion of animal owners suffer from various barriers for accessible and affordable veterinary care or there is often a lack of resources, including human resources as well as adequate medicine, material and equipment, at the available clinics.

What to do if better hospital facilities are too far away? What if the owner can not afford the cost of a private emergency/ referral hospital but is still willing to go for the surgery at the primary care clinic? What to do if opioid analgesia is not available (this is a reality in many countries because of concerns for misuse by people)? What to do if a trained anesthetist is not available? What to do if there is no hospital ICU care facility, and post-operative care has to be managed as outpatients? 

Spectrum of Care does not mean forgetting or ignoring science and evidence-based medicine. It is not about substandard care. It is about appreciating the full spectrum of options that we can provide, depending on the circumstances. 

 

Spectrum of care and access to care

Spectrum of Care is closely connected with access to care issues.  If the only available care options are the high-end gold standard, many pets go without the care they need or are euthanized because their owners can’t afford the only option that is offered to them. If, on the other hand, the owner has access to free or subsidized clinics, but those clinics lack in skill, manpower, or materials and medicines, again, many pets will go without the care they need. 

Veterinary education in many countries is not providing enough general practice scenarios

How do I relate this to India?

In India, the problems in the veterinary undergraduate education and the available veterinary care are at a different point of the spectrum. Students may be equally taught high-end gold standard treatment concepts in theory, but with very little access to hands on practical training, many fresh graduate vets lack skills and confidence in basic procedures, such as sedation, IV-anesthesia and spay/neuter surgery, all of which are essential veterinary skills in a country that battles overpopulation of roaming dogs and where traumatic injuries that would require sedation or anesthesia for proper initial wound management, are really common. 

While India has a large network of affordable or fully-free veterinary service providers as government veterinary hospitals and dispensaries that are accessible for most animal owners across the country, these hospitals may lack in resources to provide what is presently most needed essential procedure in small animal practice; spay/neuter surgery to help to prevent unwanted pregnancies and unwanted puppies. This is further complicated by the lack of hands-on practical exposure to basic anesthetic and surgical procedures during students’ clinical training. Veterinary education needs a transformation to meet the needs of the day.

Transforming veterinary education to meet the needs of the day?

With the increasing interest in incorporating models to practice and teach SoC for veterinary students in Europe and the US, the veterinary education field there is at the beginning of a new era and transformation to better meet the needs of the day. At the same time, in India, we can be asking the question, how to best develop the veterinary education to meet the needs of the day here? News about the problems caused by roaming dogs are constantly in the media and every animal welfare charity, NGO, and rescue group is way too familiar with the frustration of the constant inflow of litters of abandoned puppies or kittens that have been born to someone’s own dog, in someone’s house, and then abandoned on the streets or dumped in front of a shelter gate.

We keep asking why the mothers of these poor puppies and kittens were not surgically sterilized in time. The answer to this is not to blame the non-existence of ABC centers or poor government funding for stray dog ABC centers. ABC centers are meant for the surgical sterilization of ownerless stray dogs. Owned dogs or cats that give birth to puppies/kittens in homes, garden sheds, and garages should have been operated in time by any veterinarian – government or private sector employed. All puppies and kittens that are found in boxes and baskets on the roadside have been born to owned dogs, pet dogs, companion animals belonging to someone. Someone who did not get their pet surgically sterilized in time.

 

What are the barriers to getting owned dogs operated on in time? What are the myths to be busted?

What are the barriers to accessing this essential veterinary care for so many dog and cat owners? What are the prevailing myths about the requirements in terms of surgical facilities that are required for spay/neuter surgery? 

A couple of weeks ago, I had a short discussion with a person who was willing to financially support an owned dog spay/neuter campaign for economically fragile people at a church ground but who had been misguided to think that you need to run pre-anesthesia blood samples for each dog, even when they would be clinically healthy. This misinformation had stopped her from pursuing her much-needed initiative further since she did not have the ability to do the blood tests. Very unfortunate. The question about the usefulness of pre-anesthesia bloodwork is definitely a topic to explore more in-depth at another time.

There is a huge need to encourage spay/neuter surgeries of owned dogs in small private clinics as well as government hospitals and dispensaries. Two years ago, I wrote a series of blog posts around this topic: what are the requirements for an OT , and what are the common barriers to accessible veterinary care, specifically in terms of access to essential surgery? 

Do we continue to maintain the narrative about high-end gold standard facilities as the only way to perform spay/neuter surgery and, by doing so, fall into the same trap that has been identified in the Spectrum of Care – studies and publications and the access to care -initiatives? That increasing standards in veterinary care have pushed the cost so high up that millions of pets are not getting the essential care they need. By only advocating high-end standards for spay/neuter surgery facilities, we are failing to provide the service for millions of dogs. 

Let’s use what we have in front of us

In my family, I have come to be known as someone who rather comfortably creates meals (or something to eat) out of whatever there happens to be in the fridge or pantry, or who enjoys the transformation of a discarded door into a dining table, or old tyres into garden chairs. To utilise what I already have in some useful way. It seems this is how I also see the way forward in humane dog population management in India.

The WVS India outreach team recently conducted owned dog spay/neuter campaign clinics at different government veterinary hospitals in Karnataka. Hundreds of dog owners brought their dogs for surgical sterilization during the 2-week program. The facilities were excellent and perfect for this kind of work. They were, in the end, government veterinary hospitals. We need to be able to encourage veterinarians to be able to see what is already available and to operate dogs safely and without complications in a spectrum of spaces. 

Your OT does not need to be custom-built. And you do NOT need post-operative care kennels when operating owned dogs. Assess what you already have and just fill in the gaps – whether this is refreshing your anesthesia and surgery skills or getting a new surgery or preparation table to make surgery work flow more smoothly in your clinic. 

#justkeepspaying