So, You Want to Run a Spay/Neuter Clinic in Timbuktu Guidelines for Operating Remote Clinics Dr. Susan Monger Director, International Veterinary Consultants
Every field clinic has unique challenges Regardless, minimal standard of care exists Wide range of what is considered minimally acceptable Determine what this is for your clinic Can t establish or maintain? Reassess goals
Planning isn t sexy. It is hard work. Team members show up and everything is magically there. Or not. Can you do a reconnaissance trip?
Tips for success Determine type of clinic (MASH, mobile, stationary) Determine budget Be willing and able to adapt Cultural awareness Professional and diplomatic sensitivity Translators medically qualified Adequate, experienced staffing Don t be overly ambitious Learn to say no
Timeline and to do lists Begin 6-8 months prior to clinic Prioritize tasks Delegate to responsible parties Know local and national holidays Professional licensure
Communications Identify an in-country or and/or on-site person Able to communicate in common language Internet and phone Logistical challenges Cultural differences in response time Manner of communication
Communications Government officials Identifying who that actually is May expect monetary support Animal welfare not a high priority Assist with facilitation Local assistance Monetary or in-kind support Advertising Community education
Local veterinarians Professional respect Clinic perceived as infringing May be the person who will assist with post-clinic questions or complications Possible difference in professional experience and education May be an opportunity to elevate local standard of care
Permits Can be Difficult Time consuming Frustrating Expensive Find out specific requirements Even with all the correct paperwork Held in customs, taxed or confiscated Have copies of all communications
Controlled substances Almost always require special permits Country of origin Destination country Definition of what is a controlled substance Drug logs How to address leftover drugs Ease of acquisition in respective country?
Medical, Surgical and Clinic supplies Manifest is essential Prioritize Identify what is critical Make team aware of effort and cost Lead vet aware of medications available Oxygen Can be expensive Ability to acquire Regulators
Surgical supplies Sterile drapes, gauze, surgery gloves Suture Instruments Number of instruments/pack Number of packs Extra instruments Sterilization Autoclave or pressure cooker Chemical disinfectant
Acquisition of supplies in-country What is available? Cost Difficult or impossible to acquire some drugs Physical may be worth it to buy in-country Logistical Time and effort of permit acquisition Ease of transport Vaccines Controlled drugs Concentrations
Airline Travel Plan Ahead Flight insurance Divide up supplies Excess baggage fees Weight embargos Box embargos Travel Medical evacuation policy Inexpensive
Food, lodging, transportation Confirm. Reconfirm. Then reconfirm again. Dietary considerations Team members Host country Lodging Secure and safe Amenities Showers Bedding Air-conditioning Bathroom facilities
Advertising Intent of clinic (TNR, owned animals) Community advertising Importance of on-site person Radio Schools Churches Local markets Loudspeakers
Site consideration Ability to transport supplies Accessible to team members Cost and time Food and lodging details Accessible to community members Distance, weather Transport of post-op patients Cats are special
Electricity Expensive in many places Outlets Working? Can overload fuse boxes 110 versus 220 voltage Water and Electricity Water Scarcity Access to Cost Availability of sinks etc. for washing hands/instruments
Staffing and volunteers Ideal number? Ensuring humane and safe care for each, individual animal Recruitment Challenging Passionate team members yet unfamiliar with differences Cultural Condition of animals Professional Skills required can be very different than skills in regular place of work Lacking diagnostics Injectable anesthesia In-country and on-site person
Professional team members Lead veterinarian Responsible for all final decisions regarding clinic protocols To do surgery and/or treat or not Euthanasia Communicating decisions to team Numbers Vets Licensure Spay/neuter surgery experience Technicians Ratio vets:techs Trained and experienced person dedicated to anesthesia
Passionate, dedicated May lack experience Intake Patient prep Volunteers Surgeons are fast, patient prep and recovery slower Recovery
Organizational meetings Essential to team building Identifies key personnel Team leader(s): Lead vet +/- local coordinator Professional staff Volunteers Chain of command Bite policy Bites are big deals Know the incidence of
Records Every patient admitted required to have one Written log of information Owner/responsible party Signed consent Patient information Physical exam findings All medications administered
Caseload and patient selection Assess local needs Dogs vs cats Owned vs TNT or free roaming Let community know intent Caseload selection Parameters clear from the start (TNR, appointments, first come, first serve) Appointments Who will make them? High rate of no-shows
Pre-operative considerations Limits Age and weight Health of candidates May not be in best of health Know the common diseases in the area Weigh risks of anesthesia and surgery to benefits of surgery Surgical candidacy determined by veterinary staff Veterinary skill present but post-op care is not Physical exams required Exceptions- aggressive, feral
Anesthesia Determine degree of prep - IV catheters, endotracheal intubation Budget Time Experienced vet or tech necessary to oversee Everything in place before pre-medicating Designate a place for emergency drugs and equipment Communicate with surgeon
Surgery Surgeon prep Caps, masks, gowns? Hand washing Consider waterless Consider elements on team members and animals Sun Temperature
Recovery Critical to assure patients recovering in appropriate manner Experienced team member oversees Monitored until acceptable level of recovery Minimize noise and traffic Thermoregulation Surgeries requiring extended care
Post-operative care and instructions Written copy provided In appropriate language and wording Local literacy rate Explained to a responsible party Local contact for questions or complications Observe method of transport
Same day release vs housing 1-5 days Same day release Pros Reduced patient stress Reduced staffing Reduced costs Reduced clinic supplies Waste disposal minimized Cons Inability to monitor patient Possible lack of confinement Loss of follow up Access to food, water, Housing Pros Confined activity and restriction Easier monitoring Ensured access to food and water Ensured access to warmth Cons Increased stress Owner reclamation may be reduced Possible decreased capacity
Instrument and clipper care Instruments are expensive Chemical disinfection Washing Water often has high mineral content After clinic care Ultrasonic cleaners Instrument soap lubricates Clippers cleaned well and oiled
Conclusion These are guidelines Develop, plan, and conduct clinics in a manner benefitting the location, objectives, community and most importantly, the animals. Minimal standard of care varies based on logistics Planning takes time and effort Requires ability to adapt
Conclusion If animal welfare is compromised due to poor planning, then all your efforts are for naught Lack of adherence can: Adversely affect patient outcome Undermine the trust of the community We are their voice We are ambassadors for domestic and international animal welfare and humane care We teach by example
Questions?