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Sustainable Veterinary Service in Northern Canada -- 2017 Workshop Report

 

Executive Summary

On Friday July 14, 2017, Veterinarians Without Borders (VWB/VSF Canada) - with support from PetSmart Charities, Aimia, and the Canadian Veterinary Medical Association - hosted a panel and workshop with the participation of a variety of stakeholders from across Canada. Panelists and participants included Indigenous community representatives, small and large scale veterinary service organizations, academics, industry, tech start-ups, provincial and territorial government and non-government agencies, representatives of veterinary regulatory bodies and professional organizations, and representatives with a deep understanding of the historical context and regulatory issues. A nine-member panel discussion was followed by a facilitated break-out session for participants and panelists to share their experiences, thoughts and generate discussion on 5 key questions around the provision of sustainable veterinary services in underserviced, remote, Northern communities in Canada.

Eight key themes emerged from the panelist presentations and the break-out discussion group contributions.

  • 1) Different communities have unique ‘problems’ and are culturally different, require appropriate, individual approaches.
  • 2) There is much to be learned from previous experience – evaluating programs and supporting results-based programs and projects is key.
  • 3) There is a need for a unified guidelines and codes of practice.
  • 4) Resource management around program costs, sources of funding, and human capital needs coordination and co-development.
  • 5) Building relationships, engaging community leaders and representatives in planning, program development, implementation, and evaluation is a pre-requisite for successful outcomes.
  • 6) Cultural respect and managing expectations is important in relationship building and for rewarding experiences on both sides of the community veterinary service equation when working with remote northern communities.
  • 7) Emerging technologies and evolving animal health and welfare issues should be on the radar for future program development.
  • 8) From community by-laws to federal policy, there are regulatory barriers and inconsistencies across the country to support sustainable, innovative solutions in building veterinary capacity where there is none.

Building on this inaugural workshop, VWB/VSF Canada has several things to consider to move forward on supporting underserviced communities – development of strategic partnerships, mission clarification, and the need for continued consultations of underserviced communities and past/present veterinary service providers, VWB-VSF Canada has an opportunity to take the lead in coordinating sustainable solutions to building veterinary capacity and service provision in Canada’s north.

 

Ceremonial welcome to the traditional territory of the Mi’kmaq.

 

Workshop

On Friday July 14, 2017, Veterinarians Without Borders (VWB/VSF Canada) hosted a half-day workshop as part of the Canadian Veterinary Medical Association annual conference in Charlottetown, Prince Edward Island. A variety of stakeholders were brought together from across Canada (see appendix A for participant and panelistlist). Key objectives for the workshop were 1) to identify key needs, challenges, and opportunities to strengthen sustainable veterinary and one health service delivery in remote and underserved areas of Northern Canada and 2) provide a platform to facilitate future engagement and collaboration with key stakeholders.

Workshop participants were welcomed to PEI by VWB/VSF President John Vanleeuwen and Executive Director Chris Braeuel. A formal welcome to the traditional territory of the Mi’kmaq First Nation was extended in an opening ceremony hosted by representatives of the Mi’kmaq Confederacy of PEI. A nine-member panel discussion was followed by a facilitated break-out session for participants and panelists to share their experiences, thoughts and generate discussion around 5 key questions:

  • 1) What are the most pressing needs and challenges facing communities in remote and underserved areas of northern Canada with respect to veterinary services?
  • 2) To what extent are these needs and challenges being addressed and what more needs to be done to support northern communities?
  • 3) What are the limitations of the current approaches? How could those limitations be addressed?
  • 4) Are there un-tapped resources (human and financial) that could/should be accessed in order to serve more northern communities?
  • 5) Is there a role for national coordination of northern efforts? As a national organization with an understanding of this issues, is VWB/VSF Canada an appropriate choice as convener/coordinator?

Gerald Anawak, from the Nunavut Department of Health, and Ann Ratt, from the Lac La Ronge Indian Band Council, shared their experiences around animal and community health, and veterinary services in their communities. Remaining panellists were given 5 minutes to share their experiences and expertise in veterinary service programs, the regulatory environment, the historical context of animal-human relationships and service provision in Canada’s north and Indigenous communities. Panellists and participants were divided into 5 working groups to rotate through each question, where a volunteer recorder collected and shared the input and contributions to the group as a whole. All responses were recorded on flipchart paper and thematically summarized for the purpose of this report and to inform considerations for VWB/VSF Canada.

                    

Key Themes Emerging from the Workshop:

  1. Unique communities, similar problems, individual approaches
  2. Learning from previous experience – evaluating programs and supporting results-based programs and projects
  3. Guidelines and codes of practice – Coordination, Connection, Co-development
  4. Resource management – costs, sources of funding, human capital
  5. Creating relationships and community involvement – planning, program development, implementation, engaging community members
  6. Developing respect – cross cultural training
  7. Changing landscapes – emerging technologies, evolving animal health and welfare issues
  8. Adapting regulation and legislation – from community by-laws to federal policies

The findings from the workshop will be used to inform VWB/VSF Canada’s role in supporting sustainable veterinary service in remote, underserviced communities in Canada’s north.

For the panelists and participants in this inaugural workshop, we hope this report serves as an accurate reflection of your dedication and captures the depth and varied experiences of animal care and community service in northern Canada.

For VWB/VSF Canada, we expect this report to act as a template for future endeavours in supporting collaborative, evidence-based, community-informed, culturally appropriate, and sustainable one-health approaches to underserviced communities in Canada’s north.

The workshop break-out session and this report were facilitated by Trace MacKay DVM, MPH for VWB/VSF Canada.

The workshop was made possible through the generous support of PetSmart Charities, Aimia,  Canadian Veterinary Medical Association, and VWB/VSF Canada.

Facilitator Trace MacKay

 

A comment on words and language:

One of the sub-themes that struck a chord with participants was language – how some words have been differently understood, used and/or perpetuate negative connotations. How we use some words interchangeably, or how a word can mean something different to different people, can affect our ability to communicate and understand one another.

“Some dogs, as everywhere else in the world, do need rehoming because people don’t have the economic, social, or physical means to keep them anymore. This is a voluntary act, agreed upon by the owner and the organization/adopter, as the best option for that animal. It is not a ‘rescue’.”

A vet can mean a veterinarian or a veteran – as was mentioned, this can impact uptake of veterinary services. Care needs to be taken when advertising veterinary services.

Northern does not mean Indigenous. Most underserviced communities in the north are Inuit, First Nation or Metis, but not all. Cross-cultural sensitivities apply mainly, but are not limited to, an Indigenous scope, and may include addressing the divide between southern and northern community norms when it comes to animal ownership and care.

Accessibility, underserved and underserviced are linked but separate terms. Access to veterinary services can be affected by geography, distance, transport, finances, cultural beliefs, language, physical barriers, mental health challenges, and other circumstances. There are many historically underserved populations in Canada but underserviced, in the context of the workshop and this report, indicates populations with shortages of trained veterinary professionals due to remote location. As a guiding principle, VWB-VSF Canada seeks to build veterinary capacity where it is lacking.

 

VWB/VSF Executive Director Chris Braeuel with panelists.

  • 1) Unique communities, similar problems, individual approaches

The current privately owned veterinary business model cannot work with remote Indigenous communities due to a variety of factors. They need a public-health minded veterinary service delivery model that integrates with non-veterinary dog-related services.”

Gaining a deeper understanding of the unique needs and assets of each community around animal health, safety, welfare and control is essential for purposeful interventions. “Dog problems” are not one thing, but many different challenges that require appropriate approaches – dog roaming, dog overpopulation, feral/pack dogs, dog bites and mauling, zoonotic and infectious disease transmission, animal welfare, husbandry and housing, preventive/acute/chronic health care needs, changing human-animal relationships, community mental health, hope. Participants shared that livestock, food safety/inspection and wildlife veterinary services, should also be on the radar when discussing one-health in Canada’s north and remote regions. Not all animal-related public health issues require veterinary expertise – seeking out community-based solutions that work (bylaws, dog bite prevention education, animal care and confinement, etc.) and sharing this with others is a necessary and often overlooked part of the solution.

A clear understanding from the community about their animal-related public health and safety concerns and mapping the resources available in the community to support successful, sustainable intervention is key to planning, developing, and delivering successful assistance.

  • 2) Learning from previous experience – evaluating programs and supporting results-based programs and projects

To date, there has been no coordination of remote area veterinary service provision in Canada – there is no database or other collective resource mapping programs/projects in Canada’s north. Panelists and participants commented that they learned of new projects and programs of which they were previously unaware. The size, scope, and types of interventions introduced by panelists varied but all provided learning of what worked best in the communities they delivered programs and projects in. Community members have much to share about what has worked well and that well-intentioned but poorly executed ‘help’ should be avoided in the future.  For many projects, formal evaluation of the effectiveness and impact of current and past interventions is not as robust as it could be, and seems limited to academic and government-based pilots and programs. Common mistakes and missteps provide valuable guidance to avoid distrust of the veterinary profession in their community. Capturing trends and shifts that come with long-running programs helps address emerging needs that may be very different from the original challenges faced in the community. Proving service provision is making a difference to the problem(s) set out to solve and improving all aspects of service delivery for more efficient and effective solutions requires program evaluation – activities and outputs don’t change anything, outcomes do! Clear communication, cultural sensitivity, and relationship building are key to establishing rapport with community members and leaders.

Results matter – to learn from other’s mistakes so they are not repeated; to prove interventions are making the difference that was hoped for; to inform program improvements and lay the groundwork for new program planning; to identify and adapt to changes; to make sure resources required to support veterinary service provision in remote underserviced communities are validated.

 

A national database of remote area veterinary service providers and the communities they serve would provide up-to-date information, highlight the gaps and the scope of the problem of communities lacking veterinary services.

 

 

Panelists.

 

  • 3) Guidelines and codes of practice - Coordination, Connection, Co-development

“Coordination is welcomed and needed - especially in the area of sharing resources, information between groups.”

Just as there is no collective understanding of veterinary service provision in Canada’s northern and remote communities, there are no existing national protocols, guidelines or codes/standards of practice. Disjointed and uncoordinated efforts are risky – to the health and welfare of animals, to community members, to veterinary professionals and volunteers, to the organizations/institutions/agencies they represent, and to funders/supporters. Decision support tools for communities are needed to make informed consent on veterinary service agreements. While the standard and scope of practice can be different from for-profit veterinary businesses, it should not be (in reality and perception) substandard. An ability to share resources and unify the various service providers will improve service delivery. Protocols and guidelines to be used by community leaders and service providers to inform service delivery agreements would help to inform expectations on both sides and ensure harmonized standards of care. Co-developing these resources with experienced community representatives and veterinary service providers (the knowledge keepers) is paramount. Resources for community-based interventions (as mentioned above) also require a central platform for sharing.

Creation and dissemination of resources, in the form of guidelines and protocols, co-developed with experienced service providers and community members are necessary for ensuring quality and respectful standards of practice in veterinary service provision to underserviced communities.

  • 4) Resource management – costs, sources of funding, human capital

“Success will only come once the public health component of the problem is accepted and funding is available to deliver ongoing, sustainable service delivery. The number of communities and the inaccessibility of many of them makes the need for funding even greater.”

More often than not, projects and programs in remote communities have been charitable pursuits. The capital and incidental costs undertaken for moving people, equipment, and inventory in and out of remote areas for temporary veterinary clinics is high – the cost of doing nothing is potentially higher. The sustainability of the charitable model is constantly challenged by funding, organization and oversight, staff and volunteer burn out, strained resources, and unrealistic expectations on all sides.  Fundraising for tangible activities is one thing, having enough resources for soft costs like cultural sensitivity training, program evaluation, and communications can be difficult. “Everything” costs more in the north – transportation, housing, food, energy – the costs to the community to host volunteers cannot be overlooked. For veterinary industry stakeholders, numerous small requests for in-kind and financial donations are time-consuming and problematic. Historical agreements and treaties have left out animal care. Public health and safety is a responsibility shared by all levels of government – local, provincial, and federal. The charitable model is unsustainable and risks perpetuating colonial approaches to Indigenous community needs.

A balanced and fair approach to funding sustainable solutions for animal related public health issues requires multi-tiered approaches of public/private partnerships as well as financial and policy support from all levels of government.

 

 

Breakout session.

 

  • 5) Creating relationships and community involvement – planning, program development, implementation, engaging communities

“To build permanent solutions to dog problems in Indigenous communities, we must respect culture or risk imposing solutions that will not be received by communities. We need to avoid making the same colonial mistakes by insuring inclusion of Indigenous culture and tradition into solutions.”

Everything with Indigenous communities is based on relationship. Relationships need a significant investment of time and self successfully create a connection through shared experiences, life paths, gifts, meals, sacrifices, losses, etc. Relationships can be transferable but once broken, are extremely difficult to repair. To engage a community, relationships are pre-requisite.

As mentioned above, there is no single, “right” intervention – the communities and their needs around animal related public health and safety are unique. Some communities have assets and resources that others do not. Asserting “Southern” values and judgment ignores historical context and local expertise in addressing animal-community health problems – expertise needs to be shared, rather than delivered and this can only be accomplished by working with communities to develop appropriate solutions. Community readiness and recognizing criteria for success for sustainable animal related public health programs are a shared responsibility of the community receiving support, and the organizations and agencies providing that support. Subsidized farm service models for rural and remote communities exist in some provinces and are available in many communities that lack companion animal veterinary services – it’s a model worth exploring. Without community buy-in and trust, advanced preparation/readiness from both the community and the veterinary service provider, interventions are unlikely to succeed. Lasting change starts with awareness, knowledge and attitudes – community education should be the cornerstone of any sustainable plan.

“Nothing for us without us.” Resources, programs, policies, and knowledge transfer require community-level input. Acknowledging the appropriate channels and consulting community leaders and knowledge keepers are a key component to respectful, long-term relationships. Building relationships can take time, but are necessary for learning in both directions. When looking for solutions, the long-term vision needs both eyes – one seeing with traditional/local knowledge and one with western knowledge.

  • 6) Developing respect – cross cultural training

“Communities need first to be respected and to be full partners in the program. Those delivering programs should familiarize themselves with the cultural, social, economic, and historical context and recognize that their framework is not the only, and perhaps not the best, framework.”

 

Cultural sensitivity training services and trauma-informed program development are emerging in human healthcare provision and should be explored as requirement for veterinary service providers. Visitors to communities needs to be open for learning to go both ways – a deeper understanding of the historical and cultural realities of the community members service providers are working with is necessary for relationship building and long-term community engagement. Acknowledging past wrongs is a necessary step for moving forwards. Developing trust takes time but produces good results in the long-term. Allowing the time and space for communities to clearly identify their needs and how they will be part of any sustainable solution is critical for respectful consultations and informed community consent to services. Workable solutions and realistic expectations are created in an environment of true cultural respect.

Cross- cultural training is a standard of practice in international development projects. When working nation-to-nation within the Canadian context, cultural sensitivity training should be a prerequisite for community-based programs in Canada’s north.

 

  • 7) Changing landscapes – emerging technologies, evolving animal health and welfare issues

“Current models in which veterinary schools and not-for-profit organizations provide charitable dog population control clinics for Indigenous communities cannot be scaled up to provide ubiquitous services across 60-70% of Canada’s land mass.”

 

Infrequent, one-off, fly-in/fly-out veterinary service projects may not be the best solution to address sustainable solutions to animal related community health issues. Consistent support and community contact is required for meaningful impact on animal populations and community health. For preventive care, rabies control and animal population management, this means (minimally) annual visits to communities. Even then, temporary clinics do not address day-to-day veterinary service needs such as access to urgent care (including basic first aid), humane euthanasia, chronic condition management, and animal-owner education. Permanent animal identification and record keeping are important core considerations in service provision and should be community-controlled. VWB-VSF Canada and their local partner organizations have used Community Animal Health Worker training to augment veterinary service provision in underserviced areas in many countries, developing curriculum and providing training for basic care including vaccinations, animal health and husbandry education, and disease monitoring. Emerging technologies around animal sterilization, micro-chip identification implants, and tele-health provide opportunities to “re-think” the possibilities for community-based animal care. Transitioning from charitable models to community-based enterprises is a sustainable approach worth exploring.

Looking to community-based models of care that consider emerging technologies should be considered in veterinary service solutions.

 

  • 8) Adapting regulation and legislation – from community by-laws to federal policies

“We need national coordination with a variety of federal, provincial and territorial governments plus agencies to advance the Dog-Related Veterinary Infrastructure needs of remote and under-serviced Indigenous communities. This involves lobbying and the development of consultation-based model frameworks containing Indigenous solutions.”

 

Workshop participants overwhelming agreed that VWB-VSF Canada is well positioned to take on a leadership role in supporting responsible, respectful and sustainable veterinary service provision to underserviced communities in Canada’s north – but they can’t go it alone. Partnership with national and provincial veterinary organizations and registrars will be necessary to lobby for legislative changes and funding that is required to assist veterinary service provision and explore new models of community-based animal health care. Community solutions need to be community informed – policies and guidelines to support community service agreements should be available to veterinary service providers and well as communities seeking services. Models for community bylaws to support animal control and animal related public health exist and have proven valuable for communities to take ownership and leadership – sharing and adapting these bylaws through national Indigenous organizations would be beneficial. Recognizing that animal related community problems are public health and safety issues is important framing for gaining shared support from provincial and federal agencies. Current polices and regulations are restrictive for some solutions – they shouldn’t be ignored, but explored for improvements that support innovative community-informed solutions to lasting, meaningful change and support. Veterinary professionals and concerned citizens across the country want to be part of the solution for helping underserviced communities in Canada – but navigating how to go about this is difficult, as there is no central resource or oversight body coordinating efforts. Industry partners are looking for ways to engage their veterinary customers in South-North support for Canadian programs. An identifiable leader is needed to bring solution-makers together, to coordinate programs/projects, set standards of care, and consult with communities to co-develop resources and programs that meet their specific needs.

 

VWB-VSF Canada should explore strategic partnerships (academic, funding, programming, policy) to establish itself as leader in veterinary and animal-care services for underserviced northern and remote communities in Canada.

Future considerations for VWB-VSF Canada

 

  • 1) Include Indigenous representation on the VWB-VSF Northern Committee. “Nothing for us without us” is an important mantra to embrace. This could include participants from the workshop, community representatives from current/former VWB-VSF projects, or Indigenous veterinary professionals.
  • 2) Build strategic partnerships – in funding, program development, regulation/policy, and delivery. As the national “go-to” organization for veterinary service provision for remote, Northern communities, VWB-VSF Canada should align itself with other national partners to be effective in this space. Possibilities include: national veterinary professional organization (e.g. CVMA), the veterinary colleges, industry leaders, Indigenous leadership organizations, and key F/P/T government agencies.
  • 3) Build relationships with Indigenous communities and leaders. There needs to be a depth and breadth of experience and knowledge brought in on Indigenous relationships, culture, consultation, and rights as they relate to veterinary service infrastructure, Indigenous governance and federal, provincial and territorial governments and their bureaucracies. VWB-VSF Canada should align itself with an organization(s) that can focus on consultation-based model frameworks for the harmonization of Indigenous culture and solutions with federal, provincial and territorial jurisdictions.
  • 4) Consider organizing a multi-day summit/conference on veterinary service provision in Canada’s north. With organizational and funding support from partners to bringing together stakeholders from across the country. This builds on the momentum of the inaugural workshop to hear a wider breadth to collaborate on approaches to responsible, sustainable veterinary service provision to underserviced communities in Canada.
  • 5) Co-creating and sharing resources for community organizations. These could include a check-list of community based assets (e.g. animal control bylaws, community education, animal identification, animal health workers) necessary to support longer-term success of veterinary service programs. Samples of service agreements or animal related bylaws could be available for adaptation.
  • 6) Creating and sharing resources for veterinary service providers. These could include cultural sensitivity training, minimum standards of care, program evaluation supports, volunteer databases, etc. 
  • 7) For the long-term, consider developing and delivering VWB-made programs that are informed by VWB’s work internationally that builds veterinary capacity where there is none. This could include CAHW training (animal identification, vaccination, community education, animal first-aid, disease reporting etc.) or facilitating the development of community-based solutions for the numerous dog-related public health issues (over-population, bites/mauling, rabies and other zoonotic disease transmissions, animal welfare, housing and sheltering, etc.).

 

  

Thank You To:

 

 

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