The veterinarian’s role in Aboriginal and Torres Strait Islander community dog and cat health and management programs

Purpose

This policy aims to provide guidance for veterinarians providing veterinary services and/or assisting with the management of dogs and cats kept as companion animals within Aboriginal and Torres Strait Islander communities. This policy can be used by Aboriginal and Torres Strait Islander communities, local councils, and veterinary providers to help ensure the achievement of effective and sustainable animal health programs.  The AVA gratefully acknowledges the assistance of AMRRIC in the development of this policy.

Policy

1. Human, animal and environmental health and wellbeing are mutually interdependent within communities and should be managed using a One Health and One Welfare approach.
2. Programs to improve animal health require the invitation, permission and collaboration of Aboriginal and Torres Strait Islander communities to co-develop the best ways of identifying and implementing solutions.
3. To achieve the desired objectives and sustainable outcomes, appropriate planning, communication, personnel training and support, and community education are required.
4. Adequate funding should be available to support appropriate standards of animal health and management, minimising the need for veterinarians to accommodate funding gaps or compromise standards of care.
5. The attending veterinary teams should be committed to helping facilitate long-term community care through regular visits and the development of local capacity and resilience.

Background

Managing companion animals within Aboriginal and Torres Strait Islander communities plays an important role in promoting animal health, well-being, and population control, as well as improving community safety, and human and environmental health. (D’Onise et al., 2017; Ma et al., 2020).

Veterinarians have unique skills in being able to help maintain animal health, as well as a comprehensive understanding of zoonotic diseases, food security, preventative medicine and public health. A One Health approach can help mediate differences in goals, values and priorities and help prioritise management measures and desired outcomes.     

There are challenges associated with provision of such services in these communities. Many Aboriginal and Torres Strait Islander communities are located in rural and remote areas, which are geographically isolated from regular veterinary facilities.  Services are usually limited in scope, intermittent and for relatively short periods of time.  Physical facilities may be limited, so adaptation of usual protocols may be necessary while still complying with regulatory standards. Cultural and language differences are common, and sensitivities prevail regarding who, how, what and when work can be carried out. The cost of services presents financial challenges for stakeholders, including the veterinarians. The remote nature of the work may present security challenges for veterinary personnel, and compliance with regulations for the secure storage of veterinary pharmaceuticals also presents logistical problems.    

Recommendations

1. Planning

Participation in activities that promote animal health should occur only after consultation with and at the invitation of recognised community leaders and representatives. Veterinarians should engage with communities prior to embarking on any program to identify community wants and needs, co-develop programs, and establish mechanisms for obtaining regular feedback from the community on outcomes.

Risk assessments should be undertaken for the personnel involved, including how to respond to any medical emergencies that may occur.

Veterinarians should seek advice and collaborate with groups or individuals who have experience delivering similar programs within communities to avoid unnecessary duplication or repetition.

Animal health and management programs should be cognisant of community needs, values and aspirations.  Programs should seek to involve local community employees or employ local persons who are sufficiently trained and remunerated in order to facilitate communication and enhance local capacity.

Where appropriate and welcomed by the community, supervised involvement of veterinary students in these programs should be encouraged and supported.

2. Training

Suitable training prior to working with communities is recommended for all professional staff to ensure that the needs of communities are holistically met. Prior training prepares individuals to adapt and apply their skills in locations using the available and often limited resources. At a minimum, it is recommended that individual veterinarians have sufficient experience with the routine procedures (e.g. desexing) likely to be performed while on location.  Prior to undertaking responsibility for a program, veterinarians should participate in a period of in-community practice with a reputable, experienced veterinarian. Nursing staff need to be suitably trained and qualified for the program. It is important to recognise that many remote community programs tend to be focused on population-level health, which is different to individualised approaches that predominate in private practice settings.

3. Ethical considerations

Veterinarians must be aware of their legal obligations under veterinary practice legislation, and their professional and ethical obligations to the patient, owner, community and those funding the program. Prior consideration and discussion of potentially conflicting priorities and common ethically challenging scenarios that may be encountered (e.g. major limb fractures, the difference in cultural understandings and acceptance of euthanasia) should occur with key community decision-makers. This should include consideration of governing legislation and any relevant standard operating procedures prior to the commencement of an animal health program.

4. Cultural awareness

Cultural awareness in relation to local communities where work will be undertaken is essential. This should include an understanding of animals' roles within those communities.  All veterinarians and associated veterinary personnel should make themselves aware of the history, customs and traditions of the relevant communities they choose to work with and should respect their culture, traditions and laws.

5. Communications

Within communities, veterinarians should identify community members who can act as cultural liaisons to consult on issues or questions that may arise.  Planning should include ways of managing external communications when remote access is limited. “Maximizing community involvement, participation and control will help to ensure that initiatives are locally appropriate and sustainable and work to empower local people” (Constable et al., 2013).

Veterinarians and other accompanying personnel should seek owners’ or authorised agents’ informed consent before treatments or procedures are conducted on animals. The process of obtaining informed consent must provide the owner or agent with an adequate understanding of intended procedures, possible outcomes, any limitations, and if euthanasia is to be considered.   The assistance of an adequately trained and remunerated local community employee is recommended at all times as it can significantly reduce communication issues.  The capacity of animal owners to follow treatment recommendations should be considered when choosing and discussing treatment options.

6. Personal and community safety

The nature of remote work creates unique challenges in terms of personal and community safety. A means of communicating in emergencies should be established. Ways of helping maintain personal safety within communities should be communicated prior to arrival and during any on-site activity. Contacts within communities to assist with health and safety should be provided and available. It is recommended that all community work is undertaken with a minimum of two people present, especially in remote locations. The provision of after-hours care must be carefully assessed and may have to be reconsidered where personal safety is at risk.  Procedures must be in place to ensure that community health and safety is not compromised by any treatments provided, including maintaining the security of drugs and poisons.

7. Management and use of pharmaceuticals

There must be protocols in place to safely store and prevent inappropriate access to pharmaceuticals, in line with normal regulatory requirements. Use of all veterinary medicines should be in line with manufacturers recommendations and/or the drugs and poisons legislation in the relevant jurisdiction including any rules and regulations around off-label use.

Any potential for human exposure or environmental contamination should be considered prior to use of pharmaceuticals.

8. Remuneration for services

Programs should be funded to enable the delivery of contextualised veterinary services to an appropriate standard. Payments for veterinarians and their staff, unless participating in a voluntary capacity, should be considered, aligned with professional standards and compatible with the cost of providing services within regional communities. This includes consideration of the financial capacity of communities, their needs and the opportunity for cross-subsidisation of services.  Remuneration for services provided by community members in line with the relevant award should also be included in funding arrangements. Wherever possible, program funding should include contributions (financial or in kind) from local partners in addition to any external funding sources, as this is an important mechanism for building long-term local sustainability.

9. Registration and regulations

Veterinarians must be registered (or have their registration recognised) by the relevant state or territory veterinary practitioners board in which they are providing services. This also applies to veterinary nurses in Western Australia, and may include further jurisdictions in time.

Prior to undertaking work within communities, veterinarians should familiarise themselves with the relevant jurisdictional regulatory framework and veterinary board requirements, including expectations around clinical record-keeping and insurance.

10. Follow-up care and advice

Veterinarians and organisations employing veterinarians to provide community services should provide, or make suitable arrangements for the appropriate provision of, follow-up care and advice, including after-hours, in line with relevant state or territory legislation and board requirements. For example, the provision of telephone contact details to advise on post-surgical issues and ongoing community animal health.  Preferably, procedures, surgical techniques and materials should be selected that minimize or eliminate the need for routine postoperative care or follow-up by the owners. For longer visits, it may be possible to conduct surgeries early on in the visit and leave some routine tasks for the last few days, so that any post-operative problems become apparent before the team leaves the community.

11. Education and capacity building

Whilst medical care of individual animals is important, improving overall animal and community health and welfare in a holistic and sustainable way is equally important.

Programs should seek to integrate education and training which will empower local communities by building local capacity.  These should be tailored to the needs of that community and discussed during the consultation period prior to delivery. Collaboration with local schools and organisations experienced in delivering community education may help to facilitate this training.  Translation services may need to be utilised to deliver education in local languages other than English.

References

Constable SE, Dixon RM, Dixon RJ, Toribio JA. Approaches to dog health education programs in Australian rural and remote Indigenous communities: Four case studies. Health promotion international. 2013 Sep 1;28(3):322-32.

D’Onise, K.; Hazel, S.; Caraguel, C.G. Mandatory desexing of dogs: One step in the right direction to reduce the risk of dog bite? A systematic review. Inj. Prev. 2017, 23, 212–218.

Kennedy, B.P.A.; Brown, W.Y.; Butler, J.R.A. Frame Analysis: An Inclusive Stakeholder Analysis Tool for Companion Animal Management in Remote Aboriginal Communities. Animals 2021, 11, 613. https://doi.org/10.3390/ani11030613

Ma, G.C.; Withers, A.-M.; Spencer, J.; Norris, J.M.; Ward, M.P. Evaluation of a Dog Population Management Intervention: Measuring Indicators of Impact. Animals 2020, 10, 1061. https://doi.org/10.3390/ani10061061