A passage to India

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170415MikeLisa-26_PPMelbourne vets Michael Heath and have volunteered on street dog programs in India every year since 2011. The experience has taught them many valuable lessons about being a good vet. John Burfitt reports

It’s often said that one of the best outcomes of volunteering is it offers the volunteer a new perspective on life. And also on the way they work, if the experience in India of Melbourne veterinarians Dr Michael Heath and Dr Lisa Sander is anything to go by.

The couple has been on four volunteer trips to India since 2011, the most recent being in December last year to Kolkata in north-east India with Mission Rabies, an initiative of World Veterinary Services.

However, during their trip in 2012 to Bylakuppe with Vets Beyond Borders, the significance of what they were successfully able to achieve in the most basic of conditions really hit home.

It was on completion of Dr Heath’s first day working with a local nurse as they de-sexed street dogs and vaccinated for rabies, all completed in a giant tent with the most basic surgical equipment, that he took stock of the results they had achieved.

It quickly put the high cost of the extensive renovations on their East Bentleigh Veterinary Clinic back in Melbourne into sharp focus.

“After that day, I called back to our clinic team in Melbourne and said as a joke, ‘Stop everything—I have just seen that all we need to do our job well is a tent!’” Dr Heath says, laughing. “The experience took me back to basics and the way we had been trained to do a straightforward job.

“The thing about volunteering is you always get far more out of it than the people you are training. I always come back to Australia working more efficiently and effectively, because in India, you don’t have the time to muck around. You simply have to do everything better as you don’t have all the bells and whistles to fall back on.”

The trip last December was Drs Heath and Sander’s fourth volunteering mission to India. This time, they were working with Mission Rabies, focusing on the rampant health problem of rabies, where it’s estimated one person in India dies every hour from the condition, and an infected dog bites a person every two minutes.

The Mission Rabies truck has a full operating theatre and performs as a lecture theatre. Dr Lisa Sanders conducts the MR lecture on anaesthetics.
The Mission Rabies truck has a full operating theatre and performs as a lecture theatre. Dr Lisa Sanders conducts the MR lecture on anaesthetics.

Wide-scale vaccinating programs are being implemented with the aim to eradicate the virus from India’s dog population. Volunteer vets from around the world work with local vets to implement the programs, but also act as teachers to help establish best practice procedures.

A national sterilisation initiative is also underway across India to address the problem of street dogs, with the aim of stabilising dog populations.

“The local vets we worked with were very good. They are competent and know what they are doing, but they are really keen to learn better ways of operating,” Dr Sander says.

“You have to know they will be watching you and following your lead. But if you can manage to stay calm and give an air of confidence and competence, you really are halfway there.”

In Bylakuppe, where Drs Heath and Sander were based on the trips from 2011-13, there has not been a human rabies case since the program started. It is also estimated that when 70 per cent of the dog population is vaccinated, rabies can be eliminated.

Out-of-control behaviour by packs of dogs can also be brought under better management through sterilisation, significantly reducing aggressive nature.

“If you desex them, the dogs are no longer aggressive. They change their behaviour and are no longer having litters, of which they are protective,” Dr Heath explains. “I have been in situations where I have been confronted with a pack of street dogs and it is pretty intimidating.”

The husband-and-wife team, who met while studying vet sciences at the University of Sydney over 20 years ago, are strong advocates for volunteering. They have other expeditions planned for the coming years as well, possibly to Goa on another mass-sterilisation program run by Mission Rabies.

Dr Sander, who also volunteers one day a week at the Australian Animal Protection Society in Keysborough, says it was not just philanthropic reasons that resulted in their first volunteering adventure in 2011. It was inspired by a long-held love of India.

“It just started out as a love for the country and wanting to see it in a new way, through different eyes,” she explains. “We also wanted to do something for India and working alongside the people is the best way to really get to know them.”

But a voluntary working situation is a far cry from being on holiday, as the couple discovered. The biggest issue to deal with when they arrived was the culture shock of working in an environment a world away from a typical Australia clinic.

Aside from language differences with the local vets, there was almost no high-tech modern equipment, little chance of air-conditioning and some of the examination spaces were in tents or out in the open.

The recent Mission Rabies trip provided a contrast of experiences. On some days, they worked in a state-of-the-art, specially outfitted surgical bus, while on other occasions, they were operating in converted office spaces.

Drs Sander and Michael Heath with the Mission Rabies surgery course participants, Dr Megna, Dr Annapurna and friends off the street.
Drs Sander and Michael Heath with the Mission Rabies surgery course participants, Dr Megna, Dr Annapurna and friends off the street.

“I am sure some people would walk in, take one look at the very basic conditions and say, ‘What are you doing trying to work here?’” Dr Sander says. “We had to learn to do it, and so you take a big breath and remember you can do your best work in a sterile environment. If anything, it reminds you of all the basic lessons you learnt in training, and you find you go back there as a way to making it work.”

One example of best practice put into action is in the way dogs are sutured. As these street dogs will not be brought back in to have the sutures checked, Dr Heath explains the onus is on the vets to get it right the first time.

“We were working with a local doctor, Dr Aswin, who was so tough on the quality of work and set a very high standard,” he says. “And by doing so, the students were getting it right, so there was a minimal chance of future infection.

“By the end of the two weeks, the work these students were doing was far better than some of the suturing I see qualified vets doing back here. And the standard I expect now is much higher too because of that. It is about doing the job properly,”

An important insight of the trip that actually proved to be something of a relief was the discovery that as Bylakuppe is in a Buddhist area, it is also a no-kill area. The euthanising of animals is discouraged as a treatment.

Initially, Dr Heath says he was certain he would have difficulty operating under such conditions, but the reality provided him with a very different reaction.

“I actually returned home feeling very refreshed as I had not euthanised one animal in three weeks,” he explains. “It takes a toll, and not having the option to do that for weeks proved to be a breath of fresh air. I didn’t realise how much it was impacting on me until I stopped it.”

Returning home to Melbourne and to his own clinic, as well as a very different population of animals and clients, was the reality check he needed that different cultures operate in different ways.

“You do need to be clear about what you do, and need to have two approaches to your work,” he says. “There is a way of doing things in that culture and in our culture, and they both are valid. As always, it is about applying best practice for wherever it is you find yourself.”

Both Drs Heath and Sander remain passionate advocates for volunteering. At the moment, they are currently in close contact with two of the practice’s staff members, vet Dr Farlie Lewis and senior vet nurse Nicole Patterson (with their partners), who are in Nepal, trying to help after the devastating earthquake on April 25. “At present, the focus is on public health of which the team has skills specifically with rabies control,” says Dr Heath.

Drs Michael Heath and Lisa Sander with supplies they are sending to India.
Drs Michael Heath and Lisa Sander with supplies they are sending to India.

Despite the team’s dedication to the causes, Drs Heath and Sander suggest graduate vets should wait until they have a few years of clinical experience under their belt before venturing into volunteering.

“Nothing is the same as what you know back at home, so you need to volunteer with the ‘Four P rule’: preparation, politeness, perseverance and patience. If any are a problem, you need to consider if this is for you.”

Adds Dr Heath, “There are many anxieties with this, as anything can go pear-shaped. You need to know you can work with basic conditions and yet still do good work. There are no corners cut and we work with good sterilisation techniques and regimes. The standard of the work is excellent, but it can be tough getting it there. I’ve operated in a tent with people watching. I’ve operated as 20 school kids got off a bus to have a look. I’ve operated as a camera filmed the procedure. With all of that, you have to know your skills so well that you can cope.”

When the going gets tough, Drs Heath and Sander say, the best of intentions will not cut it. And the experience comes at more than an emotional cost that needs to be factored in.

“Airfares start at about $1000 return and a working visa is about $400, and you might need to take some equipment with you, so you need some resources behind you to do this and not expect everything to be covered as it won’t be,” says Dr Heath. “But I also believe if you are prepared to go with the right frame of mind and have done the homework, you’ll get so much out of it. You work many hours, but you quickly discover you don’t waste one of them.”

1 COMMENT

  1. Great job Drs. Heath and Sander. I think this visit of yours to our country has taught you some new rules, techniques, and lot of confidence to work in any situation. I supply Medicine required by VBB at Bylakuppa, and all the Doctors like, Dr.Sally Nixon,Dr.Amelia Fung,Dr.Bronwen Evans, and, Dr. Michel Heath, have done a great job and we Indians believe in Karma theory. That is good thing done to others and specially to a dumb animal will wash off all the sins that we have accrued in this life as well the the past. May God bless you all.

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