Leesburg Vet Blog 
Dr. Kloer’s work with the Rural Area Veterinary Services of the Humane Society Veterinary Medical Association.
You may have received an email auto-response message this summer from Dr. Kloer stating that she would be away from the office for an extended period of time. Dr. Kloer may have been away from our hospital, but she sure kept busy, taking part in several veterinary outreach trips out west. In the following piece, Dr. Kloer gives us a little insight into her experiences helping many pets in underserved areas of the Great Plains/northern Midwestern area of the United States.
Where did Dr. Kloer go?
“During several weeks this summer, Dr. Strickland graciously gave me permission to work for a group that is near and dear to my heart: the Rural Area Veterinary Services (RAVS) of the Humane Society Veterinary Medical Association. RAVS is a group which I’ve been supporting for the past nine years; I’ve participated in 14 trips in New Mexico, Arizona, North Dakota and South Dakota thus far and plan to continue to work more with this animal welfare organization in the future.
I was fortunate to be a part of an amazing and hard-working leadership team this summer – dividing my time between surgical team leadership (providing training to the surgical volunteers and helping to assure patient flow) and providing surgical support for complicated cases or higher-risk cases. I lived out of a small carry-on suitcase and a backpack for four and half weeks. My travels included layovers in Denver and Minneapolis with final meet destinations in Rapid City, SD, and Bismarck, ND. After meeting the team, we drove to specific clinic locations (1-2 per week). These locations included Ft. Totten, ND; Belcourt, ND; Cannon Ball, ND; Eagle Butte, SD; Dupree, SD; Pine Ridge, SD; and Oglala, SD.
Pictured below is Cannon Ball, ND, a struggling community.
On route toward Pine Ridge, SD.
Who are RAVS?
The RAVS group consists of a few staff members and a vast volunteer base, many of whom are veterinary students, veterinary technicians, veterinarians, and support volunteers who want to help out in underserved areas of our country. We are a non-profit group, providing free veterinary services to the pets and their families on many Native Nation reservations throughout the United States. The areas we serve have little to no veterinary care available and poverty levels prohibit many pet-loving owners from seeking care that is available. Our clinics provide vaccination, spay/neuter services, and treatments for diseases including but not limited to: mange, flea infestation, ringworm, parvovirus, distemper virus, Rocky Mountain Spotted Fever, ehrlichiosis, anaplasmosis, TVT (transmissible venereal tumors), intestinal worm infestations, and feline respiratory infections. Additionally, our field clinics serve as an emergency service during these trips – we triage and manage trauma cases and debilitating chronic injuries to the best of our ability. We strive to provide excellent and compassionate health care for the patients while also providing humane education to the communities.
Here is the “rig” – a truck and trailer into which the majority of our clinics are packed!
A positive parvovirus test from a patient in South Dakota. We offer outpatient treatment options for owners who want to try to treat, but sadly, many pets are too sick and succumb to the virus. We discuss the risks of dog-to-dog transmission of this painful, debilitating, and frequently fatal disease. We provide vaccination services to as many animals as possible to help prevent parvovirus. (Parvo is a part of the canine distemper combo vaccine, which you can learn more about here.)
A group shot of this year’s RAVS staff and volunteer team, from the 2016 Spirit Lake, ND trip.
The environment and working conditions
The conditions of the environment are minimally comfortable, at best. During each typical week-long clinic, we – a group of approximately 45-50 people – will arrive in our caravan (with the retro-fitted horse trailer containing the clinic!) to a run-down community center or gymnasium. Rarely are the buildings fully air conditioned (temps during the day inside often reach 90+ degrees), and many have minimally functioning bathrooms. The communities are often quite generous and will provide the group with lunch or dinner each day. The days are long and nights are short: morning orientations and meetings typically begin at 5:30-6:00 AM and the clinic typically closes down by around 10 pm at night, though it is not uncommon for patient care to last well beyond midnight. Group members usually sleep on the gym floor (and some of us sleep in the travel vehicles too!) and a shower is considered a luxury.
Here, Dr. Kloer is triaging a puppy to be spayed. This puppy was from a shelter on the Cheyenne River Reservation. (It is interesting to note, this newly built shelter is the only brick-and-mortar shelter on any of the native nations with which RAVS helps.) After clearing her examination and being successfully spayed, she and her sister were transported to adopters in Colorado and Wisconsin.
Vet students help Dr. Kloer triage a sick dog in Pine Ridge, SD. He was extremely anemic from severe parasitism.
Clinic Setup, Flow, and Function
The parts and pieces of the hospital are unpacked and set up. It has always amazed me how a fully functioning hospital can be packed into a goose-neck horse trailer! When the clinic opens each morning, community members are usually lined up ready for check-in. The clinics are “first come, first served”; as a result, pet owners are often lining up around 4 am, well before the clinic opens. In any given day, we’ll typically admit between 30 to 55 patients for surgery and over the course of the week, we’ll often vaccinate 200-300 additional animals, sometimes even more! Sick and injured patients are never turned away – we see these patients in the clinic any time of day or night.
The field hospital is divided into subsections, similar to a regular brick-and-mortar veterinary hospital. Even with the clinic being set up in divisions with everyone given a main role for the day, the entire team works together and helps out in other sections when needed. This helps the clinics to run smoothly.
Receiving and Triage
Patients enter through the clinic’s intake coordinator where teams of veterinary students are assigned and take down detailed patient histories and perform thorough physical examinations. Patients receive vaccinations, flea and tick treatments and deworming treatments. Healthcare and husbandry education begins at this time of the clinic. Licensed veterinarians provide feedback to the students and answer questions.
Anesthesia
Once a patient has been cleared for anesthesia and surgery, they are transferred to the student anesthesia teams who perform a more directed anesthetic evaluation. Veterinarians and/or licensed veterinary technicians also perform another examination to give further clearance and assess specific anesthesia needs. A team of veterinary students, under direct supervision of licensed doctors and anesthesia technicians, place IV catheters, provide IV fluid support, and then place pets under anesthesia and closely monitor the patients through the entire process.
An anesthetist student is assigned to each patient. Here, you can also see doctor and student surgeons at each table. Five surgeries can happen at one time with this clinic set up and volunteer staffing.
Surgery
Once a pet is anesthetized, the surgery team then spays or neuters the patient and provides any other needed procedures. A veterinarian with special surgical interests along with a veterinary student, team up to perform each surgery. The students are tested prior to the clinic to assess their clinical competencies and to allow a personalized, one-on-one teaching experience for each student. Patient safety and welfare are of utmost importance and this taken into consideration during surgical instruction. Surgery teams are also responsible for ensuring the surgical instruments and gowns/drapes are cleaned and autoclaved (steam sterilized).
Dr. Kloer and a veterinary student, neutering a dog.
Recovery and Discharge
Following the surgical procedures, the anesthesia and surgery teams transfer the patients to the recovery team where the pets’ close monitoring continues until they are fully awake from anesthesia and are eating and walking well. Once a pet had had a final exam by a licensed technician or doctor and is cleared for discharge, the initial receiving teams review specific post-operative instructions and give further husbandry and health care education to the pet’s family. We provide community members a centralized phone number to call if they have any questions; they are also encouraged to stop by the clinic if they do not have a phone or have immediate concerns about their pet.
After all patients have been discharged (or admitted for overnight care in a few cases); the group has a team meeting, topic rounds are reviewed when time allows, and sleep (even if just a few hours!) is encouraged. On many of the Reservations, the group is invited to watch a cultural and historical presentation by the local tribe elders, which I have always enjoyed.
From left: Dr. Kloer loves on a pup after her spay surgery. This sweet girl ate some plastic which had gotten stuck in her intestines. The plastic was found incidentally but would have punctured through her intestine had the surgery not been done that day. After Dr. Kloer surgically removed the plastic, the pup spent a few days in recovery with the volunteer team before returning to her owner. These other cute canines visited the clinic for vaccines and wellness checkups.
Saying Goodbye…hopefully until next time!
Once the week has ended, all equipment is thoroughly disinfected and broken down into the packing boxes. The trailer is packed (like a pre-planned game of Tetris!) and either returns to home base in Colorado or is driven to meet the next group of volunteers; the professional staff often switches over also. During these weeks, the group starts as 40ish strangers working towards the same goals and often ends with new-founded friendships. I have stayed in touch with many RAVS team members that I met back in 2007!
Packing up the clinic in travel boxes
What does it take to provide these much-needed services?
In any given year, approximately 10 to 12 week-long trips are funded and staffed; medical supplies alone typically cost $9,000-$10,000 with total weekly costs adding up to $65,000. RAVS strives to provide the best medicine possible – both to benefit the patient population and to help teach veterinary students how to practice high-quality field medicine.
Veterinary students run CrowdRise campaigns to help off-set costs of these clinics, and the professional support volunteers (DVMs, techs, undergrad students) provide their own transportation and housing before/after the clinic. The ability of the HSUS-RAVS staff to organize and run the clinics is dependent not only on the support of the volunteers but also on the support of the general public. Anyone interested in donating may go to:
https://secure.humanesociety.org/site/Donation2?df_id=6300&6300.donation=form1
Or contact the program director:
Windi Wojdak, RVT
Director, HSVMA-RAVS
P.O. Box 1589 Felton, CA 95018
Phone: 831-335-4827 FAX: 831-335-4828
Dr. Kloer’s final thoughts on the summer:
This was a fabulous summer – a very hard summer working long hours, caring for healthy pets and also treating very sick and injured pets. In a few cases where pets were too sick or injured, we offered humane euthanization to end suffering. In some cases, we were able to save animals in dire need from euthanasia (see Luna’s story below).
We were in hot, cramped conditions, often working on a growling stomach, and away from home for so many weeks. More importantly, it was a summer of enlightenment, learning, growing, teaching, and reflection. Meeting the local tribal members and getting to know their pets was delightful; the animals are so sweet, and the community members truly appreciate all that we can do for them. Additionally, I love working with veterinary students – observing their clinical and communication skills develop even over the course of a week is amazing. There is a big reason to smile when I’ve just walked a student through his or her first surgery or when I’ve helped a student to give their first vaccination or place their first IV catheter. It’s internally rewarding to give back to the profession in this way. And, working with so many talented and trained veterinarians and technicians, I always learn something new too! Many thanks again to my Leesburg Veterinary Hospital colleagues and coworkers for taking up my work while I was away this summer – I look forward to sharing stories with them as well – perhaps I can bring someone along with me on a trip next year!
In 2007, on a RAVS trip to New Mexico, Dr. Kloer scrubbed into first spay surgery of her veterinary training.
August 2016 – Dr. Kloer, after thousands of surgeries, continues to learn something new on each trip. Here, she is learning a different technique to spay kittens and having a great time!
Colorado Strong! Two alumni and one current student from Colorado State University’s School of Veterinary Medicine. Dr. Kloer loves meeting up with fellow CSU’ers on these trips!
Luna’s Story
In very rare and specialized cases, we rescue abandoned or severely injured animals from the Reservations and place them for adoption. Luna is one of those special kitties. Abandoned, Luna was left in a box at our clinic entryway. She was scared, malnourished, covered in fleas, affected by ear mites, and had respiratory and an eye infection because of a weakened immune system. We immediately began treatments for her ailments. She was so hungry she tried to eat a baked potato! As she did not have anyone to claim ownership of her, we had only one choice to save her life – she needed to find a way off the Reservation. Social media to the rescue! I posted a picture of her, stating she needed to find a home and soon! We only had 24 hours to work out a transport plan.
Thankfully, LVH technician Jo Scott came forward, offering to foster Luna until she was healthy enough for adoption. Luna was strong enough to fly after starting her treatments, and we began working on a plan for her travel. Remember, most states require a health certificate for interstate travel, so I worked on finding a computer with internet access and a printer to print out the necessary paperwork. With the aid of a volunteer who agreed to stay on hold with Delta Airlines for a while, I purchased her a ticket on my flight back to Virginia. Luna rode with us in the truck to Bismarck, where we scavenged two Wal-Marts at 10 PM to locate an airline-approved travel carrier. She lived in the bathroom of our hotel room that evening (along with a puppy we were transporting). Once I got her to the airport, my flight was delayed over 3 hours; Luna and I passed the time by getting some exercise on a carefully constructed harness! Many airline employees came over to say hi to her (If you’ve ever been in the Bismarck airport, you’ll understand the informalities. There are only four total gates at this airport.) Once we got back to Virginia, she stayed the night at my house and then settled in at Jo’s house. Unfortunately, her infection flared up a few days later. We’ve since changed antibiotics and she is doing much better.
Luna is well on her way to a full recovery. Jo and I donated our time this week for her spay surgery and she’ll be ready for adoption very soon!
Please note a few stipulations – Luna must be kept indoors for life due to the potential for periodic respiratory flare-ups. Her owners must be dedicated to bringing her to the vet if she ever starts sneezing or has watery eyes. Her adopter must also get her microchipped, have baseline blood work performed, and finish her vaccinations series; she needs to be kept on flea and tick preventives; and lastly and importantly, she should never be declawed. If you are interested in adopting her, please feel free to contact Dr. Kloer @ lkloer@leesburgvet.com or call the hospital 703-777-3313.
UPDATE: September 30, 2016 – Luna has been adopted! You can see pictures of Luna’s path to recovery and her with her new family, below.
Luna, abandoned on the RAVS clinic doorstep.
Malnourished and starving, Luna snacked on a potato at the clinic.
Luna took a nap in Dr. Kloer’s shirt in the hotel room after leaving the clinic.
A little airport exercise during a delay.
Finally on the airplane, heading back to Northern Virginia!
Luna, after her spay this week, and looking so much healthier! Her eyes are forever crossed (We think she is part Siamese), but she is that much more adorable because of it!
Our friend and local pet photographer, Ellen Zangla, took this gorgeous picture of Luna. What a beautiful little girl!
Luna has come a long way since her potato eating days on the Cheyenne River Reservation. We are so happy for her and new family!
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