Field Manual for Small Animal Medicine E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1654

Veröffentlichungsjahr: 2018

Beschreibung

Field Manual for Small Animal Medicine offers anyone working in resource-limited environments a practical resource for delivering veterinary care outside the traditional hospital or clinic setting.

• Offers the only comprehensive resource for best practices when practicing veterinary medicine in resource-limited environments
• Integrates practical and cost-effective protocols where the ideal solution may not be available
• Presents information on vital topics such as operating a field spay/neuter clinic, emergency sheltering, sanitation and surgical asepsis, preventive care practices, zoonotic diseases, and euthanasia
• Serves as a quick reference guide for common surgical procedures, cytology interpretation, anesthesia and treatment protocols, and drug dosing

Leseprobe

CONTENTS

Cover

Title Page

Copyright

Dedication

List of Contributors

Acknowledgments

Chapter 1: Introduction to Working in the Field

1.1 Overview

1.2 Scope of This Manual

1.3 What Constitutes “in the Field”?

1.4 Who Is This Manual Written for?

1.5 Benefits, Opportunities, and Challenges of Working in the Field

1.6 A Closer Look at the Book's Content

1.7 Veterinary Oath

1.8 Minimally Acceptable Standards of Care

1.9 Ways to Get Involved

1.10 Choosing a Project to Work with

1.11 Cultural Considerations

1.12 Stay Positive

1.13 Before you Go

Disclaimer

References

Chapter 2: Stray Dog Population Management

2.1 Introduction

2.2 Dog Population Numbers

2.3 Understanding the Evolution of Dog Management

2.4 Street Animal Management Strategies

2.5 The Catch–Neuter–Vaccinate–Return (CNVR) Program in Bhutan

2.6 Human Behavior Change – A Key Component

2.7 Recommendations for Global Dog Management

2.8 Conclusion

Acknowledgment

References

Chapter 3: Community Engagement and Education

3.1 Introduction

3.2 The Value of Community Engagement and Education

3.3 Important Principles of Community Engagement and Education

3.4 How to Engage and Educate Your Community

3.5 Tips and Tricks

3.6 Monitoring and Evaluation

3.7 Community Engagement Resources

References

Chapter 4: Humane Canine Handling, Capture, and Transportation

4.1 Introduction

4.2 Humane Handling

4.3 Capture Techniques

4.4 Chemical Capture

4.5 Transportation

Appendix 4.A Identifying Fearful Body Language in Dogs

4.B How to Use a Control Pole

References

Chapter 5: Operating a Field Spay/Neuter Clinic

5.1 Introduction

5.2 Planning

5.3 Site Consideration

5.4 Staffing and Volunteers

5.5 Medical, Surgical, and Clinic Supplies

5.6 Medical Records

5.7 Preoperative Considerations

5.8 Clinic Areas and Flow

5.9 Conclusion

5.10 Suggested Websites

Appendix 5.A Sample Clinic Timeline

5.B Sample Clinic Supply Manifest

5.C Patient Medical Record (Pages 1 and 2)

5.D Controlled Drug Log Template

5.E Postoperative Instructions for Clients

References

Chapter 6: General Anesthesia and Analgesia

6.1 Introduction: Developed versus Developing Countries

6.2 Preparation for Field Anesthesia

6.3 Equipment in the Field

6.4 Drugs for Use in the Field

6.5 Cardiopulmonary Resuscitation (CPR) in the Field

6.6 Pain Management

Appendix 6.A Glasgow Composite Pain Scale Short Form (Canine)

6.B UNESP-Botucatu Scale

6.C Glasgow Composite Pain Scale (Feline)

6.D Sample Anesthetic Protocols

References

Chapter 7: Regional Anesthesia and Local Blocks

7.1 Introduction

7.2 Universal Blocks

7.3 Select Blocks

7.4 Reserved Blocks

References

Chapter 8: Nonsurgical Fertility Control

8.1 Introduction

8.2 What is Nonsurgical Fertility Control?

8.3 Nonsurgical Approaches and Methods

8.4 Nonsurgical Products/compounds

8.5 Considerations Regarding Use of Nonsurgical Fertility Control

8.6 Conclusion

Acknowledgments

References

Chapter 9: Spay/Neuter Surgical Techniques

9.1: Orchiectomy and Ovariohysterectomy

9.1.1 Introduction

9.1.2 Surgical Preparation

9.1.3 Identifying Previously Altered Animals

9.1.4 Practical Techniques for Routine Spay/Neuter Surgery

9.1.5 Canine Neuter

9.1.6 Special Considerations with Spay/Neuter Surgeries

9.1.7 Management of Complications Related to Spay/Neuter

9.1.8 Conclusion

References

9.2: Ovariohysterectomy – Flank Approach

9.2.1 Introduction

9.2.2 Surgical Packs – What Instruments Are Needed?

9.2.3 Suture Material

9.2.4 Surgical Preparation

9.2.5 Surgical Technique

9.2.6 Special Feline Flank Considerations

9.2.7 Surgeries with Special Considerations When Using a Flank Approach

Reference

Chapter 10: Ancillary Surgical Procedures

10.1: Forelimb, Hindlimb, and Digit Amputation

10.1.1 Introduction

10.1.2 Thoracic Limb Amputation

10.1.3 Pelvic Limb Amputation

10.1.4 Digit Amputation

References

10.2: Enucleation

10.2.1 Introduction

10.2.2 Relevant Surgical Anatomy

10.2.3 Pre- and Perioperative Considerations

10.2.4 Surgical Technique

10.2.5 Postoperative Management

10.2.6 Special Considerations

References

Chapter 11: Sanitation and Surgical Asepsis

11.1 Introduction

11.2 Developing a Plan

11.3 Choosing a Disinfectant

11.4 Sanitation Consideration and Protocols

11.5 Asepsis

Appendix 11.A Guidelines for the Use of Bleach for Dilution and Use Instructions

11.B Instructions for Spot Cleaning Cat Cages

References

Chapter 12: Euthanasia in Veterinary Field Projects

12.1 Introduction

12.2 Ethical Imperatives of Euthanasia

12.3 Developing a Euthanasia Policy for Your Organization

12.4 Patient Assessment Algorithms for Objective Decision-Making

12.5 Euthanasia Methods

12.6 Conclusion

Appendix 12.A Euthanasia Algorithm – Medical Conditions

Appendix 12.B Euthanasia Algorithm – Behavioral Problems

Appendix 12.C Euthanasia Algorithm – Inadequate Guardianship

References

Chapter 13: Treatment Protocols

13.1 Introduction

13.2 Cardiology

13.3 Dermatology

13.4 Gastrointestinal Parasites

13.5 Infectious Disease

13.6 Neurology

13.7 Oncology

13.8 Ophthalmology

13.9 Respiratory

13.10 Theriogenology

13.11 Urinary

13.12 Renal

References

Chapter 14: Diagnostic Techniques

14.1: Point-of-Care Testing

14.1.1 Introduction to Point-of-Care Testing

14.1.2 Selected Infectious Disease Point-of-Care Tests

14.1.3 Toxicological POC Tests

14.1.4 Titer Testing

14.1.5 Fungal Culture, Trichogram, and Wood's Lamp Examination

14.1.6 Fecal Flotation

14.1.7 Urine Test Strips

14.1.8 Portable Blood Glucose Monitor (PBGM)

References

14.2: Cytology

14.2.1 Introduction

14.2.2 Cytologic Specimens

References

14.3: Blood Smear Evaluation

14.3.1 Blood Smear Interpretation

References

Additional Resources

14.4: Neurologic Examination

14.4.1 Objectives and Neuroanatomic Correlates

14.4.2 Equipment

14.4.3 The Neurological Exam Itself

14.4.4 Putting It All Together – Clinical Problem-solving in Neurological Cases

References

Chapter 15: Emergency Medicine and Procedures

15.1 Introduction to Field Emergency Medicine

15.2 Physical Examination

15.3 Initial Stabilization

15.4 Field Supplies, Equipment, and Setup

15.5 Supportive Care and Monitoring

15.6 Emergency Procedures

Suggested Reading

Textbooks

Online Resources

Chapter 16: Wellness and Preventive Care

16.1 Introduction

16.2 Operational Considerations

16.3 Spay/Neuter

16.4 Husbandry

16.5 Conclusion

Appendix 16.A

16.B

16.C

References

Chapter 17: Prevention Considerations for Common Zoonotic Diseases

17.1 Introduction

17.2 Safe Practices to Avoid Zoonotic Diseases [2]

17.3 Hand Hygiene [2]

17.4 Exposure Routes [2]

17.5 Personal Protective Equipment (PPE) [2]

17.6 Needle-Stick Injuries

17.7 Management of Dog and Cat Bite Wounds in Humans

17.8 Rabies Prevention and Control

17.9 Enteric Diseases

17.10 Vector-Borne Diseases

17.11 Diseases with Zoonotic Risk of Transmission from Dogs and Cats to Humans

References

Chapter 18: Emergency Animal Sheltering

18.1 Introduction to Emergency Sheltering

18.2 What is an Emergency Animal Shelter?

18.3 Making the Decision to Set Up an Emergency Shelter

18.4 Planning and Setting Up an Emergency Shelter

18.5 Shelter Layout

18.6 Basic Supplies for an Emergency Shelter

18.7 Emergency Shelter Staffing

18.8 Incident Command System

18.9 Animal Intake

18.10 Animal Care

18.11 Animal Enrichment

18.12 Disposition and Release of Animals

18.13 Breakdown and Deconstruction of the Shelter

18.14 Utilizing Media Outlets

Suggested Websites

Appendix 18.A Emergency Animal Sheltering Checklist.

18.B Shelter Equipment Planning Checklist.

18.C Canine Veterinary Intake Examination

18.D Animal Medical Treatment Form

18.E Master Intake Log

18.F Daily Care Sheet

18.G Canine Enrichment Cheat Sheet

References

Chapter 19: Program Monitoring and Evaluation

19.1 Introduction

19.2 Responsibility to an Individual Animal's Welfare

19.3 Responsibility to the Wider Population

19.4 Methods of Measurement

19.5 Conclusions

References

Chapter 20: Formulary

20.1 Introduction

20.2 Legal and Practical Considerations in the United States

20.3 Fluid Therapy in the Field

20.4 Formulary

20.5 Compounding Recipes

20.6 Reference Charts

References

Index

End User License Agreement

List of Tables

Table 1.1

Table 2.1

Table 2.2

Table 2.3

Table 3.1

Table 3.2

Table 3.3

Table 4.1

Table 4.2

Table 4.3

Table 4.4

Table 5.1

Table 5.2

Table 5.3

Table 6.1

Table 6.2

Table 6.3

Table 7.1

Table 8.1

Table 9.1.1

Table 9.1.2

Table 9.1.3

Table 9.1.4

Table 9.1.5

Table 9.1.6

Table 9.1.7

Table 9.2.1

Table 9.2.2

Table 11.1

Table 11.2

Table 11.3

Table 11.4

Table 11.5

Table 11.6

Table 12.1

Table 13.1

Table 13.2

Table 13.3

Table 13.4

Table 13.5

Table 13.6

Table 13.7

Table 13.8

Table 13.9

Table 13.10

Table 13.11

Table 13.12

Table 13.13

Table 13.14

Table 13.15

Table 13.16

Table 13.17

Table 13.18

Table 13.19

Table 13.20

Table 13.21

Table 13.22

Table 13.23

Table 13.24

Table 13.25

Table 13.26

Table 13.27

Table 13.28

Table 13.29

Table 13.30

Table 13.31

Table 13.32

Table 13.33

Table 13.34

Table 13.35

Table 13.36

Table 13.37

Table 13.38

Table 13.39

Table 13.40

Table 13.41

Table 14.1.1

Table 14.1.2

Table 14.4.1

Table 14.4.2

Table 14.4.3

Table 14.4.4

Table 15.1

Table 15.2

Table 15.3

Table 15.4

Table 15.5

Table 16.1

Table 16.2

Table 16.3

Table 16.4

Table 16.5

Table 16.6

Table 16.7

Table 16.8

Table 16.9

Table 16.10

Table 16.11

Table 16.12

Table 17.1

Table 17.2

Table 17.3

Table 17.4

Table 17.5

Table 17.6

Table 19.1

Table 20.1

Table 20.2

Table 20.3

Table 20.4

Table 20.5

Table 20.6

Table 20.7

Table 20.8

Table 20.9

Table 20.10

Table 20.11

Table 20.12

Table 20.13

Table 20.14

Table 20.15

Table 20.16

Table 20.17

Table 20.18

Table 20.19

Table 20.20

Table 20.21

Table 20.22

List of Illustrations

Figure 2.1

Figure 2.2

Figure 2.3

Figure 2.4

Figure 2.5

Figure 3.1

Figure 3.2

Figure 3.3

Figure 4.1

Figure 4.2

Figure 4.3

Figure 4.4

Figure 4.5

Figure 4.6

Figure 4.7

Figure 4.8

Figure 4.9

Figure 4.10

Figure 5.1

Figure 5.2

Figure 5.3

Figure 5.4

Figure 5.5

Figure 5.6

Figure 5.7

Figure 5.8

Figure 5.9

Figure 6.1

Figure 6.2

Figure 6.3

Figure 6.4

Figure 6.5

Figure 6.6

Figure 7.1

Figure 7.2

Figure 7.3

Figure 7.4

Figure 7.5

Figure 7.6

Figure 7.7

Figure 7.8

Figure 8.1

Figure 8.2

Figure 8.3

Figure 8.4

Figure 9.1.1

Figure 9.1.2

Figure 9.1.3

Figure 9.1.4

Figure 9.1.5

Figure 9.1.6

Figure 9.1.7

Figure 9.1.8

Figure 9.1.9

Figure 9.2.1

Figure 9.2.2

Figure 9.2.3

Figure 9.2.4

Figure 10.2.1

Figure 10.2.2

Figure 10.2.3

Figure 10.2.4

Figure 10.2.5

Figure 10.2.6

Figure 10.2.7

Figure 11.1

Figure 11.2

Figure 11.3

Figure 11.4

Figure 13.1

Figure 13.2

Figure 13.3

Figure 13.4

Figure 13.5

Figure 14.1.1

Figure 14.1.2

Figure 14.1.3

Figure 14.1.4

Figure 14.3.1

Figure 14.3.2

Figure 14.3.3

Figure 14.3.4

Figure 14.4.2

Figure 15.1

Figure 15.2

Figure 15.3

Figure 15.4

Figure 15.5

Figure 15.6

Figure 16.1

Figure 16.2

Figure 16.3

Figure 16.4

Figure 16.5

Figure 16.6

Figure 17.1

Figure 18.1

Figure 18.2

Figure 18.3

Figure 18.4

Figure 18.5

Figure 19.1

Guide

Cover

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Field Manual for Small Animal Medicine

Edited by

Katherine Polak

Four Paws International

Ann Therese Kommedal

AniCura Dyresykehus Stavanger, AWAKE International Veterinary Outreach, WSAVA Animal Welfare and Wellness Committee, International Companion Animal Management Coalition

This edition first published 2018

© 2018 John Wiley & Sons, Inc.

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this titleis available at http://www.wiley.com/go/permissions.

The right of Katherine Polak and Ann Therese Kommedal to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

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The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions.While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.

Library of Congress Cataloging-in-Publication Data

Names: Polak, Katherine, 1984- editor. | Kommedal, Ann Therese, 1977- editor.

Title: Field manual for small animal medicine / edited by Katherine Polak, Ann Therese Kommedal.

Description: Hoboken, NJ : Wiley, 2018. | Includes bibliographical references and index. |

Identifiers: LCCN 2018000474 (print) | LCCN 2018001335 (ebook) | ISBN 9781119243182 (pdf) | ISBN 9781119243199 (epub) | ISBN 9781119243274 (paper)

Subjects: | MESH: Dog Diseases | Cat Diseases | Poverty Areas | Veterinary Medicine–methods | Sterilization, Reproductive–veterinary

Classification: LCC SF991 (ebook) | LCC SF991 .F54 2018 (print) | NLM SF 991 | DDC 636.7/0896–dc23

LC record available at https://lccn.loc.gov/2018000474

Cover Design: Wiley

Cover Images: (Left and right images) Courtesy of Raymond Gerritsen, Soi Dog Foundation; (Middle image) Courtesy of Katherine Polak

This textbook is dedicated to the dogs and cats around the world that we share our lives with, who provide us with companionship, protection, and service; and to the veterinarians, volunteers, and caretakers who dedicate their lives to keep them safe and healthy, no matter the circumstance.

List of Contributors

Valerie A.W. Benka, MS, MPP

Alliance for Contraception in Cats & Dogs

11145 NW Old Cornelius Pass Rd., PortlandOR 97231, USA

Lori Bierbrier, DVM

American Society for the Prevention of Cruelty to Animals

424 East 92nd Street, New York, NY 10128, USA

Jennifer Bolser, DVM

International Veterinary Consultant

Qijiayuan Diplomatic Compound

9 Jianwai Dajie, Chaoyang District

Beijing 100600

China

Amie Burling, DVM, MPH, DACVPM, DABVP (Shelter Medicine Practice)

University of Missouri

College of Veterinary Medicine

900 E. Campus Dr., Columbia, MO 65211, USA

Hillary Causanschi, VMD

Bucks County Society for the Prevention of Cruelty to Animals

60 Reservoir Road, Quakertown, PA 18951, USA

Cynthia Delany, DVM

Koret Shelter Medicine Program

University of California Davis

1 Shields Avenue, CCAH, Davis, CA 95616, USA

and

California Animal Shelter Friends

34511 State Highway 16, Woodland, CA 95695, USA

Brian A. DiGangi, DVM, MS, DABVP (Canine & Feline Practice, Shelter Medicine Practice)

ASPCA

PO Box 142275, Gainesville, FL 32614, USA

Joshua S. Eaton, VMD, DACVO

School of Veterinary Medicine, Ocular Services on Demand (OSOD), LLC

University of California

Davis, CA 95616, USA

Consie von Gontard

Florida State Animal Response Coalition

235 Apollo Beach Boulevard, Suite #311, Apollo Beach, FL 33572, USA

Elly Hiby, BSc, PhD

International Companion Animal Management (ICAM) Coalition, Chaired by IFAW

International Headquarters

290 Summer Street, Yarmouth Port, MA 02675 USA

Lawrence Hill, DVM, DABVP

College of Veterinary Medicine, Clinical Sciences

The Ohio State University

232 Veterinary Medical Center, 601 Vernon Tharp St., Columbus, OH 43210, USA

Mark R. Johnson, DVM

Dog Capture and Care Resources

Greenbank, WA 98253

USA

Tamara Kartal, MS

Humane Society International

2100 L St., NW Washington, DC 20037, USA

Patrick J. Kenny, BVSc, DipACVIM (Neurology) DipECVN, FHEA, MRCVS

Small Animal Specialist Hospital

Level 1, 1 Richardson Place, North Ryde Sydney, NSW 2113, Australia

Ann Therese Kommedal, DVM

AniCura Dyresykehus Stavanger AWAKE International Veterinary Outreach, Nedre

Stokkavei 12, 4023 Stavanger, Norway

Rachael Kreisler, VMD, MSCE

Midwestern University

5715 W. Utopia Rd., Glendale, AZ 85308, USA

Kate Kuzminski, DVM

Humane Society Veterinary Medical Association – Rural Area Veterinary Services (HSVMA-RAVS)

PO Box 1589, Felton, CA 95018, USA

Jennifer Landis, DVM

Animal Welfare Consultant

PO Box 74621, Phoenix, AZ 85087, USA

Natasha Lee, DVM, MSc

Asia Animal Happiness

Jalan Kerja Ayer Lama, Ampang Jaya

Ampang, Selangor 68000, Malaysia

I. Kati Loeffler, DVM, PhD, MRCVS

Community Animals Program

International Fund for Animal Welfare

290 Summer Street, Yarmouth Port, MA 02675 USA

Carolyn McKune, DVM, DACVAA

Affiliated Veterinary Specialists

Orange Park Specialty Center

Orange Park, FL 32073, USA

Laurie M. Millward, DVM, MS, DACVP

Department of Veterinary Clinical Sciences

College of Veterinary Medicine

601 Vernon L. Tharp Street, Columbus, OH 43210, USA

Susan Monger, DVM

International Veterinary Consultants

Austin, TX 78757, USA

Tatiana Motta, DVM, MS

College of Veterinary Medicine, Clinical Sciences

The Ohio State University

601 Vernon Tharp St., Columbus, OH 43210, USA

Adam Parascandola

Humane Society International (Global Headquarters)

1255 23rd Street, NW, Suite 450, Washington, DC 20037, USA

Katherine Polak, DVM, MPH, MS, DACVPM, DABVP (Shelter Medicine Practice)

Four Paws International

11th Floor B, Gypsum Metropolitan Tower, 539/2 Sri Ayudhaya Road, Thanon Phaya Thai Ratchathewi, Bangkok, 10400 Thailand

J.F. Reece, BSc, BVSc, MRCVS

Help in Suffering

Maharani Farm

Durgapura, Jaipur 302018, Rajasthan, India

Sheilah Robertson, BVMS (Hons), PhD, DACVAA, DECVAA, DACAW, DECAWBM (WSEL), CVA, MRCVS

Lap of Love Hospice

17804 N US Highway 41, Lutz, FL 33549, USA

Andrew N. Rowan, PhD

Humane Society International

2100 L St., NW Washington, DC 20037, USA

Amanda Shelby, CVT, VTS (Anesthesia and Analgesia)

Jurox Animal Health

Avon, IN 46123, USA

Ahne Simonsen, DVM

Humane Society Veterinary Medical Association – Rural Area Veterinary Services (HSVMA-RAVS)

PO Box 1589, Felton, CA 95018, USA

Emily Walters, DVM, MS, DACVP

Antech Diagnostics

17672 Cowan

Irvine, CA 92614, USA

Acknowledgments

This manual was born out of a passion for animal welfare, veterinary outreach, and field medicine, and it truly took a village to make it happen. Providing a resource for those working in the field was only made possible by the generous contribution of knowledge and experience from numerous authors and contributors who set aside time between clinic jobs, international travel, teaching, and otherwise hectic schedules to contribute to this text.

While publications on veterinary outreach and field medicine exist, the information has remained scattered and we want to recognize Wiley Publishing for their support in the creation of a text designed to provide a comprehensive resource to those that need it most. We also want to thank the authors for helping us gather valuable material that included both peer-reviewed information and recommendations, and anecdotes based on practical experience, particularly when published literature was lacking.

We want to acknowledge the people working tirelessly to help animals and people living in limited-resourced areas who dedicate their lives, spare time, knowledge, care, and money to help improve animal welfare, veterinary training, and contribute to One Health initiatives in communities all over the world. You inspire us every day and your work, stories, questions, and compassion was what kept us going when motivation was running low after countless hours spent in front of the computer screen at home.

A special thank you to the Koret Shelter Medicine Program at the University of California Davis and Maddie's Shelter Medicine Program at the University of Florida and our mentors who helped guide us through our shelter medicine residencies when shelter medicine was neither considered popular or trendy, and who have continued to support and encourage our quests to make the world a better place for homeless and free-roaming animals. We also appreciate the support of international animal welfare charities including Humane Society International and International Fund for Animal Welfare who encouraged us to pursue this lofty endeavor back when it was merely an idea.

While editing this book, Katherine would like to personally acknowledge the many animal welfare charities throughout Southeast Asia working under extremely challenging conditions who provided daily inspiration and ongoing advice as to what materials would be most practical to include. She'd also like to thank her family who supported her international career and for their understanding when she couldn't always make it home for Christmas. A special thanks to her mother for spending countless hours assisting with editing, and undoubtedly learning a lot about field medicine along the way. Special thanks also to her colleagues and friends for their understanding of occasional tardiness and missed deadlines resulting from the preparation of this text. To her faithful dog and cat, Mangosteen Queen (มังคุด) and Grace for getting her away from the computer and onto the beautiful beaches of Thailand. To Drs. Julie Levy, Cynda Crawford, and Brenda Griffin for setting the bar so very high and supporting their resident down a unique career path. And last but certainly not least, to Dr. Claudia Baldwin, a mentor, friend, and inspiration to her and so many others.

Tess would like to thank Kate Hurley for making her think it is realistic to try and make a difference and save the world, Pixie the rottie for walking her over fields, along beaches and atop mountains, to her amazingly supportive family, friends, and colleagues for making her laugh, love, and share a lot of great memories and bubbles (may there be many more!). To Katherine for being the perfect partner in editing even across oceans. Special thanks to shelter medicine for making her heart sing, and for bringing adventure, friends, pets, and an extended family all over the world into her life.

1Introduction to Working in the Field

Katherine Polak1 and Ann Therese Kommedal2

1Four Paws International, 11th Floor B, Gypsum Metropolitan Tower, 539/2 Sri Ayudhaya Road, Thanon Phaya Thai, Ratchathewi, Bangkok, 10400 Thailand

2AniCura Dyresykehus Stavanger, AWAKE International Veterinary Outreach, Nedre Stokkavei 12, 4023 Stavanger, Norway

1.1 Overview

Veterinary outreach and field medicine projects are expanding across international boundaries at a rapid pace. Projects span from small, local initiatives to robust country-wide programs operated by international animal welfare charities. Both small- and large-scale disaster relief efforts involving animals are also becoming increasingly common. Although the majority of larger animal welfare organizations have operating manuals, guidance documents, and participant guidelines to follow, smaller groups often have few to no protocols or resources to use, other than a passion to help make a difference for the animals in a community. A Field Manual for Small Animal Medicine was born out of the editors' passion for providing a resource for those working in this exciting and challenging field.

This manual is intended to assist veterinarians, veterinary technicians, veterinary students, and those involved in animal welfare projects with improving the health and welfare of animals in remote, rural, and international contexts. The contributing authors recognize the challenges faced when executing field surgical clinics, disaster response, and treatment of free-roaming dogs and cats in the face of limited resources. Like many other textbooks, some gold-standard recommendations are provided; however, this manual strives to also provide practical and cost–effective recommendations where the ideal solution may not be available. Readers will encounter highlighted tips and tricks that suggest innovative ways to best allocate resources to provide the best animal care possible.

Practicing veterinary medicine in limited-resourced environments requires a multitude of skills and training in a variety of subjects ranging from soft tissue surgery to emergency medicine. The topics chosen for inclusion in this manual were those deemed most critical for small animal practitioners, spay/neuter surgeons, shelter administrators and program managers. On an individual animal level, treatment protocols for commonly observed canine and feline diseases, euthanasia considerations, emergency medicine, and diagnostic techniques are discussed. As fieldwork often consists of high-volume spay/neuter activities, information pertaining to humane handling and capture techniques for free-roaming animals, surgical asepsis, high-volume surgical techniques, and cost-effective anesthetic and pain management is included.

On a programmatic level, the editors also felt that it was necessary to include material on dog population management, methods of measuring programmatic success, and community engagement. Those working in limited-resourced shelters might find information on sanitation, wellness and preventive care, and emergency sheltering useful to their operations.

Although much has been published on these topics in the past decade in various journals, textbooks, and organizational manuals, the information remains scattered. The editors attempted to centralize such information in a readily accessible format. Although the majority of material included is derived from peer-reviewed sources, readers should be aware that some recommendations may be anecdotal and based on practical experience, particularly when published literature is lacking. Easy-to-read tables, charts, tips, and practical advice are included that can be quickly referenced in a field environment.

A total of 32 authors from around the world with extensive in-the-field experience contributed to the manual under the editorial guidance of Drs. Katherine Polak and Tess Kommedal. It is the editors' hope that it will ultimately improve the lives of animals worldwide by serving as a resource for practicing medicine in the face of limited resources. Readers should be compelled to not only take up the challenge of working in the field but also contribute to advancing and improving traditional medical and surgical standards and practices. It is likely that field veterinary medicine will continue to evolve into its own veterinary specialty one day.

1.2 Scope of This Manual

Although the editors appreciate that practical resources are needed for all animals, the focus of this manual is on dogs and cats. Large animals, pocket pets, and exotic animals are outside of the scope of this text. Readers may note a bias toward dogs in several of the chapters pertaining to humane animal capture and population management. In the editors' experience, most international projects tend to focus on dogs more so than cats due to the public health threat of rabies attributable to free-roaming dog populations.

1.3 What Constitutes “in the Field”?

Poverty and geographic isolation often make routine veterinary care inaccessible or unavailable due to a lack of resources; limitations may include medications, surgical supplies, staffing, local infrastructure, and even expertise. The expansion of veterinary medicine into rural and international settings has given rise to complex dilemmas on how to provide adequate medical care with minimal resource investment. Veterinarians may find themselves deciding how to best utilize limited resources to improve the health and welfare of as many animals as possible. When faced with such limitations, staff must be creative and adaptive.

For the purpose of this book, the term “in the field” will refer to any under-resourced environment that challenges the ability of workers to meet the standards of care that would otherwise be achieved in a traditional clinical or shelter setting. As veterinary professionals are increasingly involved in a variety of such settings, this manual is widely applicable to different environments including service-learning international projects, rabies control programs, spay/neuter clinics in low-income communities, rural and remote areas with limited veterinary resources, and disaster and emergency settings.

1.4 Who Is This Manual Written for?

Field-based projects tend to attract and recruit staff with a variety of skill sets and professional backgrounds. Therefore, although veterinarians and veterinary technicians are the primary intended audience, this manual is useful to a variety of readers:

Veterinarians

Veterinary students

Veterinary technicians

Emergency responders

Animal care staff

Animal welfare program directors

Lay persons/volunteers participating in veterinary service projects

1.5 Benefits, Opportunities, and Challenges of Working in the Field

The opportunity to make an immediate and meaningful difference in the lives of animals in need is what draws most people to field medicine. Animals living in underserved communities often suffer from a lack of preventive health care, treatment, and spay/neuter services. For some, the motivating factor is the degree of animal suffering in some communities. For others, motivation may not stem from first-hand experience but rather indirectly, through exposure to the increasing media attention of international companion animal welfare issues. Most recently, these have included the inhumane culling of dogs following a rabies outbreak in Penang, Malaysia, annual Yulin Dog Meat Festival in China, and the systematic slaughter of dogs in Sochi, Russia, before the 2014 Winter Olympic Games, to name a few [1–3].

International and rural veterinary outreach programs help bring medical services to animals that would otherwise likely never receive it. Such programs may focus on providing care to the individual animal, or work on a population-level through mass spay/neuter and vaccination activities. Fieldwork can undoubtedly also have direct effects on human health. One Health initiatives are becoming more widely advocated for by the public health and medical communities to control zoonotic diseases and promote both human and animal health. Canine rabies is a perfect example of a disease in which One Health initiatives have been successful in eradication efforts. Around the world, mass dog vaccination programs underpin the success of rabies eradication programs. In light of the fact that up to 99% of human rabies cases worldwide are the result of dog bites, in theory rabies should be an easily preventable disease through vaccination programs and education [4]. Unfortunately, as the World Health Organizations (WHO) explains, the cost of rabies post-exposure prophylaxis can be catastrophically expensive for those living in developing nations, costing approximately $40 in Africa and $49 in Asia per person [5]. There are therefore few opportunities in veterinary medicine that have a greater impact on both animal welfare and public health.

Many field-based programs focus on the spaying and neutering of free-roaming animals in an effort to reduce overpopulation. When the number of free-roaming animals is larger than a community can care for, animals frequently suffer from infectious disease, malnutrition, vehicular trauma, and inhumane culling. Although many factors contribute to animal welfare in a community, evidence suggests that targeted and sustainable spay/neuter programs are one of the more effective and humane methods for managing free-roaming dog and cat populations. In addition to improving the health of the individual animal, spay/neuter programs can also promote responsible pet ownership and community acceptance of sterilized and vaccinated free-roaming animals. As a result, the number of spay/neuter-based programs is increasing and such programs are receiving increasing attention within the veterinary community. Spay/neuter clinics are often fast-paced, challenging, and bring together diverse groups of people from around the world.

In addition to helping animals in need, those working in the field enjoy the change of pace of working in an environment other than their daily clinical practice. Scrubbing in to perform a castration under a tent in Latin America may appeal to the small animal practitioner in Kansas. Many veterinarians will use their vacation time to donate their spay/neuter services. Veterinary students may participate in service-based projects during their holiday breaks. Others may determine that such work fulfills their personal and professional goals and dedicate their careers to such pursuits.

Working in non-traditional field settings also allows veterinarians the opportunity to manage a diverse and robust caseload of medical conditions not commonly seen in private practice. Transmissible venereal tumors, canine brucellosis, canine distemper virus, and tick-borne disease are just a few conditions commonly seen in free-roaming dogs in many under-served communities.

Although field medicine offers many exciting opportunities, it also has its fair share of challenges and disadvantages. Field clinics often have limited diagnostic and therapeutic modalities and are frequently understaffed. Due to their temporary nature, such clinics rarely have a traditional clinic building to work out of; many must make do with a tent or municipal building. Staff must get creative in their approach to maximize limited resources to provide care for as many animals as possible. This requires both a special professional and personal skill set. Field clinics can be mentally as well as physically challenging. The work is hard and the hours are often long. Clinic staff must be able to work well together, quickly adjust to change, and exercise sound judgment. Clinics may be in remote areas with limited basic amenities such as running water and electricity. Potential participants of field projects should ask themselves if they could live for prolonged periods without the comfort of a fan or air-conditioning, eat an unfamiliar diet, and tolerate extreme weather and insects.

Fieldwork can also be emotionally tolling, particularly during disaster relief. The severity of animal suffering can be great, and it is not uncommon for responders to have strong emotional reactions. Even in non-emergency situations, dogs and cats in rural and international environments frequently lack basic veterinary services leading to malnutrition and untreated chronic conditions. When working in a field environment, animals commonly present as victims of poisoning, vehicular trauma, abuse, and neglect or starvation. Responders may also be confronted with animal hoarding, which frequently results in neglect, illness and death.

There is also an increased public health risk for those involved in field projects as dogs and cats can serve as competent vectors of zoonotic diseases. Depending on the location, many animals in field environments will be unvaccinated and have a high parasite burden. Rabies is an important consideration as well when working in the field, and all staff in contact with animals should be up-to-date on their rabies vaccinations. Traditional methods of handling animals are also often more challenging than in private practice settings. Patients are often fractious and difficult to handle due to limited socialization or prior mistreatment by humans. Furthermore, many veterinarians in local communities have little experience with handling free-roaming dogs. All staff should receive adequate training and wear appropriate personal protective equipment. Safe and humane handling and capture techniques as described in this book are crucial for ensuring animal and human safety.

Finally, a major drawback of this type of work is that it typically pays significantly less than a traditional veterinary position in a clinic. Most people working in the field full-time work for non-profit organizations. These organizations historically offer lower salaries than jobs in the private, corporate, or government sector. Therefore, one must consider a lower pay grade than what would be considered normal back in their home country when deciding whether or not to get involved. Even U.S.-registered, non-profit organizations often compensate international staff using local salary scales in the project country.

1.6 A Closer Look at the Book's Content

Although veterinary professionals perform a wide range of activities from medical treatment to surgery, the editors attempted to limit the scope of the book to topics most relevant to field-based work. Therefore, only the most practical of information was included to manage the challenges met in the field. A compilation of forms, checklists, and other helpful material that can be used and adapted by the reader are included as appendices.

1.6.1 Stray Dog Population Management

Free-roaming dogs may suffer from a wide range of welfare issues including disease, injury, malnutrition, and abusive treatment. Misguided attempts to control free-roaming animal populations often involve cruel methods of handling, inhumane methods of killing, and poor animal shelter management. Although most field service projects focus on providing spay/neuter services to reduce the population size over time, there is no single intervention that will work for all situations. The most effective strategies are multifactorial involving public education, legislative initiatives, waste management, and spay/neuter services. This chapter provides case studies to reflect on what we are learning about global dog populations and opportunities for humane dog management programs.

1.6.2 Community Engagement

Community engagement is crucial for ensuring long-term sustainable solutions for animal welfare issues. Dog and cat welfare issues are complex and intertwined with community beliefs and practices. This chapter discusses methods of engagement and empowerment of community members and provides case studies of effective community engagement.

1.6.3 Humane Canine Handling, Capture, and Transportation

The capture, handling, and transportation of free-roaming dogs is typically required for providing medical and surgical services in the field. The World Organization for Animal Health mandates that handling, capture, and transport be conducted humanely and safely [6]. This chapter discusses effective capture techniques and transportation considerations. It also includes descriptions of how to use catching equipment and photographs for quick reference.

1.6.4 Operating a Spay/Neuter Clinic

Spay/neuter programs have received increased attention over the last decade in the effort to improve animal welfare by curbing the overpopulation of free-roaming cats and dogs. This chapter provides guidance on all aspects of running a spay/neuter clinic in the field from clinic setup to patient discharge. It outlines the basic standard of care that should be upheld in any field clinic, with special attention to animal identification techniques, record keeping, and clinic animal flow-through. It provides practical tips on how to increase clinic efficiency and effectiveness on a limited budget.

1.6.5 General Anesthesia and Analgesia

The field environment presents unique challenges when implementing safe and balanced anesthetic protocols. Animals typically present with unknown medical histories, drug availability and staffing may be limited, patients may be fractious, and field clinics often involve large numbers of animals requiring anesthesia. No matter the setting, however, a balanced anesthetic and analgesic protocol is a must. This chapter discusses effective and economical anesthetic and pain management protocols that have proved successful in the field.

1.6.6 Regional Anesthesia and Local Blocks

Local anesthesia can be used to reduce pain and distress during and after a surgical procedure. Techniques involving local and regional anesthesia are used quite extensively in large animals for a variety of minor and major surgical procedures, but much less so in small animal medicine. For many of our small animal patients, a combination of general and local anesthesia techniques will provide the optimal level of anesthesia during the procedure as well as improve postoperative analgesia. In this chapter, easy-to-use local and regional anesthesia techniques are described.

1.6.7 Non-surgical Fertility Control

Over the last decade, there has been tremendous growth in the field of non-surgical fertility control as an alternative to traditional spay/neuter surgical procedures. Many communities lack the resources necessary to provide surgical spay/neuter services, while some may resist surgical spay/neuter practices due to cultural aversion. Non-surgical fertility control methods have the potential of being easier, faster, and less expensive than surgery. This chapter provides an overview of non-surgical techniques and case studies of how they are being used in free-roaming dog population management programs around the world.

1.6.8 Surgical Techniques: Spay/Neuter

Although there are many surgical techniques for performing spay/neuter procedures described in the literature, this chapter shares tried and tested techniques used by the authors. The information presented is not designed to be an all-inclusive surgery course, and it is expected that veterinarians will already have basic knowledge of surgical anatomy and technique. This chapter provides recommendations regarding instrument and suture selection, surgical knots, and time-saving techniques. Special attention is devoted to the flank approach for ovariohysterectomies. Common surgical mistakes and ways to avoid them are also discussed.

1.6.9 Surgical Techniques: Ancillary Procedures

Veterinarians working in the field are frequently confronted with free-roaming dogs and cats requiring amputations and enucleations due to trauma. This chapter is designed to provide practitioners with easy-to-follow descriptions of forelimb, hindlimb, and digit amputations, as well as enucleations.

1.6.10 Sanitation and Surgical Asepsis

Infectious disease control is challenging in most hospital settings and even more so in field clinics. Many of the patients served are unvaccinated, arrive in poor health, may be malnourished, and are highly stressed. Some will be shedding harmful pathogens, with or without any clinical signs of disease. This necessitates a plan to guard against infections and disease spread. Aseptic technique, sterile surgical instruments, and prevention of postoperative infections also need to be addressed. This chapter discusses commonly used disinfectants, how to set up a practical sanitation protocol for a facility, animal handling equipment, and surgical instruments.

1.6.11 Treatment Protocols

Many charitable organizations attempt to provide medical care to free-roaming dogs and cats, often with limited medical knowledge and resources. Free-roaming animals can serve as competent reservoir hosts of several zoonotic pathogens and a multitude of infectious diseases due to a lack of preventive veterinary care. Gastrointestinal parasites, dermatopathies, ectoparasites, tick-borne diseases, heartworm disease, and transmissible venereal disease (TVT) are some of the more commonly observed conditions in field patients. Effective treatment protocols for field patients must take into account the need for a condensed treatment timeline, ease of drug administration, and cost. Such protocols are especially important when rescue groups engage in international adoptions. This chapter provides practical treatment protocols and strategies for managing commonly observed diseases in free-roaming animals, while recognizing that the gold-standard treatment is often unavailable.

1.6.12 Diagnostic Techniques

Diagnostic testing is often underutilized in the field because of limited availability and expense. This chapter is divided into three sections, each chosen due to their clinical application in the field: point-of-care testing, microscopy, and neurological examination.

1.6.12.1 Point-of-care Testing

Point-of-care tests are designed to diagnose diseases or patient immunity “bench-side” or “patient-side” with a limited investment of resources. This allows the user to save both money, time, and animal lives by rapidly identifying an infectious disease or medical condition. The focus of this section is on inexpensive and practical methods for diagnosing commonly seen diseases such as canine parvovirus and fecal parasites.

1.6.12.2 Microscopy

With the assistance of a microscope, those working in the field with limited resources can practice high-quality medicine by making the best use of diagnostic specimens. This chapter outlines practical techniques for diagnostic testing in the field, focusing on the analysis of cytological samples to derive accurate diagnostic and prognostic information. Practical interpretation of skin cytology, ear cytology, blood smears, dry-mount fecal cytology, and vaginal cytology will be described to diagnose various pathological processes in dogs and cats.

1.6.12.3 Neurological Examination

In the field, veterinarians tend to struggle with performing a good neurological examination, and interpreting its findings. As it is a part of the overall patient examination, it is the most portable and cost-effective diagnostic techniques we have – one that can be performed almost anywhere. A neurological examination should not be considered a “specialist procedure” but rather one that can be performed by any veterinarian as described in this section.

1.6.13 Emergency Medicine

Managing emergency situations in the field will tax a clinician's knowledge, experience, and judgment. Although most field clinics are designed to provide spay/neuter services, it is very likely that emergency cases will also be seen. This chapter provides an overview on how to evaluate, resuscitate, and stabilize the critical patient, as well as instructions on how to perform various lifesaving procedures including thoracocentesis, CPR, and blood transfusions.

1.6.14 Wellness and Preventive Care

The prevention of animal physical and emotional disease is an efficient, cost-effective, and humane approach to animal care. Wellness and preventive care should be integrated into all field spay/neuter clinics, rabies control programs, and animal shelters. For many animals, the treatment provided during field clinics may be the only veterinary care they ever receive. In this chapter, proper husbandry, vaccination, parasite prevention, nutrition, and elective sterilization are discussed.

1.6.15 Prevention Considerations for Common Zoonotic Diseases

A range of pathogens including viruses, bacteria, fungi, and parasites can cause zoonotic diseases. Around 60% of all human infections and 75% of all emerging infectious diseases are reported to be zoonoses [7]. For personnel handling and treating dogs and cats with unknown vaccination histories and health statuses, the risk of contracting a zoonotic disease is increased. Therefore, it is important to know how to recognize suspect animals and how to be prepared and protected should the suspicion arise. This chapter discusses some of the more common and potentially dangerous zoonotic diseases that should be considered when working in the field, with an emphasis on prevention.

1.6.16 Euthanasia

When working in the field, every practitioner will be faced at some point with making the difficult decision of how to handle suffering animals. When suffering cannot be appropriately addressed or when an animal presents a significant risk to human health or the safety of other animals, ending the life in a humane manner may be required. This chapter discusses euthanasia considerations in the field, provides an algorithm for guiding euthanasia decisions, and discusses recommended and unacceptable euthanasia methods.

1.6.17 Emergency Sheltering

Responding to large-scale cruelty cases or natural disasters often requires the sheltering of hundreds of animals with little to no notice. The many components of a temporary animal shelter are discussed including design, setup, staffing, daily operations, and demobilization. Photographs and a schematic of a temporary shelter are included.

1.6.18 Program Monitoring and Evaluation

Programmatic monitoring requires systematic and routine data collection. This chapter provides valid, practical, and reliable ways of assessing the impact of population management interventions both on the population and individual animal. Evaluation then uses the data collected through monitoring to answer the fundamental question, “Is this program making a difference?” The use of cost-effective measurable indicators is discussed to improve program planning and performance.

1.6.19 Formulary

An alphabetical formulary is included for quick-reference. A brief description of commonly used drugs, dosages, side effects, and considerations important for the clinician are included. The information included here is compiled from both the clinical experience of the editors, authors, and other textbooks as referenced in the chapter. Handy reference charts and compounding recipes are included.

1.7 Veterinary Oath

International veterinary oaths vary by geographic region and country. Depending on where a veterinarian graduates, many take an oath to practice veterinary medicine ethically and conscientiously for the benefit of both animals and humans. Furthermore, veterinarians swear to maintain professional standards, promote animal and public health, and relieve animal suffering. In 2010, the American Veterinary Medical Association revised the Veterinarian's Oath to emphasize the importance of animal welfare [8]. Veterinarians have a responsibility to not only protect animal health but also welfare; to not only relieve animal suffering but also prevent it.

The veterinary oath should be central to everything we do as medical professionals, guiding our decisions, and ensuring that we act in the best interests of our patients at all times. Yet many countries do not have an oath or other professional affirmation of their role in the community. In some countries with an oath, most fail to recognize the concept of animal welfare, focusing purely on the importance of relieving suffering. In 2014, the World Small Animal Veterinary Association's (WSAVA) animal welfare and wellness committee developed an international oath to highlight the importance of animal welfare and that is relevant to all veterinary practitioners:

“As a global veterinarian, I will use my knowledge and skills for the benefit of our society through the protection of animal welfare and health, the prevention and relief of animal suffering, and the promotion of One Health. 1 I will practice my profession with dignity in a correct and ethical manner, which includes lifelong learning to improve my professional competence” [9].

At a minimum, veterinarians must “do no harm.” The best interest of the individual patient should be the first consideration in any decision on care. The health of animals, people, and the environment are inextricably connected.

In the field, dogs and cats are more likely to be free-roaming and semi-owned by multiple members of a community rather than owned by a single person. While ownership patterns may vary from that in more traditional settings, we should always strive to provide the highest level of individual animal care possible, just as if the animal was a pet living in a home.

1.8 Minimally Acceptable Standards of Care

Before engaging in any veterinary activity, one must have an understanding of ideal or “gold-standard” practices as well as minimum requirements. This applies to everything from equipment, facilities, staffing, medication selection, and surgical procedures. Although we can often find alternative and compromised methods to continue working in challenging situations, it is essential to know what the minimum requirements are. This will help those involved to recognize when to stop, preventing unacceptable situations for the animals and people involved.

Any attempts to provide medical care or perform surgical operations in remote areas require special attention to minimally acceptable standards to safely operate. If a program cannot maintain minimal requirements for each patient, we must re-evaluate the approach.

This manual is not meant to define the exact minimum standards of care but rather provide resources for achieving better standards of care. There are currently no universally accepted, international standards of veterinary care but we have several guiding documents that can be applied. These include the Association of Shelter Veterinarians Veterinary Medical Care Guidelines for Spay–Neuter Programs [10] and International Spay–Neuter Clinic Guidelines published by the Humane Society Veterinary Medical Association-Rural Area Veterinary Services [11]. This manual provides guidelines based on published evidence and expert opinion that can be adapted to varying circumstances. Throughout the text practices deemed unacceptable by guidance documents are also noted.

1.9 Ways to Get Involved

Opportunities abound for veterinarians, veterinary technicians, students, and animal welfare enthusiasts to work in the field, effectively combining travel and veterinary service projects. For veterinary students, many veterinary colleges offer structured international externships. Several colleges such as the Ohio State University have formal institutional arrangements with foreign veterinary colleges to facilitate student externships. Student certificate programs in International Veterinary Medicine are offered by a handful of colleges, such as the University of Georgia, in an effort to familiarize students with issues and opportunities in this field. Most students, however, can find opportunities through their college's student chapter of the International Veterinary Student Association (IVSA).

For veterinarians, there are short- and long-term volunteer projects, as well as paid permanent positions. Unfortunately, there is no single centralized database for advertising international work and most projects are posted on various organizational websites. The American Veterinary Medical Association (AVMA) website offers some information on jobs, externships, and exchange opportunities at www.avma.org.