Indigenous Community Animal Health Program (ICAHP) Model and Guidelines

Ratification Date: 27 Jul 2012

Model

Summary

Indigenous Community Animal Health Programs (ICAHPs) are designed to improve the health and welfare of the populations of animals in Indigenous communities while meeting the needs of their owners. They also aim to improve the overall health and wellbeing of the community through animal health management.

Frequency

It is ideal to have a permanent veterinary presence in Indigenous communities, but this is strongly dependent on financial viability. In the absence of a permanent veterinary presence, programs should be run ideally at least every 3–4 months, but not less than twice yearly, to ensure that animals are treated regularly and that animals reaching sexual maturity will receive appropriate birth control (desexing and/or contraception) and parasite control.

Treatments

Treatments should cover desexing and/or chemical contraception, parasite control (internal and external), injury/disease management and euthanasia of unwanted, sick or injured animals.

Surgical procedures

The main priority of ICAHPs is population control through surgical sterilisation of animals. Other surgeries can be performed at the owner’s request, but should follow the guidelines and policies set out by the relevant State’s Veterinary Surgeons Board and the Australian Veterinary Association (AVA).

Education

ICAHPs should support education of children and adults in the responsible ownership of animals.

Guidelines

Cultural awareness

All veterinarians and associated ICAHP personnel should make themselves aware of the customs and traditions of the relevant Indigenous communities they choose to work with, and should respect their culture and traditions.
1. It is recommended for ICAHP veterinarians and personnel to attend cultural awareness seminars and workshops.
Veterinarians and other ICAHP personnel should seek the owner’s or authorised agent’s consent for any treatments on their animals.

Registration and availability

Veterinarians must be registered in the relevant State or Territory before performing ICAHPs in that State or Territory.
Veterinarians or organisations employing veterinarians should have direct access to veterinary premises near or within a reasonable distance in the relevant or adjacent State or Territory through ownership, employment or agreement. For example, if the ICAHP veterinarian is a fly-in fly-out contractor, there must be a back-up arrangement with another veterinary clinic or their own premises to provide emergency veterinary services for the remote communities in the areas in which the ICAHPs operate.
Veterinarians must provide telephone contact to the relevant community to advise on post-surgical issues and ongoing community animal health.

Surgeries

Spey and castration operations of dogs and cats are highly advised as a population control method in remote Indigenous communities. All surgeries should be performed such that the risk of postoperative complications, such as wound dehiscence or eventration, is minimised. Surgical techniques and materials that do not require routine postoperative care or follow-up by the owners should be selected.
Minor surgeries can be performed in remote community settings.
More complex surgeries should, ideally, be performed in a veterinary clinic where there is better monitoring, surgical and anaesthetic facilities and emergency treatments. This may not always be possible, however, and whether more complex surgeries can be undertaken will be the individual veterinarian’s judgement, based on technical ability and available equipment.
All techniques, facilities and treatments must abide by the relevant State or Territory’s laws.
Inhalant anaesthesia may not always be available or appropriate, and in such cases veterinarians must be familiar with and experienced using suitable alternatives.

Contraceptive drugs

Contraception can be an integral part of some ICAHPs and may be utilised as a means to prevent animals from breeding. Ideally, animals given contraceptives should be identified using collars and permanent marker pens stating the date of injection or tags. This will aid another veterinarian in deciding to either continue with contraception or to perform surgical desexing.
Chemical contraception is not ideal for long-term use because of the many possible adverse side effects. The use of contraceptives should be considered as a temporary means of population control. Surgical desexing should be considered as the first choice for population control in dogs and cats.
1. Use of chemical contraceptives as a sole agent may be acceptable if desexing is not accepted by the community.
It is highly advisable to give contraceptives to any undesexed animal that is of breeding age, but only if that animal cannot undergo surgical desexing for health reasons or because of time constraints, and only after receiving the owner’s permission.
Veterinarians should use minimal (sometimes off-label) dosage levels to ensure that the risk of side effects is minimised.
All safety measures should be maintained to ensure that personnel and community members are not accidentally administered with the contraceptive medication. Accidental administration can result in risks to pregnancy and contraceptive action in women, and reduction of libido in men. For these reasons, contraceptives should only be administered by veterinarians.
Any organisation or veterinarian that trains, supervises or gives authority for non-veterinarians to administer such drugs should be fully aware of the liability upon the individual or organisation for any mishap that may occur. It is advised for the organisation or individual to have suitable insurance coverage for such an eventuality.
Common contraceptives used include:
1. proligestone – used every 3–5 months (females)
2. medroxyprogesterone acetate – used every 5 months (females)
3. deslerolin long-acting implant – used every 6 or 12 months (depending on the type of implant) (males, not recommended for females)
4. delmadinone – used every 3–5 months (males).

Medications

Veterinarians and associated ICAHP personnel should be:
1. aware of risks and benefits of each medication used
2. aware of the inter-treatment interval of each medication used
3. aware of all occupational health and safety aspects of each medication and follow acceptable protocols to minimise risks to ICAHP personel, community members and animals.
Veterinarians should not supply non-veterinarians who are not under their supervision with prescription medications, unless the drugs are prescribed for a specific individual animal. Prescribing laws must always be followed.
Veterinarians should be aware of any potential health risks associated with each medication to the community. If there are human or animal health risks from metabolites in urine or faeces, then the care and treatment of such animals should be under direct veterinary supervision and waste materials should be collected and disposed of correctly.
Any drug recommended or used in a manner not in accordance with its labelling should be subjected to the same supervisory precautions that apply to veterinary prescription drugs.
IAHPs should also ideally strive to achieve:
1. parasite control for all animals
2. animal disease control through vaccination.

Euthanasia

Euthanasia is a component of an ICAHP.
At all times the euthanasiates should be in a locked container/area when not in the possession of a veterinarian.
Veterinarians should attempt to obtain the owner’s or authorised agent’s permission before euthanasing any animal within the community, unless under orders from police or an authorised animal welfare agent.
Veterinarians should euthanase animals with pentobarbitone or other registered euthanasiate.
Sedation should be considered for extremely nervous, fractious or severely injured animals.
Other agents, such as suxamethonium, should not be administered by veterinarians as the sole euthanasiate, for welfare reasons. If it is to be used for fractious animals or animals that are not easily restrained or caught, it must be followed up immediately with a euthanasiate.
1. All safety measures should be maintained to ensure that personnel and community members are not accidentally administered with the medication.
Firearms may be appropriate in certain circumstances for use when the animal is deemed dangerous or a flight risk, and should only be used when:
1. all other means of capture have been exhausted
2. relevant Public Discharge of Firearms laws are followed
3. all health and safety issues have been addressed to ensure that personnel and community members are not harmed.
Non-veterinarians should not have access to euthanasiates such as pentobarbitone because of the adverse risks to animal welfare, occupational health and safety, and human safety. Alternate euthanasia techniques used by non-veterinarians may include captive bolt and firearms. These techniques should be used by appropriately trained and authorised personnel.
Any organisation or veterinarian that trains, supervises or gives authority for non-veterinarians to administer euthanasiates or to perform such procedures should be fully aware of the liability upon the individual or organisation for any mishap that may occur. It is advised for the organisation or individual to have suitable insurance coverage for such an eventuality.
After euthanasia, all animals should be appropriately disposed of:
1. in accordance with owner’s requests
2. in accordance with relevant state/territory laws and council regulations
3. by deep burial or cremation.

Identification

Identification techniques can be used to help identify individual animals and/or record their health status.
Desexing identification – animals can be identified as being desexed through various means, including:
1. microchips (not recommended as a sole means as it is not readily visible)
2. ear tattoos for surgical desexing
3. combination of the above techniques.
Treatment identification – depending on the treatment regimen applied to each animal, forms of identification may be required. Identification options include:
1. microchips
2. collars with tags
3. photographic records
4. combination of the above techniques.
Registration – different techniques have been used to identify animals as being registered, including:
1. collars with tags
2. microchips
3. combination of the above techniques.
Use of microchips should be in line with the AVA’s policy on electronic identification of animals.
Animals that are given an implant or chemical contraceptive should be identified by well-marked collars or tags specifying the date the medication was given. The owner should be instructed on the reason why the collar must not be taken off the animal.

Darting of animals

Darting of animals should only be performed for sedation when:
1. all other means of capture have been exhausted
2. relevant Public Discharge of Firearms laws are followed
3. all health and safety issues have been addressed to ensure that personnel and community members are not harmed.

Training and accreditation

Veterinarians who wish to conduct ICAHPs should receive appropriate training prior to doing programs on their own. There currently is not any nationally recognised training available, but many of the veterinary clinics involved in the conduct of ICAHPs and certain welfare organisations and not-for profit organisations offer training to veterinarians in the running of these programs. It is ideal for veterinarians to seek appropriate training to ensure that they are fully aware of all the issues and requirements for the running of an ICAHP.
Accreditation should not be mandatory for registered veterinarians to conduct an ICAHP.
Cultural awareness training should be received through a recognised organisation.

Surgery and anaesthesia

The choice of anaesthetic agent and surgical technique are those of the veterinarian. However, veterinarians carrying out surgical procedures in the field must be experienced and competent in the procedures they are performing and must have an appropriately trained and experienced assistant (e.g. veterinary nurse) to manage intra-operative and recovery incidents.
Veterinary students must not be allowed to practice surgery on patients in the field, but can assist an experienced veterinarian after the owner’s permission has been given.

Professional indemnity and insurance

Veterinarians should ensure that they have the relevant professional indemnity/public and products liability coverage in place before pursuing ICAHP work.
1. If a veterinarian is doing ICAHP work in conjunction with their veterinary practice, then the practice’s indemnity should cover them.
2. If a veterinarian is doing ICAHP work for a charity, non-government or government organisation, then the veterinarian should ensure that these organisations will indemnify them or seek their own individual professional indemnity insurance.
3. Regardless, veterinarians should seek the advice of their insurers before embarking on such work.

References

AMMRIC “Conducting dog health programs in Indigenous Communities: A Veterinary Guide”.

AVMA Guidelines on Euthanasia (2007).

Barton, M.A. and McEwan, D.R. (1993). Spirurid nematodes in dogs and cats from central Australia. Australian Veterinary Journal70:270

Bradbury, L. and Corlette, S. (2006). Dog health program in Numbulwar, a remote Aboriginal community in east Arnhem Land. Australian Veterinary Journal84:317–320.

Gaskin, S., Bentham, R., Cromar, N. and Fallowfield, H. (2007). The zoonotic potential of dogs in Aboriginal communities in central Australia. Environmental Health 7:36–45.

Raw, L. (2001). Human Health in relation to pets in urban and Indigenous communities. In: Canyon R and SpeareR (editors).Rural and remote environmental health I. Australasian College of Tropical Medicine, Brisbane.

Romagnoli, S. and Concannon, P.W. (2003). Clinical use of progestagens in bitches and queens [Review]. In: Concannon P.W., England G, Verstegen J III and Linde-Forsberg C (editors). Recent advances in small animal reproduction. International Veterinary Information Service, 2000. http://www.ivis.org

Senior, K., Chenhall, R., McRae-Williams, E., Daniels, D. and Rogers, K. (2006). Dogs and people in Aboriginal communities: Exploring the relationship within the context of the social determinants of health. Environmental Health 6:39–46.

Smith, B.P. and Litchfield, C.A. (2009). a review of the relationship between Indigenous Australians, dingoes (Canis dingo) and domestic dogs (Canis familiaris). Anthrozoös 22:111–128.

Tasker, L. Non-surgical methods for controlling the reproduction of dogs and cats. [Internal Document].CompanionAnimals Unit, World Society for the Protection of Animals. www.wspa.org

Thompson, R.C.A., Meloni, B.P., Hopkins, R.M., Deplazes, P. and Reynoldson, J.A. (1993). Observations on the endo- and ectoparasites affecting dogs and cats in Aboriginal communities in the north-west of Western Australia. Australian Veterinary Journal 70:268–270.