Animal Welfare - China Companion Animal Welfare Project TRAINING IN ABC SURGERY AND NURSING 27/4/2009- 8/5/2009 LOCATION 1 Shenzen (Province of Guangdong) 2 Beijing Trainers from Vets Beyond Borders Dr Elaine Ong Dr Beth Mc Gennisken Ms Robyn Ireland VN Mrs Ann Letch VN Organizers Act Asia Coordinators and founders Ms Pei Tsu and Ms Deepa Balaram Sponsors Naturewatch Humane society International Co- Organizers and Collaborators Beijing Alliance for Animals in China Beijing Xijiao Animal Hospital Capital Animal Welfare assoociation Vets Beyond Borders Shenzen Alliance for Animals in Chna ShenZen Cats Shenzen Veterinary Clinics Association Shenzen Rui Peng Pet Medical ServiceOrganization Shenzen Helida Agricultural Acience and technology development Co Vet Beyond borders Background Act Asia representatives particpated at the Asia for Animals conference in Bali in 2008 After observing the Bali street dog program funded by IFAW and the ABC Program at the Bali Animal welfare Association, the founder approached Dr Ong to assist in the capacity building of itsVets in China who are servicing the Animal foster groups and welfare organizations Shenzen was selected based on the strength of the animal welfare groups in particular the ShenzenCats, a 200 member(volunteer) cat rescue and fostering program founded and headed by Ms Isobel Zhang and the strength of the Veterinary clinics, progressive thinking Veterinarians and the increased veterinary needs in the community Beijing has a growing number of strong veterinary interest groups, strong veterinary community and historically strong animal welfare groups and progressive Thinking Veterinarians. The Target trainees are the Veterinarians and Veterinary nurses who currently service the Shenzen cats welfare group on a probono or low cost basis The target Trainees in Beijing are the Veterinarians and nurses who service the Animal welfare groups for probono or low cost and selected veterinary students from the Beijing agricultural university and a few Veterinarians from the Beijing Zoo Several of the Vets and their nurse travelled a long distnace from other provinces, such as Changsha in province of Hunan, and Jinan in the Province of Shandong. These vets service shelters in their province 1st Day Lecture and presentations Dr Elaine Ong The role and reponsibilities of the Veterinarian Ethics Importance of continuing education - and aids Using the internet as a learning tool - free website list provided to all participants Principles of Pain relief Principals od anaesthesia Principles of surgery Prinviples of antimicrobial use Ptnciples of fluid administration Principles of treating skin and ear diesase including easy cytological diagnostic methods Top ten Opthalmology tips and Emergency tips Tips on treating cats Dr Beth McGennisken Principles of ABC surgery Overview of ABC – R Projects using SARAH Sikkim antirabies and Animal Health Program as a model Emergency Protocols Demonstration of Aseptic preparation for surgery and ABC surgery in principle Mrs Ann Letch and Ms Robyn Ireland Principles of Animal handling and Animal nursing: How to approach cats and dogs How to hold cats and dogs for the Vets Safety for staff Safety and care of animals How to prepare the surgical theatre and instruments Principles of aseptic techniques Correct tattooing and ID methods Monitoring anaesthesia Pre and Post op care of animals Importance of keeping animals in a quiet and warm environment Monitoring recovery Afternoon session Handling of cat and dog in 2 group sessions Demonstration of how to examine animals Demonstration of performing cytology on skins and ears Questions Day 2 to day 7 Practical surgery sessions 2 groups Vet Trainer and Vet nurse with 2 Chinese Vets and their 2 nurse trainees All participants received: Dose rate charts for all the drugs used Premed chart Anaesthetic chart Other drugs- Pain relief, antibiotics, ivomectin Use of Hospital charts Use of anaesthetic charts The following protocol was followed each time: Initial capture and handling by nurses Humane, gentle and quiet handling Examination of animal if safe to Premed with xylazine and atropine Induction of anaesthesia with Zoletil IV or IM Entubation of every animal Maintenance of asepsis in room Preparation of animal for surgery Preparation of spray bottles of scrub and disinfection for the surgery site Importance of using correct and exact dilution rate for these solutions Gentle clipping so as not to create clipper rash Vets taught to do proper scrubbing technique and drying of hands usng autoclaved towels gloving/gowning properly Taught flank spey approach for cats and dog speys Castrations also performed Correct and reinforcing how to tie knots and how many knots to tie, gentle techniques Correct use of intruments Not to allow disinfectants to contact the wound or to get inside a wound No Bandaging Last night at each city At farewell dinners- combined a Question and answer session and feedback session SUMMARY POSITIVES 1 The Organizers Act Asia directors and founders, Ms Pei Hsu and Ms Deepa Balaram are found to be extremely professional They demonsrated a maturity in their approach and commitment to detail and thus was a well organized program They demonstrated great integrity and responsibility with donors funds- their admin structure is not expensive nor cumbersome They administered the program efficiently and delivered as promised We all stayed in a $50 per night hotels with very basic service and Ms Hsu shared a room with the intrepretor 2.Interested and willing participants Mostly cooperative and receptive participants Established very good rapport with most of them By the end of of the tripwe were all very much bonded to almost every one who particpated includng the organizers ,vets , nurses , the foster people and the animals) The Vets Most were gentle, smart, keen to learn and asked a lot of questions Some already used modified form of spey hooks Most were clearly devoted to their job,understood their responsibilities regarding animal welfare and are animal lovers Identified 6 vets and 6 nurse who are extremely trainable - They were diligent, quickly understood the principles and were very deft and gentle surgeoins The Nurses Likewise the nurses identified were smart, efficient and quickly understood the concepts Most were gentle and keen to learn They were reminded again on gentle and safe handling Performing injections Administering premeds Preparing the animal the room and the Vets for surgery Monitoring anaesthesia and Post Op Monitoring 3 The Venues The Venues were excellent- generously hosted by private vet clinics and the Beijing zoo 4 The Operation Cats and dogs were waiting for us at 8 am sharp, brought in by the carers and fosters The Shenzen cats fosters were all smartly dressed in their Shenzen cat uniform to identify themselves Numerous volunteers were on hand to clean cages and attend to everyones needs including the patients Everyone quickly learned and revised protcols eg covering cat cages with towels to keep cats stress free or cats were put in a quiet roomn Noise levels were kept to minimum Volunteers ensured wwe had water and supplies for oursleves Due to meticulous planning the operation worked like Clockwork 5 The Interpretors apart from one The 2 intrepretors were focussed hardworking and accurate They worked and focussed for a very long time and was worn out at the end They understood the concepts so well they were able to tell the Vets what they were doing Wrong without being promtped by us in the end! Negatives 1 Too many observers in some sessions Ie the rooms are small and the temperature is high – Overheating on several occasions due to full gowning Extra photographers, observers from various groups 2 Too many participants for the time allocated All vets and nurses only had 1 day of training, which was still valuable but some missed out on performing a hands on flank spey as the previous vet took too long 3 Too Long without a break for trainers We all quickly realised that working every single day from 8.30 to 6 pm or later took a toll on our health 4 Some particpants wrongly believed they are attending a course/conference It was pointed out that we are here for animal welfare only and to teach them flank spey techniques and important principles such as handling, anaesthesia and pain relief 5 Lack of availability of drugs eg limited choice of anaesthetics antibiotics and premeds available Huge and unreasonable cost of certain anaesthetics and premeds Eg Not available or illegal to use Ketamine Barbiturates Not available Long Acting Penicillin Chrlohexidine scrub Too expensive Premed- Zylazine and domitor- over A$80 per bottle! Zoletil- Over A$60 per bottle One senior vet was only using Xylazine as an anaesthetic The Vets resort to using a chinese mixture of injectable general anaesthetic that contains haloperidol 6 Scrubbing technque needs to be altered completely Currently many do not scrub their hands and use a bucket soaking system- hands soaked in bucket for 10 mins The solution contains , among other dinfectants some formaldehyde! Which is highly dangerous for humans I found that most vets say they do not soak their hand for 10 mins anyway and the bucket at the end of the day will be a soup of resistant bacteria 7. Different levels of confidence, competence and knowledge with the Vets and nusres Various levels of competence, Some had more knowledge of drugs and methods A few were not dexterous ,too rough or far too slow Knot tying was an issue, not enough or not using correct knots Some were using non absorbables in tying internal structures 2 were overconfident and made many mistakes in terms of breaking asepsis and one created a second hole that was not stitched up leading to a hernia 48 hours later Many nurses were not trained at all in handling, in cat behaviour in asepsis amd monitoring of anesthesia and patient care, but quickly undertood the principles For most of the paticipants it was clearly due to lack of training or lack of understanding of principles of the sciences (eg of asespsis, microbial behaviour, physics, surgical techniques, animal behaviour,pain relief ,pharmacology of drugs, nursing principlesetc) This is easily rectified with further capacity building programs Recommendations made to Act Asia and the participating Vets and nurses 1 Feedback from The Vets and nurses are encouraged to ensure we improve our future training sessions Although we have each been involved in 4 different ABC AR projects in 4 different countries every project is unique and have different demands and needs 2 Recommend that the Chinese Vets form a Coop and export a wider range of drugs and for cheaper costs for all Vets to use Xylazine is only A$25 per bottle in Australia( retail) Zoletil is only $38 perbottle in Australia( Retail) 3.Lobby the Govt for use of Barbiturates, ketamine Otherwise the cost of an ABC AR program in China will be too prohibitive It means that the Chinese vets will find it unsustainable to use good premeds and anaesthetics for stray animal work They will resort to cutting corners or using substandard drugs or using drugs that are not suitable for general anesthesia to perform major surgery such as speys 4 Preparation for surgery and scrubbing technique changed Explained the principles of scrubbing as a better way of removing bacteria from hands and the fact that scrubbing for 2 minutes was more practical than soaking hands for 10 minutes Proper use of and accurate dilution of disinfectants The Gentler technuqes have imediately negated the use of bandaging for the cats after speying ( knots not too tight, not to over clip, not to create clipper rash, not to get disinfectants on the wound or into wounds) 6 Future sessions Less no of partipipants or observers Conitnue hands on sessions- seem to be very positive Each Vet and nusre should be allocated 2 days of surgery To Allow Sustainability of project and to allow disemination of skills Identify and further upskill the 6 vets and nurses identified Act Asia to Fundraise to fund the training for the Chinese trainers Future trip- Take these people along to provide hands on training to the vets in other regions This way the project can mushroom without an inordinate and inproportionate amount of financial resources and volunteer resource Dr Ong and Dr Beth and the nurses are happy to oversee the training or recruit others to do so. This is to ensure that the Chinese Participating Vets have the confidence that the training has been instituted and originated from experienced and qualified Veterinary surgeons and nurses from Australia, the US or the UK , approved by Vets Beyond Borders 7 Thank the Box Hill College of Tafe for the use of the very comprehensive nurses manual Lobby to allow us to use that in other parts of China or even round other needy projects imvolving nurses and paravets training 8 Encourage collaboration with other Reputable Organizations and NGOs working in China such as IFAW ,Animals Asia and RSPCA Hong Kong The Vets from these groups visited and observed some of our surgery sessions and indicated interest in a collaboration in future projects
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