Article Evaluation and delivery of domestic animal health services in remote communities in the Northwest Territories: A case study of status and needs Ryan K. Brook, Susan J. Kutz, Caroline Millins, Alasdair M. Veitch, Brett T. Elkin, Ted Leighton* Abstract — Domestic animal health services are supplied to communities in Canada’s Northwest Territories (NT) in diverse ways, including private veterinary practices in 2 of 33 communities, and by mail-order, fly-in, free clinics, and a government-coordinated lay vaccinator program in some of the other 31 communities. We evaluated delivery, needs, and potential uptake of domestic animal health services in the Sahtu Settlement Area, NT by offering free clinics for 225 dogs in 2008 and 2009; and administered questionnaires to 42 dog owners and 67 students in 2008. Owners indicated that 20% of dogs were neutered, 37% had had rabies vaccinations, and 29% had been dewormed. Physical examination of dogs demonstrated that 54% were “thin” and 4% were “emaciated.” Owners and youth showed a range of attitudes toward dogs and supported improved domestic animal health services. Future services need to build on existing programs and collaborate with communities to ensure relevance, ownership, and sustainability. Résumé — Évaluation et prestation de services de santé aux animaux domestiques dans les collectivités éloignées des Territoires du Nord-Ouest : Une étude de cas sur la situation et les besoins. Des services de santé aux animaux domestiques sont fournis aux collectivités dans les Territoires du Nord-Ouest (T.-N.-O.) du Canada de diverses manières, incluant des pratiques vétérinaires privées dans 2 des 33 collectivités ainsi que par la poste, des services livrés par voie aérienne, des cliniques gratuites et un programme de vaccinateurs non spécialistes coordonné par le gouvernement dans quelques-unes des 31 autres collectivités. Nous avons évalué la prestation, les besoins et la mise sur pied potentielle de services de santé aux animaux domestiques dans les établissements de la région de Sahtu des T.N.-O. en offrant des cliniques gratuites pour 225 chiens en 2008 et en 2009 et en administrant des questionnaires à 42 propriétaires de chiens et à 67 étudiants en 2008. Les propriétaires ont indiqué que 20 % des chiens étaient stérilisés, que 37 % avaient été vaccinés contre la rage et que 29 % des chiens avaient subi un traitement de vermifugation. L’examen physique des chiens a démontré que 54 % étaient «maigres» et que 4 % étaient «émaciés». Les propriétaires et les jeunes ont manifesté un éventail d’attitudes envers les chiens et appuyaient des services de santé améliorés pour les animaux domestiques. Les services futurs doivent être établis autour de programmes existants et en collaboration avec les collectivités afin d’assurer la pertinence, la prise en charge et la viabilité. Can Vet J 2010;51:1115–1122
A
Introduction
ccess to and uptake of domestic animal health services in many rural, remote, and culturally distinct areas of the world is variable and often poorly understood (1). The limited availability of such services can result in dog overpopulation, animal health and welfare concerns, and human health issues (2–6). Poor access to communities hundreds of kilometers from
(Traduit par Isabelle Vallières)
an urban center or with no road access is a factor (7). When services are available, they may not be used because of the nature and level of education, and economic and social positions whereby individuals cannot afford animal health services or choose not to use them because of cultural norms, spiritual motivations, or different perspectives on animal health and welfare (8,9).
Department of Ecosystem and Public Health, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta T2N 4N1 (Brook, Kutz, Elkin); Canadian Cooperative Wildlife Health Centre, Western College of Veterinary Medicine, Saskatoon, Saskatchewan S7N 5B4 (Millins, Leighton); Department of Environment and Natural Resources, Government of the Northwest Territories, Norman Wells, Northwest Territories X0E 0V0 (Veitch) and Yellowknife, Northwest Territories X1A 2L9 (Elkin). *Drs. Brook, Kutz, and Millins contributed equally to this paper and are listed alphabetically. Address all correspondence to Dr. Susan Kutz; e-mail:
[email protected] Dr. Brook’s current address is Indigenous Land Management Institute & Department of Animal and Poultry Science, College of Agriculture and Bioresources, University of Saskatchewan, Saskatoon, Saskatchewan S7N 5A8. Use of this article is limited to a single copy for personal study. Anyone interested in obtaining reprints should contact the CVMA office (
[email protected]) for additional copies or permission to use this material elsewhere. CVJ / VOL 51 / OCTOBER 2010
1115
A R T I C LE
Several models exist for providing animal health services in rural and remote areas (10). Some type of shared public and private responsibility is most common, with the government regulating services and developing centralized reporting for disease outbreaks, and private clinics doing the clinical work (10). Para-veterinarians, animal health workers without a veterinary degree but with formal training to provide basic services, are common in developing countries but rare in developed nations because of legislated restrictions (7,11). Failure to address critical social, technical, and sustainability issues, engage communities, or ensure financial sustainability has limited the success of many animal health care delivery programs in underserviced regions (12). In the Northwest Territories (NT) in northern Canada, there is a broad range of interconnected concerns about domestic animals, dogs in particular, including animal health and welfare and risks to human and wildlife health. In many areas of the NT, addressing these concerns may be hindered by limited accessibility, availability, affordability, and acceptance of primary veterinary services and conventional animal health education. Only a few publications have explored these domestic animal health issues in northern Canada (6,13). Our objectives were to: 1) summarize the current status of domestic animal health care services and issues in the NT; 2) characterize local attitudes toward dogs and potential and actual uptake of veterinary services in the Sahtu Settlement area of the NT (“the Sahtu”); and 3) develop an initial framework for enhancing animal welfare awareness and building local capacity to manage animal health issues.
Materials and methods Domestic animal health services are often evaluated by considering accessibility, availability, affordability, acceptance, and quality (14). Accessibility and availability of veterinary services was evaluated through documenting the presence and distribution of practices, mobile clinics, and the distance to and types of access un-serviced communities have to veterinary services. This was based on interviews with all available veterinarians operating permanent or mobile practices in the NT and municipalities and wildlife and health divisions of territorial governments. The role of existing legislation in facilitating or inhibiting service delivery was examined through a review of the literature. Acceptance of dog owners who attended the clinics was examined through questionnaires, and the attitudes and acceptance of youth were explored through questionnaires, classroom interactions, and by involvement in our animal health care activities. All available nurses in the Sahtu and Environmental Health Officers (EHOs) were interviewed regarding occurrence of zoonoses and bites. The published literature, the Canadian Cooperative of Wildlife Health Centre (CCWHC; http://www.ccwhc.ca) database, and the NT Rabies Surveillance Database were also sourced for information.
Clinic delivery In January 2008 and February 2009 we held veterinary clinics in all Sahtu communities except Norman Wells, which already receives annual services. The clinics were advertised 1116
through public meetings, posters, radio announcements, and school visits. In 2008, histories and physical examinations were documented for each dog. Vaccination was offered for rabies and other common viral diseases, and dogs were dewormed. In 2009, surgical castrations and ovariohysterectomies were also offered as part of a 4th-year veterinary student rotation in “Northern Community Health,” hosted by the University of Calgary, Faculty of Veterinary Medicine. Clinics were free in both years and donations were solicited in 2009. Following the program in 2009, feedback on the clinics was requested by e-mail from stakeholders.
Engaging youth in animal health Concurrent with the clinics, and building on our Sahtu Wildlife Health Outreach and Monitoring Program (15), we engaged K-12 students in interactive presentations on wild canids and dog health, welfare, and safety and we left educational materials (World Society of Protection of Animals and purchased from Doggone Crazy!TM) with each school. Interested students were encouraged to assist with the veterinary clinics.
Questionnaires In 2008, a questionnaire (approved by the University of Calgary Conjoint Health Research Ethics Board and the Sahtu Divisional Board of Education) was distributed to Sahtu schools. Principals obtained consent from parents and distributed the questionnaires to all students. Questionnaires were also completed by owners of the dogs examined at the clinics. For analyses, unless otherwise indicated, all data were pooled from the school and clinic questionnaires. Comparisons between means were made using Mann-Whitney U-tests and relationships among variables were assessed with Pearson productmoment correlation coefficient. P-values , 0.05 were statistically significant. Questions about attitudes towards dogs were reduced into a single variable using factor analysis (unweighted least squares method, varimax rotation) (SAS Version 8.3; SAS Institute, Cary, North Carolina, USA). This approach categorized respondents along a continuum from negative to positive about dogs based on Likert scale responses to the statements “I like dogs very much,” “My dog is generally happy,” “My dog is healthy,” and “I am afraid of most dogs.”
Results Current status of domestic animal health care services and issues in the Northwest Territories Access to and availability of veterinary services In the 33 communities across the NT, there is considerable variation in the level of domestic animal health services. Private veterinary practices exist only in Yellowknife and Inuvik, and practices in Yukon and Alberta provide occasional services for adjacent NT communities. Of the 31 communities without a resident practice, only 4 are serviced regularly by mobile veterinary practices. Of the 27 un-serviced communities, 12 have all-season road access (average driving distance 167 km, range: 3 to 637 km), 10 have winter-only road access (average driving distance 155 km, range: 97 to 322 km), and 5 communities have air-only access. Direct access to veterinary services is largely CVJ / VOL 51 / OCTOBER 2010
Human health concerns related to dogs Of 28 dog-attack fatalities reported in Canada from 1990 to 2007, 3 were in northern Canada, a rate that is higher than that in the south (18). In the NT, from 2000 to 2006, 582 animal CVJ / VOL 51 / OCTOBER 2010
bites were reported to EHOs, 98% of which were from dogs (GNWT Dog Bite Database, unpublished data). The rate of reported dog bites at 22/10 000 people/year in the NT is considerably higher than 13 in the United States (19) and 16 for the City of Guelph in Ontario (20), though these numbers should all be interpreted with caution since many bites go unreported. Of NT bite cases, only 35% of the dogs involved were confirmed as having been vaccinated against rabies and 5% of these dogs were destroyed (21). In 48% of the dog bite incidents, the EHO suggested that the bite was provoked. Other human health issues included several preventable zoonotic diseases, especially rabies. In the NT, the Arctic fox is the primary reservoir for rabies. Rabies has also been reported in wolves, lynx, and grizzly bear (22). Nine cases of rabies were documented in dogs within the NT from 1998 to 2004 (22). There has never been a documented case of rabies in humans in the NT; however, 20 individuals received rabies post-exposure treatments during 2002 to 2003 indicating an ongoing perception of risk (21). Dogs in northern Canada are host to at least 6 genera of zoonotic parasites, some of which are transmitted to people from canid feces (6). Dogs fed wild game or housed outdoors may be more likely to be infected (6). Hydatid disease (Echinococcus granulosus), is directly transmitted to people from eggs in canid feces, and 17 definite or suspect cases were diagnosed in NT residents attending hospitals in Edmonton, Alberta from 1991 to 2001. Many cases may also go undiagnosed as clinically “silent” (23). Giardia is not uncommon in residents of northern Canada and wildlife-human and domestic dog-human transmission cycles are postulated (6,24). Toxocara canis is present in dogs in NT (6), and although no human cases have been reported, it is an important zoonosis, especially in children (25). Diphyllobothrium, Alaria, and Toxoplasma are also present in northern dogs; however, transmission from dogs to humans does not occur (6). Wildlife-dog health concerns Direct and indirect interactions between dogs and wildlife in the NT may lead to transmission of infectious disease among these hosts. Dog owners report interactions between dogs and red and Arctic foxes, and the feeding of foxes in communities is common. Wolves often enter communities and kill or injure dogs. Dogs also accompany people when they travel on the land, functioning as companions, guard dogs, and occasionally as sled dogs. Dogs shot for animal control purposes or because of injury or diseases are typically disposed of at community landfills, and may be scavenged by a variety of wildlife species or free-roaming dogs. Neurological signs or altered behavior were the most frequent causes for submissions of wild canids for disease testing in the NT from 1990 to 2007 (data include Nunavut until 1999). Of the animals submitted, 114/120 (95%) Arctic foxes, 43/95 (45%) red foxes, and 13/26 (50%) of wolves tested positive for rabies [unpublished data, Government of the Northwest Territories (GNWT) Rabies Test Submissions Database]. Note that this is a biased sample of animals that exhibited clinical signs or had had domestic animal or human contact. 1117
A R T I C LE
associated with community size: 6 of the 8 NT communities with . 850 residents receive regular service, communities with , 850 residents have no on-site service. The willingness of veterinarians to establish practices, join existing practices, or even visit remote communities is influenced by factors that may include financial viability, logistical challenges such as housing and places to hold clinics, and perceptions of the physical and cultural environment. For communities without direct access to veterinary clinics, private practices provide mail-order services for some products, including vaccines, and some advice via telephone or e-mail. Occasionally, pets are flown to a private practice; however, residents in remote communities are often unaware of available veterinary care and may not have the resources to pay the high transportation costs and veterinary fees. Free veterinary clinics offered by universities and not-for-profit organizations are held sporadically and on request in some NT communities, but these are typically one-time events. All veterinary services in the territory are regulated under the NWT Veterinary Professional Act, 1988, which outlines the qualifications needed to practice, licensing requirements, and complaints procedures (16). All veterinarians practicing in the NT must be licensed with the Veterinary Registrar of the Department of Health and Social Services, GNWT, and by the Canadian Veterinary Medical Association. The NT has a “lay vaccinator” program coordinated by the GNWT in collaboration with the Canadian Food Inspection Agency (CFIA). This program is under provisions in Section 134.2 of the federal Health of Animals Act and regulations (17). While administration of rabies vaccine is normally restricted to licensed veterinarians, this provision allows for federal approval of specially designated rabies vaccination programs delivered in the communities by trained EHOs or select other professionals, such as By-Law Officers or Royal Canadian Mounted Police (RCMP) “in a remote area where veterinary services are not readily available.” The legislation does not define “remote” or “not readily available.” Interpretation of both terms and identification of where the program is delivered is based on distance and access to resident veterinary clinics, and frequency of mobile clinics. “Remote” has been interpreted to mean fly-in access only. The lay vaccinator program has been in existence in some form for decades, initially administered by the CFIA and RCMP in the 1950s. The territory veterinarian now manages the program and provides training, vaccines, and support materials to EHOs and lay vaccinators. Approximately 3000 to 4000 doses of rabies vaccine are distributed each year. By-Law Officers, present in many NT communities, enforce Animal Control By-Laws and are responsible for dog control. They encourage people to keep dogs tied and authorize the shooting of loose dogs when necessary. However even in communities where a By-Law Officer position exists, it is sometimes vacant for long periods.
A R T I C LE
Canine distemper virus (CDV) and canine parvovirus (CPV-2) appear to cycle in wild and domestic canid and mustelid populations throughout the North and may limit population growth [CCWHC database, unpublished data (26–29)]. Periodic epizootics of CDV occur in dogs in the NT and Nunavut, often involving multiple communities and high mortality rates (28). Several macroparasites are also transmissible between dogs and northern wildlife. Dogs may amplify environmental contamination, enhancing transmission to other canid final or intermediate hosts such as moose, caribou, fish, and rodents. Dogs may also introduce new parasite species that infect wildlife as is hypothesized in the case of lice in wolves in Alaska (6). The relative roles of domestic dogs and wild carnivores as sources or spill-over hosts for infectious diseases, and the epidemiology of these diseases in the North, are important topics in need of research (6). Dog welfare and health legislation The specific nature and extent of neglect toward dogs in the NT are unknown (30). Many concerns regarding abuse and how it is managed have been highlighted (examples, 30–33). The NT and Nunavut were recently ranked by the Animal Legal Defence Fund as tied for having the worst domestic animal protection laws in Canada (34). The GNWT’s Dog Act, 1988 does not effectively explain unacceptable treatment of dogs and the language makes it difficult to prosecute anyone for neglect (30). The maximum fine of $25 for mistreatment of dogs, compared to $ $5000 in most other provinces, is unlikely to effectively deter dog abuse. Limitations of the existing legislation have been recognized, and the GNWT is consulting stakeholders to identify and address areas requiring change. The Cities, Towns and Villages 2003 Act allows communities to initiate local bylaws to protect dogs. Clinic delivery Uptake of the clinics in 2008 was estimated at 5% to 30% of dog-owning households, based on proportional dog ownership from school questionnaires. Several owners brought select dogs to the clinics suggesting different perceptions of need for services for dogs within the same household. There was a significant increase in uptake of services in 2009, with 131 dogs seen by veterinarians, an increase of 39% from 94 dogs in 2008. During the clinics we also worked with local RCMP and By-Law Officers to restrain and vaccinate dogs so they could administer booster shots and assist with the Lay Vaccinator Program. Few clients from the veterinary clinics followed up to get booster shots even after repeated reminders and offers from lay vaccinators to do house calls. Engaging youth in animal health education and outreach In 2008–2009 we interacted with 510 students in classrooms and in clinics. In 2009, we held the clinics in schools to facilitate youth involvement. Working with veterinarians, 4th year veterinary students, graduate students, and animal health technicians, youth helped in completing animal health records, preparing 1118
Figure 1. A high school student from the Sahtu Settlement Area, in the Northwest Territories assists with surgery on a dog during the 2009 Community Health Rotation.
vaccines, administering questionnaires, and preparing for and observing surgeries (Figure 1). Students were invaluable local guides and community contacts for the mobile clinics. Six adult dog owners commented that they hoped one of these local youth would become a veterinarian and stay in the community to provide regular services. Kindergarten to grade 6 students demonstrated knowledge on animal welfare, readily identifying the Five Freedoms: freedom from hunger, thirst, and malnutrition; freedom from discomfort; freedom from pain, injury, and disease; freedom to express normal behaviors; and freedom from fear and distress (35,36). Teachers indicated that the presentations and clinics were valuable learning experiences. One school principal noted that: “The vet clinic was very useful in a few key ways. Raising awareness amongst students who often are the primary caregivers of the animals. The buzz leading up to, during, and after the clinic amongst the students about caring for their animals was amazing. Having the clinic in the school allowed students to see a career in action. Being so isolated, they often only interact with a very limited number of career options. As a science teacher, the clinic also provides a novel avenue to talk about and to experience science with my students... I can’t stress how impressed I was with the vets, their interaction with the kids, and the kids’ keen interest in caring for their animals. I think we may have a few young vets in the making.” Another school principal underscored the importance of the project: “Given the current conditions that the [community] dog population is living in, the vet clinic is more than useful, it is essential. At any given point, there is a sizable population of ‘free range’ dogs fending for themselves as well as those chained in questionable locations, neither of which are ideal situations. Puppies are loved and valued to a point, then discarded once a new litter comes along. Any efforts to raise awareness, promote population control, CVJ / VOL 51 / OCTOBER 2010
and to vaccinate those that you can are all steps in the right direction.” A long-term aboriginal resident also indicated
A R T I C LE
“The clinics are very important for the communities; it helps them understand the importance of keeping their dogs healthy. The clinics have raised awareness with the adults and elders, but the kids have to be reminded. They have to be informed on how to keep their pets healthy, and be responsible for their pet. It has improved the health of the dogs, but again the kids have to be reminded, of their responsibility to their pets, because, most of the stray dogs running at large belong to kids. I believe that the clinics were a valuable experience for the kids. Some of them now know that dogs can have operations, the same as humans. We must remind them about the importance of vaccinations... If not done, dogs could get sick and pass it on to the other dogs in the settlement. And loose dogs who are sick with rabies would be a threat to kids, adults, elders and other dogs in the settlement.”
Questionnaires Of the 67 student respondents 58% were female and 42% were male, mean age was 14 y (range: 10 to 22 y); 81% of respondents owned dogs, and the average number of dogs per household was 1.8 (range: 1 to 4). Forty-one questionnaires were received from owners attending the clinics and there were no refusals. Mean age of respondents was 33 y (range: 11 to 67 y) (NT mean age is 31 y, Statistics Canada 2006 Census, unpublished data). All clinic respondents owned dogs and the average number of dogs per household was 2.0 (range: 1 to 10). Dogs were small (25%), medium (29%), or large (46%) and included purebred (24%) and mixed breed (76%) animals. For all respondents combined, 59% of their dogs were male and 41% were female; 62% of dogs were primarily for companionship, 10% for guard dogs, 13% for hunting, and 22% for “other.” Several respondents who answered “companion” did this by default, that is, only after all options were offered did they choose companionship. Dog ages ranged from 0.1 to 14 y (mean = 3.2 y), and 46% of all dogs were # 2-years-old. Dog diets were highly variable and included wild meat, fish, table scraps, store bought food, game birds, and cat food. There was no significant relationship between the condition score assigned to a dog by the veterinarian (emaciated, thin, ideal, overweight, obese) and the owner’s response regarding how frequently they felt their dog received enough to eat (scored as every day, most days, some days; r = 0.323, P = 0.28). Although 82% of veterinary clinic respondents felt their dog got enough to eat “every day,” veterinarian assessment of these same dogs was 4% — emaciated, 54% — thin, 38% — ideal, and 4% — overweight. Sixty-nine percent of dogs were kept mostly indoors, 25% were mostly outdoors on a chain, and 6% were free-roaming. Of the dogs kept outdoors, 70% had shelter. Interactions between dogs and wildlife were volunteered as concerns by 9 participants. For dogs brought to the veterinary clinics, 37% had been vaccinated against rabies, 21% had been vaccinated CVJ / VOL 51 / OCTOBER 2010
Figure 2. A notice that was posted in a Sahtu community in 2009 indicating important concerns related to dogs.
against other common canine diseases, and 29% had been previously dewormed. Only 20% of the dogs had been spayed or neutered, but 75% of respondents indicated they would spay or neuter if the service were available in their community; and of these respondents, 64% indicated they would be willing to pay for the service. There was no significant difference between the proportion of female dogs and male dogs that owners were willing to spay or neuter (x2 = 0.004; P = 0.95). Both students and adults had a broad range of attitudes toward dogs that ranged from very positive to very negative. Perspectives regarding dog overpopulation were summarized by responses to the statement “There are too many dogs in my community” and mean responses were significantly greater than neutral, indicating perception of too many dogs in Deline (P = 0.02) and Tulita (P , 0.001); however, there were no significant differences in mean responses among communities. One respondent noted that: “there aren’t too many dogs in the community, just not enough that are well cared for.” Factor scores based on questions related to attitudes toward dogs placed each respondent along a relative scale and 62% of respondents had factor scores . 0 (positive attitudes toward dogs). There was no significant difference between the communities with $ 90% aboriginal people (Tulita, Deline, Fort Good Hope, and Colville Lake) and Norman Wells, which is 41% aboriginal (U = 124; P = 0.77) and there was no significant difference among factor scores for respondents , 13-years-old, teenagers, and adults (U = 107; P = 0.81). In the Sahtu, 42% of student respondents and 27% of veterinary clinic respondents had been bitten 1 or more times, but 1119
A R T I C LE
only 20% and 30% of these, respectively, had received treatment at a health centre and, therefore, would be included in territory records. For all respondents who were bitten, 31% were $ 18-years-old, 46% were 13- to 17-years-old, and 23% were , 12-years-old at the time they completed the questionnaire. Half of the bitten respondents were male and half were female. Of all respondents, 55% had been chased or frightened by a dog, and 31% had been knocked over. We observed notices posted in several Sahtu communities warning dog owners to tie up their dogs because of concerns regarding public safety (Figure 2).
Discussion Our results demonstrate that across Sahtu communities there are concerns with human-dog health interactions. Dog bites and zoonoses were prominent issues yet only 37% of dogs in the Sahtu were vaccinated against rabies, compared with 97% in rural Ontario (37) and 89% in urban Canada (38). The Sahtu data were based on owner recollection but are consistent with the NT Dog Bite Database, which reports that only 35% of dogs that had bitten humans had been vaccinated for rabies. The apparent low coverage of rabies vaccination may in part reflect the relatively young dog population; however, it is apparent that there are also important barriers to uptake of vaccination services. It is imperative that an approach be developed to identify and document the vaccinated and unvaccinated dogs in each community and to explore the reasons for the apparently low proportion of vaccinated dogs. Similarly, prevention of zoonotic parasite transmission requires further consideration. Regular deworming and appropriate husbandry of dogs reduce the risk of parasite transmission to humans, yet , 1/3 of the dogs in this study had been previously dewormed and some lived in conditions with extreme environmental contamination with feces. With regard to population control, only 20% of the dogs had been spayed or neutered compared with 66% in rural Ontario (37) and 69% in urban Canada (38). This low rate in the Sahtu is particularly problematic since at least 6% of the dog population is free-roaming. Dog health and welfare were significant concerns voiced by many stakeholders. These concerns are consistent with our extensive collective northern experience where we have found that the major sources of mortality for dogs include: being hit by vehicles, being shot, exposure (often puppies), malnourishment, dehydration, and infectious disease; all of which are preventable. Recent media reports on dog neglect and shooting in northern Canada highlight the extremes of some of these issues (31–33,39); however, our results suggest that there is a wide range of attitudes and actions with respect to domestic animal health care. There are also diverse perspectives toward shooting of dogs within communities, ranging from acceptance to deep concern regarding the ethics, safety, and psychological impact of such actions. School and dog owner questionnaires indicated a desire for better access to animal health services and education; however, uptake rarely exceeded 50% each year, but in 2009 uptake was much greater and may have been over 50%. Less than half of all dog owners attended a clinic, and of those, almost one third indicated that they would not use a spay/neuter service or would be unwilling or unable to pay for the service. The sample of dog 1120
owners was small and biased towards those proactive about dog care. It is, therefore, essential to recognize that dog owners who do not attend clinics may have quite different opinions with respect to dog health and welfare and may not necessarily value provision of such services. It is clear that, given the distinct cultural, economic, and social context of these communities, the diversity of attitudes, together with the remote setting, simply providing additional traditional veterinary services or increased enforcement is not likely to fulfill this need. This is evidenced by the low numbers of dog owners who used vaccination boosters that were available. A more holistic and community-centered approach respecting the unique and diverse perspectives that exist, while building local capacity and working collaboratively toward a long-term sustainable process, is needed. Importantly, social, cultural, and regulatory barriers to delivery and uptake of services should be investigated and solutions should be developed (1,7,12,30,34). Options for developing local capacity, perhaps modeled after the “Community-based Animal Health Care Workers” that have been established in remote regions of many developing nations, need to be explored (40). These options should build on existing programs, infrastructure, and human resources and expertise such as existing veterinary practices and the territorial lay vaccinator program. Such an approach is well-established for human medicine in northern Canada where nurse practitioners deliver preventative health care services under the remote direction of medical doctors (41). Development of local capacity for delivery of basic domestic animal health services that are remotely supervised by a licensed veterinarian would ensure that these services are accessible continuously rather than sporadically or not at all. Such an approach will require revisiting with an open mind the existing veterinary legislation regarding para-professionals since there are few successful models of para-professionals in animal health in North America, despite their successes in developing countries (7). Concerted efforts should be made to critically evaluate possible solutions to more effectively promote animal health and welfare, and therefore human health and welfare, in these under-serviced communities. Sustainability will require external support, such as local and regional governments, private practices, universities, and not-for-profit groups, at least in the short-term, and opportunities for novel private-public partnerships should be explored (10). A key challenge to establishing sustainable domestic animal health services is engaging local residents in identifying problems and shaping solutions. Despite the expressed concerns of Sahtu residents regarding managing animal health issues, public consultation meetings on these issues were poorly attended by all stakeholders. This may reflect “meeting fatigue,” competing events, or perhaps apathy or a sense that someone else is responsible. The youth are a key group of stakeholders, and future leaders, and they can be readily engaged through schools. They are frequently the primary caregivers for dogs, thus their engagement in the topic of animal health and welfare is essential. Our multifaceted approach to engage youth in classroom and clinics met with active and enthusiastic youth participation, questions about future career options in animal health, and unanimous praise and support from educators, public health CVJ / VOL 51 / OCTOBER 2010
Acknowledgments We are grateful to community members in the Sahtu who shared their time and knowledge; Drs. Maelle Gouix, Doris Hubbard, Gord Krebs, Pat Curry, and Erin Fraser for their assistance; Laurel Cowburn, Tony Stevens, Gayle Cummings, and Allison Murray for their participation; the By-Law officers in Fort Good Hope and Tulita; and Tim Melnyk and Richard Popko for logistical support. Financial support was generously provided by the University of Calgary, Faculty of Veterinary Medicine, the Department of Environment and Natural Resources of the GNWT, Veterinarians Without Borders, the Natural Sciences and Engineering Research Council of Canada PromoScience, the Sahtu Renewable Resources Board, Pfizer Animal Health, Western Drug Distribution Center Limited, and Bayer Canada. Canadian North, Heritage Hotel Norman Wells, Little Dipper Services (Fort Good Hope), Northern Store in Fort Good Hope, the Behdzi Ahda First Nation in Colville Lake, the Deline Land Corporation, North-Wright Airways Ltd (Norman Wells), Margaret and Bernard Brown (Colville Lake), the schools of Fort Good Hope, Deline and Tulita, and individual animal owners CVJ in the communities.
References 1. de Haan C. Introduction: The provision of animal health services in a changing world. Rev Sci Tech 2004;23:15–19. 2. Wolfe A, Wright IP. Human toxocariasis and direct contact with dogs. Vet Record 2003;152:419–422. 3. Sidibé AS. The present and future organisation of veterinary service in Africa. Rev sci tech Off int Epiz 2003;22:473–484. 4. Matter HC, Wandeler AI, Neuenschwander BE, Harischandra LPA, Meslin FX. Study of the dog population and the rabies control activities in the Mirigama area of Sri Lanka. Acta Trop 2000;75:95–108. 5. Bradbury L, Corlette S. Dog health program in Numbulwar, a remote Aboriginal community in east Arnhem Land. Austral Vet Journ 2006;84: 317–320. CVJ / VOL 51 / OCTOBER 2010
6. Salb AL, Barkema HW, Elkin BT, et al. Dogs as sources and sentinels of parasites in humans and wildlife, northern Canada. Emerg Inf Dis 2008;14:60–63. 7. Catley A, Leyland T, Mariner JC, et al. Para-veterinary professionals and the development of quality, self-sustaining community-based services. Rev sci tech Off int Epiz 2004;23:225–252. 8. Serpell JA. Factors influencing human attitudes to animals and their welfare. Animal Welfare 2004;13:145–151. 9. Banks J, McCormack D. Local laws: Two traditions, two laws, or common ground and mutual respect. Proc Dog Peopl Conf Anim Manag Rur Rem Indig Comm 2006:1–5. 10. Nielsen O, Evans B, King LJ. The concept of rural community practice (RCP). J Vet Med Educ 2006;33:549–553. 11. Allport R, Mosha R, Bahari M, Swai E, Catley A. The use of communitybased animal health workers to strengthen disease surveillance systems in Tanzania. Rev sci tech Off int Epiz 2005;24:921–932. 12. McCorkle CM. Community-based animal health workers: The story so far. In: The IDL Group, eds. Community Based Animal Health Workers — Threat or Opportunity. The IDL Group, Crewkerne. 13. World Society for the Protection of Animals. Northern dogs: A summary of the 2007 conference. Available from http://old.wspa.ca Last accessed August 9, 2010. 14. Catley A, Admassu B. Cross-sectoral learning for service provision in the Somali region of Ethiopia. Available from http://wikis.uit.tufts.edu/ confluence Last accessed August 9, 2010. 15. Brook RK, Kutz SJ, Veitch A, Popko R, Elkin B, Guthrie G. Fostering community-based wildlife health monitoring and research in the Canadian North. EcoHealth 2009;6:266–278. 16. Northwest Territories Health and Social Services. Veterinary Profession Act. Available from http://www.hlthss.gov.nt.ca/english/our_system/ legislation/legislation_o_to_z.htm#Veterinary_Profession_Act Last accessed August 9, 2010. 17. Canadian Food Inspection Agency. Health of Animals Act. Available from http://www.inspection.gc.ca/english/reg/rege.shtml Last accessed August 9, 2010. 18. Raghavan M. Fatal dog attacks in Canada, 1990–2007. Can Vet J 2008;49:577–581. 19. Weiss HB, Friedman DI, Coben JH. Incidence of dog bite injuries treated in emergency departments. JAMA 1998;279:51–53. 20. Szpakowski NM, Bonnett BN, Martin SW. An epidemiological investigation into the reported incidents of dog biting in the City of Guelph. Can Vet J 1989;30:937–942. 21. Mitchell R, Kandola K. Rabies in the Northwest Territories Part 2: Rabies surveillance in the Northwest Territories. EpiNorth 2005;17: 4–6. 22. Walker J, Elkin B. Rabies in the Northwest Territories: A historical overview of rabies in NWT. EpiNorth 2005;17:1–3. 23. Somily A, Robinson J, Miedzinski L, Bhargava R, Marrie T. Echinococcal disease in Alberta, Canada: More than a calcified opacity. BMC Infect Dis 2005;5:1–7. 24. Kutz SJ, Thompson RA, Polley L, Kandola K, Nagy J, Wielinga CM, Elkin BT. Giardia assemblage A: Human genotype in muskoxen in the Canadian Arctic. Parasit Vectors 2008;1:1–4. 25. Jones JL, Kruszon-Moran D, Won K, Wilson M, Schanz PM. Toxoplasma gondii and Toxocara spp. coinfection. Amer J Trop Med Hyg 2008;78:35–39. 26. Choquette LPE, Kuyt E. Serological indication of canine distemper and of infectious canine hepatitis in wolves (Canis lupus L.) in Northern Canada. J Wildl Diseases 1974;10:321–324. 27. Maes RK, Wise AG, Fitzgerald SD, et al. A canine distemper outbreak in Alaska: Diagnosis and strain characterization using sequence analysis. J Vet Diagn Invest 2003;15:213–220. 28. Leighton T, Ferguson M, Gunn A, Henderson E, Stenhouse G. Canine distemper in sled dogs. Can Vet J 1988;29:299. 29. Mech LD, Goyal SM, Paul WJ, Newton WE. Demographic effects of canine parvovirus on a free-ranging wolf population over 30 years. J Wildl Dis 2008;44:824–836. 30. Northwest Territories Municipal and Community Affairs. Discussion paper: Improving the Dog Act. Available from http://www.maca. gov.nt.ca/Consultations/Dog_Act_Discussion_Paper.pdf Last accessed August 9, 2010. 31. Canadian Broadcasting Corporation. Euthanizing N.W.T. man’s 34 dogs ‘saddest day of my life’ for vet. 2008. Available from http://www.cbc.ca/ canada/north/story/2008/09/30/behchoko-dogs.html Last accessed August 9, 2010.
1121
A R T I C LE
professionals, community members, and leaders in the Sahtu. Engaging youth now aims at building capacity and support for local animal health services in the future. This study is the first of its kind in Canada and has provided important insights into the issues related to domestic animal health services that are likely common in many remote northern and aboriginal communities. Many areas of critical research needs are highlighted. Limitations of the study include a relatively short time frame (2 y) and small and biased samples of respondents, though low response rates are not unexpected in surveys conducted in remote and rural areas, especially with small aboriginal communities. Results suggest that, for much of the population of the NT, domestic animal health care services are not readily available, accessible, or affordable. Acceptance of services when they are offered varies considerably as reflected by the range of responses which included everything from passionate appreciation to apathy. Although evaluating quality of services was beyond the scope of this study, we have no reason to question the quality of the existing veterinary practices or mobile services. The challenge is now to develop effective, community-based and culturally relevant methods for delivery of quality domestic animal health care services and education in remote communities in a sustainable manner.
A R T I C LE
32. Canadian Broadcasting Corporation. Three dogs found dead, three starving in Tuktoyaktuk. Available from: http://www.cbc.ca/canada/ north/story/2008/12/24/dead-dogs.html Last accessed August 9, 2010. 33. Canadian Broadcasting Corporation. Give NWT animal law more bite, MLA urges assembly. http://www.cbc.ca/canada/north/story/ 2009/02/13/nwt-dog.html Last accessed August 9, 2010. 34. Animal Legal Defense Fund. 2009. Canadian animal protection law rankings: Comparing overall strength and comprehensiveness. Available from http://www.aldf.org/article.php?id=945 Last accessed August 9, 2010. 35. Jalongo MR. Beyond a pets theme: Teaching young children to interact safely with dogs. Early Child Educ J 2008;36:39–45. 36. Wojciechowska JI, Hewson CJ. Quality-of-life assessment in pet dogs. J Am Vet Med Assoc 2005:226,722–728.
37. Leslie BE, Meek AH, Kawash GF, McKeown DB. An epidemiological investigation of pet ownership in Ontario. Can Vet J 1994;35:218–222. 38. Perrin T. The business of urban animals survey: The facts and statistics on companion animals in Canada. Can Vet J 2009;505:48–51. 39. Canadian Federation of Humane Societies. Arctic dogs saved from shooting. Available from http://cfhs.ca/info/arctic_dogs_saved_from_ shooting Last accessed July 22, 2009. 40. Leyland T, Catley A. Community-based animal health delivery systems: Improving the quality of veterinary service delivery. Proc World Vet Congr 2002:1–15. 41. MacLeod M, Browne AJ, Leipert B. International perspective: Issues for nurses in rural and remote Canada. Austr J Rur Health 2008;6:72–78.
Answers to Quiz Corner Les réponses du test éclair 1.
d) E. coli is involved in approximately 40% of canine urinary tract infections. d) E. coli est impliquée dans environ 40 % des infections urinaires chez le chien.
6.
e) Activated clotting time reflects the integrity of the intrinsic coagulation pathway. e) Le temps de coagulation activé reflète l’intégrité de la voie intrinsèque de la coagulation.
2.
e) Chronic pancreatitis is a predisposing factor, along with genetic predisposition, infection, insulin antagonistic diseases and drugs, and immune-mediated ileitis. e) La pancréatite chronique est un facteur prédisposant, de même que les prédispositions génétiques, les infections, les maladies et les médicaments antagonistes insuliniques et l’iléite à médiation immunitaire.
7.
a) Endotoxemia from mastitis caused by gram-negative organisms frequently results in paresis that can resemble milk fever. a) L’endotoxémie résultant d’une mammite causée par des organismes à gram négatif résulte fréquemment en une parésie qui peut ressembler à la fièvre du lait.
3.
8.
a) Parvovirus infection typically causes vomiting, bloody diarrhea, and leukopenia. The other answers listed may cause vomiting and bloody diarrhea but not leukopenia. a) L’infection à parvovirus cause de façon caractéristique des vomissements, de la diarrhée sanglante et une leucopénie. Les autres affections énumérées peuvent causer des vomissements et de la diarrhée sanglante mais pas de leucopénie.
b) Most cows with milk fever have a slightly elevated heart rate, usually in the range of 70 to 90 beats/min and seldom over 100 beats/min. b) La plupart des vaches souffrant de fièvre du lait ont une fréquence cardiaque légèrement élevée, habituellement entre 70 à 90 battements/minute et rarement au-dessus de 100 battements/minute.
9.
e) Pigs become infected with S. Typhimurium by contact with infected pigs and infectious excretions. e) Les porcs s’infectent avec S. Typhimurium par contact avec des porcs infectés et les excrétions contaminées.
10.
b) Bluish-purple wound edges indicate that blood vessels under the skin are congested with blood. b) Les lèvres d’une plaie de couleur bleu violet indiquent que les vaisseaux sanguins sous la peau sont gorgés de sang.
4.
5.
1122
a) High-dosage dexamethasone suppression and endogenous ACTH levels are used to differentiate the types of hyperadrenocorticism. They are used after the disease is diagnosed with a screening test, such as the ACTH stimulation test or low-dosage dexamethasone suppression test. a) Le test de freinage à la dexaméthasone à forte dose et le taux d’ACTH endogène sont utilisés pour différencier les types d’hyperadrénocorticisme. Ils sont utilisés après le diagnostic de la maladie à l’aide d’un test de dépistage, tel le test de stimulation par l’ACTH ou le test de freinage à la dexaméthasone à faible dose. a) Pleuropneumonia or lung abscesses are found in approximately 2/3 of horses with pleural effusion. a) La pleuropneumonie ou les abcès des poumons sont rencontrés chez environ les deux tiers des chevaux qui souffrent d’épanchement pleural.
CVJ / VOL 51 / OCTOBER 2010
