Street medicine reaching pets of the homeless

Pop-up clinics serve the impoverished with basic veterinary care

By Susan C. Kahler

Posted Aug. 15, 2018

Dr. Cathlin Craver puts a flea-and-tick collar on a dog at the AVMA Street Clinic in Denver as part of his visit. Dr. Craver plans to start a street dog team in Grand Junction, Colorado, where she is a shelter veterinarian and works with the national nonprofit Target Zero, which mentors shelters on best practices. (Photo by R. Scott Nolen)

Pets of the homeless and near homeless were the center of attention July 15 at AVMA Convention 2018 in Denver. These cherished companions received free medical care from veterinary volunteers outside the Colorado Convention Center.

The first AVMA Street Clinic was part of the new AVMA Cares program designed to give back to the local community (see story). It was a partnership with The Street Dog Coalition, which launched the first street clinic in 2015 for pets of the indigent in Fort Collins, Colorado.

Street clinics, or pop-up clinics, offer services such as basic examinations, rabies and core vaccinations, parasite control, microchipping when requested, and treatment of minor skin, eye, and ear problems. Medication is dispensed when needed. The veterinary care relies heavily on clinical skills and resourcefulness rather than technology. Diagnostic tests range from simple blood tests to free-catch urine dipsticks to running an ECG on an iPhone.

The past few years have seen an expansion of the coalition's street clinics as well as the wellness clinics and emergency services provided by the national organization Pets of the Homeless.

With the AVMA clinic's successful debut in Denver, the Association plans to reprise the clinic at AVMA Convention 2019 in Washington, D.C.

AVMA Street Clinic

Dr. Jon Geller, Street Dog Coalition founder, was on-site to oversee the AVMA Street Clinic. Two days earlier, at his convention session on street medicine, Dr. Geller had posed the question: Homeless pets and pets of the homeless—what is the difference? He said, "Home isn't necessarily a place. It's being with a loving person or family."

At the AVMA Street Clinic in Denver, 2017-18 AVMA President Michael Topper talks with Joel Hillan of CBS4 Denver about AVMA Convention 2018 and the AVMA partnering for the first time on a street clinic. "Pets need care no matter who their owners are and what their resources," he said. Fox31 Denver and The Denver Post also reported on the clinic. (Photo by Cheryl Atkins)

Having a pet makes the lives of homeless people even harder in many ways. It keeps them from riding a bus, living in most homeless shelters, or going to a job interview or doctor's office. "You have to admire them for (facing extra hardships) and realize that reflects the strength of their bond with the pets. The pet gives them a reason to get up. It's their protector on the streets," he said.

Two teams of 12 volunteers each, working together for the first time, helped a steady stream of 60 owners with 75 pets—12 of them cats—from 8:30 a.m. to 1 p.m. The volunteers included Colorado-licensed as well as out-of-state veterinarians, veterinary technicians, practice managers, and veterinary students.

The AVMA clinic began on a sad note, with a gravely ill 14-year-old Chihuahua dying of end-stage pulmonary disease within five minutes of arrival. Even then, Dr. Geller and others were able to lend emotional support, and the owners were given transportation to a cremation facility, with the cost of cremation paid.

A mother had her family's 7-year-old Dachshund, Tinker Bell, in tow, and she and her two daughters each cradled one of Tinker Bell's 7-week-old pups—Angel, Gizmo, and Liebchen. "It means everything to get their shots and have them checked so we know that they're OK," said the mother, who was concerned about weakness in Angel's back legs.

The Dumb Friends League provided free spay-neuter vouchers to distribute that day. Vouchers for more involved care were given for local veterinarians who donate the care or reduce their fees. The cost difference is often made up by the Ladybug Fund, Dr. Geller's nonprofit, and other organizations. He said in his convention session that the American Veterinary Medical Foundation "is doing a great job" with its Veterinary Care Charitable Fund, which accepts donations from an enrolled clinic's clients and disburses payments directly to the clinic for charitable care, with donations being tax-deductible.

Dr. Geller worked with local advocates for the homeless to get the word out about the AVMA Street Clinic, including Jennifer Bettridge of the Colorado Coalition for the Homeless. She informed many recently homeless pet owners who had moved into entry-level housing subsidized by the program. Bettridge and her husband, veterinary orthopedic surgeon Dr. Chad Devitt, ended up volunteering at the clinic as well.

The presence of CBS and Fox news affiliates as well as The Denver Post may have helped create more awareness among those needing services as well as the public about future clinics. The coalition holds monthly pop-up clinics in cities throughout Colorado.

Shara Cohen, a licensed veterinary technician from Aldie Veterinary Hospital in South Riding, Virginia, auscultates one of the AVMA Street Clinic's 12 feline patients. (Photo by R. Scott Nolen)

It was the first time Dr. Deborah Patterson of Brooklyn Veterinary Clinic in Castle Rock, Colorado, volunteered at a street clinic. She said, "I am a general practitioner, and this is my daily work, but there was something more rewarding about that day, knowing that I was helping people that would do anything for their loved companion, even if it meant going without for themselves."

The convention keynote speaker, Shiza Shahid, inspired Dr. Patterson to find a meaningful way to give back to her community, and she intends to continue working with the homeless. She said, "The street clinic was a perfect first step in that new goal. There is a great need for veterinary services in our homeless population."

One man she met that day had come to Colorado for family and soon became homeless. "He was extremely depressed and at the lowest point in his life," she said. "One day, a woman asked if he could take her dog since she was not allowed to have him where she lived. From that day forward, he had something very important to live for. … The human-animal bond is amazing, to lift a man from the lowest point of his life to feeling needed by a loved companion."

Dr. Ken Brunson, an associate veterinarian at Tipp City Veterinary Hospital in the Dayton, Ohio, area, heard of the clinics and coalition through an AVMA Convention email and volunteered.

His role was walking patients and their owners through the stations. Dr. Brunson was paired with a Colorado-licensed veterinarian, and they started with a history and full physical examination and discussion of any concerns. The two then moved onto vaccines, heartworm testing for dogs, parasite preventives, and any diagnostic testing, though none was needed.

Dr. Brunson's first case made a special impression on him. Pet owner Octavia had recently adopted Cash, a year-old male Siberian Husky mix, and thought she had made a big mistake. But she talked about how much support Cash provided her and how he has helped her through some dark moments. "Volunteering really reinforced the power of the human-animal bond," Dr. Brunson said. "We were set to work in two shifts, but I ended up staying over because I enjoyed working with the families. … I'm actually discussing with Dr. Geller setting up a clinic in my area."

Gaining steam

Dr. Geller said the AVMA Street Clinic triggered interest among participants in starting a Street Dog team in their own cities. He expects three to four new teams as a direct result of the AVMA event.

Romeo is one of many beneficiaries of emergency care from Pets of the Homeless. The 10-year-old Dachshund mix was living with his owner, a certified homeless veteran, in a tent in a forest near Mobile, Alabama. The owner called POTH after Romeo was having trouble eating and a large lump near his eye ruptured. Periodontal disease and a tooth root abscess were diagnosed. The dog's teeth were extracted, and a thankful owner was reunited with his companion. (Courtesy of Pets of the Homeless)

Dr. Geller said discussions are also underway with Colorado State University veterinary students to run a free screening clinic for homeless pet owners going into housing. They would provide it at the same facility where mental health checks and medical and dental services are given. "This will give the students a chance to be in on the startup and operations as well as the medical care aspects," he said.

Since 2015, street clinics have spread to the cities of Ashland, Kentucky; Boston; Chicago; Ithaca, New York; Kansas City, Kansas; Las Vegas; Nashville, Tennessee; Omaha, Nebraska; the Raleigh-Durham area of North Carolina; and Sarasota, Florida.

The greater Las Vegas area has the eighth largest homeless population among major U.S. cities, according to the Department of Housing and Urban Development's 2017 annual Point in Time survey conducted one night in January 2017.

The Street Dog Coalition joined with The Animal Foundation of Las Vegas last November to provide vaccinations and medical care in Las Vegas during Project Homeless Connect, a broad outreach of services for the homeless held in various cities. "Close to 5,000 people attended the multiservice event, and well over 100 pets of the homeless received veterinary care," Dr. Geller said.

Last October, Drs. Tad Coles of Overland Park, Kansas, and Larry Kovac of Kansas City, Missouri, piggybacked a veterinary street clinic onto Project Homeless Connect KC for the homeless and near homeless in the Kansas City area.

An ally in Pets of the Homeless

Nevada-based Pets of the Homeless celebrated its 10th anniversary in July. Its mission: to feed and provide basic veterinary care to pets of homeless people in the U.S. and Canada.

POTH partners with veterinarians to provide free wellness clinics in their communities at locations that serve the homeless. Through June, 299 pets had been helped this year. Veterinarians and veterinary technicians donate their time, and POTH underwrites the cost of medical supplies. The clinics offer examinations, vaccinations, minor treatment and medications, nail trimming, and ear cleaning. Vouchers are handed out for spaying or neutering.

These events usually have three or four veterinarians set up in a conference room, each bringing their own veterinary technician. The most recent one, in Carson City, Nevada, saw more than 90 pets in four hours.

Pets requiring extensive treatment are referred to the emergency care program, and a clinic in the POTH network is called. A 25 percent discount is asked of those clinics. Besides emergency cases referred from the wellness clinics, an average of 26 emergency cases are called in each week from around the country.

Founder Genevieve Frederick said, "(Over 10 years) we have treated over 18,000 pets through emergency care or wellness clinics we've sponsored. Since 2015, we've spent almost $800,000 on veterinary care at individual veterinary hospitals, and they've been so generous with their discounts to us. Last year, they discounted over $44,000 in veterinary fees."

About 70 percent of the calls end up as emergency cases, amounting to 572 cases this year through June. The other 30 percent of people can't afford veterinary care and are referred to another organization for help.

POTH data indicate more than 65 percent of the pets in emergency cases were owned by homeless women, the owners had been homeless a mean of two years, and only 17 percent had transportation. Dogs account for 88 percent of animals treated, and cats for 11 percent.

One woman's bequest allowed POTH to expand its Carson City headquarters staff to six and reach communities with a high concentration of homeless people in Washington, D.C.; Seattle; Reno, Nevada; Los Angeles; and San Diego.

Current donation sites exceed 430. "Our donation sites have collected over 577 tons of pet food," Frederick said. On the distribution side, the 480 locations are in food banks, soup kitchens, and pet food pantries in nearly every state.

Nationally, POTH has more than 900 volunteers recruiting donation sites, transporting food from the donation sites to distribution sites, fundraising, and running pet food drives.

Frederick hopes more veterinarians will partner with POTH on wellness clinics in their areas. "We'll sponsor veterinarians who do wellness clinics, give them seed money, and give them a planning guide to let the community know. They should have it when and where the homeless congregate, such as a food bank or soup kitchen. All it takes is a couple folding tables, and you're in business," she said.

Veterinarians are encouraged to contact their medical distributors for free vaccines, but short of that, POTH will reimburse them for any hard costs. The organization also urges them to approach their city for free dog licenses if the volunteers tag the dogs. Indigent owners who want to spay or neuter their pet can work with a low-cost clinic, Frederick suggested. "There are all kinds of opportunities for people who want to volunteer with us," she said.