Thursday, September 5, 2013

Interview with Dr Lila Miller on shelter medicine and getting to zero

Dr Miller examines a young patient.
Dr Lila Miller is best known internationally as co-author of Shelter Medicine For Veterinarians and Staff (you can check out the second edition and download an exerpt from Wiley here) and more recently Infectious Disease Management in Animal Shelters (order a copy or download exerpts from here). She was also the first African American woman to graduate from Cornell's veterinary program and has witnessed massive diversification of the profession.

Dr Miller has more than 30 year experience working in animal shelters for the ASPCA and is Vice President of the organisation's Veterinary Outreach. She taught the first course in shelter medicine in the US, co-founded the Association of Shelter Veterinarians and has recieved a swag of awards in what many consider the toughest field in vet-land.

One of the most fascinating things about Dr Miller is that she almost quit vetting. She spoke candidly with SAT on the eve of her visit to Australia this month to speak at the 5th National Getting to Zero Summit (you can register here - the program looks amazing and its running next week, 10-14 September). 

[NB Dr Miller was apologetic that she writes "like she talks - a lot"...but I think you will agree that this interview needs to be run in full].

Tell us about yourself.

I have a bachelor’s degree in animal science and a veterinary degree. I grew up in Harlem, New York, where I still reside. My father worked in a clothing store as a tailor and pressing clothes and my mother sold tokens in the subway. I went to Cornell University as an undergraduate majoring in animal science and then went onto the veterinary school, where I graduated in 1977. To give you an idea of the times, I was the first African American woman to graduate from Cornell’s veterinary college, and was a member of the first class to admit more than just a handful of women! (How things have changed!) 

At the urging of my mentor,   Dr.  Joseph Tait, who was providing veterinary oversight of the shelter system in New York, I went to work at the ASPCA right after graduation to help the organization develop a health care program for the shelter animals. The ASPCA had the contract for animal control for New York City, operating 5 shelters that were open 24 hours a day, 7 days a week. The vast majority of the animals were euthanized by lethal injection or decompression chamber.

After helping convert to all euthanasia by injection, setting up health care and spay neuter protocols and helping implement adoption criteria, working both hands on and supervising the program for about 5 years, I became director of a clinic that provided low cost veterinary care to the community as well as the shelter animals. The clinic underwent several physical and staff expansions to meet the demand, but after 15 years, when the ASPCA finally decided that operating a municipal animal control program did not fit the mission of a national animal welfare organization, the clinic was closed by the agency that took over animal control. 

I then went on to teach shelter medicine at Cornell and write about what I had learned about caring for shelter animals. I then became director, senior director and vice president of the ASPCA’s Veterinary Outreach department, which had a staff of 3 other veterinarians dedicated to teaching shelter medicine to veterinary and shelter professionals, providing consultations and grants to shelters to help improve the lives of shelter animals, decrease euthanasia and increase the live release rate. My current job is vice president of shelter medicine, where I continue to focus on teaching and training veterinary and shelter professionals about shelter medicine. I also lecture extensively to veterinarians about their role in handling animal abuse, whether through education or participating in investigations and prosecutions.

In addition to co-editing the three shelter medicine textbooks, I co-founded the Association of Shelter Veterinarians and have been actively involved in veterinary regulatory medicine. I was a member of the New York State board that regulates veterinary medicine and on the National Board of Veterinary Medical Examiners that creates veterinary examinations for licensing boards.

What motivated you to become a veterinarian?

I always wanted to be a veterinarian from the age of about 5. I don’t recall what my initial motivation was, but as I got older I never wavered from it. I liked animals but wasn’t overly involved with them-I had a dog, parakeet and hamster over the years as a young child-and as I got older I found I liked biology so it seemed like a good match. All my education through high school was focused on attaining that goal.

Shelter medicine is a tough area to work in. What attracted you to this area and what sustains you in it?

I was never “attracted “to shelter medicine. It didn’t exist when I was in veterinary school or even after I graduated. As a student, I disliked visiting the shelter with Dr. Tait, thinking it was a depressing place and that I would never work there. But Cornell was very grueling and when I graduated I was drained and didn’t feel qualified to go into private practice and didn’t want to undergo the rigors of an internship either.  In fact, I wasn’t even sure I wanted to be a veterinarian any more. 

Adult dogs with parvovirus, a common affliction in unvaccinated populations.
When Dr. Tait  asked me to work at the shelter  and help him improve conditions for the animals I hesitated but thought it would be a good place to get hands on experience with animals for a couple of years without the pressure of private practice.  I also saw it as an opportunity to make a big difference in the lives of hundreds of homeless animals who didn’t seem to get much attention from veterinarians, and realized the impact of any improvements I could make would be far greater than I could make for the individual animals I would treat in private practice. 

I thought I’d stay at the ASPCA just long enough to help set up a program and train staff. After about 5 years, when the program was established and running well, I was asked to run a clinic in an underserved area of New York as well as continue to oversee the shelter program.  I saw another opportunity to help animals who would otherwise be neglected because their owners could not afford the cost of care. When the clinic closed, I was offered the opportunity to help teach others what I had learned over the years and it was another chance to make a difference. So what started out as a short term commitment borne of uncertainty about my future turned out to be my life’s work.

How have shelters changed since you graduated?

Shelters have changed dramatically over the last 30 years. When I started working in New York City, animals were essentially warehoused and most were killed after being held for a few days, sometimes only 48 hours.  All animals were admitted to the shelter regardless of their medical condition or conditions in the shelter, often leading to overcrowded conditions and some long term stays that sometimes lasted for months for legal and cruelty cases. The influx of animals far exceeded the adoption and return to owner rate. The focus was on animal control and nuisance complaints, not animal welfare.  But as the human animal bond increased and more was and is being learned about animal behavior and emotions, the focus has been shifting to rejecting euthanasia as the primary method of animal control.

Other ways shelters have changed?

Providing for quality of life, reducing euthanasia and increasing the live release rate have become an increasingly important goal for shelters. In addition to paying more attention to the physical health and behavioral needs of shelter animals, shelters are engaging the community in the struggle to end euthanasia of healthy but unwanted pets. Foster care, rescue groups and volunteer programs are much more common than 30 years ago.

Shelter staff are becoming more professional, receiving training in animal behavior and handling, and research is being conducted to debunk the myths surrounding adoptions and determine the best ways to get more animals into loving, long lasting homes. Research is showing that fee waived adoptions, adoptions as gifts and during holidays can result in good, long lasting placements. Behavior assessments are being used to match an animal’s behavior  to the lifestyle of potential adopters, and to make their stay in the shelter while awaiting adoption less stressful.

Early age desexing and high quality,  high volume sterilization techniques and protocols were pioneered by shelter veterinarians in an effort to decrease the births of unwanted litters that were finding their way into the shelters, swelling population numbers and making the job so much more difficult.  

Early-age desexing is a safe and effective means of controlling the number of unwanted animals.
Shelters are being retrofitted and designed with the welfare of the animal in mind, and as inviting, cheerful destinations for the family to visit to acquire a pet.

Shelters are also seeking alternative and more innovative ways to deal with free roaming cats, instead of the traditional method of just trapping and/or killing them.

Shelters are also starting to work together collaboratively, transporting animals at risk of euthanasia to areas of the country where they can be rehomed due to shortages. In some communities, shelters with greater resources are working with shelters with lesser means to save the lives of adoptable animals who would otherwise be euthanized because of minor health problems or overcrowding.

How do you think shelters need to improve?

One of the biggest areas we need to work on is the management of cats. The number of free roaming cats is unknown but estimates are over 50 million in the US alone.  Bringing healthy cats into the shelter ends up often being a death trap for them-so much so that some shelter professionals are recommending not bringing them to the shelter at all, and redesigning cat housing to meet their needs when they must be brought in. We need to improve getting the message out to the public about desexing, humane care and responsible pet ownership. We also need to improve customer service and outreach.

Shelter cats need our help!
You’ve written extensively about infectious disease control in shelters. Why is the shelter context different?

Disease control in shelters is problematic for a number of reasons. Shelters are often underfunded, understaffed and overcrowded, which creates a perfect storm for disease transmission. 

This puppy is suffering from parvovirus. Affected dogs are extremely flat and depressed, and display gastrointestinal signs including vomiting and haemorrhagic diarrhoea. It is treatable but requires intensive care.
Animals are admitted from varying sources with all types of disease exposure that the shelter has no history about. Mandatory holding of animals who may appear healthy but are incubating disease results in disease spread. Shelters are inherently stressful, which contributes to disease transmission. Many shelters were not originally designed to house animals so poor ventilation and porous housing materials that are difficult to disinfect may be used, contributing to disease spread. Many shelters are unable to provide ongoing staff training and the very sanitation protocols designed to prevent disease spread may inadvertently contribute to it. When disease does occur, many shelters cannot afford diagnostic testing and don’t have proper isolation and quarantine facilities for appropriate management. The list could go on and on as to why it is more difficult to control disease in shelters. 

Can you tell us about any non-human companions you share your life with?

I have a 10 year old tortoise shell cat named Miss Coco. I found her as a stray outside my building when she was about 6 months of age.  I had planned to turn her into the shelter, but she was very friendly and insisted on rubbing and endearing herself to me and my mother, who insisted on keeping her.  As my mother can no longer care for her she has been living with me for about 6 years now.

Burnout and carer’s fatigue are commonly associated with many areas in veterinary medicine, including shelter work. What are your strategies for dealing with these?

I don’t really have any strategy for dealing with burn out. I have certainly experienced it over the last 35 years but when I ask myself what else I could be doing that would have the same impact, I draw a blank and feel renewed.

Do you have any favourite resources that you can share on shelter medicine?

My favorite resources are, www.shelter, the shelter medicine and forensics on- line courses offered by U of Florida’s shelter medicine program, Maddies fund webinars, Humane Society of the US (HSUS) Animal Sheltering magazine and  the shelter medicine textbooks I edited with Stephen Zawistowski and Kate Hurley. The Veterinary Information Network (VIN) has a shelter medicine page, but the membership fee is expensive. Of course, one to the best resources is the Association  of Shelter Veterinarians (ASV) member’s list serve.

Dr Miller with a puppy.
Any tips for veterinary students or veterinarians seeking to work in shelter medicine?

Veterinary professionals who wish to work in shelter medicine should try to familiarize themselves with the resources that are available and join ASV. The practice of veterinary medicine in a shelter is very different from typical private practice. Failure to understand the differences often results in unsatisfactory interactions between veterinarians and shelters. Students should select a veterinary college with shelter medicine training available-there are several in the US- join the student chapter of ASV and try to do a supervised externship program at a shelter.

What does “getting to zero” mean to you?

To me “Getting to zero” would mean society had finally met its obligations to the animals it domesticated and no more healthy adoptable animals would be euthanized for lack of a home.