It’s complicated…

During our time in Botswana we have sterilized 413 dogs and cats, vaccinated 441 animals, preformed 3 limb amputations, several minor surgeries and one blood transfusion over a period of 25 working days. While these numbers look good on paper, and  of course it feels good to do something rather than nothing (For the love of dog), it still feels like a drop in the ocean, so overwhelming is the need. Despite this, I suspect some of you might also be asking yourself the obvious question:  “why travel abroad to provide free veterinary care when there are plenty of animals in need in your own , backyard?” My response?  It’s complicated.

Although many of you know me as a veterinary practice owner and hospital manager, I was not always “the boss” and during my years in the profession I have had the opportunity to work as both an associate veterinarian (employed vet) and a locum veterinarian (relief vet). I have experienced different management styles and a variety of working conditions, from a militant, fear based approach to controlling employees, to the extreme hands off approach where the “monkeys run the circus”. I have worked with vets who will never say no and whose sense of self worth is dangerously linked to the need to be loved by every client. I have watched teams suffer low pay and burnout because the practice owner gave away services leaving them unable to compensate the team fairly and invest in the practice infrastructure. And as a young veterinarian, I have considered leaving the profession due to abuse and a lack of mentorship and support.

We purchased our own practice partially out of need (a baby was arriving in a month and we needed an income) but also out of a desire to provide a stable and positive workplace for our staff.  The reality is, a veterinary practice is a small business. It needs to be profitable, your team deserves competitive salaries, benefits, to feel valued and be treated with respect. This does not happen on its own.  It takes effort and has an associated cost.  Profitability in a veterinary practice allows a practice owner to take care of their team as well as maintain software, invest in new equipment and improve the quality of care your pet receives. Unfortunately, some in our profession and the public at large, think the word “profit” somehow makes us a less noble profession. “Don’t you do it for the love of the animals? Shame on you that you want to make a good living too!” What they fail to see is the link between the profitability of a veterinary practice and the level of job satisfaction and happiness of the employees working in that practice.

Over the years we have often discussed the 80:20 rule with our team, the law of the vital few or as it is properly termed, the Pareto principle. Named after an Italian economist, Vilfredo Pareto, who who observed that 80% of income in Italy was received by 20% of the Italian population, this principle can be applied in a wide range of situations from management practices to lifestyle choices. At its core, the Pareto principles states that most of the results in any situation are determined by a small number of causes. 80% of the result come from 20% of the causes. Or, for example, 80% of your profits come from 20% of your clients or at home you spend 80% of your time in just 20% of the your rooms or despite having 35 apps on your smart phone, you use 20% of them, 80% of the time.   I love this principle and it’s wide reaching applications but for the point of this article, lets focus on the Pareto principle’s as it applies to client complaints in veterinary practice. Although it may not feel like it some days, the truth is, a small number of your clients are unhappy, complain and make your life as a vet unrewarding and stressful.  The majority of clients are great to deal with, appreciative and are the reason we love our jobs as veterinarians.  As long as you recognize the 80:20 rule, it’s all good.  The problem develops when you start to believe the comments from the 20% and base your management decisions on the complaints of this vocal minority.  For some, your fees will never be low enough, your clinic never clean enough, your hours never accommodating enough and your caring and compassion never altruistic enough.

I have been told “you don’t care, you’re only in it for the money” more times than I care to recall and while I understand the emotions behind this response, it is the most unoriginal way to berate your vet.  Trust me, if we were just in it for the money, we would not be veterinarians.  So the question still remains, how do you manage a successful and profitable practice while still giving back to the community?  How do you choose which clients deserve a discount or charity and which do not? Just because a veterinary practice is profitable, does not mean they do not give back to their clients and community. Often the discounts, free exams, free treatments and rehoming of pets and donations to local charities is not advertised and goes unnoticed by the public.  In fact, profitable practices are often able to give far more.

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Veterinarians often believe they need to be all things to all pet owners.  Inconsistency and trying to please everyone is a dangerous path, especially when you recall that 20% of people will be unhappy with your service regardless of your best efforts.  Human nature is interesting and I have worked in practices where fees were waived for clients who could not afford veterinary care and this “free care” now becomes the expectation on future visits. The challenge is to find a way to help meet the patients needs, within the owner’s budget rather than just giving a handout.  For the health of our profession, we need to educate people that pet ownership is not your right, but a privilege. A privilege that comes with a cost. Handouts can quickly become a future expectation and I have more than once, witnessed a client once grateful for a discounted or free service quickly turn nasty once the handout was discontinued.  Allowing this situation to develop in your veterinary hospital affects the culture of your practice and things can quickly spiral out of your control, resulting in a team suffering from burnout and compassion fatigue fuelled by negativity, demanding clients and a lack of profits.

The idea of giving a hand up instead of a hand out can also be applied to volunteering with a project abroad. I have spent time pondering this question: by providing free veterinary care in a developing country are we actually helping or are we devaluing the service of local veterinarians and the sustainability of the project? Are we teaching the local people that we will take care of them for free and in doing so, taking work away from a local veterinarian?  It is a question I struggle with but the reality is, in many of the countries we visit, the veterinary education and training is vastly different than a veterinary education in countries like North America, the UK, Europe, Australia and New Zealand. Veterinarians in many countries are either not qualified or not interested in spay and neuter programs and the yet in these areas the need for these programs is great.

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Outreach clinic in Shakawe Botswana for MAWS

For many the world is black and white and the answers to these questions are obvious.  How simple things would be if this were true for myself. Instead, I see the world in shifting shades of grey and I find the answers are often elusive. All I can do is try to leave my judgement at home, ask questions and hopefully find my own answers in the many shades of grey.

Will Spay for Food

Rob and I have just returned from an amazing week doing outreach clinics in the Shakawe region of Botswana.  Shakawe is a village located in the northwest corner of Botswana close to Namibia and Angola. The panhandle or head waters of the Okavango delta is next door and the small community, 375 km from Maun, is without access to veterinary care. 

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We loaded up our rental 4WD truck with all the gear necessary for setting up a mobile spay and neuter clinic and headed north on what passes for a highway to the village of Shakawe. Fortunately traffic on this road is light, as it is littered with massive potholes often requiring us to take advantage of our 4WD and use the ditch, instead of the highway, as we navigated around the axle bending holes.  Our host for the week was the lovely Ansie, who put us up at the Crocovango Crocodile farm’s research station. A shady camp with sturdy tents, a kitchen and outdoor showers made for a perfect retreat after a day of hard work. Each morning we would head to a different community in the region and set up our clinic at the local kgotla.  A kgotla is a traditional meeting house for the community and our host, Ansie, had made arrangements with the local chiefs to use their kgotla for our mobile hospital.  Most days the chief would arrive as we were setting up and greet us.  By the end of the week I almost had the traditional handshake down, generating a few laughs as I fumbled to do it properly!  For all but one of our clinics, we had shelter from sun and rain and worked inside a small building or under an overhang beside the building. One day our hospital was organized under the shade of a large tree.  I think this was my favourite site however, more than once, sterility was breached by blowing leaves and crawling bugs.

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We started the days early and were up by 6 am and on the road by 7 am to set up for the day.  Most days, locals from the village would start to arrive with their pets around 8 am. By far the majority of dogs were brought in by local children, as their parents were at work.  The children would arrive with dogs of various colours and sizes and we would give them a number and proceed to weigh their pet. Each day had the atmosphere of a “special event” starting with the fun of weighing the dogs and continuing as the children gathered around the surgical tables to watch us operate. On one of the slower mornings, our veterinary assistant Kenny, had the children weigh their own dogs which was met with a lot of laughter and smiles.

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The children would stay all day waiting for their dog (or cat) to be awake and ready to transport home. Many of them walked several miles with their pets to attend the free clinic. For the most part they were shy and quiet, always respectful and very patient, spending the day in whatever shade they could find, while they waited.

While in Shakawe we met a young boy of 12 years who arrived at the outreach clinic by himself with his dog and another small child in his care. He advised us he wanted to stay with his dog and told us “he is afraid but he is a good dog and will be comforted by my presence”.  We advised him this was just fine and as we sedated the dog and started surgery, Rob started to talk to him.  Because my surgery table was only a few feet away from Rob’s, I had the pleasure of listening in on their conversation. What I heard will stay with me always and pretty much sums up what we are doing here in Botswana. First, he told Rob that the young boy in his care was his 3 year old cousin who, by the way, he loved very much.  He closely watched his dog’s surgery and then looked at Rob and thoughtfully said “So sir, I can see that what you are doing here helps the dogs and people of Botswana and for that we are grateful, but what I am wondering is how this benefits you”. Rob had a great response and told him the benefits to us were not something you could see, not money or pula. He said that we loved visiting Botswana and we think it is a special place. We love the wild life and that by sterilizing the dogs and vaccinating them we are helping to keep both the dogs and also the wild animals healthier. I could see the boy was both a little surprised but also proud that we loved his country and wanted to help.  They then talked about the idea of “paying it forward” and that we were lucky to be in a situation that we could help the people and dogs of Botswana and that perhaps someday he would be able to remember us helping his dog and it would remind him to help someone too.  By “paying it forward” each of us can do our part to make the world a better place. The conversation ended with me asking him what he wanted to do when he was an adult.  He thought about this and said “I do not know what I want to do, ma’am, but I know I somehow want to make history”.

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Over a beer last night, we asked ourselves what it is about Botswana and MAWS that draws us here.  The days are long, hard and we come home hot, tired and smelling of urine. We are practicing veterinary medicine with the most basic of tools to service the most needy population of pets. We often feel at a loss when it comes to making a diagnosis and we try our best to help and not harm.  Our patients bleed easily and profusely during surgery, our clamps don’t clamp our suture is on a spool requiring our old eyes to thread needles all day and our scissors are as dull as the ones you buy for a first grader.  Yet we make do, we struggle, we laugh and at the end of the day it feels good to go home bone tired and feeling like we did some good today. It feels good to sit outside as the day cools to night and listen to the sounds of Botswana.  In so many ways it takes us back to life on the Canadian Prairies, big sky and big sunsets and our roots as rural veterinarians.

If I am honest, I came to Botswana for purely selfish reasons, a chance to begin this new stage of our life with an adventure and a chance to get back in the bush with the elephants, antelope, zebra and giraffes. Volunteering with MAWS was a means to a selfish end, I regret to admit. A free place to stay in exchange for some veterinary care. But in the end it became so much more.  How do you tell someone how good it feels to help an animal in need and to see the relief and thanks on the faces of those you help? How do you explain the amazing ability to make friends and deep connections with a community that will last a lifetime in just 6 short weeks? How do you thank  that same  community that took you in, accepted you without reservation and made you feel as if you are now a part of something bigger?

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Our 7 weeks in Botswana is coming to the end and while I know we will return, it is still hard to leave.  And as I sit here tonight, putting thoughts to paper,  I think of that boy and his question “I was wondering, how this benefits you?” How do I answer this? How do I put what is in my heart into words? For me, it has always been easier to give than to receive. Independent, stubborn and raised to stand on my own two feet, asking for and accepting help is something that is difficult for me.  So tonight, as we approach this season of giving, I choose to just graciously accept the joy and happiness that  Botswana has given me and simply be grateful to “feel” how this benefits me. 

Never trust a fart and other travel tales

It is midday in a crowed market place in downtown La Paz, Baja California Sur when I realize what started as a feeling of being “slightly off” this morning is quickly turning into a tsunami in my bowels.  The smell of meat in the open air butcher shop is not helping my condition. I swat away the flies buzzing around both the hanging sides of beef and my head and suddenly, it hits me.  I need a bathroom and I need it NOW! I am too embarrassed to say what happened next, but I am sure you can guess.  As the saying goes, shit happens!

It was 1994 when two prairie farm kids decided to take two months off work and travel from Alberta, Canada to the tip of Baja California on motorcycles.  As kids, our family holidays consisted mostly of camping trips, ski holidays and trips to the big city of Calgary for back to school shopping.  International travel, was either outside the family budget or outside the family comfort zone.  Looking back, it no longer seems like such an epic adventure, but what we did not realize, is how pivotal that trip would be in our evolution both professionally and personally.  As veterinarians, leaving a mixed animal practice for two months to travel, was not done and, in hindsight, it was the first nail in the coffin of our failing partnership.  Leaving that prairie partnership, while terrifying, became the first step towards creating a life that was the right fit for us, rather than trying to make ourselves fit into the life we thought we should live.  From crashing my bike on a winding, mountain road in the northern California redwoods to stripping down to our swim suits so we could wash ALL our clothes in a small town laundromat, while the locals laughed at the crazy gringos, that trip left me wanting more. it changed the way I viewed myself, how I viewed the world and the way I viewed travel.

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Fast forward several years. We own our own practice, now have two small children and have finally managed to book a locum for a glorious two week holiday. We decide, it is time to have an adventure. The plan is for Rob to drive our Toyota truck, loaded with camping gear and supplies to San Diego.  I will stay and work for a few extra days, then the kids and I will drive 2 1/2  hours to Spokane, Washington (the nearest major airport) and fly to join Rob. From San Diego we will head south to Baja to recreate that epic trip, this time with two children in tow.  Finally the exciting day arrives.  Rob has made it to San Diego, enjoying 2 days of driving and blissful solitude along the way. The kids and I are on our way to the airport.  Suddenly a moment of inattention leaves me standing on the side of the road beside a crumpled car with two small, nicely shaken children.  A short ambulance ride and set of X-rays later and we determined to be intact and are discharged from the hospital . We once again I find myself standing beside the side of the road, holding a small pack filled with snacks and activities for the airplane as well as the hands of two small, nicely shaken children.  It is at this point my son, James looks at me and asks “Mom, what are we going to do now?”. I bend down, lean in and say in a cheery mom voice “Well, we are all okay and so we are going on this holiday.  I guess we will just have to hitch hike “.  Unknown to me, the driver who towed our car into town overheard us and quickly realized I was not kidding.  He kindly took pity on us and offered a ride.  It was an unfortunate start to what turned into an amazing trip.  From learning to do the stingray shuffle on the beach at Baja Conception to petting gray whales in their calving grounds at the Bay of San Ignacio, it introduced us to the joys of traveling with children. Seeing the world through their eyes, sharing adventures as a family and expanding their world, was for me, worth every episode of “shit happens”.

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The reasons for travel are as unique as the individuals who decide to take a journey. For us, travel was always a way to escape the pressures of our hectic life. To escape the internet, school pressures and just be together as a family.  An opportunity to realize the world over, humans wants and needs are the same and happiness is not necessarily dependent on money or status.  Then life moves along and the reasons change. Now there is no stress awaiting us upon return and the experience or journey becomes more important. We have discovered that having a community to connect with enriches the experience and working with organizations like the Maun Animal Welfare Society has allowed us to meet amazing people, interact with the local community and get a better sense of what life here is really like.  Tomorrow we head to the community of Shakawe a village in the northwest corner of Botswana where we will do daily outreach clinics over the next week. It will be hot, dirty and hard work but also a fun adventure, a chance to make new connections, see a new part of this country and, of course, to see what “shit happens”!

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