In the middle of the Turtle Mountain Indian Reservation in North Dakota, nearly 200 miles away from the capital of Bismark, several vans pull up to an empty gym. For the next few hours, fifty strangers will methodically unload a trailer filled to the brim with medical equipment that’s packed like Tetris pieces. Each person has a job and a mission: efficiently set up your station in the gym so that you can provide veterinary care for underserved animal patients.

Soon the place fills up with supplies in such an orderly fashion it seems like a computer simulation. The stations are laid out in a conveyor-belt-style to increase efficiency as volunteers set up tables and stock caddies. They top it all off with several additional hours of orientation and training. Then the strangers — volunteer veterinarians, technicians, students, intake staff — set out their sleeping bags in this same gym and immediately fall asleep. In a matter of hours, the place will be bustling with animal patients and their owners from the reservation. For most of these animals, this visit will be the only care they receive all year.

“There’s a shocking level of poverty that exists in some of these rural areas in the United States,” says Elizabeth Berliner, D.V.M. ’03, the Janet L. Swanson Director of Shelter Medicine at the College of Veterinary Medicine. 

The group, a mix of Cornell professionals and volunteers from veterinary schools and practices across the country, will see hundreds of patients throughout the day for spay/neuter services and vaccines. Then, just as quickly as it appeared, this pop-up field clinic will vanish, dismantled by the same volunteers, who must drive another few hours to the opposite end of the reservation. They’ll arrive at the next gym — or community center, or some other central space worked out with their cultural liaison — and start the whole process over again.

Veterinary medicine has always found ways to serve communities in need, but this need has become much more apparent in the last decade. Shelter medicine, for instance, has expanded beyond brick-and-mortar practices so that practitioners aren’t tied to one building for their tenure; they can extend their services to these underserved communities through humane outreach programs like Rural Area Veterinary Services (RAVS), which provides both wellness and surgical trips to Native American reservations in the western United States.

“There are animals in need in every community, but in some communities, there’s nothing — no shelter, no veterinarian, not even a pet store,” says Windi Wojdak, registered veterinary technician and director of RAVS.

Members of the college have learned to be adaptable in the face of unexpected scenarios. At the Cornell University Hospital for Animals in Ithaca, they train in some of the most advanced facilities in the world, but in the field, they must find a way to apply that gold standard however they can. Since 2007, over 300 members of the College of Veterinary Medicine community have participated in RAVS trips, taking the long flights and extended car rides in stride. RAVS has served over 40 Native American communities across the western United States over the years, and they currently work with 10 reservations regularly. Since 2003, RAVS has cared for more than 115,000 animals with over 6,400 volunteers. It’s all for one purpose: improving the lives of animals and providing their owners with the tools and education they need for a pet-healthy home.

“It’s one thing to make medical decisions in a tertiary facility with an owner who has resources and you have significant equipment and experts to work with,” says Berliner. “It’s another to figure out how to improve an animal’s life in the middle of a remote area with only the tools you brought with you.”

This flexibility is a trait all clinicians, faculty, students and alumni share. Whether it’s work in an understaffed county shelter, informing the community on animal laws and regulations or physically moving watermelons out of a gym so your pop-up clinic can be ready for the morning intake, the service-oriented mindset of the college extends across the nation.

Animals without advocates

Like most Cornell veterinary students, Renee Staffeld ’16 is busy. The third-year student’s schedule is full of lectures, clinics, studying and — of course — volunteer work. Staffeld estimates that between her duties as a student and her role as the college’s student representative for its Humane Society Veterinary Medical Association (HSVMA) chapter, her day ought to have about five extra hours in it to get everything done.

She knows she’s not alone, however. “The students are busy, and we want to be,” she says, “but we have to choose the organizations we participate in carefully. If we overextend ourselves, the whole reason we’re here is in jeopardy.”

Because of the time constraints on students, the HSVMA chapter on campus was inactive for about a year or two. Staffeld revived it in 2017.

“We want these groups to be visible,” she says. “Even if it’s just a name on a screen, it’s important people know that they exist as a resource and an opportunity.”

HSVMA has been more than a name on a screen in the last year. The group has organized multiple events that members thought would be useful for the college community. They asked Berliner, who provided the group with suture lab training as well, to speak about service opportunities with RAVS, and they coordinated with veterinarian Holly Cheever, D.V.M. ’80, vice president of the New York State Humane Association, to give a lecture on how to identify and report animal abuse. “Our group really wants to promote animal welfare and humane standards across the board,” Staffeld says.

Staffeld’s work doesn’t end there, however. She’s a certified wildlife rehabilitator and president of the college’s shelter medicine club. “It’s a lot, but the extra groups can really enrich your experience here,” she says, acknowledging that, even so, “you can’t help animals if you don’t have time to do your homework.”

Like the HSVMA group, Staffeld and other members of the shelter medicine club, overseen by Berliner, are also passionate about providing additional educational opportunities for the college. For the 2017–2018 academic year, they arranged lectures on topics that might not be in the curriculum — breed-specific legislation in New York, for example, and an overview of shelter medicine for the curious — in addition to running clinics every Saturday, Monday rounds and various fundraising activities. Their work is never done.

Berliner notes the expansive nature of shelter medicine, which encompasses more than may meet the eye. She describes it as two parts of a whole: The first part is comprehensive shelter medicine, focused on population medicine in actual designated buildings. The second is a community component. Groups like HSVMA and the shelter medicine club are particularly engaged with this second component. “It’s a matter of caring for animals in shelters as well as preventing them from showing up in shelters in the first place,” says Berliner. “To the veterinarians and students who are drawn to the public service piece, there’s no distinction between the two groups of animals in need.”

Animals in need are what drew Staffeld to the college initially. The Ithaca native is passionate about bringing more students into the field, who, when they graduate, will disperse and share what they’ve learned in jobs, internships and other service opportunities across the country.

“Animals without advocates is really what we’re focused on. They don’t have anybody responsible for them, no collar, no tag. What happens when you see a deer dying on the side of the road? No one is really obligated to stop,” she says. “I’m the kind of person who always wants to stop.”

Have training, will travel

Working beneath the fluorescent light in a hotel bathroom, Amanda LaCroix, D.V.M. ’18 practices her suture lines. She and her companions are prepping for their test the next morning, when RAVS veterinarians will time them and note their accuracy on this and a range of skills needed for the trip. LaCroix, who was then a third-year veterinary student, must complete a length of suture successfully in under two minutes to be able to perform the necessary spay/neuter procedures during the first week of the surgical trip on a reservation in rural Arizona. If she fails, she has to wait until the second week to test again, assisting the volunteers in other ways, but she’s determined to pass from the get-go.

And sure enough, when the time comes, LaCroix performs the task beautifully in under two minutes. Those hours spent practicing in the hotel bathroom paid off.

RAVS is a non-profit veterinary outreach program combining community service and veterinary education to bring free veterinary services to underserved rural communities, where poverty and geographic isolation make regular veterinary care inaccessible. They serve western Native American reservations, utilizing the service mindset of thousands of volunteers on hundreds of trips. During the two-week surgical trips that occur in the summer, volunteers perform high-volume spay/neuter services and provide immunizations and other medical services. During the wellness trips, which are a week long and occur during the spring and fall months, pets receive general check-ups, health assessments as well as a range of other medical services.

In 1995, RAVS held their first clinic on the Rosebud Indian Reservation in South Dakota. From there, they expanded to include other reservations as well as rural communities in Appalachia, in addition to small animal and equine international work. “It evolved quickly and organically from there,” says director Wojdak. In 2002, RAVS became a program under the wing of the Humane Society of the United States and continued to expand in all three program areas until 2009, when their domestic work shifted to focus resources on the reservation communities. Their international programs continued in various forms until 2016, and their resources are now focused on reservations, as these are areas of need that do not receive other services.

“Cornell has been a fairly consistent part of these trips,” says Berliner, who has been involved with the organization since 2007 and served as trip leader many times, noting her desire to fulfill this need for people who cannot access animal healthcare either geographically or financially. “They are the ones we look to serve.”

Berliner has shared this service opportunity with Cornell students, faculty and staff, who arrive at the college already expressing a strong desire to help underserved groups however they can. They want to take what they’ve learned in their studies in Ithaca and share it where it can do the most good. This exchange is often inspiring.

“The pet owners on the reservations know when the clinic is coming,” says Sarah Nickerson, program coordinator of Maddie’s® Shelter Medicine Program at Cornell, who went on a RAVS wellness trip to Arizona’s San Carlos Apache Reservation in April. “They look out for it, because it’s their primary means of getting care for their pets.”

Hundreds of pet owners will flock to these clinics. Alumna Alison Lindsay, D.V.M. ’18 saw the news spread like wildfire across the reservation when she went on a surgical trip during her last year in the D.V.M. program. “The lines begin early and it’s nonstop,” she says. “We’ll have people pull up as we’re closing because they just heard we were there and gathered the pets up in the back to the truck. We have to tell them to come back at five a.m. the next day — or let them know where the next clinic site will be.”

Nickerson was impressed by the dedication the pet owners had to obtaining this care. “They’ll walk, sometimes for miles, if they can’t afford the gas to drive. They’ll ride their bike, they’ll take off work and do whatever it takes to get their pets to the clinic for care,” she says. And when they get to the clinic, sometimes they must wait a long time to be seen — usually in the heat of the desert sun. Volunteers often set up sun screens and pass out water to keep people and their pets comfortable while they wait their turn.

Although Nickerson does not have training in veterinary medicine, she was able to contribute during the wellness trip performing intake duties — the essential task of sorting through the constant stream of owners with their beloved cats and dogs, asking necessary questions as efficiently as possible. On these trips, there are no extra wheels; everyone contributes their best however they can.

“Because we’re in the field with relatively limited resources,” says Wojdak, “we rely heavily on the fact that we have a team of people who are incredibly skilled and can bring the creative solutions needed to care for the animals that come in.”

Students like Lindsay and LaCroix, who have since graduated from the veterinary program, say that initially they were excited about the opportunity for more surgical experience. On a RAVS trip, it’s all hands on deck for spay/neuter procedures, which will often give a volunteer more time with the scalpel than an entire academic year because of the high volume of cases that these pop-up clinics address.

“During the trip,” says Lindsay, “I saw how the educational aspect of it was also just so worthwhile. You see your work make a difference and that the message you’re sending is getting through to people.”

LaCroix agrees. When she went on her first trip, she had just finished her first year of veterinary school. “I was still able to help people with just one year under my belt.”

A strong, knowledgeable foundation of veterinary medicine is necessary for each case on these trips. Although the passion of students like Lindsay and LaCroix is an excellent quality, they must supplement that with sound science from the beginning so they can apply it when the need arises. The College of Veterinary Medicine excels at creating a community of professionals who think on their feet — and trips like this allow them to hone those skills, says Berliner. “It’s about communication,” she says. “We’re teaching cultural competency. It’s about professional relationships and how you work with your colleagues. It’s about respect for people regardless of where they come from or what they have.”

The fifty-some-odd strangers who embark on these journeys arrive as individuals but grow into a team. “It really reminds you of your passion for the field,” says LaCroix.

Beyond graduation

This quest to serve doesn’t stop at commencement. What brings future veterinarians like Staffeld to Cornell is often what sees them through to graduation and beyond: “There’s a lot of interest in relief work, disaster work, the SPCA, shelters in general, because there you find pets that don’t have homes and few people to take care of them,” she says.

While they’re studying and practicing during their time with the college, students often fulfill these goals with local programs like participating in the Southside Healthy Pet Clinics — where student clinicians provide healthy pet services to families in need — in addition to RAVS and HSVMA. There’s also Expanding Horizons, an international outreach arm of the college, and Spring Farm Cares, an organization run by a local veterinarian that allows fourth-year students to practice spay/neuter surgeries in a high-volume feral cat setting.

Alumna Deirdre Halloran, D.V.M. ’17 participated in all of these and more before she graduated. “I have a more open mind on how to treat my patients thanks to my service experiences,” says Halloran, who is currently an associate veterinarian in a small animal private practice in Phoenix, Arizona. “The innovation that is required for field medicine can benefit any practitioner.”

Such service opportunities available through the college allows students to refine their commitment to the Veterinarian’s Oath. They must be mindful of their clients’ situations and offer the best care options possible. “The most important thing this kind of outreach work has taught me is how to practice non-judgmental medicine,” says Halloran. This can be complex to balance, as a practitioner must educate clients as comprehensively as the case allows, but without judgment or condescension. When it works, however, everyone wins. “Client education is one of my favorite aspects of veterinary medicine,” says Halloran.

Alumna Suzanne Nelson, D.V.M. ’16 is currently a shelter veterinarian with the Humane Rescue Alliance in Washington, D.C. Her outreach experiences at the college allowed her to form a tight bond with her peers. “They were usually pretty hardy and had a sense of humor,” she says of those who joined her in service work. “They tend to be a really great group of people to work with — they share a lot of the same qualities of selflessness and dedication.”

In addition to the cross-country network that connects Nelson to like-minded colleagues around the United States, her own particular service work — such as going on both surgical and wellness trips with RAVS — prepped her to expect the unexpected. It was an opportunity to put her knowledge through a constant, high-stress test. “Sometimes you have enlarged lymph nodes that we’re all taught to feel for, but we never feel until we come across a sick reservation dog,” she says. “It may be the first time you’re actually feeling a dog’s spleen, all because of how different the circumstances are.”

Lila Miller ’74, D.V.M. ’77 is a world-renowned expert in animal cruelty and shelter medicine, and is a leading advocate for companion animal welfare in the United States and abroad. 

After graduating from CVM, she launched into what was then a novel field: working as a veterinarian at the ASPCA shelter. In a time when shelter medicine was not a recognized field and had no formal structure, recognition or standardized protocols, Miller spent her first five years working in the trenches of a shelter as animal care supervisor, where she developed some of the first protocols and guidelines for the healthcare of shelter animals.

“When I graduated there was no such thing as shelter medicine, and when I first went to work in a shelter it was awful because the outcomes for most of the animals were so depressing,” says Miller. “It seemed like a hopeless situation. I’d guess 80 percent of animals were put to sleep. But I also saw it as an opportunity to have an impact on whole populations of animals in a way private practitioners can’t.”

Expanding her role in the burgeoning field, Miller moved on to become director of the ASPCA Brooklyn Clinic in an impoverished area, where she spent 15 years overseeing the care of thousands of shelter animals and providing care for the pets of owners who may otherwise not have been able to afford it.

“This was very satisfying work,” said Miller, “and I’m grateful to the ASPCA for giving me the opportunity to explore something that hadn’t been done before.”

While in this role, Miller began an outreach program for veterinarians to enhance their understanding of the importance of companion animal welfare and shelter medicine. As part of this effort, she made extensive contributions to teaching throughout the country and the world. Invited by Cornell professor of epidemiology Dr. Janet Scarlett, Miller co-taught the first didactic course in shelter medicine in the country in 1999 at Cornell and became an adjunct assistant professor. Together they went on to found the Maddie’s® Shelter Medicine Program at Cornell.

Miller, Halloran and Nelson all share a passion which drives their careers. Halloran, for example, says that she has always been interested in serving veterinary deserts — areas where people have limited to zero access to veterinary services. “In these deserts, animals are at risk of being relinquished to shelters because their owners can’t access or afford their care,” says Halloran, who, like Nelson, continues to perform service work during downtime. “Anything I can do to strengthen the human-animal bond and keep pets in their homes is worthwhile.”

An island in need

The United States saw a high number of natural disasters in 2017. Wildfires raged in southern California and storms caused devastation and flooding in southern states such as Texas and Florida. After Category 5 Hurricane Maria devastated much of the island of Puerto Rico in September 2017, the unincorporated territory with 3.4 million residents saw their entire electrical grid destroyed. Hurricane Maria was the costliest natural disaster in the island’s history, incurring $91.61 billion in damages across the storm’s path and an estimated over 4,000 human casualties. Approximately 450 human shelters opened in the days before the storm made landfall.

In the midst of this confusion and devastation, family pets became separated from their owners. Regular spay/neuter operations for strays ceased. Residents who could barely provide for their children after the storm found they had nothing with which to feed the cat or dog. Animal shelters were quickly overwhelmed. Humane workers saw families surrendering their animals — not because they didn’t want them, but because they thought the beloved pet would fare better in a shelter than in a home with no electricity, no running water and just the barest necessities of food.

Several animal welfare groups organized the transport of some 1,000 animals from Puerto Rico to no-kill shelters across the mainland immediately following the storm, but as relief efforts continue, more work remains even now almost a year later.

Maddie’s® Shelter Medicine Program at Cornell, the college’s shelter medicine group directed by Berliner, is part of a national initiative to alleviate such difficult conditions. “In the years prior to Hurricane Maria, some shelters on the island were euthanizing more than 95 percent of their intake,” she says. “Their intake numbers are expected to rise because of the difficult situation.”

Berliner herself traveled to the island this summer to take part in the Spayathon for Puerto Rico campaign, organized by the Humane Society of the United States. In early June, she joined other volunteers performing high-quality, high-volume spay/neuter services in seven cities throughout Puerto Rico.

The Humane Society has a stated goal for this campaign of reaching 25,000 animals on the island by May 2019. They will accomplish this number through four trips to Puerto Rico, of which June’s was the first. Berliner will return to lead a surgical team representing Cornell to provide clinics during the three subsequent trips.

“Access to veterinary services for residents living below the poverty line is already difficult, and diseases like leptospirosis are spreading in the post-hurricane conditions,” says Berliner.

Providing these services to the expected 25,000 animals on the island at no cost to their owners will help both the people and their pets recover. The campaign also aims to create a lasting spay/neuter infrastructure by training veterinary professionals on the island in addition to donating all of the surgical equipment, supplies and other remaining assets at the end of the campaign. Non-profits like Maddie’s® Fund provided financial assistance in obtaining the needed supplies, such as vaccines, pet food and crates.

Shelter medicine veterinarians like Berliner and the students who follow in her footsteps must be ready to provide expert care upon entering any shelter, any pop-up clinic, any area affected by a natural disaster. In the best of scenarios, they should be well-versed in legal, regulatory, ethical and emotional aspects of shelter animal care. In the worst, they utilize their passion to help those that need them the most.

Power to make a difference

Recently, Halloran found herself with an armful of puppies on the San Carlos Apache Reservation outside of Phoenix, Arizona. It was midday, the weather miserably hot. After diagnosing the dogs with parvovirus she treated each of them on top of the owner’s car, returning them to the backseat one by one. “At the end of the process, I had seven puppies started on their treatments for parvo, and an owner who felt empowered to continue the treatments at home,” she says.

Unconventional, determined, focused even in the most uncomfortable conditions. The College of Veterinary Medicine empowers its students to work with the resources they have and share their passion to do good with others.

“I think a lot of students starting out in their careers don’t even know yet what is possible,” says Wojdak. “They have a lot of power to make a difference in the world, and they should wield it.”

By Melanie Greaver Cordova

The story originally appeared in the summer 2018 issue of our college magazine 'Scopes.