Stories from the Field
2013 HSVMA-RAVS Clinics in South Dakota

Pine Ridge reservation signDarci Adams/The HSUS

by Ada Norris and Darci Adams

Tucked away in a beautiful spot along the Missouri River in the middle of South Dakota is a band of the Lakota Sioux called Lower Brule. This reservation spans 132,000 acres and the tribe has slightly more than 1,300 enrolled members. This June, the community opened up their local firehouse, elementary school, and community center for HSVMA-RAVS to conduct a week-long wellness and surgery clinic for their dogs and cats.

The following week, the team travelled two hours to the Pine Ridge reservation in in the southwest corner of South Dakota to conduct another week-long clinic for the community's pets.

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Day 1 – Sunday, June 2, 2013
Travel to Lower Brule

Fancy Pants
Our favorite resident stray puppy, “Fancy Pants,” going for a walk with one of our many veterinary student volunteers.
Darci Adams/The HSUS

Today, our travel day, students arrived in Rapid City, S.D. from veterinary schools across the country, while RAVS staff and professional volunteers arrived from as far as Texas, New England, Colorado, and the west coast. After a brief morning meeting, the caravan rolled out for a three-hour journey to Lower Brule. With only minor mishaps, the trip resulted in the team sitting outside the Lower Brule Firehouse with RAVS' 35-foot horse trailer loaded with action packers full of equipment and supplies. The professional volunteers and veterinary students who are new to RAVS have only vague ideas of what's about to unfold…

Today is the day before our clinic is set to open, and a friendly, scruffy little husky mix puppy has already been dropped off at the firehouse. One of our staff veterinarians, Dr. Lisa Shriver , discovered that a Good Samaritan had found the puppy and, since there isn't an animal shelter in Lower Brule, figured it would be best to bring the puppy to the RAVS clinic. The scruffy little stray endeared herself to the team quickly. She's a squirmy little fairy of a dog who pranced about, pooped in her cage, and went swimming in her water bowl; she captured the hearts of our team.

We would eventually call her "Fancy Pants." On physical examination, we found a recent spay scar along with a marking tattoo used by spay and neuter clinics like ours. We suspect she had been vetted by another clinic that operates out of Iowa State University, which had provided services the previous week to the Crow Creek reservation just across the river. The team is now challenged with the task of reuniting this little cutie with her family.

So, on this Sunday before a week of clinics at Lower Brule which will be followed by another week on the road on the Pine Ridge reservation, we already accomplished the usual RAVS first day feat: assembling a team of veterinary students, veterinarians, technicians, and other interested folks into a functional group that could erect a full-service clinic from a bunch of boxes packed into a horse trailer. We also conducted a surgical skills exam and began the search for our adorable and howling stray puppy's owner. Then the exhausted team retired for the night: two veterinary students in tents pitched in a patch of grass next to the clinic, several staff members cozied up in the rig, and the rest of the team packed like sardines in sleeping bags lining the high school floor. Everyone is snoring now, but ready – and anxious – for what's to come tomorrow.

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Day 2 – Monday, June 3, 2013
First Day of Clinics

HSVMA-RAVS student volunteers examine dog
Veterinary student volunteers, Hannah Doran and Robert Parkins, perform a physical exam.
Darci Adams/The HSUS

Just 24 hours after our new team met for the very first time, the RAVS clinic is officially open for business. We gathered at 5:30 a.m. at the Lower Brule Firehouse and began the day with an hour and a half orientation in three clinic areas: receiving, anesthesia, and surgery. Beginning at 7:30 a.m., community members lined up to have their animals spayed or neutered. The intake volunteers maintain a client list and, as receiving teams become available, direct clients to the next appointment. Some exams take place in the bed of a truck, some on a grassy patch near a car, and others inside the firehouse at a receiving station. Students work in teams of two, armed with a caddy full of syringes, vaccines in cooler packs, dewormer, flea and tick preventative, a mini-lab to make slides or draw blood, and their hands, ears, eyes, nose, and stethoscopes. One student takes a history while another might start the exam or start drawing up treatments. When infected ears, or confusing health histories, or hair loss, or growths in mouths become complex, or as any "alerts" arise – heart abnormalities, pediatrics, geriatrics, animals with signs of illness, unusual wounds or conditions – students call Dr. Shriver or one of the other volunteer veterinarians, Dr. Shelley Pasternak, to oversee the case.

RAVS protocol is for one student team to see every animal in a family, so that might be a mama cat and eight tiny kittens in a box (depending on how tiny, the kittens may or may not become patients), it might be one nice two year old dog, or it might be five adult semi-feral cats and a mama dog and her litter of two month old puppies. That team gets every last one of the animals, plus the two additional adult dogs found sleeping under the truck in the middle of the exam that the family forgot to mention. One team, one family. Some days, that is your entire day.

Volunteers examine a dog in a truck bed
Some exams happen in the back of the family truck.
Darci Adams/The HSUS

Even better, the receiving teams' duties aren't over after their patients go to surgery. Usually with big families, just as the students finish examining the last of the animal family members and getting them cleared for the surgery board, the first and usually youngest animal family members start coming out of surgery. So the receiving team then becomes the discharge team for the family, going over discharge instructions and answering post-surgical care questions. It's special to have that kind of continuity with one family.

At 10:30 p.m., the last surgery patient of the day is discharged. The surgery board shows 35 Lower Brule pets were spayed or neutered, and the team, despite being exhausted, restocks the clinic, attends rounds, and settles in for a few hours of sleep.

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Day 3 – Tuesday, June 4, 2013
Command Central

HSVMA-RAVS Command Center at a Lower Brule, N.D. clinic
A view of of induction and surgery from the command center – things in motion.
Darci Adams/The HSUS

Command Central of a RAVS clinic is located at the triage and induction tables. Staffed by RAVS "celebrities," Director Windi Wojdak, RVT and field technician Melina Stambolis, RVT, as well as rock star technician volunteers like Ben Mabley, Rachel Duffy, CVT, and Brooke Gladstone,CVT, the anesthesia area of the clinic has a rotating cadre of technicians, not only extremely talented, but willing and interested in teaching a ragtag collection of vet students of a wide range of skills and personalities. Most students are lucky to get out of vet school with a glimpse at anesthesia, but here they are mentored and involved in every step, and oversee anesthesia for each surgery patient, one-on-one. The technicians are master overseers – tending primarily to the safety and well-being of the patients, while giving each student, who has a different ability and comfort level, individual instruction and experience.

Once receiving teams do intake exams and determine what treatments their patients will need, if surgery is on the list and the animal is deemed a good candidate for surgery, the student goes to the two large white boards facing command central to enter the animal on the surgery board. There are separate boards for dogs and cats, and grids on each board for gender, procedure, age, assigned anesthetist, surgeon, and "comments" that alert the anesthesia team to any special needs the patient may have.

HSVMA-RAVS volunteers prep dog for surgery
Volunteers prep a dog for surgery.
Darci Adams/The HSUS

This particular day there were as many cats as dogs and the comment boxes overflowed. Literally, there were comments on every case. We are used to there being a different range of "normal" at RAVS clinics than we see at urban referral and university clinics, but today there really was nothing even resembling "normal." This included six heart murmurs, two pets previously hit by cars, 12 cautions (indicating various levels of potential aggression from "nervous" to "may bite" to "is actively trying to bite"), and three prolifically breeding cats who recently miscarried and had signs of infection . And then there was Mr. Wilson, an adventurous cat who loves a high intensity chase, who had his tail amputated today due to an infection resulting from an earlier injury to his tail, undoubtedly secondary to a chase or other mishap.

Roxy Foxy. Doritos. Snickers. Muffin. 8 Ball. These are pets who have as much character and personality as their names suggest. Facing a wide array of challenging cases, our technicians at Command Central keep an eye on each one of them and their unique challenges and needs, and teach us to expect the unexpected and roll with the punches. They also double check our drug doses and review our notes to be sure everything is logged in the animals' medical records. A total of 36 pets were spayed or neutered today – 18 cats and 18 dogs.

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Day 4 – Wednesday, June 5, 2013
The Ups and Downs of Clinic Work

A puppy recovers after surgery
Veterinary student volunteer, Carrie Bargren, doing the “difficult” job of sitting with a puppy in recovery.
Darci Adams/The HSUS

As the saying goes, "life is full of ups and downs;" the trick is to enjoy the ups and have courage during the downs. The day started with several students spotting a white shepherd mix who was non-weight bearing on the left side while wandering around the firehouse. Worried about the dog, our intake crew began asking community members if they knew who she lived with. By late morning we were thrilled to see several community members had put the injured dog in their van and transported her to our clinic for emergency care. The students assigned to the docile, injured shepherd were Nick and Matt, and they carried her into the clinic. After reviewing the dog's history they learned she was truly a community dog who the neighbors called Mama Dog, and she frequented several homes for attention or meals. This meant that no one person actually "owned" the dog. In recent days, they had noticed Mama Dog, now almost 8 years old, was lame and not her usual boastful self. Upon further examination they could tell she was in pain and consulted with Dr. Lisa. It was determined Mama Dog's right left front leg was severely injured as was one of her rear legs and she had decreased lung sounds on her right side – all signs consistent with being hit by a car. The team discussed several options with the community member who brought her in, which included taking her to a veterinary clinic 30 miles away for x-rays and even potentially amputating her front leg. However, after discussing post-surgery requirements which included confinement and twice a day medications, as well as the fact that our team couldn't tell for certain how extensive the damage was to her rear leg, the community member made the difficult decision to end Mama Dog's suffering.

Another case came in today involving a friendly, mellow, 9-year-old brown lab named Coco, who was "just in for shots," but our intake coordinator noticed that something more might be going on so she put her on the list for an exam, even though she was already spayed and wouldn't need surgery. Usually during surgery-only clinic days, for efficiency, we ask wellness-only appointments to come back on Friday so we can be sure to get all of the surgical patients seen. However, during Coco's exam we found an invasive growth in her mouth that had spread to both sides of her gums and soft palate. On one side it was so extensive as to have loosened one of her back teeth, and on the other the tumor was getting in the way of her fully closing her mouth. Not surprisingly, considering she's primarily a Labrador, Coco was wagging her tail and her family said she still wandered down to her grandaughter's house to beg (successfully) for table scraps. Dr. Shelly – a returning volunteer veterinarian from Austin, Tex. – agreed that the growths "appeared " malignant. The options for treating gingival cancer are not very good; even in cases where the jaw is removed the cancer can quickly return. Coco's family decided on home hospice. We sent her home with some pain medication and a prescription so Coco could continue to do all of her favorite things for the rest of the week.

Ada with Leigha and family
RAVS veterinary student intern, Ada took a quick break from surgery to give Leigha "Fancy Pants" a hug good-bye.
Darci Adams/The HSUS

At this point, the team was certainly challenged to find courage, but we also celebrated several ups today: clients were lined up for veterinary services before we opened, we found our groove as a team and started to perfect the clinic flow, and best of all, we were able to reunite "Fancy Pants," our little stray pup from day 1, with her family. But how we found her rightful owner is even more interesting since the phone number provided through her tag was no longer in service. Our team reached out to the Iowa State University clinic team and, although they too only had a bad phone number for Fancy Pants, they were able to tell us the puppy's name was Leigha. As fate would have it, when one of our team members ran to the local grocery store to purchase garbage bags and ice, she saw a lost dog poster describing Leigha, AKA Fancy Pants. After calling the number provided on the poster, Leigha's family came to the firehouse to be reunited with her. The moral of Leigha's story is the importance of collars, tags with current contact information, and lost posters when a pet goes missing since, as a result of one these modalities, our team was able to see our little, scruffy stray puppy go home with her family.

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Day 5 – Thursday, June 6, 2013
Evening Rounds to Debrief

Dog in surgery
Veterinary student volunteer, Patrick Satchell (center), spaying a dog with long-time RAVS volunteer veterinarian Dr. Paul Badeau (right).
Darci Adams/The HSUS

Dr. Elizabeth Berliner ("EB"), staff veterinarian with RAVS for the past five years and our current trip leader, leads rounds every evening usually around 9 p.m., or 10 p.m. on days that start early (5 or 6 a.m.). It's no small testimony to the dedication of the students and, moreover, the professional volunteers and staff, that rounds are always lively and interactive, and, as often as not, followed by suture practice. Over rounds, Dr. EB talks about interesting or difficult cases, inviting volunteer surgeons like Dr. Paul Badeau – a longtime volunteer who is also in private practice in Connecticut – to discuss the surgery and treatment decisions made in complicated cases. Each section of the clinic addresses any logistics or housekeeping, assignments are announced, and we get a little bit of framework on which to hang our long days.

Dr. EB is talking a lot about teamwork tonight. Pitching in even when your job seems to be done, being nice to each other, watching each other's backs, working far beyond what you expect is your normal capacity, and double- and triple- checking our calculations. I've heard this talk before. Tomorrow is the day when Dr. EB puts everyone on high alert. On this trip, Thursday is the day when all of the students have rotated through each section and everyone has received all three orientations and is starting to feel comfortable with RAVS protocols. Thursday is the day when we make sure the previous student sent home the correct dosage of medication and do our math twice. It's the day of occult sleepiness, misplaced confidence and, inevitably, the day when increasingly strange cases continue on in the clinic.

Evening rounds conducted outside
Today, evening rounds were held early enough to catch a little sunlight alongside the fire trucks.
Darci Adams/The HSUS

We have become more situated and the community has integrated us a bit – folks are overheard talking about the vet clinic at the firehouse, as if we've always been there – and so people start to bring us the strange cases they aren't quite sure what to do with: another dog with oral cancer, a golden retriever with a healed gunshot wound to her chest, two dogs with cherry eyes, six 2-day old kittens waiting while their mother is spayed, 13 lab mixes from a rescue situation where the mom dog suffered from generalized demodex mange and a severe ear infection, and Princess, a 10-year-old pit bull mix with a history of chasing cattle and porcupines, and getting shot and quilled for her efforts. She had already been spayed, but had a draining, infected wound on her shoulder that our surgeons decided was worth taking into surgery to be cleaned, flushed, and allowed to drain completely.

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Day 6 – Friday, June 7, 2013
Pet Wellness Day; Let the Fun Begin

Our final clinic day at Lower Brule was a pet wellness day. The team expected to see more than 150 animal family members for vaccinations, flea/tick treatments, deworming, and other basic care. The day started early with student teams examining pets in the firehouse, throughout the parking lot, on grassy areas in the shade, and even on the beds of pickup trucks. Veterinarians and technicians rotated between the groups, providing consultations on exam findings and helping to facilitate each appointment. By 10:30 AM, the team had already received more than 80 patients and the steady flow continued into the afternoon. A highlight of the day was seeing so many returning clients: owners who had spayed or neutered their animal family member last year at the RAVS clinic and brought them back this year for annual vaccinations. By 2 p.m., we had provided wellness services to 155 dogs and cats, which brought our total number of appointments for the week to just over 340.

During evening rounds last night, Dr. EB remarked to us that there is usually a special moment on these last wellness days of the clinic – the sun is shining "just so" and you pause for just a moment, looking out at all of the student teams spread out seeing appointments in patches of shade and front seats of cars, surgeons and technicians freed from command central are circulating and helping with care and treatment, then a client drives by, honking their horn, and thanks us for taking care of the Lower Brule dogs. If it were a movie, the music would be soaring. It would be very clear why it's not just students here, but adults – veterinarians, technicians, neuroscientists – all with paying jobs and families, who choose to head out into the field for weeks at a time to do similar work as their day job, but with fewer resources, in harder, more demanding situations. And, just as quickly, the moment passes, the two rowdy dogs are done jumping all over each other in the back of the pick-up and decide to jump all over you, and the wide angle lens changes back to normal focus and you finish your appointment.

On cue, Leigha Fancy Pants' family walked our favorite little reunited-formerly-stray puppy over to say thank you and goodbye. Another family brought us a cake signed by all of their pets. Coco's family came by to share stories of a week spent swimming at the river, eating delicious wet food, and celebrating a most excellent life of a top hunting dog turned beloved family pet. The RAVS team began the job of tearing down the clinic and loading the rig, then departed for Rapid City where we will enjoy one day off before the journey to the Pine Ridge reservation on Sunday.

RAVS team at Lower Brule
The Lower Brule RAVS team.
Darci Adams/The HSUS

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Day 7 – Saturday, June 8, 2013
Much Needed Day Off

The RAVS team celebrated a great first week and enjoyed a much-needed day off – yes, an entire day off – before we head to the Pine Ridge reservation tomorrow. Everyone slept in, took the opportunity to do some laundry, and regroup before another week in the field. Most students, staff, and professional volunteers visited some of the popular tourist attractions in western South Dakota. From Mount Rushmore and the Crazy Horse Monument, to the Badlands and Jewel Cave, we made great use of a beautiful South Dakota day. A few students with extra energy hiked Harney Peak and others enjoyed some horseback riding. All in all, it was a good day that capped off a great week.

A few HSVMA-RAVS volunteers at Mount Rushmore
Volunteers took advantage of their day off, visiting some tourist attractions such as Mount Rushmore.
Liza Newsom-Stewart

 

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Day 8 – Sunday, June 9, 2013
Week Two Begins – Caravan & Setup in Pine Ridge

Volunteers unload the HSVMA-RAVS rig
Volunteers wait to help unload supplies from the rig to set up for the week at Pine Ridge.
Darci Adams/The HSUS

The team, consisting of the same students who just completed the RAVS clinic in Lower Brule, S.D., and a handful of new professional volunteers, gathered at 10 a.m. to caravan two hours to the Pine Ridge reservation located in the southwest corner of South Dakota.

The Pine Ridge Reservation consists of 3,468 square miles of land and is the eighth-largest reservation in the United States, larger than Delaware and Rhode Island combined. With a population of 29,000 people, the community itself includes the poorest county in the country. According to a 2007 survey, the unemployment rate on Pine Ridge is as high as 80-90%, per capita income hovers around $4,000, and men on the reservation have a life expectancy lower than anywhere else in the Western hemisphere – second only to Haiti. The nearest veterinary clinic is more than 40 miles away in neighboring Nebraska. With statistics like these – and seeing several friendly, mangy stray dogs running throughout the town – we knew it could be a challenging and rewarding week. Jim, our local coordinator, welcomed us to the community on behalf of the tribe before we drove to Billy Mills Hall in the City of Pine Ridge to set up the clinic.

Cheeto gets his head wrapped
Cheeto gets his head wrapped by Dr. Berliner after being treated for injuries from a dog attack.
Darci Adams/The HSUS

Before we even unloaded the rig we met Cheeto, a Chihuahua mix who was attacked by another dog earlier in the day. Dr. EB and veterinary technician Melina used the end of our receiving table to examine this 3-year-old dog who was missing a portion of his ear. After cleaning the wound, they bandaged him up and asked the family to return for follow-up care when the clinic officially opened on Monday.

Meanwhile, the sound of drums pounding at the pow wow honoring veterans echoed from the rodeo grounds, the skate park was full of kids, and a couple of handsome stray dogs appeared at the clinic door. We spotted two kids riding through town – two to a pony, a colt in tow – and a lighting storm complete with tornados, blew past bringing an end to the busy day. We had to giggle as it was your typical start to a RAVS clinic on the plains of South Dakota. It's beautiful. the sky goes on forever, the dogs are friendly and mangy, and there are indeed pine trees along a ridge. We were excited to be there.

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Day 9 – Monday, June 10, 2013
The Buzz of Downtown Pine Ridge

Mr. Bones
Mr. Bones spent the week in RAVS' field ICU at Lower Brule after eating a large dose of medication intended for the family dog. With IV fluids and intensive monitoring, he recovered and went home to his very relieved family.
Windi Wojdak/HSVMA

RAVS can cause a buzz in downtown Pine Ridge, and we were up early preparing for what would be a busy day at the clinic. The energy was edgier and livelier than many places RAVS visits. There was a feeling that things were happening here, yet we still caught a glimpse of gorgeous wild ponies traveling over the plains. The friendly locals began lining up for services in the early morning. As is the case everywhere RAVS goes, we meet many community members who care very much about their animals and were willing to endure tedious days full of questions, protocols, and instructions to have their dog or cat examined. Almost 50 pets were spayed or neutered during our first day on Pine Ridge, and we completed about 70 pet wellness exams. We definitely learned what "busy" means.

While eating our dinner in the Billy Mills Hall, which served as home to our clinic for two consecutive days, trip lead Dr. Kate Kuzminski gathered us for evening rounds while the intake team continued to discharge surgery patients. A highlight of rounds was receiving updates from Dr. EB on some cases from last week's RAVS clinics on Lower Brule. One of the most impressive aspects of the RAVS program is the follow up completed by the trip lead. Dr. EB reported "so far, all good:"

  • Princess, the older pit bull mix we performed surgery on to clean a chronic, healed-over gunshot abscess on her shoulder, was eating and walking around doing well.
  • Mr. Bones, the cat who ate the peanut butter blob and its 100 mg tablet of carprofen intended for the family dog (an NSAID highly toxic to cats), was continuing to do well, still not showing any signs of liver or kidney failure.
  • Mr. Wilson was doing well after his tail amputation, and while they weren't keeping him inside as we'd strongly recommended, they assured Dr. EB that he wasn't straying far from the house and wondered, "same difference, really, as staying inside – why are we so fussy?"

We ended the clinic late, discharging afternoon surgery patients and tidying up in preparation for another busy day in Pine Ridge.

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Day 10 – Tuesday, June 11, 2013
Celebrating our Pine Ridge Incident Commander

Dr. Kate has been leading the Pine Ridge trip for five years, and she's been "playing" with RAVS far longer than that. A true veteran, we were very fortunate to have her leadership for the extremely busy clinics here. Dr. Kate's day job is the Director of Shelter Medicine at the San Francisco SPCA. For summertime fun, she heads out to the prairies of South Dakota to oversee RAVS operations on Pine Ridge. This is no small feat. The responsibilities include holding court over receiving, helping students learn how to prioritize a problem list, and modeling just how much information can be learned from a thorough and efficient physical exam, among others.

At least a few of us on this trip had been through wilderness first responder training, and while the scene on the reservation was not a disaster, at some moments during the day it might bear more than just a passing resemblance. And while RAVS isn't run along a formal incident command system with its strict hierarchy, defined roles, and centralized control, it also is more similar than not. This week, Dr. Kate was Incident Commander (IC). As I learned it, the IC – almost by definition – walks around with a coffee cup because they can't have their hands in stuff; they have to be overseeing it all. Yet RAVS-style Incident Command requires both, and Dr. Kate was available at any moment to drop into a case. Watching her try to walk from the rig parked outside to surgery located at the most interior part of whatever building we were in, she was stopped almost constantly. When walking up to Dr. Kate with stethoscope still in your ears and a Chihuahua wrapped in a towel, you began to master the art of the two-minute SOAP (quickly reciting patient signalment, relevant history, findings, and problems) and asking for a second listen to make sure you're not missing a murmur. For that moment, the clinic seemed to fade into the background and the only thing Dr. Kate did was listen to the history and put in her own stethoscope to listen to that individual dog. When finished, she walks off, trying to make it all the way to surgery, but stopping another 3, 4, 5 times along the way.

HSVMA-RAVS veterinary student volunteer and Dr. Paul Breckenridge in surgery.
HSVMA-RAVS student intern, Ada Norris, consults Dr. Paul Breckenridge on a case.
Windi Wojdak/HSVMA

By the end of our second day in Pine Ridge, we had seen a lot of puppies – more than we are used to; more than on other trips. Dr. Kate led rounds on pediatric surgery, opening a sort of panel discussion where each surgeon discussed their thoughts and experiences with pediatric spay and neuter. RAVS, in line with most high-quality spay and neuter clinics, will sterilize healthy puppies and kittens as young as 8 weeks and as small as 2 pounds. Staff veterinarian Dr. Paul Breckenridge talked about the safety of the procedure and that, like any procedure, it requires specific knowledge of anatomy and special attention to physiology; however, the procedure itself can actually be faster and easier if done with proper technique. These are not in heat, pregnant, or post-partum animals. With pediatrics, there's minimal body fat, minimal bleeding, and they wake up seemingly instantly after anesthesia. Before wrapping up, we are reminded that even though we use protocols to make the running of a clinic effective, safe, and streamlined, we also know that each animal is different and each animal deserves that we stop what we are doing and just look, using all our senses, running through all of our checklists, and applying the very best of what we've learned to make this animal well and safe.

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Day 11 – Wednesday, June 20, 2012
Oglala

HSVMA-RAVS veterinary student volunteer and Dr. Paul Breckenridge in surgery.
Dr. Paul Breckenridge (right) works one-on-one with a veterinary student in surgery.
Windi Wojdak/HSVMA

In the Dakotas, RAVS sees a lot of dogs quilled by porcupines. Similar to problems associated with grasses like foxtails (any grass that has barbed awns that protect the seed), the barbed end of porcupine quills enters dog either by swallowing or by penetrating the skin. Usually the remnants of the quill will be encapsulated and become a minor abscess. Of bigger concern is if this doesn't happen and the quill migrates to the heart or lungs. One Chow-Chow came in for an exam with a recent history of being quilled by a porcupine, and a more recent history of inappetence and weight loss. His already thick coat was extremely matted, so a thorough physical exam was difficult without shaving him. On oral exam, there were numerous round, raised, and reddened inflammatory lesions on his gums that appeared to contain the broken remnant of quills. Through his dense coat, his lung sounds appeared harsh on expiration. We told his family that he needed to be seen by a full-service veterinary clinic that had the capacity for diagnostic imaging. The client agreed and called for an appointment at the closest clinic, about an hour away in Gordon, Neb.

This is not an unusual sequence of events for a RAVS clinic. Clients will often take their animals for more advanced care than we can offer after we have had a conversation about what we thought was going on, and what the consequences might be of doing one thing over another. It isn't until the client is fully educated about the situation and the options available to them that they leave. Students volunteering with RAVS learn as much about client communication as they do about anesthesia and surgery.

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Day 12 – Thursday, June 13, 2013
Frisky Cats and Project Dog Collar

HSVMA-RAVS Pine Ridge team
Some of the Pine Ridge team pause for a picture.
Darci Adams/The HSUS

It was hard not to feel an extra tug of significance setting up our clinic in Manderson, just 10 miles from Wounded Knee. We were visiting Pine Ridge to provide care to the dogs and cats – and by extension, the people who care for them – yet we were also stepping into a complex and still contested part of the country. On the 30 mile journey to Manderson, our caravan passed Wounded Knee Creek and the church that was built at the site of the mass grave where, in 1890, more than 300 Lakota people died in a chaotic gunfight with the U.S. cavalry. While armed conflict continued past this massacre, Wounded Knee is widely considered the symbolic end of the so-called US-Indian Wars. Its enduring potency as a site of contestation and history was shown when, nearly hundred years later in 1973, the American Indian Movement occupied the site to bring attention to endemic poverty and the ongoing legal injustices faced by the Oglala Sioux and other plains tribes. Our clinic site this day was idyllic – the St. Agnes Church atop a soft hill, with sky surrounding us and a view of the bluff.

Soon after we admitted our first patient of the day, we learned that the cats were sensitive here, despite this being the site of our most elaborate and comfortable receiving cat tent. Our first cat of the day, Cuddles, was bid good-luck by her mom with a big kiss and the hope that she could survive surgery given her extreme nervousness. Cuddles made it all the way inside our clinic into the tent where we examined all of the cats, and though her student clinicians took every precaution – moving slowly and egetting everything ready ahead of time – once her kennel was opened just enough to put a figure-8 harness on, she bolted. Quickly and systematically, she bounced around "cat-style," testing the integrity of each tent wall before we could get a cat net on top of her and a towel on top of that – pausing, bringing calmness. The exam was done through the net and she was fast-tracked to surgery. Perhaps the cats knew the wind was going to pick up and preferred for their examinations to take place inside the building in our cat recovery tent because, shortly after the Cuddles incident, two more cats followed suit. Fortunately, all cats were gingerly caught and returned to the clinic.

Boomer lays down with HSVMA-RAVS rig behind him
Boomer lays down for an outside nap while waiting to be seen at the clinic.
Ada Norris

Perfect Hollywood movie clouds rolled in as the sun set on the bluffs, and we began loading our horse trailer with clinic boxes. One last dog named Boomer, who lives with the Pumpkin Seed family on the St. Agnes Church grounds, was our final patient of the day. Boomer received his yearly shots, de-wormer and tick preventative. We've seen him every year in Manderson for at least the last 4. After his vaccinations, Boomer was sporting a brand-spanking-new collar with his bright blue rabies tag. Many dogs on the reservation don't have collars so,in an effort to better identify dogs, Dr. Lisa came up with the idea to provide every dog a collar to place their new rabies tag upon vaccination at the clinics. Thanks to Dr. Lisa and the help of her friends and family in Ohio, the dogs of Lower Brule and Pine Ridge got collars this year. They made 500 sturdy black nylon collars in a variety of sizes just one week before she departed for Lower Brule. Dr. Lisa lugged the collars, neatly organized and sorted by size, to South Dakota in a giant duffle bag that was checked with her other pieces of luggage at the airport. "Project Dog Collar," as we liked to call it, was a huge success and it could very well save lives.

On our return trip to the school dorms in Pine Ridge, several of us stopped at the Wounded Knee monument and learned more from locals about the significance of this landmark. Following a quick dinner and an abbreviated version of evening rounds, we were off to bed in the hopes of being rested for our final day on Pine Ridge.

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Day 13 – Friday, June 14, 2013
Final Day & Farwell

Jersey and Ginger
Young community member, Jersey, says goodbye to his dog, Ginger, before she goes in for surgery.
Darci Adams/The HSUS

We left our dorms in downtown Pine Ridge at 5:20 a.m. in order to leave time to fuel up at Big Bats and make the hour drive to Kyle. The goal was to have the clinic open by 7 or 7:30 a.m., but before we could leave the gas station, one of our patients strolled up with her person ambling along our parked caravan. It was Rhodie, a sweet old Red Heeler we'd seen on our second day in Pine Ridge. She was taken to surgery to drain a chronic aural hematoma. Basically a collection of blood within the cartilage of the ear from a past trauma, the hematoma is a concern if it bursts on its own and becomes infected, especially for a dog living far away from regular veterinary care. Surgical correction involves draining the fluid under anesthesia, and then tacking the cartilage with suture so that the ear can drain but not re-collect blood. Rhodie's owner was laughing about our parking lot encounter. She had taken off the head bandage herself. The ear looked great and Rhodie looked bright and nonplussed by the whole affair. Rhodie is an older dog who had already been spayed, so we only took her to surgery to resolve the hematoma. It was nice to see her walking alongside her person, wagging her little stump tail and enjoying downtown Pine Ridge for this impromptu recheck.

At 6:30 a.m., recheck complete and rig refueled, the caravan hit the road to Kyle for our last day of surgery and pet wellness appointments. A small circular community building, our Kyle headquarters had the tightest indoor capacity of any of our Pine Ridge clinics, which meant we would be doing a lot of appointments outside. So not only would we be fighting the clock, but also midday heat. It's our last day on Pine Ridge, and we would have to clean, do inventory so supplies could be restocked before the next trip, and fully break down the clinic one last time before returning to Rapid City. Our surgery list filled up quickly: a lot of dogs, not as many cats – good since there was no place inside the small building to put up a cat recovery tent. When we asked Dr. Kate if it'd be a good idea to set up a cat recovery tent outdoors you could almost see her glaze over with visions of students running around with cat nets far into the adjacent fields. We relented and did the best we could, turning the indoor bathrooms into cat recovery.

One of our favorite families of the day included Jersey and Ginger, pictured here as Jersey was saying goodbye to his dog before leaving her for surgery. A sensitive and inquisitive little guy, Jersey peppered Ginger's receiving team with questions about his dog and about the various things she was doing. Another in his pack of dogs, a little German Shepherd mix named Cici, was the last dog off the surgery table. As his surgeon, Dr. Ahne Simonsen, a RAVS staff veterinarian, was outside with Ginger's receiving team trying to encourage Cici to start walking about, they called over Jersey to say hi to his dog. Gently, he sat right down with the still disoriented Cici and talked softly with her, looking around wide-eyed at how to interpret this groggy dog's presentation. Jersey sat, watching them examine the incisions from surgery, learning what to look for when checking her progress at home, and gently offering food and water. We're already looking forward to seeing Jersey and his dogs again next year for a check-up.

Taking in the peacefulness of the big sky and the vastness of the prairie one last time, we caravanned back to Rapid City, said our goodbyes, and celebrated the fact that in two weeks with RAVS, serving Lower Brule and Pine Ridge, we helped more than 1,000 dogs and cats as well as their people.

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HSVMA-RAVS volunteers Ada Norris and Darci Adams with a canine client
Ada Norris (left) and Darci Adams (right) at Lower Brule with a canine client named Princess.

Ada Norris is a veterinary student at Cornell University, spending her summer "playing in the field" as the 2013 HSVMA-RAVS student intern. In a former life, she co-edited a Penguin Classics book on a Sioux writer named Zitkala-Sa (1876-1938) who wrote popular short stories about American Indian life on and off reservations. She loves working MASH-style veterinary field clinics, like the ones HSVMA-RAVS sets up on several Native American reservations each year.

Darci Adams works daily to improve the lives of animals as the South Dakota State Director for The Humane Society of the United States. Her regular job duties include promoting animal welfare legislation, fighting animal cruelty, helping animals during man-made and natural disasters, and engaging like-minded citizens in the animal protection movement. Her experience ranges from humane education to grassroots efforts. Adams is active with the Ogala Pet Project and other organizations working to address animal care and spay/neuter challenges on South Dakota's nine Indian Reservations. Adams serves as an executive officer with the South Dakota Voluntary Organizations Active in Disasters, and she is certified in animal-response disciplines, including large-animal technical rescue, swiftwater rescue, and ICE recovery. And each year, she joins the HSVMA-RAVS team in the field on reservations in South Dakota, whole heartedly taking on the challenging position of Intake Coordinator.

 
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