The Student Becomes the Teacher

by Lauren Kloer, DVM

March 18, 2013

Dr. Lauren Kloer with an HSVMA-RAVS canine patient
HSVMA-RAVS volunteer veterinarian Dr. Lauren Kloer with a patient at an outreach wellness clinic near Cibecue, Ariz.
Lauren Kloer, DVM

This past May I participated in my second HSVMA Rural Area Veterinary Services trip as a volunteer veterinarian, after participating in three trips as a veterinary student. The experience was, as it has always been, amazing! The days are long, the nights are short, and the floors are hard. During any trip, a considerable amount of sweat is shed and we are often left with suture cuts on our fingers and sore, stiff joints. On one particularly memorable trip, we had limited food, were only able to shower once, and had to hold the clinic in a building with no running water and a heater stuck in the "on" position during 100 plus degree days. If I haven't been clear enough, the trips are mentally and physically challenging.

Why then, you might ask, do I continue to return? The answer is quite simple. Many of the communities in the Native Nations that RAVS serves don't have access to basic veterinary services due to prohibitive economic and geographic circumstances, and I enjoy providing as many free services as I can to each animal family member. The added benefits are that I always meet a great group of people, I learn so much while I'm there, and I can help pass along training to the next generation of veterinarians.

Memorable Moments and Gratifying
Learning Experiences

While in veterinary school, I participated in three RAVS trips, starting in the summer of 2007 after my second year. After graduation, I couldn't wait to volunteer for my first trip as a veterinarian so I joined up with the team again, just a few weeks after getting my degree. It's difficult to single out my favorite parts of the trips because there are so many. I love working with all the other volunteers – the vet students, the technicians, the veterinary assistants, the veterinarians, and the intake coordinators, as well as the amazing RAVS staff. I also enjoy interacting with the members of the communities. I've listened to many heartwarming stories about their animal family members and they are always so appreciative of the services and education that RAVS provides to their community. I will always remember a little, weak, anemic puppy that was brought to a clinic in San Carlos, Ariz. This sweet pup needed a blood transfusion to live, and thankfully another clinic attendee volunteered their dog as a blood donor. We utilized available transfusion supplies and, thanks to a group of very dedicated volunteers and the generosity of the donor family, we were able to give this puppy a second chance at life.

Another medical case stuck in my memory involved a sweet pit bull who was experiencing weight loss, vomiting, and head shaking. The student on the case reported that something was wrong with the dog's ear – it was malodorous and filled with fluid due to infection from multiple grass awns. We also discovered she was positive for Ehrlichia, a tick borne disease frequently diagnosed in Arizona. After talking with her concerned caretaker, we also ascertained that her below-average body condition score was at least partially due to the other dogs at the home stealing her food. We removed the grass awns, flushed her ear, started her on pain medication and antibiotics that would treat both her ear and Ehrlichia infections, and discussed nutrition and separate feedings with her worried caretaker. The students on the case got a valuable lesson in the importance of taking a good history, being prepared to treat multiple problems in one patient, and understanding that in most of the cases that we see, multiple conditions in one animal speak to a lack of access to veterinary care rather than a lack of concern for an animal family member. Giving back to the profession by helping to educate the next generation of vets is admittedly very rewarding. Plus, I learn so much on every single trip because the students love to share the current knowledge that they are learning in their veterinary school curriculum.

In addition to learning more about high-quality critical care field medicine, I have learned much about the history, culture, and daily lives of the community members of the Native Nations that I have visited while volunteering with RAVS. The poverty I have witnessed is disheartening, and to work with a family that has trouble getting food and healthcare for themselves, much less their animal family members, is so incredibly eye-opening. The community members really do want the best for their animals and are incredibly grateful for the services offered by RAVS and the local public health departments. Client communication at the clinics is such a gratifying part of volunteering because they appreciate the information about the conditions we are trying to prevent via annual vaccinations, de-worming, and monthly flea and tick prevention, as well as the conditions that are currently afflicting their pets.

Becoming the Teacher

As a volunteer veterinarian with a broad surgical background, I have spent a considerable amount of time in the surgery and anesthesia sections of the clinics. I love the challenge of anesthesia and surgery on a population of compromised patients. I enjoy teaching the students about patient support protocols, like endotracheal intubation, catheter placement, surgical fluid rates, and appropriate use of a heat source; appropriate anesthetic protocols for individual patients; the use of anesthetic monitoring tools, like esophageal stethoscopes, pulse-ox machines, and blood pressure monitors; and how to assess the big picture of trends made evident by their consistent five minute TPRs. I also enjoy helping the students build their surgical skills one-on-one from the most basic to the more advanced techniques. If something is done well, praise is in order. If a mistake is made, I teach the student how to correct it in a non-threatening environment. I remember assisting Dr. Elizabeth Berliner during one of my first surgeries on a trip in 2007. I was nervous, but I was ready to use the skills that I had been practicing for months before the trip. Dr. Berliner talked me through the procedure, providing some great tips and tricks, and at the end of the procedure, I looked proudly at my patient's surgical incision and adjacent tattoo that marked her "spayed" forever! That experience, and all those to come on other trips, certainly boosted my surgical confidence and expertise by the time I graduated.

Now when I attend trips, I have the opportunity to pass along the tips and tricks to the next generation of veterinary students. During my summer 2012 trip, I recall being gowned and "elbow deep" in a 90-pound aggressive female Rottweiler. I was mentoring a fourth-year veterinary student on the spay. The main learning goal of the surgery was TIGHT ligatures on any vessel that would bleed because, since the dog was aggressive, we knew that once she was awake we wouldn't be able to check her vital signs or gum color to assess any post-operative bleeding. The student got great practice at ligature-tying as well as surgical assisting, where she learned how to provide better exposure of critical structures for ligation, which can result in a shorter procedure time for the patient.

Teamwork, flexibility, and a positive attitude are by far the most important factors in a successful clinic. The RAVS team does a great job of fostering all three, and all the trips I have attended have been great successes despite all the crazy challenges – such as location logistics, vehicle breakdowns, and human illness – that we encountered on each one. I would encourage anyone looking for a unique and very rewarding volunteer experience to consider volunteering on a RAVS trip. You won't regret it!

Dr. Lauren Kloer
Ellen Zangla

Watching animal programs on television was one of the things that inspired Dr. Lauren Kloer to become a veterinarian, but it wasn't just television that was behind her interest in animals. Dr. Kloer grew up on a farm surrounded by barnyard animals in Vona, Colo.

Dr. Kloer earned her Doctorate of Veterinary Medicine (graduating Magna Cum Laude) from Colorado State University School of Veterinary Medicine in 2009. While in school, she performed hundreds of spays and neuters at the Larimer Humane Society's veterinary department and helped treat infectious diseases at the shelter. She helped to further develop the student animal behavior club and spent a year coordinating the critical care student volunteer program. She also performed a canine and feline heartworm surveillance study and presented her research findings at the National Institutes of Health in Bethesda, Md.

Dr. Kloer is currently employed at Leesburg Veterinary Hospital in Leesburg, Va. where she enjoys focusing her time on advanced soft tissue surgery, preventive medicine, shelter spay/neuter medicine, behavior medicine, and exotic pet medicine.