Let’s Talk About Vets, Baby

by Catherine Besch, Founder and Director Vietnam Animal Aid and Rescue

When I obsess over veterinary medicine in Vietnam, I rarely get a sympathetic ear except from those whose pets have died as a result of medical negligence here.  The rescue community as a whole has ignored the desperate need to invest in the veterinary industry here and globally in order to achieve our goals. If we continue on the line of thinking that shelters are the ultimate answer to ending animal suffering, we are badly missing the point. Shelters are a drop in a bucket with no bottom.

In order to reduce the animal population that ends up on the streets, dog meat restaurants, or dying of disease, abuse, and neglect, we require a highly functional veterinary industry that can safely STERILIZE and treat the animals who would otherwise die or end up in overcrowded shelters. As it stands now in Vietnam, this is a pipe dream.  The universities are churning out vets who often leave school without the ability to even vaccinate an animal properly and the clinics they end up at are poorly equipped and funded, run by vets and clinic managers who are left without adequate resources to pull from in their case load.

Ongoing training is all but absent for the majority of the practicing clinicians unless they get extremely lucky to get into one of only a few decent private clinics in Hanoi or Saigon.  Rescues are popping up all over the country that have no professional guidance on medical care and animals languish in pain cared for by clueless, overworked volunteers who cannot help them. This is not improving in Vietnam and until the focus shifts from prevention of animal cruelty rather than crisis management, veterinary capacity will remain desperately low.

As a rescue, we must see many horrible cases of abuse and neglect, often accidents that require surgeries, and from what I have seen of the clinics and their idea of animal care, the veterinary industry is not capable of handling the animals in the majority of these cases.  Many years of trying to work with local vets and giving them the benefit of the doubt has left our rescues in bad shape with nonsense diagnoses and mistreatment. When trying to rectify this situation by starting to train a recent graduate with our international vet volunteers, we received little attention for this project. As 98% of our donations come from abroad since we live in a poor country with a population unable to donate much, we were relying upon people who have never experienced such a low veterinary capacity in their own lives to be interested in funding a vital need for not only our rescue, but for the millions of other animals in Vietnam who are not able to receive basic care due to this desperate lack of properly trained vets.  

If you follow our posts on social media, you might be aware of my ongoing critique of the horrors of vet care in central Vietnam and how we are working on moving out of the region as a result.  For those of you who have not heard the passionate telling of any of my horror stories in person, I have compiled a short list of just a few of the big ones that stand out:

  • The Danang Pets clinic told a client their puppy had rabies and sent it home with the family.  That vet also works for the local animal health department giving out rabies vaccines.
  • Many calls from clients in Da Nang have been about serious infections after sterilization surgeries.  Deaths are extremely common after even simple neuter surgeries because the surgeries are not clean. We cannot even recommend sterilization locally due to the risk of death.  
  • The head vet at Danang Pets refused to take blood samples while an animal was sedated, saying that the drugs will distort the results of a CBC and Blood Chem.  He would not have been able to interpret the results either way, so it’s best he didn’t bother though the dog died anyway.
  • A cat came in with distended belly, vet says to come back every day (on motorbike) to vet for IV antibiotics. After a couple of days of this the owner came to our clinic.  We took the cat, wormed it, fed it cat food for a week and it was FINE. Driving a cat around town on a motorbike every day for an IV injection of a drug it doesn’t need while ignoring the basic need for deworming makes very little sense.
  • A British vet who volunteered with us ended up with a cat at her last clinic with a mid-line incision from a previous vet who was dying quickly after a “neuter surgery”.  Turns out the local vet had removed both its kidneys. Balls and kidneys aren’t quite the same. Assuming this vet was male, it makes you wonder about his understanding of his own anatomy…
  • At Dr. Son’s clinic in Da Nang, I was given the drugs to perform the euthanasia on my friend’s dog as the vet nurse was afraid to kill the animal (though obviously that was the whole point of us bringing her for euthanasia in a horrible state of terminal illness…).
  • Often I have not been allowed to see blood test after paying for it, not told what drugs my own pet is taking.  No vet wants to be questioned on his diagnosis as we are required to simply take his word for it in spite of endless evidence as to why that would be detrimental to our animals when they misinterpret the results.
  • After sterilization, animals must return every day for antibiotic injections at local vets, causing undue stress and pain in motorbike transport when either a longer acting antibiotic or daily oral dose combined with a properly clean surgery would do just fine.
  • Instruments are rinsed with tap water and spritzed with alcohol, no drapes, sometimes not shaving or cleaning the incision area.  This is not everywhere, but I have seen it enough times at the “best” vet in Da Nang to go through the hell of starting my own clinic.
  • Animals are forcibly tied down PRIOR to surgical anesthesia, as well as when they are on IV fluids with a tight muzzle (see photo of Hue University)
  • Amputation surgeries we have seen brought to our are often badly botched and stumps are left infected and necrotic.  We have had several to redo after bad surgeries locally.
  • Reusing needles and catheters- My first month of running the rescue, the local vet saw two dogs sick with different issues and used the same catheter for their IV antibiotics.
  • Sedation not done well or at all- Most vets now are using Ketamine alone, Acepromazine alone, or induction agents like Propofol alone.  After seeing a C-section with no sedation, I finally decided we needed to stop supporting local vets and get internationals in. The vet and clinic owner at Danang Pets told me once I had a choice between a safe surgery or one with sedation, meaning he did not feel sedation was ever safe as evidenced by the fact that he neutered one of our cats while he was still kicking him and his eyes moving. I had to fight a vet to sedate one of our dogs for a C-section because he said he would not use it because the puppies would be sleepy…   
  • Vets almost never give a proper exam including checking vitals, eyes, heartbeat, etc. No history recorded.  Most vets are going on just basic observation and asking only what the current issue is. Unless an animal has just been in an accident, you want to know the history and vital signs to be able to accurately diagnose the patient.  
  • A vet at a well-equipped but still very dirty clinic in the fancy district of Hanoi performed what can only be described as a surgery to repair a broken pelvis on a puppy with a few wires randomly placed and causing infection throughout the leg that needed to be drained.  The French vet could only shake her head and say “WTF” when we brought her the x-rays.
  • A rescue in Saigon had a dog contract distemper from the local vet clinic who then brought it home to the rest of the shelter of unvaccinated dogs who then died.  The same clinic has rows of cages of clients with no water in wire cages.
  • A friend’s cat was kept for over a week for bladder stones while they refused to do surgery and instead just kept draining it with a catheter.  Then they sent it home after a few hundred dollars telling her she should just squeeze his bladder.
  • Non-absorbable stitching is routinely used in interior sutures that should be absorbable.  Suturing in general is about as basic as it gets and it rarely stays in place. We used to have many re-stitchings after surgeries before we opened our own clinic.
  • A Da Nang vet sedated a dog for an x-ray, muzzled him tightly, and packed him in a styrofoam beer cooler for a local volunteer to drive an hour in midday sun on the back of a motorbike to our clinic. He arrived with a high fever and severe heatstroke. I covered him in ice packs and put him on fluids and he managed to survive.
  • Another local vet in Da Nang put a dog who had both back legs cut off by a car running over it (or so the story goes…) out in a thin wire-bottom cage in the hot sun with no cover, bedding, or water, and soaked in his own urine. He was painfully thin and filthy and suffering from mange and we ended up amputating both hind legs after fattening him up and getting him healthy for a couple of weeks. This was from a caring “vet” who had no understanding of the basic welfare of an animal in pain.

Aside from the unnecessary suffering and stress to the animals themselves, no rescuer, whether local or foreign, can take the daily stress of dealing with this level of incompetence with our caseload.  The entire reason I opened the vet clinic in 2015 was because we found after many experiences with dozens of animals that the vets in Da Nang are not open to training, but only wanted to show us certificates they earned to prove they had better training. They are dead set in their ways that are not ever going to change. Watching shit show after shit show with so many suffering animals became more stressful than just opening my own clinic, or so I thought at the time.  I quickly realized that the younger generation of new vet grads, trained only by international vets rather than the older local vets, are our only hope. Get them fresh out of school and train them up right rather than fight against an older man in a position of authority as a vet who can do no wrong in his mind and in society here. We must wait for the older generation to retire and be replaced by a group of up and coming vets who are committed to not only better care, but continuing to learn throughout their careers and accepting that veterinary medicine is a constantly changing field in which one needs to keep up with the new research, techniques, tools, and medicines.  

The standard scene in vet clinics countrywide is sick animals in open wire cage floors with no bedding, all animals chained up with no water or food.  Welfare and comfort of the patients are not considered and animals languish in their own waste surrounded by disease from other animals. When I highlight these conditions, I don’t do so to shame the clinics and their vets, but to bring to the discussion the lack of veterinary capacity to care for the animals throughout the country. This subject is not at all being addressed by local or international organizations and we are still expected to just continue taking in more and more animals while having no one with the training, tools, or facilities to provide proper care for them. It is not possible and we will no longer even try.   

Considering the lack of exposure to better facilities and modern treatment protocols, vets see no reason why what they’re doing is not in the best interest of the animals. From their view, they are running the best clinic in the world. The clients know no better given their own experience with the human health care system and the lack of quality vet clinics, so there is no incentive to improve. Without access to a better way of doing things, this will never change, especially for the older vets and professors. As long as the students only have access to professors lacking clinical experience under experienced mentors (ideally abroad), and a university clinic with very low standards of care, it will be difficult to change the veterinary infrastructure.  

Constructive Criticism

I have been frequently criticised for my critical view of Vietnamese veterinarians, but it is important to recognize that I am addressing a flaw in the industry itself and the complete lack of investment of organizations and donors towards building vital veterinary capacity in this country. However, there are individual veterinarians locally who I personally dislike based on past experiences of their inflated egos, medical negligence, and general attitude of being above critique.  I’ll admit that these are mostly older men who have had their skills questioned as they screw up again and again and admit to no wrongdoing. In Vietnam, the all too common “saving face” is often translated into pomous older male vets selling bold-faced lies about their non-existent skills while attacking anyone who dares question their obvious medical negligence. My patience has run out for that crap after 7 years here of seeing the harm they have done. My job is hard enough as it is without having to kiss the ass of yet another Vietnamese man on a power trip just to protect his fragile ego while he continues to inflict pain on animals suffering under his care.

People often tell me how a vet is good because he is “nice”, thinking that a smile means something to the animals who is about to suffer after receiving a nonsensical diagnosis and incorrect treatment.  I have no doubt that most vets are extremely friendly as Vietnam is just a very friendly country with smiles all over the place, but we need to stop equating friendliness with medical competence and start demanding professionalism rather than just good customer service. I have met many vets in this country who are incredibly nice, but could not tell me the difference in the use of a steroid and an antibiotic. For the sake of the animals, I’d prefer an asshole who could read an ultrasound correctly to someone who seems nice enough to chat with over a cold beer. Customer service is great, but a healthy and properly treated animal is the outcome we are actually looking for.  

Our previous vet intern turned out after 2 long years of training with only international vets to be incapable of grasping just how little she knew as she went off to do it all on her own with no oversight or international assistance.  Now her private clinic is just another low-welfare hole in the wall in which she still does not even wash her hands between handling animals and can treat any ailment with only fluids, an NSAID, and antibiotic, misdiagnosing just about every case I have sent her. I continue to send her clients since she still represents the best that the region has to offer just because I know she at least can perform safe enough sterilizations, but beyond the basics, she has no desire to improve.  Ambition is not something one can force upon a person no matter how hard you try. While I had set her up with an internship in Australia a couple of years ago in hopes that would spark some measure of ambition in her, she quit while we were out of the country and left to start her own clinic with her “vet” husband who has no clinical experience at all. She is now heavily pregnant and unlikely to advance beyond cat neuters in her veterinary career at this point. I do not say this to shame her, because frankly, it is great that she can at least neuter a cat and I really have no time for being angry with someone who is not even on my radar any more. I do, however, regret spending 2 years of my life, 6 days a week, and endless donations on someone who I thought of as family and trusted with everything we had worked for who ended up quitting and leaving without even saying goodbye. I worked hard to drive ambition and determination into her in order to build up a female vet in an industry dominated by egotistical men who care little for animals and the progress of veterinary science. I failed miserably at that, unfortunately, and now we have just another local vet who has three drugs in their arsenal to treat diseases based on shotgun diagnostics. Life lesson learned.

I have- like most people living here long enough- found my fair share of local vets who lack any kind of ambition or desire to provide better care for the animals, relying instead on decades-old training and obsolete methods because admitting they are wrong is not something one does in any position of authority in Vietnam.  I do not at all regret my criticism of such people and will continue to look for vets who are actually interested in becoming better clinicians and seeking advice from those who can actually teach them better veterinary science. Obstinance and pride have no place in a medical profession of any kind in which ongoing education in rapidly evolving veterinary science is obligatory. At the same time, I have also met a much larger contingent of ambitious, animal-loving vets who are yearning for the opportunity to learn more and use their skills to truly help animals.  The opportunities for those young vets is almost nothing, however, and as long as we lack the training facilities and the serious investment in the veterinary industry in Vietnam by the government, nonprofits, and private investors, that collective ambition will disappear. I am writing and highlighting this topic because the many young vets eager to learn and grow as veterinarians are not being given the resources necessary to develop the veterinary industry for the purpose of saving animal lives. We have a duty to them to provide such opportunities so that they can bring the Vietnamese vet community up to international standards for all species.

The Veterinary Industry in Vietnam: Animal Agriculture’s Effect on Veterinary Care

The veterinary education system and regulatory infrastructure has badly let down veterinarians joining the industry in order to help the animals that need them by preventing and treating diseases of all species.  The government has failed to invest in veterinary education in the way that would save lives rather than just adding more to be slaughtered for human profit. Animal Agriculture is not what this country needs, particularly as it lacks the necessary environmental regulatory infrastructure and public health care to handle what a hastily built industrialized system of animal production will do to both the land it pollutes and the human bodies who will suffer from the diseases brought on by animal consumption and zoonotic epidemics.   When the government’s main purpose for veterinarians is breeding and “raising until profitable age” veterinary science, the message to students and the public continues to be that animals are here for us to use and abuse until we kill and eat them. The message animals and anyone who cares about animals rights wants vets to have is that the purpose for their profession is to protect and treat animals for the sole purpose of giving them a good quality of life. The veterinary education system is currently very far from this line of thought.

A veterinary industry built only for raising and killing animals is not one that will ever progress in animal care. This is true for all countries, but is easily applied here in Vietnam where the number of small animal vets compared to farm and government vets is so small.  As it stands, veterinarians work for people, not animals. Farms need vets only for the purpose of making sure their stock are healthy enough to kill eventually while pet owners just want their animals to be healthy. This difference in mentality of the owners makes a big difference in the care that the animals receive. It also affects the amount of investment the country makes in developing products and improving care for certain species.  Farmed animals receive little care as the cost of each vet visit cuts into the amount of money that can be made off of their bodies. The market for products improving the quality of life and the longevity of animals remains inadquate as a result. This affects the entire veterinary industry in Vietnam.

Globally we lack the vets necessary to manage the increasing number of farm sanctuaries in which animals typically used for profit are now being kept alive long past their typical slaughter date and require lifelong care. Running a farm sanctuary in Vietnam as we do is thus an even greater risk as the number of vets who are capable of treating small animals well is so limited and the number shrinks even more when looking for vets who care about the longevity of a farmed animal as opposed to its profitability from its unnaturally short lifespan. With so few vegan vets in the world, it is very hard to get the veterinary industry to turn itself into a machine that actually works to protect and defend animals rather than producers and consumers.  

When we see a change in veterinary education and private investment, we will see the effects in the treatment of animals in general.  In a country in which veterinarians hold some authority in regards to how animals are treated, we need to focus our attention on their training and continue to engage them in ongoing education programs and incentives for improving their facilities and client care. When the vets are able to be ambassadors for the animals rather than just the producers of animal products, the general population will catch on to the message.  Shelters and grassroots animal welfare organizations that are overwhelmed with rescues and run by inexperienced but caring local volunteers are not ever going to be able to develop this industry on their own. They need caring and competent vets at their side. This requires the will of the larger organizations and their donors along with the Vietnamese government to invest in building the veterinary capacity of this country.  

While the world cries over the dog meat trade and seeks a legal ban, millions more dogs and other species lack access to veterinarians capable of preventing or treating common diseases and performing safe sterilizations to end the growth of the population of unwanted animals. If you are against the dog meat trade and have no interest in building up the local veterinary industry to be capable of performing mass sterilizations, you might want to step back into an economics class and approach the subject of supply a little more logically.  It is time to shift our focus in the animal rights community to where we can really make a difference in the daily lives of animals in Vietnam.

Solutions

Let’s work to create a veterinary industry capable of serving the animals of Vietnam and preventing the spread of disease, stemming the population of animals who will live short lives and die miserable deaths in a country where they cannot receive the care they need. A long term commitment to providing the training, equipment, and facilities needed for providing the necessary care of millions of animals is only possible if we focus on high impact solutions and put our money where it will most effectively work for the animals. A little investment would go a long way in a Vietnamese university when coupled with a long term commitment to providing the resources necessary to build a new generation of veterinarians working for the animals. The university clinics to start with could go for a massive upgrade. Providing their facilities with veterinary equipment and supplies along with the experienced clinicians to teach hands on veterinary care would change hundreds of students’ view on how they need to be handling, diagnosing, and treating their clients once they get out of university. While professors have PhDs in hematology and do not know how to hold a cat or perform a neuter surgery, the students will not have any practical care knowledge.

Last time I visited the Hue University’s vet school, I walked into a clinic with a fully-conscious, very stressed out dog painfully stretched onto a table and muzzled with tape receiving IV fluids for whatever mystery illness he had and would not receive the appropriate diagnosis for. The picture is seen below. This “treatment” came from the DEAN of the Veterinary University, Dr. Hai, in a clinic that is dirtier than the toilet at my shelter full of animals. This is the standard of care that is being spread to hundreds of students every year who look up to professors who are not trained or cognizant of basic welfare standards for patients. This is the beginning of a vet’s exposure to client care by a respected mentor, so how can we expect a change in care when this is their baseline?

Hue University of Agriculture and Forestry veterinary college clinic

Hanoi and Saigon also have their own veterinary science universities, both with the focus on farm animal production. Half of the students of the Hue university take the veterinary pharmaceutical track which leads them to a career working for companies selling feed and drugs to farmed animals that are meant to be kept alive only long enough for them to be profitable. Teaching proper aseptic surgical procedure, modern sedation protocols, and basic daily clinical needs such as differential diagnostics and inpatient welfare remains on the bottom of the priority list. For a vet to operate a clinic, there seems to be little training available. It is no wonder walking into a local clinic is usually a terrifying experience for anyone that prefers medical facilities relieve pain and suffering and prevent disease rather than causing harm and spreading illness.

With a growing contingent of pet owners in the country who are eager to access vet care for their animals, the supply of quality care needs to grow to meet the demand and this will take INVESTMENT, not donations, and will require a long term commitment to training and mentoring vets day-in and day-out for decades, not just pop up internationals who think training happens in a week-long workshop on their holiday. Internships abroad to international veterinary universities and clinics will open up a much larger world of client care to young vets who can come home and begin to revolutionize the industry from the ground up as the older, and untrainable vets slowly vacate their positions.

Currently the only access to quality vet care exists in Hanoi and Saigon and even there it is limited to just a few clinics with internationally trained vets and modern equipment. In a country of 90 million people spread over 4200 km from top to bottom, this is completely inadequate. Central Vietnam has only the underfunded and poorly-equipped university run by inexperienced clinicians and the few vets in Da Nang who have learned nothing over the years in terms of client care and diagnostics despite adding a couple new blood machines. Caring vets abound along the entire country, but without access to the training, tools and facilities they need to operate better for the animals they care for, their good intentions are wasted. Connecting these outlying vets better with the clinics in the larger cities and investing in their continuing education and oversight would provide thousands more animals with the care they need. Once we have better vets operating, the bad ones will be driven out of the market and we will have an overall improvement in care. When these vets are able to give their clients sound advice on care of their animals, then the day to day lives of animals and their long term health is positively affected. As it stands now, we have the veterinary professionals showing clients that tying down their animals to a grate for hours, providing them with no food or water, and performing surgeries while they are conscious and screaming is perfectly OK. Clearly there is some work to do.