MICHELLE LEM

Canada,

Leveraging the connections between people and their pets, Michelle is bridging the gap between marginalized populations and critical support services by offering free veterinary care, leading to free person care. She is also engaging veterinarians as community health workers, redefining their roles as engaged citizens rather than just animal doctors.

This profile below was prepared when Michelle Lem was elected to the Ashoka Fellowship in 2013.

INTRODUCTION

Leveraging the connections between people and their pets, Michelle is bridging the gap between marginalized populations and critical support services by offering free veterinary care, leading to free person care. She is also engaging veterinarians as community health workers, redefining their roles as engaged citizens rather than just animal doctors.




THE NEW IDEA

Michelle engages veterinarians in new ways, to restructure their role in society from health-care provider for animals to a community health liaison for people. In doing so, she is building a process of identification and utilization of non-traditional networks in order to facilitate social inclusion of isolated populations.

Recognizing the incredibly strong bond between an individual and their pet, Michelle is capitalizing on this important trigger for changemaking. While a person may not be driven to action in order to care for themselves, many pet-owners will go to great lengths to ensure their pets are well cared for.  Michelle is offering a new and insightful tactic to overcoming systemic and behavior-driven access barriers to social services. Through this, Michelle is enabling local communities to reach a greater number of its marginalized populations.

Specifically, Michelle is transforming the way in which medical services, social services, and local government agencies are able to interact with large segments of marginalized populations, by facilitating their access and entry points through the community veterinarian. Michelle is equipping local veterinarians to establish free, regional, mobile clinics, which target pet-owners in need of housing services and/or health support services.  These clinics provide access to free veterinary care for the animal and access to temporary or transitional housing, public health and social services for the person placing the veterinarian as a local liaison and convenor of an integrated model of care.  

Michelle is establishing an inter-city network of mobile veterinary outreach clinics designed specifically to address the needs of the homeless, transitionally-housed and economically marginalized people across Ontario and ultimately the rest of Canada.  Michelle sees this segment of the population as the most resource limited and therefore urgent in need. However, Michelle is also at an inflection point, in which she views her model as not only able to scale in size but also in reach.  Michelle has built her approach to be adapted to connect to larger segments of marginalized individuals such as: elderly people with pets, women and children in situations of domestic violence, individuals with disabilities, and other isolated persons.

Michelle’s vision is to tap into the inherent, empathic and entrepreneurial nature of people -like those who become veterinarians- to play a role in addressing social issues in society that utilizes much more than just their professional training.




THE PROBLEM

Canadian charities offer many social services to address the symptoms of poverty. However, many individuals for whom these services are designed do not access them, either out of choice or because of systemic or personal barriers to access. For example, when attempting to access local governmental and non-governmental services, people who are street-involved and/or homeless often face barriers made larger by mental health issues or addiction. A 2009 report from Charity Intelligence Canada estimates that between 35% and 65% of Canada’s chronic homeless suffer from schizophrenia. This is much higher than the national average of 1% of all Canadians suffering from schizophrenia. The chronically homeless in Canada also suffer from a higher prevalence of addiction issues; for example, half of homeless youth in Canada suffer with substance abuse. It is estimated that as high as 25% of chronically homeless individuals are unable to access health care.

In Ontario, it is believed that more than 18,000 individuals who are currently homeless or transitionally housed own pets. Individuals obtain these pets in many different ways; for instance, some youth who have left home for reasons of domestic violence or abuse will leave with their pets. Other transitionally housed individuals will obtain animals through a culture of street-bartering or will encounter and adopt stray animals. In the city of Toronto, pet ownership amongst the street-involved is estimated to be as high as 19%. In the United States it is calculated that between 175,000 and 350,000 homeless people live with pets. Unfortunately, having a pet poses additional challenges to people in impoverished situations from accessing services. Individuals are often refused housing or hospital admittance with their pet, or if their pet does not have up-to-date and well-documented vaccinations and immunizations; this situation can also lead to criminalization issues like animal neglect and public health violations. Some individuals will not utilize services (such as staying in transitional housing or visiting a hospital) if their pets are not also accommodated.

There are at least 18,000 individuals in Ontario and 48,000 in the United States whose pet ownership – and deep connection and commitment to their pets – keeps them from accessing critical services to address their own personal health and mental health needs. Despite this, pet ownership is known to provide benefits to the physical, mental and emotional well-being of people. For example, young children who grow up in houses with pets tend to score higher in measures of empathy than those who grow up without pets. An article published in the British Journal of Occupational Therapy found that companion pets among homeless individuals provided friendship, a sense of responsibility and contributed to emotional well-being. The article further cited that individuals who had to give up their pets (mostly because of housing arrangements and costs), were significantly impacted by this loss, a situation that could lead to further isolation and self-withdrawal of the individual from social support systems.




THE STRATEGY

In 2003 Michelle met with the executive director of her local homeless shelter to see if she could help provide veterinary care to animals belonging to those who are homeless in the area thus facilitating opportunities to other social services. With a warm reception to the idea and a successful pilot, Michelle soon realized that any veterinarian could play this critical role in facilitating collaboration between social service agencies. As a result, Michelle built a highly localized model of care for marginalized individuals, via free, mobile veterinary clinics. She also worked with local veterinarians to see the role they could play as community health leaders. Inspired by the international One Health initiative, which forges equal collaboration between various disciplines of medical and health professionals, Michelle developed what would eventually become Community Veterinary Outreach (CVO).  

CVO addresses the capacity needs of local communities to house and provide medical and social services to the homeless and economically marginalized (with pets) by placing the veterinarian at the centre of an inter-agency and intra-professional community collaboration focused on improving the lives of individuals through their pets.

Michelle’s strategy is driven by her vision to improve the health and welfare of both people and pets. Her initial work focuses on homeless and economically marginalized individuals, but the model is meant to extend to any person with a pet. For example, Michelle is growing her initiative to support elderly individuals and women and children in domestically risky situations. To achieve this vision and growth, Michelle employs a multi-pronged strategy: 1) establish multi-lateral collaborations with community organizations and agencies, 2) build and popularize the role of the community veterinarian through curriculum-development and training, 3) conduct ongoing peer-reviewed research to contribute to the scientific knowledge base on the social issues involving animals, and 4) develop programs that are reproducible and can be modeled in other communities. In addition, Michelle actively works on several committees tasked with improving animal welfare and is an invited speaker at veterinary and animal welfare groups.  In this capacity her goal is to educate public service sectors, such as humane law enforcement and welfare using her “One Health, One Welfare” model in order to change policies that penalize low-income individuals as opposed to supporting their re-entry into society through social services.

Michelle is shifting public and professional mindsets surrounding the purpose of veterinarians within communities by identifying through professional networks and word of mouth and engaging what she calls regional community directors, who are established practicing veterinarians within a particular community. Michelle provides the tools, a set of guidelines and on-going mentorship and coaching needed for the regional directors to mobilize professional contacts, develop strong inter-agency relationships and launch and lead their own mobile outreach clinics under the Community Veterinary Outreach umbrella. With a mandate for regional directors to “establish themselves as stewards in each community” and “advocate for marginalized pet owners” Michelle’s model ensures that each mobile clinic brings together public health agencies, mental health organizations, medical professionals, case workers, housing services and others to create opportunities for clinic attendants to be introduced or re-introduced to much needed social and medical services while accessing care for their pets. Each clinic is highly tailored and therefore different in the services that are provided to the pet owner.  In one instance Michelle set up a mobile clinic in partnership with a local public health nurse who was able to provide flu vaccinations to homeless individuals seeking services for their pets.  In another instance, Michelle and her team worked with a group of community agencies to ensure that women leaving situations of domestic violence and abuse had the pet health documents required to access temporary boarding for their pets.  In all of her clinics, Michelle ensures the participation of regional directors and managers for infectious diseases at local public health agencies, who are provided with full registration lists of clients and their animals that have accessed the services.  

Community veterinarians – with Michelle’s support – have also established partnerships with private industry, social service agencies and local Humane Societies. Each outreach clinic is also set up to recruit student volunteers, through formal and informal partnerships that Michelle has developed with both veterinary schools and veterinary technician students, in an effort to usher in the next generation of veterinary professionals who view themselves as community health leaders.  Michelle has a clear and ultimate goal of integrating outreach experiences into the veterinary curriculum of colleges across Canada, and is building the professional contacts and support required to do so.

Coming from a strong research background, Michelle conducts ongoing research to contribute to relevant knowledge bases. For example, Michelle’s master’s thesis is one of few Canadian research documents that provide insight on the effects of pet ownership on street-involved youth. Michelle also recognizes the need to develop better means of determining the number of homeless people in any defined area. A current popular and in effective practice is to send people to walk around the streets and count the number of individuals they see. A similar approach is used to estimate pet ownership among the homeless and under-housed. Both methods are prone to producing numbers that arguably misrepresent the actual severity of the issue. Michelle utilizes both qualitative and quantitative methods to research the positive and negative effects of pet ownership on accessibility of services, quality of life, physical and mental health and she has purposefully affiliated herself with researchers in the scientific community to create ongoing opportunities to conduct and publish her research in well-respected media.

Michelle and her team of volunteers have treated more than 1800 animals and she has spread her clinic to four major Ontario cities (Ottawa, Kitchener-Waterloo, Toronto and Hamilton).  In 2011, veterinarians donated over 160 professional hours in these mobile clinics with an additional 230 hours donated from veterinary technicians and veterinary student volunteers. From September 2012 to December 2012, CVO clinics served more than 100 marginalized individuals and are on track to offer more than 15 clinics serving over 300 people by September 2013. 

Michelle’s work has equally influenced public service and policy procedures. CVO is often contacted by local by-law enforcement or public health to verify that street pets have received the legally mandated animal care required. This has, on several occasions, prevented criminalization of street involved individuals. Michelle drafts tailored agreements with agencies to prevent further isolation of marginalized people who are often criminalized for issues that have much deeper root causes, where criminalization only serves to compound the root problems rather than solve them.  

Michelle’s work is financed through a combination of in-kind donations and pro bono services, grants and donations from individuals and foundations, and through income-generation strategies such as Mini-Vet Schools™, her trademarked lecture series. Mini-Vet Schools™ create unique educational outreach opportunities and provide community veterinarians with a platform to highlight their work from a One Health perspective. The Schools engage and educate the community around animal health, veterinary medicine and the work of Community Veterinary Outreach and provide a sustainable source of revenue to the organization.  Established in 2009 and now engaging more than 450 community participants, Michelle is looking at licensing models of her Mini-Vet School™ in communities where CVO programs are operating. As Michelle’s work grows, she is taking aim at cities outside the province of Ontario. Aspects of her model have been used by others in her field to access other marginalized communities such as First Nations groups in Northern Ontario. Michelle is also working to secure resources to support an expansion of her program, which includes helping street youth to build life skills and tools through the attachment they have for their pet by teaching youth non-aversive dog training methods, building on the strengths that youth have developed as dog owners, including responsibility, structure and routine, and pride of pet ownership. Michelle realizes that focusing on strengths that youth have developed through the human-animal relationship will contribute to their sense of self-esteem and resiliency.




THE PERSON

Michelle grew up in a household in which humanitarianism and advocacy went hand in hand with health care.  Her mother was a nurse and her father, a dentist and well known community activist who was integral in getting governmental recognition of the contributions of Chinese-Canadian immigrants in Canadian history. Both of her parents encouraged volunteerism at a very early age, and Michelle would spend a substantial amount of her volunteer time working with people with disabilities, then later in her career at homeless shelters and clinics. 

Michelle first studied psychology at the University of Western Ontario where she remained active in volunteering. After graduation, Michelle continued her formal educational training by attending the University of Guelph, and pursuing a degree in microbiology.  It was here that Michelle received the opportunity to travel to Kenya as a visiting lab technician for a study on sleeping sickness in farm cattle. Michelle’s time in Kenya opened her eyes to the significance of human-animal relationships, the significant role that empathy plays when working with animals and the economic, educational and emotional interdependence that humans often have with animals. It was then that Michelle decided to turn to veterinary medicine and combine her knowledge base to learn more about the human condition through animals.

After finishing her veterinary degree, Michelle practiced in Ottawa for a year before moving to New Zealand to work in a rural area of the country, where her experience as a veterinarian would take a great shift. Practicing out of a minimally-equipped and minimally-staffed mixed animal practice, Michelle learned how to practice veterinary medicine from a different perspective. Rather than the “gold standard” approach that is taught and practiced in much of North America and which is financially out of reach for many - in this rural clinic Michelle learned how to “provide the best care with the best of what you have”. This experience would eventually help her to advocate for increased accessibility to veterinary care and help bridge the gap between cost of care and care provided. Upon returning to Canada, Michelle moved back to Ottawa and continued to practice while also teaching at the local community college and started several small businesses) including an online pet sympathy card business to help veterinarians express empathy and acknowledge the human-animal bond after the loss of a beloved pet. This business would later take off as a social enterprise with national distribution, and proceeds supporting her charity. Michelle also started a consultancy practice for companion animal behaviour issues. When she accredited a companion animal mobile unit, Michelle saw it as an opportunity to use the mobile to provide care for pets of individuals at the local mission. Michelle would eventually turn away from a safe and practical career as a veterinarian in a companion animal practice, returning to school to research the effects of pet ownership on street-involved youth receiving her MSc; and take a leap of faith to fill a gap in care for marginalized people that she believed was best addressed by the community veterinarian, ultimately establishing Community Veterinary Outreach.