MICHELLE LEM

Canada,

Leveraging the connections between people and their pets, Michelle Lem is bridging the gap between marginalized populations and critical support services by offering free veterinary care, leading to free person care. Michelle 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 Lem is bridging the gap between marginalized populations and critical support services by offering free veterinary care, leading to free person care. Michelle 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 to restructure their societal role from healthcare provider for animals to community health liaison for people. In doing so, she is building a process of identification and utilization of non-traditional networks to facilitate the 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 to care for themselves, many pet owners will go to great lengths to ensure their pets are well cared for. Thus, Michelle offers an insightful tactic to overcome systemic and behavior-driven access barriers to social services. In doing this, Michelle is enabling local communities to reach a greater number of its marginalized populations.

Michelle is transforming how medical services, social services, local government and law enforcement agencies 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 medical support services. These clinics provide access to free veterinary care for the animal and local shelters, public health and social services for the person; placing the veterinarian as a local liaison and convener of an integrated model of care. 

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 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 for whom these services are designed do not access them, either out of choice or due to 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 percent and 65 percent of Canada’s chronic homeless suffer from schizophrenia. This is much higher than the national average of 1 percent 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 percent of chronically homeless individuals are unable to access healthcare.

In Ontario, it is believed that more than 18,000 individuals currently homeless or transitionally-housed own pets. Individuals obtain pets in 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 persons will obtain animals through a culture of street bartering or will encounter and adopt stray animals. In Toronto, pet ownership among the street-involved is estimated to be as high as 12.8 percent. In the US it is calculated that between 175,000 and 350,000 homeless people live with pets. Unfortunately, having a pet poses additional challenges to impoverished people to access 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 people will not utilize services (such as staying in transitional housing or visiting a hospital) if their pets are not also accommodated. 

For many, a 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 do not. 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 due to housing arrangements and costs), were significantly impacted by this loss, a situation that could lead to further isolation and self-withdrawal 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 facilitate housing opportunities to homeless people in the area. She asked to use her veterinary skills to set up a clinic to provide the necessary care for pets of the homeless to give them access to shelters. 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 center of an interagency and intra-professional community collaboration focused on improving peoples’ lives 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, women and children in domestically risky situations, and people with companion pets such as seeing-eye dogs. To achieve this vision and growth, Michelle employs a multipronged strategy: (i) establish multilateral collaborations with community organizations and agencies (ii) build and popularize the role of the community veterinarian through curriculum development and training (iii) conduct ongoing peer-reviewed research to contribute to the scientific knowledge base on the social issues involving animals, and (iv) develop programs that can be modeled in other communities. In addition, Michelle works with public services, such as police and welfare programs, to change policies that penalize low-income individuals, ultimately aiming to change public policies.

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 ongoing mentorship and coaching to the regional directors to mobilize professional contacts, develop strong interagency relationships and launch their own mobile outreach clinic. Regional directors have a mandate 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, medical professionals, case workers, housing services and others to create opportunities for clinic attendants to be introduced or reintroduced 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 medical care center and was able to provide flu vaccinations to homeless individuals seeking services for their pets. In another instance, Michelle worked with a community women’s shelter to ensure that women leaving situations of domestic violence and abuse had the legal public health documents required to access transitional government housing with their pets. In all of her clinics, Michelle requires that the regional medical officer of health and local public health agencies 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 industry and with social service agencies. As examples, CVO receives products and supplies from Pfizer, EIDAP Inc., Medi-Cal, and Royal Canin, as well as partnerships with a number of local Humane Societies. Each outreach clinic is also set up to recruit student volunteers, through partnerships that Michelle has developed with veterinary schools, in an effort to usher in the next generation of veterinarians who view themselves as community health leaders. Michelle has a clear and ultimate goal to integrate 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 ineffective 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 researches the positive and negative effects of pet ownership on accessibility of services, quality of life, physical and mental health, and has purposefully affiliated herself with veterinary schools and the scientific community to create ongoing opportunities to conduct and publish her research in well-respected media.

Michelle has treated more than 1,200 animals and has expanded her clinic to four major Ontario cities (Ottawa, Kitchener, Toronto, and Guelph). 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 100+ marginalized individuals and have more than 15 mobile clinics in operation. 

 Michelle’s work has equally influenced public service and policy procedures. CVO is often contacted by local law enforcement to verify that street pets have received the legally mandated animal care claimed by their owners. This has, on several occasions, prevented criminalization of street-involved individuals. Michelle has also drafted an MOU that is used by all the CVO mobile clinics when establishing partnerships with service agencies like the local Humane Societies. The MOU prevents volunteers and agency workers from contacting law enforcement in suspected cases of animal neglect before first bringing the case to CVO volunteers. Michelle works to prevent further isolation of marginalized people who are criminalized for issues that have much deeper causes, where criminalization only serves to compound their 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 School™ 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 the work of CVO and provide a sustainable source of revenue. Established in 2009 and now engaging 400+ community participants, Michelle is looking at licensing models of her Mini-Vet School™ in partnership with Canadian universities.

As Michelle’s work grows, she is taking aim at cities outside the province of Ontario, and her model is being used by others in her field to access other marginalized communities such as northern First Nations groups. She is working on a new aspect of her program, to help street youth deal with psychosocial issues of depression and anger by learning how to first identify and treat these issues in their pets. 




THE PERSON

Michelle grew up in a household in which humanitarianism and advocacy went hand in hand with healthcare. Her mother was a nurse and her father a dentist and well-known community activist, integral in getting governmental recognition of the contributions of Chinese-Canadian immigrants in Canadian history. Michelle’s parents encouraged volunteerism at an early age, and she spent a substantial amount of her volunteer time at homeless shelters and clinics. 

Michelle studied psychology at the University of Western Ontario where she remained active in volunteering. After graduation, she continued her formal educational training by attending Guelph University, and pursued a degree in microbiology. Michelle had an opportunity to travel to Kenya as a lab student for a study on sleeping sickness in farm cattle, while there, she saw livestock treated poorly and destroyed without reason. Michelle rallied to change the practices of the lead veterinarians and scientists on the project, not only concerned about the treatment of the animals, but also about the effects this destruction had on many of the local Kenyan farm workers, economically dependent on the livestock and with whom she had bonded. 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 moved to New Zealand to help manage an animal welfare clinic for economically disadvantaged farmers. This experience helped her to realize that veterinary professionals can act as much more than service providers, but as community health leaders.

Returning to Canada, Michelle moved to Ottawa and started several small businesses (while pursuing her master’s degree in veterinary care) including an online sympathy card business for animal lovers and people with pets. She also founded a veterinary practice specializing in providing house calls and consultancy work for animal behavior issues. When Michelle purchased a van to conduct her business, she saw it as an opportunity to provide care for pets of individuals at the local mission. With a successful research background and the qualifications to practice veterinary medicine, Michelle turned away from a safe and practical career as a researcher, but instead took a leap of faith to fill a gap in care for marginalized people, establishing Community Veterinary Outreach.