‘In chunks?’

Dead animals at Zurich University weren't going to deter Nadine from becoming a vet when she was only a tween. If anything, it encouraged her more. But after a few turns in her career, she wanted to go back to the roots of veterinary medicine. Welcome to Carriacou Animal Hospital, a veterinary charity in the Caribbean country of Grenada.

Nadine tells us how the project started and how it works. The charity hospital welcomes veterinary volunteers to enjoy a working holiday on the fascinating island of Carriacou, only a few steps from the beach. As she puts it, they are the heart of the project. She talks about the endemic diseases you would encounter on the island and how these can be treated and prevented.

We also have a thoughtful chat about mental health and how she sees the working demands of clinics as one of the causes of mental health deterioration in today's for-profit practice.

Listen to Nadine Cerny and read about her journey here or on your favourite podcast platform:

First, I would like to know a bit more about you.

Are you and your family from where you work now? When did you qualify as a vet, and why did you choose this profession? Does it run in the family?

Now I live in Grenada, but I am originally from Switzerland, where I grew up and studied veterinary medicine. I graduated from vet school in the fall of 2008 and added a Doctor’s thesis, which I finished 2,5 years later.

My family lives in Switzerland, and no one in my family is a vet, but my parents have always been animal lovers. My sisters and I were fortunate to grow up with lots of pets.

I have been interested in veterinary medicine from an early age. I remember visiting the anatomy theatre of the vet school in Zurich for the first time when I was still in primary school, somewhere between 10 and 12 years old. I always had veterinary medicine in mind, so I chose math and biology over languages or art.

Between 16 and 18 years old, I briefly lost this goal as there were sooo many other things that I had an interest in, like computer science or sports or even law or food science. But when it came down to choosing what to study at university, my inner voice told me to be a vet.

Then, I would like you to tell me about your day. What is a regular day at work for you?

Do you work independently, for a private firm, or do you work for the government?

I work for an online veterinary telehealth medicine company in the UK, but I live on a small island in the Caribbean called Carriacou, located in Grenada. There, I help run a charity animal hospital: It is the only veterinary clinic on the island, and we are the only veterinarians there with an actual veterinary degree.

The charity is entirely run by volunteers, so I too donate my time and skills to the project.

A regular day in my life starts between 6 and 6:30 in the morning. After getting up and getting ready for the day, I usually work for my paid job for a few hours doing admin work and having meetings. Then, I head to the charity clinic.

When we have visiting veterinary volunteers staying at the clinic, depending on the skill and comfort level at the practice, I can head in a little later. But when we have no other vet on the island, I have to get there before opening hours.

At 11 am in the Summer and by noon at the latest in the Winter, I have to start making my way back home, so I am there in time for my online consulting shift to begin. (5 pm to 10 pm UK time, but the afternoon in Carriacou).

Again depending on Winter or Summer time…and how busy the queue on the app is, I finish somewhere between 5 pm and 7 pm, but usually, by 6 pm I should be done.

On a Wednesday, I usually get to the clinic by 9 am, or if I am good a bit earlier, and I spend the whole day at the clinic as this is our big surgery day when all the spays and neuters come through.

But even when the working day is officially finished, I often spend hours in the evening answering queries for the charity or working on the social media account.

What sort of animals do you treat the most, and what is the most prevalent disease in your area/country? How is it treated?

Is the treatment successful? What are the constraints of your work?

Is it the lack of medicines, transport, funds or instruments, or infrastructure? Or are your worries totally different?

In a charity setting in Grenada, I guess some things might be harder to get than others. Or is that presumption misplaced?

At the animal hospital in Carriacou, we treat dogs and cats mostly. Occasionally, we treat rabbits, wildlife (birds, especially seabirds, and a turtle, once in a blue moon) or livestock.

The livestock approach on our island is quite different than in the UK or Switzerland. Registered farmers receive veterinary care for their livestock and are funded by the government. But there are many people who own sheep and goats here without a clear objective. They neither care for them like a pet nor keep them with a financial goal, so it is difficult to help and give advice since we are stocked and equipped as a charity for companion animals.

In dogs, the most common diseases we see, apart from flea, tick and worm infestations, are ehrlichiosis and heartworm disease. We treat ehrlichiosis with doxycycline, and we have a combination slow kill protocol for heartworms. As most dogs have a substantial heartworm burden by the time they present to us, treatment with the recommended melarsomine would be fatal. 

Yes, sourcing medications is difficult. We can order essential medicines from Trinidad, the closest country to the South. But most of the medicines we get are donated in the UK and then shipped to us. Because of the limitations of our reach and the island size, it is difficult to get grants for a small charity like us, especially continuous ones.

Being privately funded and relying on private donations does not make us less valuable for the island pets and their owners, although if you look at it purely based on numbers, our impact is too little for many grants. And the problem is that most pet owners can not afford veterinary fees in Carriacou: This is what many do not see, but a vet running a for-profit practice on this island could not survive. There is no way to make enough income to pay for living expenses, let alone if you have a family to support or would like to make some provisions for your retirement. 

This discrepancy means that the life and business of a vet costs close to the same as it would in the UK or the US. Yes, maybe the rent of facilities may be cheaper, but anything else is actually more expensive.

Drugs and supplies are mostly imported from abroad, which means adding taxes on top of already costly medications. Any equipment, especially tools, instruments or electronic equipment, gets taxed too and even more so. So even without considering costs for yearly CPD and travel (or like I said, any provisions for family support or retirement), it would be impossible to run a for-profit vet practice on this small island without any costs funded. As for our charity, we are fortunate to have visiting veterinary professionals who keep the project going, and we get most medications and supplies either donated or purchased with donations. 

Cost is also a limiting factor to our equipment. Although we are better equipped than most visiting volunteers would expect, our worries are maybe different than those of your regular vet practice in Europe or the US. 

Other concerns are similar. The reality and client expectations of what we can do are often very different. Personally, I may not have the long taxing hours that many of my UK colleagues have, but I struggle to disconnect from the job because wherever I go, I am “the vet”. It rarely happens that I go to the grocery store or enjoy a meal at a restaurant without getting prompted with the question: “Can I ask you a question about my dog?” … and don’t even get me started about social outings, there are some quite rude people on this planet… and with us being the only practice on the island, even at home, there are at least 2-3 calls or messages per day that require vet advice, triaging and, occasionally, actual emergency measures.

What do you most look forward to when finishing work for the day? Can you tell me a little about it? 

On a regular day after finishing work, there is not much time left. Living close to the equator also means that it gets dark quite early. Sunset is year-round between 6 pm and 7 pm. The first thing I usually do after finishing work is to feed my eight cats (nursed and fostered five kittens a year ago, and it turned into the biggest foster fail ever!), which allows me to do a headcount to make sure they are all okay.

I do have hobbies, though. Recently we tend to spend at least one day of the weekend leisurely on a boat with friends, or we plan fun trips or events with our volunteers or have friends over for dinner. Apart from this, I love to hike, swim and snorkel. I should go diving more and take my dog to the beach more. My newest hobby is quails. I have been wanting a flock of pet quails for quite a long time, and we are just incubating eggs for the first time, hoping we will hatch a few birds to start our covey. These are probably the first quail eggs that already have their own Instagram account. :-)

And, finally, what is your main worry outside work? Is there a common problem? Is there a political or social issue that you are free to talk about and interests you? 

Do not worry if you prefer not to answer this question. 

My main worry is keeping track of all the cats! Haha! :-)

There are not any local political or social issues that I feel it is my place to talk about because I am rarely ever stepping outside of my role as a vet. But since I come across so many veterinary professionals per year with the visiting volunteers, I have to say that the state of the profession, especially in the UK and the US (but, really, across the world), is really concerning. When you reached out to me first, I was trying to support a friend, a fresh grad vet, and in my opinion, a brilliant mind with skilled hands who was suffering from severe anxiety only a few months after starting to work as a vet. It is so concerning, and it makes me angry and sad that they have to be in such a situation and environment. We are facing one of the highest suicide rates out of any profession.

And even though this information is slowly sinking into the general public, their instant response is, yes, I understand, they must be suicidal because they have to put animals to sleep. I often read this online or even hear it from people in my environment. They understand nothing. Offering animals an end to inevitable and prolonged suffering is not why vets get pushed over the edge of what they can handle. The problem is that the system has developed into something that cannot support itself, and on top of this, there is the attitude of the general public. ….happy to elaborate on this one further…

One final question: What is your dream? This is a really difficult question. :-) I do not know how to answer this one yet...