CNVR in practice in India (Part I): How it ‘eased’ its way in India ‘through’ the sub par TANUVAS-AWBI research

Its not everyday that you see a report ‘commissioned’ by a Govt body on a deeply invasive surgical procedure – that show’s that 60% of the population of study 1 has severe-to-adverse results and 38% of the population of study 2 simply goes missing! And then the study declares the surgical procedure a success. The one thing worse could be that a complex invasive surgical procedure is tested on only 24 individuals and would then be used on millions each year. And the only thing worse than that could be that the Govt agency decides to not actually mandate it but allows it to be quietly put in practice. That is the story of CNVR in India. Because dogs don’t talk. They don’t get nominated on boards meant for their welfare. But they can get you domestic & foreign funding.

If you see the large number of dogs found with their intestines hanging out and if you ask the NGO that did the surgery – you’ll get to know that it was CNVR. Maybe poorly performed surgery by ill-trained staff but its CNVR nevertheless. You can’t even challenge that its ill trained staff – there is NO Standard Operating Procedure written by AWBI and as such all the AWOs doing CNVR surgery are doing something ‘illegal’. But AWBI don’t give a damn as long as its officers, esp those that have a buy-in facilitated by agencies that advocate CNVR in India such as Humane Society International (HSI), choose to only ratchet up ABC numbers. There is great merit in being the father of ABC in India. The effect that it has on dogs in practice is not something that crosses the conscience.

CNVR in practice in India: This female dog was rescued by Darshan Desai and the team of volunteers on 25th July 2012. She did not make it. She was found with her guts spilling out of the mid-line cut where the stiches failed after ABC surgery using the CVNR method (against the explicit direction of the AWBI). She had and no chance of recovery as she was thrown back on the road the day of the surgery.

But if you do challenge the practice of CNVR and its implementation and indeed its very existence with an NGO and/or should you approach AWBI – you will learn that the only basis of its existence is ‘TANUVAS Report’. You will not get the report. You will not get data. You will get the term. Now since this something of a ‘public document’ it should be available publicly – right? Its not. Its not available on AWBI’s website and its not available on Tamilnadu Veterinary and Animal Sciences University (TANUVAS) website and its not available anywhere else. Try on Google.

So we got a copy of it. This article is on the findings of what the report really contains. And here for the 1st time is a publicly available full copy of the TANUVAS report itself.

AWBI commissioned this a study that was released as a report by the Tamilnadu Veterinary and Animal Sciences University called “Evaluation of catch-neuter-vaccinate-release (CNVR) as a humane technique for birth control in dogs”. The report was prepared by a team led by Dr. D. Kathiresan with the of Tamilnadu Veterinary and Animal Sciences University (TANUVAS). The study was conducted at 2 AWOs at 2 major cities of the country in Bangalore (Animal Help Foundation, Ahmedabad) and in Chennai (the Blue Cross of India, Chennai) between 05 Sept 2008 to 19 Jan 2009.

For its mandate, interestingly, the report says “Recommendations arising from this work are expected to offer great valuables (sic) in containing dog populace in the country. The outcome of  this work is expected to help the planners and administrators of the Ministry and the Animal Welfare Board of India in enhancing the output of the scheme on ‘Birth control and immunization of stray dogs’  funded by the Ministry through AWBI.”

CNVR in practice in India: Another female dog found its guts spilled out after CNVR surgery on 4 June 2012

As we see in this paper this report is full of holes, its recommendations in terms of data inconclusive but its subjective conclusions steadfast. And it is these that are cited repeatedly by the CNVR backers in argument after argument. There was another report that was analysed for its data and correlation – which matches this one in its understanding of any data, or lack thereof – which was the KIMS audit on ABC programs in Bangalore showed BBMP failure, not ABCs report. VoSD’s critique of the report can be seen here.

Restrictions and definitions in this paper

1. The TANUVAS report details the findings of the anti-rabies effectiveness through CNVR in much more detail than the surgical procedure itself. This paper however restricts itself to the data and analysis of the CNVR surgical procedure.
2. In the TANUVAS report and in this analysis
   • Castration (Neuter) via prescrotal procedure and Ovariohysterectomy through right flank method of neutering (Spaying) is called conventional Animal Birth Control or ABC.
   • Catch – Neuter – Vaccinate – Release through midventral ovariohysterectomy in female dogs and prescrotal castration in male dogs is called CNVR.
3. This is not an assessment or a critique of the CNVR method itself. It is of the research that provides CNVR sanctity and gateway in practice in India.
4. Though the report was published by TANUVAS it was commissioned by AWBI and is referred to as the TANUVAS report or the TANUVAS-AWBI report interchangeably

Why did AWBI commission this report and what was TANUVASs scope of the study?

The report repeatedly mentions the reason for its commission:

• The report says “With the procedure followed currently for ABC being found to be less progressive to attain the expected levels of performance due to various extraneous factors such as relatively less number of AWOs involved in ABC program, lack of infrastructural facilities, longer duration of holding time for operated dogs, non-availability of technical staff and skilled dog catchers, less co-operation from local bodies, etc., it needs to be stressed that all these factors either make the program too costly and / or make the targets less attainable, realizable and feasible.”
• “As a result, the AWBI has made it to (sic) explore the possibility of adopting CNVR procedure as a technique of ABC across the country to overcome the disadvantages and bottlenecks being encountered in dog population control and the resulting Rabies incidence.”
• The report says “In ABC programme, the dogs are captured humanely and sterilized surgically. After the postoperative care, the neutered dogs are vaccinated against Rabies and released at the same locality from where they were caught. As one can understand, the problems with this procedure followed in the present ABC programme are mainly related to postoperative care including feeding and maintenance in the kennels for at least five days, as it involves considerable expenses to the AWOs.”
• Further the report says it was an evaluation of the CNVR technique since “Recently, claims are being made that the procedure called as Catch-Neuter-Vaccinate-Release (CNVR) technique has been successfully adopted in countries like Sri Lanka, Maldives and Indonesia”.

The real question is does CNVR address the ‘bottlenecks’ that plague the ABC programs across the country including “non-availability of technical staff and skilled dog catchers, less co-operation from local bodies”? There is not a single mention of it. Clearly this report was restricted to the findings of the effect of CNVR on dogs and the connected result of anti-rabies immunity.

• If this was not an adequate study in terms of scope of answering the CNVR questions then why did AWBI did not follow it up with other studies? Since is is evident with or without AWBI’s mandate CNVR is a ‘commercial’ reality in India.
• There is no discussion on meeting the operational challenges  and those of cost so how did TANUVAS make sweeping recommendations and they went uncontested by AWBI?
• The report commissioned on the premise that there were ‘claims’ that CNVR was successful. Who made these claims? To whom? No sources or data is provided. It looks suspiciously like the report was commissioned because someone wanted to get it commissioned and was in a hurry to let it be tabled.

TANUVAS’ study design: Location, duration and extent of the research

In the section ‘Methodology of Study’ the report says:

• CNVR method at Animal Help Foundation of Ahmedabad at the Mahadevpura Zone and Bommanhalli Zone of Bruhat Bangaluru Mahanagara Palike (BBMP), Bengaluru were evaluated in this study.
• “A total of 42 male and 42 female dogs were selected for this study and the observations were recorded.”
• The report says “On an average, the AHF is performing around 40 sterilizations per day. This AWO had a contract with the BBMP, Bengaluru”.

This leaves very serious questions to be answered:

• The report clearly says a total of 84 dogs studied – which includes the control. They were studied in an certain inconclusive environment and with inconclusive findings. And yet it become the blueprint for treatment of 8-10 million dogs in India and certainly the 300,000 in Bangalore (where all but one of the AWOs practice CNVR)
• AHF could not have carried a mandate to do CNVR since was (and is) not an approved practice. But it clearly was an operation in ‘production’ and AWBI was studying it – when they should have come down hard on an illegal practice.

TANUVAS reports sample size: The experiment and control groups

The study was carried out by TANUVAS by observation of these 84 dogs in 2 locations. But the basic of any study/ experimentation is that there needs to be a ‘control’ a base against which you test the effectiveness of this procedure. As you see in this section the study was poorly designed and these controls non-existent or compromised. In Bangalore the CNVR dogs that needed to be observed on Day 1, Day 2, Day 3, Day 7, Day 14 and Day 21 after surgery were simply not under observation.

These were the groups under observation:

• Group–I (Chennai): 12 male dogs and 12 female were operated conventionally (this is the control group for CNVR)
• Group-II (Chennai): 12 male and 12 female dogs had CNVR (but would be kept in kennels for observation)
• Group-III (Bengaluru): 12 male dogs and 12 female dogs had CNVR.
  • Shockingly they were not kept for observation and were released! So essentially only the surgery could be observed its effects over a test period of 21 days were not!
  • More shockingly even this set of 12 + 12 is not a definite set since actually “69 female and 87 male dogs that were subjected to CNVR”.
• Group-IV (Bengaluru):
  • There was no conventional ABC done, rather
  • “It was planned to randomly catch 12 male and 12 female dogs which were already released after the CNVR”. However, “only 8 males and 7 females could be caught … and were clinically examined to evaluate the postoperative status of the CNVR procedure”. Essentially there was no control group.
  • The report clearly says “However, only 13 dogs could be followed up to 21 days after release, since some dogs could not be located by the dog catchers for observation”. All the dogs could not be observed – and those that were – will yield to shocking subjective conclusions.
• Group-V (Chennai): 6 male and 6 female dogs with anti-rabies but no anaesthetic and surgical procedures to assess against anti-rabies titre (control group for anti-rabies)

In terms of purely experiment design it was not only ill-conceived it was almost foolish!

Since Group III in Bangalore does not have a control it is critical that all the dogs are present for Day 1, Day 2, Day 3, Day 7, Day 14 and Day 21 after surgery. This is critical since the effectiveness of CNVR in real life condition hinges on the outcome of what happens to these 24 animals. Here is what happened:

• These 24 dogs are released the same day! Essentially moving observation to the field.
• But of these 24 only 8 males and 7 females could be followed through the ‘observation’ period. That is 38% of the sample went missing.
• Not all observations was directly of the dogs by the researchers making the report – it was done directly by catchers and via the ‘community’ that is the people of the area where the dogs came from:
  • “The enquiry with the community also revealed not much postoperative complications were there in the dogs released on the same day of surgery”
  • “ A CNVR member is reported to be periodically inspecting the area subsequent to the release of operated dogs and collecting information from the community about the health status of the released animals,  who also could provide necessary treatment in dogs that required Evaluation of CNVR as a technique for birth control in dogs”.

Essentially it was deemed to be understood that only one male dog showed any complication and the others were therefore all OK including the 12 females that were released into the filth of Bangalore. And it is this poor observation quality and the even more subjective analysis thereafter that ‘proves’ to AWBI (?) or at least some champions therein, and to the AWO’s and perhaps HSI that CNVR works in India in practice!

The outcome of CNVR surgery in Bangalore and Chennai

Maybe the observation team thought of a complex reproductive surgery as something trivial since only that could have have led to the observation “Possible post-operative complications that could be encountered after reproductive surgeries in dogs are wound dehiscence, wound disruption, seroma, incisional hernia, evisceration, peritonitis, haemorrhage and stump pyometra and of course they are only rare in reality”.

So how did the CNVR dogs released in the field immediately fare against the ones that were kept in kennels for observation? In one line – the ones that went back to the grime of the road did very well, and the ones that stayed in kennels and got taken care of did very poorly.

For the CNVR dogs in Chennai the observation notes are:

• Day 1: “No postoperative complications could be noticed on the first day”
• Day 2: “Oozing of serum was noticed from the site of incision on the second day in eight dogs of CNVR programme”
• Day 4 & 5:
  • “One female dog each was found to be eviscerated through the surgical site”
  • “Wound dehiscence was noticed in another female dog”
  • “Scrotal swelling was noticed in one male dog”
  • “Surgical wound necrosis in another”

Essentially 14 out of 24  dogs that is 60% of the dogs that had CNVR were showing some complication. But this is not how it was reported.

For the CNVR dogs in Bangalore the observation notes are

• It was reported that the CNVR dogs released on the street where healthy (“the neutered animals were released to their familiar environment, they were found to return to their normal life-style (Bangalore Group III))!
• Of this speculation rather than observation this is the ‘clinching’ argument on which the CNVR report hinged:
  • “In general, there were no postoperative complications in the dogs that were released on the same day of surgery, except a case of a male dog, in which there was wound disruption.”
  • And this led to the conclusion that CNVR works!

How could that happen – that dogs in kennels in observation were unhealthy (“complications were observed in the CNVR operated animals that were sheltered and  kept under observation for a few days (Chennai Group II)” but the group that was released the same day was ok? This is, bizarrely, is justified with unsubstantiated observations that:

• “When the animals were kept in confinement, postoperative complications were found to occur possibly due to their psychological alteration to the new environment and maniacal behaviour that might have provoked stress and self mutilation”.
• Complications could arise in the dogs in the kennels because they were lying in the “prone position”. By that token no vets should be keeping dog after ANY surgery in kennels because that the position dogs lie in.

Recommendations of the TANUVAS-AWBI research ‘study’?

On the back of a muddled research set and contradicting data – the recommendations were generic and sweeping

• “Wherever there is inadequate shelter facility (with local bodies/AWOs) for postoperative care, the CNVR method of birth control is strongly recommended as there would be no need for pre and postoperative maintenance of dogs in this procedure.”
• “The results of this study imply that the CNVR method of birth control in dogs can be recognized as an effective birth control program from its inherent advantages such as less need to maintain pre and postoperative facilities including shelter, feed, personnel, etc and good, if not better, postoperative status of the operated dogs in terms of recovery from anesthesia, wound healing, haemato-biochemical status, post vaccination antibody titre against rabies, etc.”
• “Although there are unconfirmed reports that the cost of CNVR per dog is no less than that of conventional method, the fact that the operated dogs can be released on the same day of surgery indicates that more coverage can be made in a shorter time which is really the need of the hour”

In effect this was an inconclusive and poorly conceived study of a total of 84 dogs. In the study of the 24 dogs that underwent CNVR at Blue Cross Chennai and could be kept under observation  60% showed complications – and this is when both the surgical team and the operational team were under study. What is the fate of the dogs in real life situations is anyone’s guess and something that most people familiar with ABC programs painfully familiar with. And it is this study that has become a blue-print for ABC for a large part of India.

Further reading: Observations of Bangalore CNVR that still ring true

• Interestingly the same building with the same conditions is the scene of the CNVR  surgery today in Bangalore for which it was reported “An ideal theatre environment, as per the aseptic surgical procedures mentioned in the CNVR protocol of AHF, was not observed in the present CNVR programme at Bengaluru. Surgeries were performed in a temporary old building which was also not clean. The building was as such not suitable for performing aseptic surgery.
• “There was also no water supply facility to the theatre. In another CNVR  site, electricity and water supply were not there. Hence, any AWO should ensure adequate supply of tap water and uninterrupted power in its operating theatre, before starting CNVR programme.” In Bangalore we don’t know one AWO other than CUPA that provides close to these facilities.
• “The surgical team and animal handlers were not wearing surgery theatre uniforms. The surgeries were found to be performed on unsuitable tables covered with daily newspaper (Plate.25)”

• “In most instances, surgical blades were not fixed to the handles, the absence of which might result in imprecise incision required for mid ventral surgery”
• “Surgeons were using industrial grade paste (for e.g., Fevi Kwik) to seal the skin incision”
• “In CNVR programme, the average recovery time was found to be between 60 and 90 minutes

• “Some of the dogs were in disoriented stage even after recovery during release”
• “The operated dogs may be released in a calm area of the street than in busy main roads, as some of the dogs might be disoriented, to avoid road accident(s) and the community may be informed for further care. It is better to retain dogs with disorientation in the shelter till they become alright for release.”