Mega-MASH clinic: The Spayathon for Puerto Rico

MASH spay and neuter clinics are nothing new for me: during the past 13 years I’ve done well over 1000 MASH clinic days in Vermont and New Hampshire. My own MASH clinics are small: one veterinarian, one veterinary technician, and between 2 and 10 other volunteers or shelter staff. We set up our clinic for just a day at a time and see somewhere between 20 and 60 patients in a day (depending on dog or cat, male or female).

But recently, I’ve had the chance to participate in Spayathon for Puerto Rico: four, one-week-long rounds of multi-site, multi-vet MASH clinics. I’ve spent Spayathon Rounds 2 and 3 with the group Veterinarians for Puerto Rico, a fabulous new group formed in the wake of Hurricane Maria. The Spayathon for PR clinics are large: some sites like ours served between 150 and 200 (or so) patients a day with about 4-7 veterinarians in surgery each day, while the biggest location served about 500-600 patients a day with about 20 vets in surgery each day. Lots of people have posted cute pictures of pets and owners at Spayathon and talked about the rewarding and exhausting experience of volunteering– just search #spayathon4pr to see some examples– so here I’m going to talk about the logistics and flow (physical and organizational ergonomics) of running a large MASH clinic like this.

Large MASH clinics are full of logistical challenges. How do we create a safe and efficient flow of animals through the clinic? How do we keep the animals and the people as safe and un-stressed as possible? How do we make the best use of the space we have for the clinic? How do we make the best use of the dozens of volunteers at each site?

This round, utilizing our limited indoor space as efficiently as possible was one of our biggest challenges in Toa Baja. While the community center looked large when it was empty, it was much smaller than the sports arena we had occupied in round 2 in Aguada.

One of the space-savers was using the covered balcony area for dog physical exams; clients and dogs also waited outdoors (under the cover of tents, on the balcony, in the shade of the building, or on the small lawn) until it was their dog’s turn for surgery. When it was time for the dog to come inside for surgery, the owner was there too. Pets who had received their anesthetic injection waited in their owners arms or on a bed on the floor until the sedation kicked in and they fell asleep.

Cats were a little different (they’re cats after all…). We admitted the cats in their carriers into the building so that they could have physical exams in a confined space, rather than using the open-air balcony with the dogs.

Once the cats were examined, they could be injected with anesthesia and brought out to a post-induction table (aka Kitty Sleepover Party) where they could be under continuous observation until they were anesthetized enough to move to a surgery prep table.

Dogs too were moved into surgery prep– this is where their pathway merges with that of the cats. And after prep, patients were moved to an unoccupied surgery table.

As in many high volume settings (but not in my own MASH clinics), the Vets for PR surgery area had more surgery tables than surgeons. This mean the surgeons don’t have to wait for the exchange of patients on their table; they can re-glove and move directly on to the next surgery. It also allows the postoperative patients an extra minute or two on the anesthesia machine, to breathe oxygen and breathe out the anesthetic gases before being moved to recovery.

After surgery, animals were moved directly to Recovery 1, or “the beach.” Here they were attended by a team of veterinarians, technicians, students, and volunteers who watched their recovery and recorded their temperature, pulse, and respiration at intervals throughout their recovery. The beach was all soft padding, heating pads, and “warmies,” the hot water bottles and rice socks that were microwaved and re-microwaved throughout the day to help the patients warm up. (The air-conditioned facility, while comfortable for most of the workers, was chilly for anesthetized patients, so we had to make efforts throughout the day to keep them warm, including heating pads on the tables in surgical prep and in surgery).

Once patients were warm and alert, they could leave the Recovery 1 beach and be reunited with their owners in Recovery 2. Veterinarians, technicians, and other volunteers watched over the roomful of “pet parents” waiting with their animals until the animals were recovered enough for discharge. An instructional video played, and owners also received instructions from and were able to ask questions of the vets and techs. Once their animals were recovered and ready to go home, they were discharged with post-operative instructions and emergency contact information, along with donated pet supplies and pet food.

Once the animals were gone, the work wasn’t done: data had to be entered from all the medical records into a centralized database that would allow researchers to study the users (clients and pets) and outcomes of the Spayathon clinics. Our site in Toa Baja had such limited indoor space that the data entry station was in a tent outdoors that was in theory air conditioned but was in actuality a bit of a sauna. Also, the data tent was the volunteer lounge and lunch tent, so data warriors also got to be lunch patrol (“only two plantains per person!”; “save the pitas and hummus for the vegans!”). Next round, we’re hoping for a space that puts these folks back inside the building in a climate controlled setting.

Meanwhile, I got to spend my time between many different areas of the clinic, but mostly between induction, prep, surgery, and recovery 1, trying to keep an eye on the big picture and flow, and pitching in where I could (and trying to remember to take pictures here and there). It was a great experience working with so many talented and dedicated people, and I’m looking forward to going back to the fourth round of Spayathon for Puerto Rico in May!