The Humane Alliance Spay/Neuter Clinic has sterilized thousands of cats and dogs in western North Carolina, and its team of dedicated vets, vet techs, and assistants won’t stop there. Already implemented in six other communities, the Humane Alliance model of efficiency and cooperation is going national—and may be coming soon to a city near you.

© Carrie Allan Amanda Sexton drives hundreds of miles to pick up animals from communities around Asheville. Back at the Humane Alliance Spay/Neuter Clinic, she helps unload the truck.

Usually, Amanda Sexton is up before the sun, and today is no exception. She’s on the road at 5:30 a.m., and she has hundreds of miles to go before she sleeps. Working for the Humane Alliance Spay/Neuter Clinic in Asheville, North Carolina, Sexton drives a large delivery truck into remote areas of the western part of the state. Her daily journeys take her to the hometowns of 30 different humane societies, animal control agencies, and adoption groups in the area surrounding Asheville.

Today, she’ll pick up animals in Watuga and Avery counties before returning mid-morning to deliver them to the clinic. Then it’s on the road again to bring newly sterilized animals back to Morgantown and Hickory, the towns she traveled to the day before. Some of the groups she works with are in communities so small and sparsely populated that they don’t have a central bricks-and-mortar shelter; in those places, Sexton often makes her pickups in pre-arranged places such as the parking lots of local grocery stores or Wal-Marts.

© Carrie Allan Biscuit, Amanda Sexton’s Chihuahua road buddy, supervises the unloading of the transport truck.

There she loads crated animals—mostly homeward-bound for new adoptive families the next day—into the back of the truck, stacking the crates carefully and then binding them down with elastic ropes to make sure the animals don’t slide around during the ride back to the city.

By 3 p.m.on this August afternoon, Sexton will have driven close to 400 miles. She’ll do the same tomorrow. And the next day. And the next.

She’s been doing this for two and a half years now, with nothing to keep her company on the drives but the radio, some books on tape, and Biscuit.

Biscuit is her adopted Chihuahua, a tiny and appropriately golden brown pooch who sulks if he doesn’t get to come along for the ride. He isn’t just cute window dressing. Though he doesn’t share driving duties, he has his own job on the trips: Sometimes the animals Sexton picks up show up with their owners, and sometimes those owners have children who are upset and nervous to see their pets disappear on the back of the delivery truck. Biscuit is the chief cuddler, using his wiggles and snuggles to distract worried kids from the impending overnight hospitalization of their own critters.

Biscuit seems to take his job seriously. Back in Asheville, he supervises the loading and unloading of the truck nervously, hopping in and out of the loading bay and up and down from the open arms of various staffers at the clinic as they retrieve the vehicle’s precious cargo.

“Organized chaos,” one assistant jokes—but while there is a frenzy of activity, the process seems to happen like clockwork: Staff gather at the back door of the clinic and, one by one, remove crates containing 49 unaltered kittens, puppies, cats, and dogs from the truck. And while Biscuit is slightly underfoot at times, the staff don’t mind; they seem to have developed an innate Biscuit radar, moving around him quickly and gingerly, carrying crated pets—an adult husky named Aspen, various tabbies and tuxedo cats and kittens, puppies of all colors and shapes—into the prep and examination areas, without once treading on Biscuit’s tiny paws.

If Biscuit seems to know that serious work is underway, the staff are even more dedicated. As they bring animals in one by one for surgery, veterinarians on duty examine each pet, double-checking to make sure he’s healthy enough for the procedure. Animals are weighed, and veterinary staff calculate the dosages of anesthesia drugs needed for each one. Once anesthetized, each animal is added to the line of patients, all of whom—over the course of the day—will be sterilized.

The staff of veterinarians, vet techs, and assistants at the Humane Alliance clinic are largely young and energetic. Most of them seem happy to be at work, kidding around with each other or cooing over their temporary charges. They seem to develop favorites for the day, picking out particularly adorable puppies and kittens for the rest of the group to admire. The sound of laughter and friendly conversation is constant in the building, even as the pace of the work speeds along.

It’s the end result that makes the endless driving worthwhile, says Sexton, whose favorite thing about the often tiring and repetitive job is her sense that she’s making a difference. She recalls having a recent encounter with eight puppies who’d been dumped by the side of the road. “I just kept thinking, if that one mama had been spayed it’d be eight less to worry about,” she says. “Eight less who wouldn’t be run over or maybe euthanized.”

Even one sterilization surgery can make a difference, and over the course of this day, the Humane Alliance Spay/Neuter Clinic staff will spay or neuter 79 animals. (More were scheduled for surgery today, but heavy rain has caused some flooding in outlying areas, so fewer animals came in on the transport than staff expected.)

On average, the clinic spays or neuters 75 animals a day, with a record high of 120. Since they opened their doors in 1994, the staff has sterilized over 106,000 animals, 70 percent of whom came in on one of Sexton’s transport runs. Local groups that participate in the program raise money to keep it operating, and pet owners pay discounted rates of $55 for dogs and $35 to $50 for cats.

Intake and euthanasia rates at nearby shelters have dropped significantly, and local animal groups with differing philosophies are working together better than they ever have before. Their cooperative efforts have also led to local passage of impressive spay/neuter legislation that prohibits the keeping of an unaltered animal older than six months unless owners pay a special fee. Enacted in outlying areas of Buncombe County last year, the legislation also became law within Asheville city limits at the beginning of July.

It’s no wonder the clinic’s executive director, Quita Mazzina, believes the initiative in western North Carolina should serve as a model for the rest of the country.

“I don’t believe that you will find a coalition that is stronger and that is accomplishing more than what’s being accomplished in North Carolina,” says Mazzina. “And it’s really about making friends. When we go into other communities and we mentor groups on setting up programs that are similar to this one, I’m always amazed because they’re like, ‘Well how do you do it, how do you do it?’ But we all grew up making friends. It’s just treating people with respect and building relationships.”

Bringing Animals and Their Advocates Together

An arts haven in the middle of richly green and largely undeveloped mountains, Asheville is home to some of the prettiest scenery in the southeast. Asheville’s hospital system and the grocery store chain Ingles are the area’s largest employers, and the city draws both retirees looking for antiques and second homes and thrill-seekers looking for fun on the whitewater rapids that adorn the many rivers that cut through the area. In 2000, the same year that Modern Maturity and Money magazines listed the city as a great place to retire, Rolling Stone fired a shot across the bow by naming it America’s New Freak Capital. Walks around town reveal both to be true: Well-heeled seniors and their well-groomed dogs chow down together at the tables of the many restaurants with outdoor seating. Around the Grove Arcade Public Market, they mingle peaceably with a rotating cast of middle-aged hippies selling beads and pottery and multiply-pierced, slightly dazed-looking youths complete with their own (slightly scruffier) pooches.

The surrounding area of Buncombe County and the areas outside of it are a different story altogether. Largely immune to the prosperity and population growth that Asheville has enjoyed for some years (about 30 people move to the city every day, according to the local chamber of commerce), the outlying areas are mostly rural and economically depressed. The towns are small, often not holding enough people to merit a shelter or animal control division. The movie Deliverance was filmed on one of the nearby rivers, and a T-shirt sold at several of the local rafting centers conjures the film’s images of hillbillies and untamed wilderness with the slogan, “Paddle Faster—I Hear Banjo Music.”

Animal advocates in Asheville and its environs are trying to meet the needs of both these populations and their animals. In many ways, the Humane Alliance Spay/Neuter Clinic is the hub of the local animal advocacy wheel, bringing together all the local shelters and animal welfare groups by providing spay/neuter services to their clients. The groups that use the clinic’s sterilization services each raise about $15,000 a year to help subsidize the work. All of the area adoption organizations—including humane societies, animal control agencies, and rescue groups—adhere to a policy of sterilization before adoption. Most of the animals coming into the clinic are pets about to go home with their new families.

The clinic’s transport service is the driving force behind its reputation as a central influence in the local animal welfare community. By sending Sexton out to the far reaches of the region to pick up pets who would otherwise never be sterilized, the Humane Alliance is helping portions of the human and animal population who are, due to an unfortunate mishmash of geographical, economic, and educational forces, hopelessly underserved.

A 2002 survey of close to 1,000 clients indicated that 85 percent had never taken their animals to a veterinarian before. Clinic staff have tried to change that behavior by working with area vets to arrange financial incentives for potential customers. When the clinic opened in 1994, founder William McKelvy approached local veterinarians, explained that the clinic had no intention of stealing their clients, and asked them to offer free post-surgery checkups to Humane Alliance patients.

Most of the local veterinarians agreed, says Karla Brestle, one of the staff veterinarians and the medical director of the Humane Alliance. But few people who bring their animals in for surgery actually take advantage of the deal. Most can’t—or believe they can’t—afford regular veterinary care, and there’s also a general laissez-faire attitude towards pet health that the clinic hasn’t yet been able to puncture. As Eileen Bouressa, head of the Animal Compassion Network, a local fostering and placement group that uses the clinic’s spay/neuter services, says, “This is an area where people come in and brag, ‘I’ve never taken that dog to a vet in nine years, and look how healthy he is!’ ”

Given those prevailing attitudes, it’s doubly impressive that the clinic has managed to get so many animals sterilized. Even in more affluent areas of the country, spay/neuter surgery is often seen as an elective procedure, an option to consider only when Tiger’s nightly love prowls result in angry visits from owners whose pets have become new teenage pregnancy statistics. That so many animals in western North Carolina have come through these doors is a tribute to the efficient work of the clinic, the stricter spay/neuter requirements, and dogged community outreach by all the participating adoption groups.

© Carrie Allan Veterinarian Margee Moncure spays a female shepherd mix. The vets at the clinic see quite a few outdoor dogs; these animals often come in overweight and matted, making for a more time-consuming surgery because of the thicker layer of fatty tissue on their tummies.

One Down, Thousands To Go

Of course, the dog who hasn’t been to a vet in nine years may have health problems that aren’t apparent to the untrained eye. The veterinarians who work at the Humane Alliance clinic see a lot of those less obvious issues; right now, the two outdoor dogs being spayed by vets Sarah Alexander and Margee Moncure have come in overweight, with badly matted tummy fur, and both are in heat.

The veterinary staff at the clinic work on a point system for the animals they sterilize; animals are assigned point values based on the complexity and length of time a typical surgery takes. Thus spays of female dogs are worth five points and neuters of male dogs three; cats and juvenile animals in general have a lower point value. Each veterinarian on duty aims to rack up about 100 points a day—which could equate to as few as 20 animals but usually means more.

The extra weight on the two dogs under the care of Alexander and Moncure means there’s a thicker layer of abdominal fat to cut through in order to perform the surgery; the dogs’ estrus status also makes the surgeries more complicated, time-consuming, and messier than a typical spay. Though the surgeries take a little longer, both doctors finish their work cleanly, and they jokingly tell the assistants that they should each get a young male animal to work on next—as a reward.

Alexander and Moncure are young, recently out of school, and enjoying the knowledge and experience they get from working at the clinic, as well as the sense that they’re providing a little TLC for needy animals, some of whom may never see a vet again. It’s one of the many reasons the clinic uses absorbable suture: Staff know their clients probably won’t be taking their animals back to a veterinarian for a checkup any time soon, so the suture needs to come out cleanly and safely on its own.

The Humane Alliance clinic is a great place to work and learn and be a part of something bigger, says Brestle, who’s quick to credit Mazzina for nurturing such a positive atmosphere for staff. “Quita has created an opportunity for this staff not only to work here and have a good environment to work in. … She appreciated what we did every day and everyone’s job individually, [and] she wanted to create more of a career for the folks here, not just a job,” says Brestle.

Brestle, who worked briefly in private practice before getting involved with a shelter in Greensboro, says she loves the work. “I heard about this place and I came down here to learn how to do pediatrics,” she recalls, “and I was just like, ‘Why didn’t I know about this before?’ ”

And she’s not bored by the repetition. “Honestly,” she says, “there is something new every day, some complication. And anyway, I’ve done more than 10,000 spay/neuter surgeries in my career, and every time I pull my gloves off, I think, ‘There’s one more that can’t have more.’ ”

© Carrie Allan Arriving on the Humane Alliance’s transport truck, Aspen the husky will be one of 79 animals sterilized at the clinic on this day.

The Long and Winding Road to Success

Witnessing the work that takes place here and the obvious cheerfulness and dedication the staff bring to their jobs makes it hard to believe that, at one point, the clinic was seriously struggling. Mazzina has been involved with the clinic off and on since it opened in 1994. Her latest stint with the Alliance began five years ago; she wondered then whether the clinic would be able to continue operating.

“When I came back in 2000 … we had some problems,” she says. “We weren’t doing the number of surgeries we needed to do, so we were not covering the costs of running.”

The clinic had been founded with the idea that it would serve the local shelter and the community of Asheville. The first year it was in business, staff worked with three local groups; by the time Mazzina came back, the clinic was working with 15. But that still wasn’t bringing in enough business to make the clinic cost-effective. The only way to keep going was to keep growing. “So what I did was look at the budget and say, ‘OK, if we’re going to cover these costs, this is the number of animals we need to be doing surgeries on,’ ” says Mazzina.

An analysis of area demographics showed that Asheville alone didn’t have a sufficient population to support the number of surgeries that would make the clinic economically viable, so clinic staff began to broaden their base, forming connections with groups within a 90-mile radius. “We increased the number of groups we were working with and increased the number of surgeries we were doing,” says Mazzina.

Many spay/neuter clinics end up going under because of the kinds of problems the Humane Alliance faced. It’s a credit to Mazzina, the board, and the staff that they were able to turn the situation around, improving and expanding their services instead of closing down. It turned out to be a time of growth not just for the clinic itself but for the entire animal protection community of Asheville, Mazzina notes, acknowledging that the period was marked by animosity and mistrust among groups with differing philosophies but similar long-term goals. Part of the trick to saving the clinic and improving the climate involved helping stakeholders move past their disagreements and focus on what they had in common.

The application process for a major grant provided a boost in that regard. The Alliance’s efforts in 2001 to submit a grant proposal to Maddie’s Fund, a California foundation that’s funneling millions of dollars into animal welfare projects, was “the best and worst experience we’ve had,” Mazzina says.

Before agreeing to fund initiatives that promise to increase spaying and neutering and decrease euthanasia, Maddie’s Fund requires that communities applying for one of its multi-year, often multi-million-dollar grants designate one organization to serve as a lead group. “What happened in Asheville is the local organizations said, ‘We want you to be the lead organization, and we want you to apply for that grant,’ ” recalls Mazzina. “So we spent literally a year writing that application.”

As most people who’ve been involved with grant writing know, the process can be laborious, time-consuming, and frustrating. And in the case of the Humane Alliance and Maddie’s Fund, it reached a dead end. The Asheville coalition was never officially rejected, but the groups eventually gave up trying to meet the requirements.

Learning From Frustrations

But Brestle and Mazzina both acknowledge that there was a benefit to the application process. It forced the clinic and all the local animal welfare groups to refocus their attention on their missions, both individual and collective, and to examine what they were doing in their community and where they could improve their work.

“The process … meant that we brought the groups together several times and 30 people would be talking in this little lobby area out front,” says Mazzina. “And I think that truly, because we wanted to provide the services, we learned more about each other, and we made it clear to those people that this clinic belongs to the region. It doesn’t belong to us or to Humane Alliance; it is a regional facility. And I think everybody started getting more comfortable.”

Mazzina credits lots of local representatives with propelling the peace process and providing focus. A particularly strong influence, she says, came from Shelley Moore, the then-new executive director of the Asheville Humane Society. Moore, who had come from a shelter in Maryland that served a population of the same size yet had about half Asheville’s intake rate, recalls that when she started her job in 2001, she initially got call after call from representatives of groups who wanted to complain about what other groups had been doing.

“I came in here with no preconceived opinions of anybody,” she says. “My first few months, everybody was telling me all this old stuff. And I said, ‘I’ll listen to all of this stuff, and I understand it was traumatic. But I’m just not letting any of that old stuff influence how I’m going to interact with any of those groups.’ ”

The new era of cooperation has made working in animal welfare in the area much more productive and pleasant, Moore says. “We still have our little tensions, of course,” she says. “But now there’s no one I don’t feel comfortable calling to say, ‘What’s your position on this? How do you feel about this?’ ”

That ability to talk things through and reach a compromise proved crucial recently when a few groups butted heads over spay/neuter legislation introduced in Asheville. Modeled after an ordinance that had already passed in Buncombe County in 2004, the proposed language required all owned cats and dogs over six months old to be altered. Owners could bypass the law only by paying a $100 “fertile animal” fee; officers would enforce the fine only if they were responding to another call such as noise complaints or a bite report. And any organization adopting out animals would be required to sterilize them before placement—a policy already followed by all the animal groups in Asheville and the rest of the county.

Even though it had already been enacted in Buncombe County, the bill before the Asheville City Council faced resistance from a couple of rescue groups that place animals within Asheville city limits. Investigating the concerns, Bouressa of the Animal Compassion Network, Moore of Asheville Humane, and Stewart David from Carolina Animal Action discovered that the rescue groups were worried about the logistics of getting their own animals sterilized prior to adoption, the safety of pediatric spay/neuter, and the stipulation that placement groups operating in the city be federally recognized 501(c)(3) nonprofits.

Bouressa, Moore, and David were able to educate the city council about the merits of the neuter-by-adoption requirements, and together they worked with one of the rescue groups to tweak some of the language of the ordinance so that only state-recognized nonprofit status would be required. But it still wasn’t clear that the other rescue group would accept the same deal.

“Karla [Brestle] gave me quite a bit of the info about pediatric spay/neuter that I forwarded to the council,” says Bouressa. And just to be sure, Bouressa brought Dr. Whitney Eure—one of the Humane Alliance’s other veterinarians—along to the council meeting to answer any questions the members might have about the safety of pediatric spay/neuter.

After much behind-the-scenes finagling by all the groups, the measure passed unanimously. The Humane Alliance was instrumental to that success, says Bouressa. And while the process created some tension, representatives from the other rescue groups are all working together peacefully once more, she says.

“We compromised and are back on track,” she says. “Sometimes I think it's harder to get rescue groups to work in sync than it is to pass legislation! We were fortunate that we are a close animal community and we were able to keep an open dialogue. … We can be our own worst enemies. Thank God we didn't let that happen this time.”

©Carrie Allan Newly sterilized animals begin their recovery from anesthesia in a row of their friends, snuggled up together with blankets and hot water bottles. As the animals begin to wake up and become more alert, they are moved back to individual cages to recuperate.

Small Clinic, Big Numbers

Midway through the day, the clinic’s staff are still hard at work—cleaning, doing laundry, prepping animals and surgical supplies. Some animals are still being treated, while other now-neutered cats and dogs lie in a long line in the main surgical suite, snoozing softly as the anesthesia slowly begins to wear off. The staff have lined them up for observation, making them comfortable on blankets and wrapping them in snuggly sheets and towels. Each animal is laid close to a neighbor and given a hot water bottle for extra warmth. Staff comfort the animals as the drugs wear off; Aspen the husky is particularly vocal about his woes, yodeling softly in his sleep. “You always know when a husky is in the recovery room,” Moncure says.

Later they’ll move the animals back to their individual crates, and the next morning, they’ll send them on their way back to their hometowns, back to their families or the adoption groups that sent them in. Sexton is already back on the road, returning yesterday’s crew of pets to the places they came from.

In the prep area, veterinary tech Daniela Wells relates stories of some of the funnier questions from the public the clinic has gotten over the years—questions like, “Why does my dog still have his penis if you neutered him?”

The funniest, she says, was the man who called to ask why his dog was licking himself after surgery. “I told him, ‘Because he can. You’d do it too if you could.’ And the guy was quiet for a couple of seconds, like he was thinking about it, and then he goes, ‘Yeah, you’re right. Thanks!’ and hung up.”

That was the funniest, but perhaps the sweetest was a woman who stopped Wells at the mall one day because she remembered her from the day she’d come in to have her dog spayed. The woman remembered Wells fondly, it seems, and wanted to make sure Wells remembered Brownie, too.

Wells has seen literally thousands of animals come through the clinic for surgery, but she recognized that what is, for her, a daily occurrence, had been a special event to this woman and her dog. She asked how Brownie was doing, and the woman filled her in on all she’d missed.

“She just had no idea how many animals are coming through here!” Wells says.

© Carrie Allan Veterinarian Karla Brestle provides a feline client with some post-operative cuddle care.

Taking It National

The system the clinic has developed works so well that staff are trying to expand further by teaching their model to animal advocates in other communities. In 2004, they formed the National Spay Neuter Response Team (NSNRT) and began speaking about the clinic’s work at conferences and meetings around the country. They hope to use the commitment of their staff to help spread their working model far and wide—through more conferences and individualized trainings. And they plan to mentor advocates in other communities, training them on the Humane Alliance’s operating procedures so that other areas can develop clinics modeled after theirs.

In fact, Brestle says, it’s Mazzina’s desire to push the model as far as it can go that’s kept the clinic’s staff so excited about their work. “Part of the NSNRT idea, the goal, was not only to do duplicates across the nation, but to have these folks have something to work towards, something to feel like they’re a part of, involved in a national movement,” says Brestle. “They actually feel good about what they’re doing. We have some people who get so excited when they know a training is coming up that it’s like they can barely contain themselves.”

In November 2004, the Humane Alliance opened a clinic about 30 miles away in Brevard, North Carolina, a smaller town that exemplifies the depressed economy of much of the surrounding area. Several of the factories that were the main employers in the town have shut down over the past few years, and lots of people are looking for work. Still, the community cares about its pets: Volunteers from the area came in to the old building the Humane Alliance is using to clean it up and paint it. Staff from the Asheville clinic do rotations at Brevard, and close to 2,000 pets have already been sterilized at the subsidiary clinic.

Right now, the Brevard clinic is open only on Mondays and Tuesdays, but Mazzina and Brestle hope to expand the hours and use the clinic as a training location, too. And four communities outside the area—Bristol and Harrisonburg, Virginia; Greenville, South Carolina; and Bloomington, Indiana—have already opened clinics modeled after the Humane Alliance.

In the coming year, with financial assistance from The Humane Society of the United States, Mazzina and Brestle will be expanding the clinic’s reach even further. The HSUS will provide funds to cover the two women’s salaries, an arrangement that will allow the clinic to use its money to hire a director of clinic operations to oversee the ongoing day-to-day work of the clinic in Asheville.

Mazzina and Brestle, meanwhile, will be seeking groups all over the country that may be in the position to take the Humane Alliance’s model and put it to work within their own communities. The plan is to open a total of 27 new clinics over the next three years, each working the way the Alliance does: cooperatively, efficiently, and with a sound economic footing that will ensure that the work can continue. If all goes well, this small town clinic’s work will soon go national, helping to bring about the sterilization of close to 300,000 animals over the next three years.

When you consider the scale of those numbers, it seems no wonder that Sexton and the other staff—as they finish up the day doing paperwork, cleaning up the suite, sterilizing surgical supplies, stacking the crates for the next day’s arrivals, checking out the sleeping critters in their cages—feel connected to a larger purpose.

Mazzina has devoted many of her efforts to creating that sense of purpose among the people who’ve come to work for the clinic, she says. “Not that I don’t love animals, because I do. But when you speak to the rest of the staff, you see how much they love animals,” she says. “And so really what brought me here is that I witnessed a group of people who were so committed to a mission that I felt that they deserved more of an opportunity than they had. They truly had the potential to be something, to be the model that we are today, and to mentor other people. So my commitment, even though it is to the animals and to this mission, my commitment is to this staff and to help make it possible for them to do what they do.”

The National Spay Neuter Response Team will soon accept applications from community groups interested in creating high-volume sterilization clinics based on the Asheville model. For more information about the plans and about how to apply, visit the Humane Alliance Spay/Neuter Clinic’s website at www.humanealliance.org.