How Dr. Yuki Nakayama is making surgical care accessible to all
Dr. Yuki Nakayama is helping Cummings School increase access to surgical care for pets whose owners otherwise couldn’t afford it—and giving students hands-on training in the process
One day earlier this year, Khelsea Singh was surprised to find her grandmother’s cat, Kiki, in distress. The cat was only 2 years old, but she was bleeding and having trouble using the litter-box.
“I took her to a veterinarian, and they told me she had a large bladder stone that was damaging her insides,” recalled Singh, a full-time student at Babson College. “They told me it doesn’t usually happen to young cats.”
The stone was preventing Kiki from being able to empty her bladder, which can result in an emergency situation where the bladder ruptures and fills the abdomen with urine. Kiki needed a life-saving procedure called a cystotomy.
“The surgery at the emergency hospital was going to cost $3,000—not including medication. My grandmother is on government assistance. She can’t afford that,” Singh said.
Singh contacted multiple organizations that help pet owners with the cost of veterinary care. She ended up being referred to Cummings School of Veterinary Medicine’s Community Veterinary Medicine program, which offers reduced-fee services to underserved clients—pet owners in financial need, clients who live in public housing, and shelters and rescue groups—in partnership with a teaching program designed to increase student confidence and clinical competence. Cummings School has been expanding its programming in this area for the last decade, culminating in the opening of the Tufts at Tech Community Veterinary Clinic (based at Worcester Technical High School) in 2012.
Veterinary student Edward Unay, performed the procedure under the supervision of veterinarian Dr. Yuki Nakayama,.
“We essentially saved Kiki's life and gave her the opportunity to spend more quality time with her owner, which is even more meaningful in this era of social distancing,” said Unay.
The surgery was a win all around. Kiki made a full recovery, Singh’s grandmother was able to afford her care, and Unay got valuable surgical experience. But perhaps the biggest win is that this scenario is becoming possible for more and more pet owners in need, thanks to a $418,000 grant from PetSmart Charities.
Teaching Students, Healing Animals
Nakayama has volunteered her time at Cummings School’s community outreach clinics, Tufts at Tech, and the Luke and Lily Lerner Spay/Neuter Clinic since graduating from Cummings School, but the PetSmart Charities grant enabled Tufts to hire her full-time in 2020.
Her job is to prepare veterinary students to graduate with practice-ready surgical skills by caring for under-served pets in the community. This expanded surgical training not only allows students to hone their skills in spay/neuter surgeries, but also the opportunity to learn other common surgeries, such as Kiki’s cystotomy, so that they are ready to save lives upon graduation.
One of the ways she’s fulfilling that mission is with an elective rotation called Primary Care Procedures, in which veterinary students perform surgeries on patients in need at the Lerner Clinic. Each day at least one surgery appointment is held open for emergencies—such as Kiki’s surgery. By working in both the Lerner Clinic and Tufts at Tech, Nakayama has the opportunity to train more students in surgery, and when the students arrive at their Tufts at Tech rotation, they will be more prepared.
“As a student, it is difficult to get hands-on surgical experience as a primary surgeon,” said Unay. “You can study every book, but until you actually perform surgery, you’ll never learn the tactile sensation of handling things such as surgical instruments or body tissues.”
For many students, stress levels skyrocket during their first few surgeries—a feeling Nakayama remembers well. “But every surgery brings more and more confidence,” she said. “The students have the knowledge; they just need to put it together—and they're more capable than they think they are. They're doing surgery in a safe environment where someone is responsible to guide and help them if they need assistance.”
Nakayama recalled the support she received as a Cummings School student from veterinarians on her clinical rotations, particularly those who volunteered their time from the community, and said they inspired her to continue in their footsteps. She sought out as many surgical opportunities as she could and ultimately graduated with more than 50 operations under her belt. Students who graduate having performed many procedures will have the confidence to perform surgery in practice.
“For me, the best part of my clinical rotations was being able to be the primary surgeon for a variety of surgical cases,” she said.
Another way Nakayama accomplishes her mission of teaching surgery to veterinary students is by guiding them through routine spay and neuter procedures on healthy shelter pets that need them. Every veterinary student performs at least two of these surgeries at the Lerner Clinic before they graduate.
“It’s challenging to have an ethical veterinary teaching curriculum that doesn’t involve the loss of animal life, but this is a really important core value to the school,” said Emily McCobb, V00, VG02, VR-06 Co-Section Head of Cummings’ Community Medicine Program. “Because of that, we need to come up with surgical teaching models that don’t harm animals. Spay/neuter has been a linchpin of our approach because shelters and rescues always have had a need for students to do free or low-cost surgeries. Since the opening of Tuft at Tech, we have also become aware of surgical cases among the low-income pet-owning population, and we are excited to enhance the students’ surgical training with these cases, as well.”
Supporting New Access-to-Care Programs
In Massachusetts and New England today, well over 90 percent of owned pets are spayed or neutered. However, while overpopulation is no longer a life-or-death issue for pets in the region, many animals still end up being surrendered to shelters. That is why McCobb and other veterinarians working in shelter and community medicine have adopted a new priority: making veterinary care available to pets whose owners otherwise couldn’t afford it.
“What we’ve realized is that there are millions of pets—some estimate as many as 38 million nationwide—that don’t have access to regular veterinary care,” said McCobb.
She called Cummings School a leader in this space, noting that Tufts at Tech has become a national model for other school-based community veterinary medicine clinics. However, she said Tufts at Tech is limited in capacity—both by space in the facility and particularly by the number of veterinarians available to supervise the student doctors.
Hiring Nakayama full-time was one way to increase the clinic’s capacity and expand access to surgical care for many local pets, like Kiki, while working to transform the veterinary profession over time.
“The reason we believe it’s so important to teach students they can do, for example, an enucleation (removal of the eye) or repairing a simple fracture (broken leg), is that these cases can stay with the general practitioner instead of being referred to a specialist. This lowers the cost for the client and makes that care accessible to more pet owners,” said McCobb. “And that’s the transformation we’re hoping to see.”
Unay said he’s witnessing this transformation in real time. “Having visited multiple veterinary practices throughout my training as a student, I've learned from many practice owners that there is actually a demand for more veterinarians that are willing to do surgery,” he said.
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