April 7, 2019 ⋅ 10:00 A.M. ⋅ Isita Tripathi⋅ Editor: Guadalupe Sandoval
In the pre-op waiting area at the Kigali military hospital, a patient sat with a dense neck mass protruding from his neck. As the doctors and medical students gathered in awe to see two maggots wriggling around the giant tumor, the man gazed at the ground with a look of pure humiliation. But when I conducted his interview the next day, it seemed as if he was an entirely different person. From uncomfortable and embarrassed, he became bright and jubilant. He was joking with the staff, laughing, and unabashedly pointing at the gauze around his neck. What had changed? Clearly, the procedure had transformed the man physically. But more importantly, it had bolstered his confidence to unprecedented levels.
I had always thought about surgery in the “Grey’s Anatomy” trauma lens: conducting the most crucial, life-saving procedure in a fight to put together all the pieces before everything falls apart. After volunteering on this surgical mission trip in Rwanda, I realized that even surgical procedures that do not seem “life-saving” in the moment do have the capacity to create long-lasting change that can transform someone’s quality of life.
Although the procedures were a huge success, the rest of the “operation” was not always the smoothest. Due to the different resources available at the Kigali military hospital, doctors often had to improvise their tactics. This could range from placing a sterile glove on the light fixture to move it around, to executing slightly unfamiliar procedures because the surgeons did not have their usual supplies. Volunteers, like myself, ran back and forth in the middle of procedures to gather extra materials from a small storage room brimming with medical supplies. Clearly, it was not the most polished practice, but it definitely got the job done. Every time people were faced with a challenge, they found a creative and innovative solution to push forward. We did not need the best equipment or the best facilities, just a team of individuals with unparalleled passion and dedication for their work.
With these thoughts in mind, I started to ask the medical staff why we never conduct these trips in the United States. In my time volunteering to aid homeless individuals on Skid Row, I had encountered many people who were completely unable to access the health resources they needed. One man shared a story about watching his friend bleed out on the sidewalk as ambulances failed to arrive in time because they refused to prioritize a call from the homeless in LA. Another man with a walker discussed the way his feet froze, since he was unable to fight the people who robbed the socks from his feet. Everything I had learned about the “social determinants of health” in the classroom had a story attached to it in the world. There were evidently so many people suffering from unaddressed medical and surgical issues, and I was confident that holding a similar mission within the United States would spur change.
Although the physicians agreed with my thoughts, they claimed that the healthcare system was too difficult to work around in America. First, there was the issue of resources. Finding a hospital willing to rent out its operating room for volunteer purposes was practically impossible, as it posed a liability and safety issue for the institution. For physicians conducting volunteer procedures at home, there may be malpractice concerns as well. But even if there was a willing hospital and surgical team, it was economically unsustainable to hold these missions. For the same price, it was possible to conduct several surgical mission trips abroad, since insurance would never cover the cost of these operations.
I felt that someone could say the same thing about conducting these procedures abroad, yet there were countless nonprofit organizations invested in the idea of a “medical mission trip.” After arriving home, I continued researching the feasibility of this project, when I found a nonprofit organization, Mending Kids, that actually coordinated one domestic surgical mission every year. Overjoyed and eager to contribute, I immediately contacted them about the opportunity to further their work.
In my first meeting with Mending Kids, I asked a series of questions to find ways in which I could help as a student. It appeared that many of the organization’s patients had conditions that were relatively stable. Consequently, insurance providers deemed their procedures “elective,” since they were not life-threatening. However, many of the families did not have enough funds to cover these procedures that were creating large complications for the children in their day-to-day activities. During one of my Disability Studies courses at UCLA, I had watched a documentary describing the covert ways in which many insurance schemes exclude people in need. Insurance providers asked parents of children with cleft palate if their child could do everything a “normal” child was able to accomplish. Families that answered “yes” were disqualified from disability insurance, and essentially penalized for feeling that their children were “normal.” As a result, their children had to continue grappling with breathing issues, hearing loss, and other chronic consequences of cleft palate, even as they proceeded with their routine activities. In the event that Mending Kids’ patients were facing similar circumstances, it would be extremely important to understand why they were unable to access care through mainstream routes.
Through determining the root cause of their issues within the medical system, I figured that we could raise awareness about inequities, and effectively tackle these issues. In this process, our community would have the opportunity to listen to an unacknowledged narrative about people’s lived experiences with unresolved surgical conditions. In addition to collecting “objective” scientific data, I thought it might be impactful to share these children’s strengths and struggles as they navigate their medical conditions. Through focusing on their lives as a whole, we could challenge the idea that these are rare circumstances affecting only certain unfortunate children, and instead, highlight the way that structural issues within healthcare can adversely affect any of our lives.
As a result, we may also provide support in other areas that are contributing to the progression of the child’s health issues, even beyond their immediate surgical condition. So, after about an hour of discourse with Mending Kids, I realized I would need a team of students to create the level of impact that we desired. Although there is still a far road ahead until we become healthcare professionals ourselves, we do not need to wait. We can channel our passion and dedication for healthcare into helping people who are marginalized within our current systems. While we may not be able to scrub in or perform the procedures, we can make an impact as we “Speak Out for Surgery.”
About the Writer
Isita Tripathi is President of Speak Out For Surgery at University of California - Los Angeles.