Introducing: Vic Garcia

Hey there listeners, if you haven't already, download the Stay Current in Pediatric Surgery app. It's in the Apple App Store, it's in the Google Play Store. You can listen to podcasts like this, watch technique videos, read up-to-date guidelines. All of that in the app. So download it today, but until then, enjoy the episode. As a busy general surgery resident, sometimes it's hard to remember that the care for our surgical patients doesn't just start and end in the OR. These patients come from these complex backgrounds of socioeconomic status, race, geography, all of this plays a role in their health. And that is what we're going to talk about today from an expert. Let me introduce you to Vic Garcia. You know, the business that we're in is not necessarily the business of just providing health care or doing operations. The business that we're in is really improving the health and well-being of individuals. Dr. Vic Garcia is a pediatric surgeon at Cincinnati Children's Hospital. He's an expert on health disparities and how they potentially affect the pediatric surgical patients. I mean, he's done so much outside of the OR. He's teamed up with Toyota to make sure that children in the community have safe car seats. He works with the Cincinnati Police Department on injury prevention programs. But to get to know him before he was a pediatric surgeon and before he was a decorated man in the military. I had to ask, what about Young Vic? So, like, it sounds like Young Sheldon or Young Turk? Vic grew up in New York City in Harlem. I brought up that I also used to live in Harlem and he was quick to laugh at me and point out that we did not live in the same Harlem. Yeah, that's that's exactly what I was thinking. You know, you were there after Clinton. I was there decades before Bill Clinton and it was certainly not a a gentrified Harlem. Vic hasn't forgotten where he came from. We had our Harlem projects, 2190 Madison Avenue. And at that time, Vic didn't know he wanted to be a doctor, let alone a pediatric surgeon. So, young Vic had no idea that he wanted to pediatric surgery. Young Vic wanted to just survive. Survival was on his mind. You see, Vic's parents came to America on a boat from Puerto Rico. And so, um, you know, the suburbs were not something that was an option for them. They lived in the, you know, in Barrio. For a sheltered millennial like myself, Vic's explanation helps to paint a picture, to start to understand what he was growing up around. Young Vic lived in in a in in a you know, a very highly segregated neighborhood. Um, and um, and so there were, you know, characteristic disinvestment of these neighborhoods, and there were drugs, and there were gangs, and there were murders. I mean, one of the things that I remember walking to this all- Catholic all-Saint school was a, you know, a body that you saw early in the morning. And uh, you didn't want to look over there for fear of what you were going to see. You know, you didn't look left and right, you just went straight ahead. Vic says that's the code of the streets. You don't look at other people on the way to school, you just got to get to school. And that was one of the motivations from my father wanting to move out of that area too. Out of the Barrio and where did you guys end up? Well, we we ended up in uh St. Alban's Queens. Um, and um, you know, an interesting, an interesting perspective is my father was a New York City police officer. But not just any police officer. Vic's dad was a lieutenant, and at that time, he was the highest ranking Puerto Rican in the New York City Police Department. Uh and that was in St. Alban's Queens, which uh very quickly within five years, we were the only black family or black Puerto Rican or black Hispanic family there. And then within five years it was all, it was all black. Vic explains to me that this is a phenomenon known as white flight. Basically the white families leaving the neighborhood because minorities are moving in. Now, Vic spent a lot of years in Queens, but then it was time for him to go to college and he ended up going into the military. All right, well, number one, it wasn't because I was militant. The very simple answer is that that's the only place where my father could afford to spend me. And so, West Point was a place where they paid you to go. I had no aspirations of becoming a military officer. Uh I had no idea that when I went to West Point that it was five years of active duty and I could be sent to Vietnam. He's humble about it, but you and I know that West Point is like the creme de la crop. So there's already something really special about Vic at this young age, but he doesn't want to take any credit for it. Instead, he wants to give to the drill sergeants and well, this is how he explains it. When you get off the bus, this nappy-headed kid from uh, you know, New York City, uh, and you're asked to report to the man in the red red sash. And then he tells you to jump and drop your bags. I mean, all you have was one suitcase and I had no idea that they would break you down and then build you up again. Um, I will tell you Rob that we're not for West Point and then my time at Children's Hospital in Philadelphia, I wouldn't be where I am right now. What you have in your mind as a limitation is just that in your mind and then you can do more than what you could possibly do, not only mentally but physically. He keeps a picture in the back of his office to remind him of what he's capable of doing. Shows me in 1968 as one of five blacks in a class of 1013, uh leading a battalion of cadets. So, um, that was the kind of transformation that I went through there at West Point. And um, uh, and I think that that was, the having gone to West Point will allowed me to be competitive to get into the University of Pennsylvania and ultimately uh to pediatric surgery at Chop. His time at the Children's Hospital of Philadelphia was another formidable moment for him because he got to work under the wing of a pediatric surgeon and surgeon general, Dr. Charles Everett Coop. He was, um, he he was an extraordinary man. I mean, he he had the courage of his convictions. Um, he was a technical genius. Dr. Coop is remembered for taking on big tobacco. During the AIDS epidemic, he pushed for early safe sex education to go on in schools, proper condom use, things like that. So, it's clear how Dr. Coop had a big influence on Vic early on in his career. I mean, he he he he helped me understand that we had a responsibility not just simply to take care of kids in the operating room, but to look at the health and well-being. And as some of us may not know, is that he really saw himself as the health conscience of the country. What is what is beneficial for the health of the country? And that was, that was then and continues to be one of my motivations for doing the work outside of the four walls of Cincinnati Children's Hospital. So you can start to get an idea of how strong Vic's convictions are when it comes to public health. But how do you explain that to your run-of-the-mill surgeon who is operating, doing well, taking care of patients, but maybe doesn't really think about health disparities on a regular basis? Well, I mean, I think, you know, as a, as a healthcare provider, specifically as a pediatric surgeon, uh, but more generally as a healthcare provider, uh, you know, you're, you've taken oath, if you will, or you have your purpose in life, your calling, it's not a job or a career, your calling is uh to improve the health and well-being of of of people, of the population. And that can be the population uh within your sphere of uh of influence or it could be a much larger population as far as the sphere of concern. And um, and so I think that, you know, the business that we're in is not necessarily the business of just providing health care or doing operations. The business that we're in is really improving the health and well-being of individuals. And Rod, you know, the thing that we got to realize is that despite our spending more than 50% of the global healthcare dollars, we are at the bottom of the ranking of the OECD countries as far as health outcomes. And you can look at that whether it's premature births, uh infant mortality, uh longevity, okay? Uh, we're not doing that well. And so, you know, what is our role to do a lot of procedures, make a lot of money and and, you know, go off to Florida or Arizona. Uh or you know, take it upon yourself like Coop had uh had like Chic Coop did. Um, not to retire, uh, but to retire and then continue the work that needed to be done outside the walls of at that time chop, Children's Hospital of Philadelphia and and in my instance outside of the walls of Cincinnati Children's Hospital Medical Center. If that doesn't bother you, I don't think you were listening close enough. Vic was explaining how in the United States, we spend a tremendous amount of money on healthcare. But by any international standards, we're at the bottom of the list. It's horrendous and it makes me think of that pediatric surgical patient. It makes me want to do better, but how? That's a question we're not going to answer in a 10-minute podcast. So instead, we're going to start a new series. We're going to talk to Vic on a regular basis about this, health care disparities, socioeconomic status, race, and how all of these factors work together in a complex ecosystem to ultimately affect patient care. We're going to call it Social determinants of health, the next moonshot. So until the next episode, I'm Rod from Cincinnati Children's and remember, knowledge should be free.