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Pandemic spurs expansion of surgical care for underserved

Oct. 7, 2021, 9:11 AM

Rondi Kauffmann, MD, MPH, seated, reviews a patient’s medical history with Vanderbilt University School of Medicine students Natasha Hughes, far left, and Candace Grisham, during a recent surgical clinic.
Rondi Kauffmann, MD, MPH, seated, reviews a patient’s medical history with Vanderbilt University School of Medicine students Natasha Hughes, far left, and Candace Grisham, during a recent surgical clinic. (photo by Susan Urmy)

by Jill Clendening

When the COVID-19 pandemic shut down international travel necessary for overseas medical initiatives, Rondi Kauffmann, MD, MPH, assistant professor of Surgery, began brainstorming ways to extend surgical care to those in need much closer to home.

“My entire motivation for going into medicine was to be involved in global health,” Kauffmann said. “I came to Vanderbilt initially [as a general surgery resident] because of the strong global health focus, and I came back as faculty because of what Vanderbilt Surgery in particular is doing in global outreach.”

When Kauffmann’s youngest daughter was born in 2017 with medical challenges that shelved her own international travel, she continued to fully support medical outreach in her role as associate program director for the General Surgery residency program. When the pandemic halted overseas work for VUMC’s surgical faculty and residents, she was undeterred.

“Taking care of your neighbor is something I think every person, regardless of your position, training or background, should do,” Kauffmann said. “COVID, to some extent, brought that into more focus, because suddenly it was very, very apparent that the health of people on the other side of the world does have direct impact on the health in our community.

“And likewise, the health in our community has direct impact on the health of people on the other side of the world. When COVID shut everything down, I really started to put some action behind my conviction that addressing disparities and lack of access to health care in our own backyard is really important.”

In August, Kauffmann and fellow VUMC surgeons Michael Holzman, MD, MPH, and Adrian Barbul, MD, began working alongside Vanderbilt University School of Medicine (VUSM) students and VUMC residents, volunteering their time, knowledge and skills for monthly surgical clinics in community-based facilities in Nashville which primarily serve uninsured individuals.

They meet their patients at Shade Tree Clinic, a comprehensive health center for uninsured individuals operated by Vanderbilt medical students, and Siloam Health-Melrose, a faith-based clinic providing care for a largely immigrant and refugee population. Similar surgical clinics have been run at Shade Tree Clinic in the past, but the availability of volunteers combined with an increased number of individuals in need whose issues may have worsened during the pandemic made this the right time to begin again, Kauffmann said.

“These community clinics have the ability to get their patients with urgent conditions to several of the hospitals in town, but uninsured patients who have surgical problems that are not urgent but still life-altering are pretty much left without access to affordable care,” she said. “We wanted to address that problem.”

When the providers at the community-based clinics identify individuals who can benefit from a surgical consultation, Kauffmann matches the individual to a volunteer surgeon specializing in their area of need. During the initial clinics, patients were seen with breast concerns, benign colorectal issues, hernias and other non-emergency but serious concerns.

After individuals are evaluated by the VUMC surgical team, they can be referred for diagnostic testing, if needed, before having surgery at a Vanderbilt Health facility. This care is made possible through Vanderbilt Health’s financial assistance program which aids qualifying uninsured individuals.

“VUMC has a deeply rooted history of taking responsibility for providing care to the underserved in our community,” said Paul Sternberg Jr., MD, Chief Medical Officer for Vanderbilt Medical Group and associate dean for Clinical Affairs. “It is wonderful to see Dr. Kauffmann and her colleagues leading us in our commitment to this mission, while also being meaningful role models for our medical students and residents.”

Natasha Hughes, a first-year VUSM student who assisted with the first surgical clinic at Shade Tree, said she’s looking forward to continuing to participate in this outreach.

“It goes without saying that it is wonderful to be able to help provide care to individuals who may otherwise not be able to receive it,” she said. “However, it’s not just that. There is a lot to learn from the people we meet. It’s important for us to really learn to see patients not just as their medical diagnoses, but as full and complete individuals who can face many barriers to receiving care that we have to learn to help them navigate as a team.”

Seeing individuals get connected to surgical care who might otherwise do without is invaluable, said Jim Henderson, MD, Siloam Health’s chief medical officer.

“Siloam Health has had a long and wonderful relationship with Vanderbilt University Medical Center,” he added. “We are so thankful for Dr. Rondi Kauffmann and her efforts to organize a surgical clinic here. The residents and attendings help screen patients who have no options for surgery and enable them to receive the care they need.”

Recognizing that surgical trainees need greater exposure to the knowledge and skills needed to provide appropriate care to underserved populations, whether at home or abroad, Kauffmann, worked to establish a new Global Health Equity and Access Leadership in Surgery (Global HEALS) program for Vanderbilt surgery residents. Similar global health training programs are available in the departments of Obstetrics and Gynecology, Anesthesiology, Emergency Medicine and Neurosurgery.

The foundational Vanderbilt Collaborative for Global Health Equity course, presented in partnership with Vanderbilt Institute for Global Health, covers core skills for global health leaders — everything from recognizing key determinants of health to how to work effectively within diverse cultural settings and across local, regional, national and international political landscapes.

Course directors and faculty representing anesthesiology, behavioral health, emergency medicine, global health, neurologic surgery, otolaryngology, neurosurgery, obstetrics/gynecology, pediatric medicine, psychiatry and surgery present the content, and 40 trainees from seven medical disciplines are taking the inaugural course this year.

“The tenets of global health are very much applicable to uninsured populations in Nashville that have challenges in accessing health care for various reasons,” Kauffmann said.

“That’s something we want to be an important part of how we train our residents. They need to know these skills are applicable everywhere, whether or not they’re going to be spending time abroad providing care when they’re done with training.”

“I’m so thankful that Dr. Kauffmann is part of our faculty in the Department of Surgery,” said Carmen Solorzano, MD, chair of Surgery and John L. Sawyers Professor of Surgical Sciences. “She has always been passionate about improving access to surgical care for those in need. Exposure of our residents and faculty to these experiences, whether locally or globally, opens our minds and energizes us to act and push for needed change.

“The creation of the Global HEALS program will help create future surgeon leaders from VUMC and elsewhere; it also demonstrates Dr. Kauffmann’s national leadership and influence in this space.”

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