Hands to hold on the path to surgery

The first-of-its kind Center for Surgical Health provides navigation and support to help under- and uninsured patients receive surgical treatment before it becomes an emergency.

Without health insurance or a primary care provider to consult with on non-emergency medical issues, José (who immigrated to the U.S. from Mexico in 1999 and did not provide his last name), was rushed to the Roxborough Memorial Hospital last year in acute pain. After he was stabilized, José learned that the problem was his gallbladder, and that the treatment was surgery to remove the organ. But if just accessing primary care was a difficult hill for José to climb, arranging and paying for a major surgery felt downright insurmountable. What was more likely, though far from ideal, José thought, was that he’d deal with the intermittent pain until his gallbladder eventually ruptured, sending him back to the hospital for a lifesaving medical intervention.

After José was released from the emergency room, a friend told him about Puentes de Salud, a Spanish-language community center that serves many undocumented immigrants at 17th and South Streets in Philadelphia. The clinic’s staff soon connected him with Penn Medicine’s Center for Surgical Health, a new program with the goal of connecting underserved patients with the surgical care they need but struggle to access.

A medical professional sits with a patient at their desk.

The Center for Surgical Health grew out of a Perelman School of Medicine free clinic called the University City Hospitality Coalition, which provides medical consultations for uninsured patients. Patients would come to the clinic with complex surgical needs but few tools with which to navigate the health care system, said Alan Herbst, now a Penn general surgery resident who had volunteered at the free clinic when he was a medical student.

Maybe instead of expecting these underserved patients to find their way to surgery through a web of complexities, the students thought, we could promote health equity by bringing surgery to them. It took a few years to lay the groundwork—and a full year to get the first patient to surgery—before the Center for Surgical Health officially launched.

The center, housed in the Department of Surgery, is thought to be the first of its kind. The team, now comprised of some 150 volunteer faculty, residents, medical students, and graduate students, knows of no other academic medical center that has a program guiding underserved patients from pre- to post-surgery. When patients are able to schedule planned surgeries, instead of coming to the emergency room only after their conditions have escalated, they are more likely to have shorter hospital stays, a quicker return to work, and more financial stability.

At the core of the center’s work is the “personal patient navigator.” The navigator, usually a medical student, helps pave the patient’s way from the initial referral to the operating room and through post-operative care. José’s navigator was Linda Saikali, a second-year medical student who now leads the center’s women’s health division. Saikali says she volunteers with the center, in part, because she’s considering a career in surgery. “That,” she says, “combined with the direct way this organization helps reduce disparities in the community, was really appealing to me.”

This story is by Christina Hernandez Sherwood. Read more at Penn Medicine Service in Action.