Urgency Underscores Surgeon’s Work

Victor Garcia is a mission-driven man. At a time in his career when most people would be thinking of ways to lighten their workload, he is keenly aware of the ticking clock and how much still needs to be done.

Garcia’s goal is to bring health, peace and prosperity to children of all species for all generations. The pediatric surgeon and founding director of Trauma Services at Cincinnati Children’s, is a firm believer in applying science as evidence to transform care.

“When we first started the trauma program here in 1991, I had to convince people that the current way we were caring for injured kids wasn’t necessarily the best way,” he recalled. “The data showed that minority children were disproportionately being injured and killed. We worked hard to develop the African-American Injury Prevention Initiative. That initiative went on to become the Buckle Up for Life program—in partnership with Toyota—which is now in some 20 to 30 cities in the U.S.”

But unintentional injury was only part of the problem. During Garcia’s tenure as director of Trauma Services, he saw a 300-percent increase in the number of children coming into the ED with gunshot wounds. “Homicide is the leading cause of death for African-American adolescents,” he said. “Child abuse is the leading cause of death for children under the age of 1. All of this is preventable.” Complex Challenges In response to what Garcia saw happening in the ED, he helped pioneer the Cincinnati Initiative to Reduce Violence (CIRV), a multi-agency and community collaborative modeled after the Boston Gun Project. The program was effective and provided some valuable lessons, as well. “We learned that if you stop a drug market in a particular neighborhood, it will simply reappear in another neighborhood unless you address why selling drugs has become a default for people,” said Garcia. “If you want to solve complex issues, you have to work with the people who are afflicted by them, including the people you view as a problem. Some cities have actually engaged gang members to help understand what’s driving their behavior and create solutions.”

"Some sociologists advocate moving people out of the neighborhood. But why don’t we transform the neighborhood so everyone wants to come into it?”

The key is to go further upstream to deal with the social determinants of health—like substandard housing, domestic violence, substance abuse, and even climate change—which data show are more powerful than any virus or infection when it comes to population health.

In 2011, Garcia founded CoreChange, a non-profit dedicated to addressing these issues.

“Science has proved that growing up in segregated, highly impoverished neighborhoods creates toxic stress and Post-Traumatic Stress Syndrome (PTSD) that is more severe than the PTSD our veterans come home with from Afghanistan or Iraq,” said Garcia. “The Urban League published a booklet, “Tale of Two Cities,” that describes the 20-year difference in life expectancy based on where you live—South Avondale vs. North Avondale; Winton Terrace vs. Winton Hills. Depending on what neighborhood you live in, your life expectancy can be shortened by 10 years.”

A Personal Passion Garcia’s passion may be fueled in part by personal experience. He was born and raised in Spanish Harlem, the son of poor immigrants from Puerto Rico. His father endured segregation and discrimination, but he emphasized to his children the importance of education.

“He would say, ‘Knowledge is power, and they can’t take that away from you.’ He sacrificed mightily to send us to the best parochial schools,” Garcia recalled.

Garcia became the first person in his family to graduate from college—the U.S. Military Academy at West Point. “The experience turned out to be one of the watershed periods of my life,” he said. He went on to earn his MD from the University of Pennsylvania School of Medicine, then studied pediatric surgery at Children’s Hospital of Philadelphia under former U.S. Surgeon General C. Everett Koop, MD.

Garcia has followed his father’s mantra and used his education to bring about positive change—first in his long, successful military career and then in his work at Cincinnati Children’s as a pediatric surgeon and social activist. He’s been recognized as a Great Living Cincinnatian, a National Jefferson Award winner, a Healthcare Hero (Lifetime Achievement Award), a distinguished West Point graduate, and most recently, as a recipient of the Cincinnati Pediatric Society’s Founder’s Award.

He sees these honors as motivation to continue his efforts to bridge the health disparities and inequities he encounters first-hand every day.

“In impoverished neighborhoods, you don’t see kids playing out in the street, making up games. Play should be a right for all children,” he said. “That dissatisfies me. It frustrates and angers me. But it’s a constructive anger. I’m not going to be content with turning on a fire hydrant during a heat wave or trying to improve the quality of food in neighborhoods that feel like a prison. Some sociologists advocate moving people out of the neighborhood. But why don’t we transform the neighborhood so everyone wants to come into it?” Taking a Holistic Approach Garcia has long subscribed to systems thinking and complexity theory. From his perspective, violence, obesity, depression, child abuse and prematurity are all inextricably interconnected. “The agents are different, heterogeneous, and they’re learned,” he explained. “If you only try to solve one aspect in isolation, you typically make the problem worse.” Garcia points out that, in terms of population health, the U.S. ranks at the bottom of the developed world for child and adult outcomes. While there’s heavy investment in building cancer treatment facilities, science says a lot of cancer could be prevented by addressing neighborhood issues. Data also show that things are getting worse at a faster pace than people realize—the opioid epidemic is rampant, adolescent suicides are on the rise, and for the first time in recent history, the mortality rate for middle-class whites is increasing. Yet Garcia remains hopeful and excited that these “wicked challenges,” as he calls them, can be resolved through a disciplined approach of study, science and understanding. “I was blessed to get out of Harlem—which was very different then than it is now—and there was a reason for that,” he said. “It wasn’t to accrue wealth. It was to make a dent in the universe. God speaks to us in different ways, and for me, this work is a calling. I have to do this, and I need all the help I can get. I pray there will be enough time to bring about the changes that are necessary, the changes that science says are possible. I hope, too, that more people will see what I see, so that even if I don’t make it to the mountain top, there will be others to continue the work.”

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