I was born and raised in Texas, USA but my family traces its roots back to Qu茅bec. In the pursuance of a multidisciplinary education, I have developed a keen interest in health policy, institutional protocol writing, and medical system designs. I believe that in order to create a more accessible and equitable health system, we need to learn from foreign systems to evaluate what works well and what does not.
For summer 2024, I have undertaken an internship at the Centre Hospitalier R茅gional Universitaire de Nancy (CHRU Nancy) located in Nancy, Grand-Est, France within the Department of Thoracic Surgery. The objective of this internship was to help me in building my understanding of various health systems and the policies influencing them. The CHRU Nancy Thoracic Surgery department is that largest surgical lung cancer service in the east of France and performs over six hundred surgeries a year. This is an enormous number considering that there are only three staff surgeons and three surgical residents.聽This created the perfect setting for me to experience a foreign health system and delve into institutional policies while getting to know the team members personally.聽
A generous portion of my work has been devoted to evaluating and integrating an institutional protocol for intraoperative sentinel lymph node evaluation. Sentinel nodes are lymph nodes that typically are the first site of metastasis for lung cancer, and as such are important to be able to effectively evaluate. To evaluate them, protocols need to be parsimonious as it requires the use of many forms of technology such as indocyanine green colorants, infrared cameras, and 3D modeling of the lungs.
This work has allowed me to work with bioethicists at the hospital to understand how protocol design can be practical while respecting laws and regulations of the health system they operate within. Two things that really stood out to me as I spoke to physicians and patients were the 鈥渂on de transport鈥� system and patient expectations of their health system. The bon de transport system allows patients to receive fully government funded transportation to and from any medical appointment. Billions of Euros are spent a year to keep this system operational, but all patients and doctors seem to support the system. Because of this increased access to care, patients are comfortable with traveling larger distances to visit specialists. While in patients in Quebec are challenged by geography and transportation, a patient in France is easily able to access a specialist in the next department (region) over from their hometown, in fact they expect that they will be able to do it with ease. When designing a policy in France, this gives the policy creator significantly more freedom in mandating certain visits to hospitals or medical institutions, as the transportation system of patients allows for a smoother policy implementation.
I took a lot of pride in being able to see our protocol design for sentinel testing be added into the standard of care at the CHRU Nancy. Within the clinics, I had the opportunity to be involved in conversations and explanations as to what the protocol involves. In the operating room, I got to support patients from the moment they went under anesthesia and until they were taken out of anesthesia. After surgery, I was able to visit the patients every day and understand their concerns throughout our protocol implementation. This continuation of care allowed me to assess all aspects of my protocol and find the errors that needed to be addressed.
On a personal note, this internship has provided me a better understanding of European quality of life. No one is rushing to do anything. Everyone respects boundaries about when individuals are on vacation and people are happy to socialize with their co-workers outside of work. It is a good quality of life and I hope to integrate some of these practices into my future life and career.
This internship was graciously supported by the Brousseau Arts Internship Award. Without this funding, I would have had to take on a substantial financial burden to make this internship a reality. I am extremely grateful for this funding, support, and investment into the next generation of leaders. My work experience from this internship has further solidified my passion for pursuing a multidisciplinary career and creating positive changes for cancer patients around the world.
