A Heart of Hope
SreyRam Kuy, 38
Chief Medical Officer of Medicaid, Louisiana Department of Health
As a very young child in 1980, SreyRam Kuy found herself in a refugee camp in Thailand after her family fled the genocide being committed in her native Cambodia. After she and her mother were severely injured by errant rocket-propelled grenades, volunteer doctors operated on them, saving their lives. It marked the first step in Kuy's journey toward becoming a doctor helping underserved populations. Her family arrived in America in the early 1980s, and Dr. Kuy came to Baton Rouge after being named Chief Medical Officer of Medicaid in Louisiana in May. In her short time here, Dr. Kuy has already helped Louisiana become the first state to develop a Zika prevention strategy for pregnant Medicaid patients.
NAME THREE MAJOR PROFESSIONAL ACCOMPLISHMENTS.
As Chief Medical Officer for Louisiana Medicaid I'm proud that for the first time women with breast cancer have access through Louisiana Medicaid to contralateral breast reconstruction. In addition, cancer affected individuals and those at high risk for breast or ovarian cancer now have access to BRCA 1 and BRACA 2 mutation testing. I am deeply committed to providing women with access to early diagnosis and quality treatment for breast cancer. For me, this is really important on a public health level because Louisiana has one of the highest cancer mortality rates in the nation. On a professional level, this comes back full circle to where I started 16 years ago as a Kaiser Family Foundation Health Policy Scholar working for Senator Tom Harkin in Washington D.C., writing Senator Harkin's speech in support of the Breast and Cervical Cancer Prevention and Treatment Act. Congress passed this important act in 2000, allowing women in the U.S. diagnosed with breast and cervical cancer to access treatment through Medicaid. It is satisfying to now, as a part of Louisiana Medicaid, be able to expand upon those services at a state level. These new policies allow genetic testing for conditions that are hereditary so patients can make informed decisions about their plan of care; and now women who required a mastectomy as part of their treatment can have reconstructive surgery on the opposite breast as well; improving physical and psychological outcomes for these women. On a personal level, twenty years ago my own father died from cancer and now my mother is a survivor of cancer. I've seen firsthand as the child of cancer patients how devastating this disease process is. Now, as a general surgeon, I can draw upon those personal experiences as I care for my own cancer patients and their families. I am honored as a surgeon to have the opportunity to share the compassion and empathy that my family and I experienced during our own journey with cancer. So for me, my work as a surgeon caring for cancer patients, as a healthcare advocate and as a health policy maker, is personal. It's less about accomplishments, but more about "Paying it Forward."
It's less about accomplishments, but more about "Paying it Forward."
TELL US ABOUT YOUR VOLUNTEER & COMMUNITY AFFILIATIONS AND INVOLVEMENT.
Much of what I do is inspired by my mother. Growing up very poor, our family didn't have a lot materially. My mom couldn't afford to buy Christmas gifts or birthday gifts for our family. But we always felt loved, and my mom still found ways to help others who were even needier than us. She shared home cooked meals and warm clothes with a blind, elderly woman in our town. She bought school uniforms for children and helps support girls in third world countries to get access to an education. My sister, Dr. SreyReath Kuy, and I try to continue my mom's traditions. Last Christmas, instead of buying a tree and presents, we hosted a benefit for NOMI Network, an organization combatting human trafficking. Inspired by Kathy Ireland's work fighting human trafficking, we raised $3,350 that night. Just a miniscule drop in the bucket when you consider the magnitude of the problem with 32 million trafficked people fueling a $99 billion dollar industry. However, my mom taught me that it isn't the magnitude of the problem that matters but the willingness of our hearts to do something, to do anything.
My mom taught me that it isn't the magnitude of the problem that matters but the willingness of our hearts to do something.
This year I received a community service award from the Ford Family Foundation, and as a result was able to donate $5,000 to help veterans at the New Orleans Veterans of Foreign Wars Post. As a surgeon who cared for veterans, I've seen the challenges many of our veterans face. I truly appreciate their sacrifices for the freedoms we enjoy. If anything, I hope this small seed grant will help draw attention to the tremendous need among veterans and encourage others to donate, volunteer or find other ways to serve the veterans in our community. I've been blessed with wonderful mentors throughout my career. As a result, I love mentoring the next generation of doctors, medical students, and college students. Some of them shadow me throughout the year, others come and spend a summer, and some are long distance tele-mentoring relationships via phone and email. I've also volunteered as an instructor for Mini-Med, a program through Louisiana State University that educates the general public about medical topics. I really enjoyed teaching non-medical members of the community, who ranged from accountants to department store sales clerks, lawyers to radio hosts about health. It's amazing the insightful perspectives I get from my students and the lay public. I realized that when I teach, I learn so much along the way. In the medical community, I served as a volunteer Board Member on the National Board of Medical Examiners. The NBME governs licensing for all medical doctors in the United States through a series of examinations designed to test knowledge and competency of doctors. As a Board Member, I helped guide the NBME in its budgetary decisions, future direction of the licensing exam, and incorporating new topics such as professionalism and diversity in medicine. I also served as a volunteer member on the Accreditation Council for Continuing Medical Education. The ACCME governs continuing education for all U.S. physicians, and as part of this volunteer committee we meet to review the different organizations providing continuing medical education to doctors. I believe being a part of the process that ensures our healthcare providers continually learn about new practices of care is important for promoting good quality of care for all patients. I've also served as vice-chair of the Association for Women Surgeons Communications Committee, member of the Association of Academic Surgeons Information and Technology Committee, Membership Committee and Program Committee, and on the American College of Surgeons National Diversity Committee.
NAME ONE BOOK THAT HAS INSPIRED YOU PROFESSIONALLY.
How Will You Measure Your Life? by Clay Christensen
WHEN YOU WERE A CHILD, WHAT DID YOU WANT TO BE WHEN YOU GREW UP?
My passion for medicine began in a refugee camp, birthed as a casualty from war. The doctor who saved my life in Khao-I-Dang was the first step of my journey into medicine. I've known for as long as I can remember that I wanted to be a doctor, and in particular, to work with underserved populations. My own memories of those experiences are lacking, but the story of my family's flight from Cambodia's Killing Fields is woven into the fiber of my being, formed from my mother's frequent retellings of our history and the scars that we carry as daily reminders. After escaping from Cambodia, my family and I fled to Khao-I-Dang refugee camp in 1979. We thought we were safe, but we were wrong. Just weeks after our arrival, we were severely injured by errant RPG explosives. A volunteer Red Cross surgeon operated on my mother and me, saving our lives. After a year and a half of migrating between four different refugee camps, we were resettled in the United States. Though we left behind the clamor of warfare in Cambodia for the idyllic college town of Corvallis, my mother inculcated in my sister and me a deep appreciation for the blessing of being alive; and it is this gratitude that drives my passion for medicine and caring for vulnerable populations.
My mother inculcated in my sister and me a deep appreciation for the blessing of being alive; and it is this gratitude that drives my passion for medicine and caring for vulnerable populations.
As a surgeon, I cared for veterans, a number of whom struggle with PTSD, poverty and substance abuse. War is savage, and witnessing it is brutal, whether you're a child or a soldier, and its ramifications linger. With these obstacles, I sometimes wonder what difference do we actually make in the lives of our patients? One veteran came into the E.R. with a diabetic gangrenous leg, which we had to emergently amputate to save his life. A year later, he came back, severely ill from uncontrolled diabetes. He had severe lung disease as a result of years of smoking and congestive heart failure. He now had an infection of the remaining leg, which had progressed to gangrene, causing a systemic disruption of his body called sepsis. His kidneys, his heart and his lungs were shutting down as a result of the infection, and to save his life we would need to amputate his remaining leg. However, it felt futile, remembering the same fight we had fought to just one year ago. He was despondent, and refused surgery despite knowing that this was tantamount to a death sentence. Sometimes, we look at a problem, and it feels like we are facing an impossible ocean of obstacles. It's easy to ask, "What am I with just my two hands?" However, I've learned that there is a great deal that two hands can accomplish when they are guided by a compassionate heart. A year ago I presented a medical lecture and I chatted afterwards with an audience member who told me his story. He had spent several months in the Khao-I-Dang border camps taking care of Cambodian refugees as a young doctor in 1979. This was the same camp where my family lived during that time. It must have seemed futile to him as to what he could accomplish in the span of a few months, with little resources beyond his two hands, and a seemingly endless ocean of need, hunger and poverty. It is one thing to bandage a child's wounds, but what impact does one person actually have on a future already battered by genocide, political conflict, and starvation? He showed me photos of a sea of brown faces; Cambodian children giddily grinning for an American stranger's camera. Over the years, he had looked at these pictures and often wondered what happened to the children that he taken care of, and questioned what impact, if any, he had made. Then he smiled at me, as if to say that now he knew. What I learned from this chance encounter is that we have the capacity to impact people's lives, even when our resources are few and the needs are overwhelming. We often don't see the results of our efforts. But sometimes, decades later, we may be surprised. The surgeon who saved my life in Khao-I-Dang was the first step of my journey in medicine. To him I am deeply indebted. Because of that doctor, what I value most about being a surgeon is the opportunity to express that gratitude through another patient's life, whether or not I ever see the results of those efforts.
We have the capacity to impact people's lives, even when our resources are few and the needs are overwhelming.
After a series of heart to heart talks, my patient eventually agreed to undergo surgery and I took him to the operating room for an emergency amputation. With the infection controlled, slowly his lungs, heart and kidneys began recovering. Long term, he faces a sea of challenges. The effort is on patient education and with social work to help him continue his medication regimen and resume his much needed preventive primary care treatments. My work was just one small step. However, I'm grateful to have the opportunity to help start that small step.
WHAT WAS YOUR FIRST JOB, HOW OLD WERE YOU AND WHAT DID YOU LEARN FROM IT?
My mom was willing to do anything honest to support my sister and me, even if that meant holding down two to three jobs at a time. In the evenings, after she finished her janitorial job at the hospital, my mom cleaned houses for doctors and professors in town. And my sister and I would go along and help with dusting, mopping and cleaning toilets. On weekends we went with my dad to help mow lawns and weed yards. In the summers when school was out, we worked in the fields of the Willamette Valley alongside migrant farm workers, picking strawberries, blueberries, raspberries, green beans, onions, garlic, tomatoes, boysenberries, and even a little blackberry called black cats. What I learned from that job was don't eat them! They may look like cute little black raspberries, but they taste like ink! Which is what they're used to make. And ink does not taste good! Second, I learned that an opportunity to work is an opportunity. We all have to start somewhere. And I'm so grateful for the opportunities I've had.
WHAT IS THE STRANGEST JOB YOU'VE EVER HAD?
My strangest job was working as a surgery intern. On my first day as a brand new doctor, I was sent to pronounce a deceased patient. Another day, I plucked maggots out of a gangrenous leg.
WHAT DO YOU CONSIDER YOUR GREATEST ACHIEVEMENT?
I'm always very happy, and a little bit proud, whenever I convince my patient to quit smoking. I know it's challenging, and people often think why would a surgeon care about smoking? That seems like a primary care issue. However, smoking is one of the main reasons why some of my patients need surgery, and it affects the ability of my patients to recover after surgery. Whenever I have to perform an amputation for a gangrenous diabetic leg, or for complications of severe peripheral vascular disease, it always feels like a failure. I always wish I could have prevented my patient's disease from progressing to that point. And preventive care, such as smoking cessation counseling, diabetes treatment and prevention, and hypertension management, all contributed to that amputated leg. So even though it seems like a small win, every time I get a patient to quit smoking, I feel so happy and, yes, proud. I still have a photo of the package of Winston's that one patient handed over as he agreed to quit. The fact is, we have to think about health on both the individual level, as well as the population level. That is why, since expand Medicaid in Louisiana on July 1 under the pioneering leadership of Secretary Gee and Governor Edwards, we now have the opportunity to care for this 19-64 year old adult population for the first time. Preventive care is a critical component of our success as we work to move the needle on healthcare.
HOW DO YOU GET PUMPED UP BEFORE A BIG MEETING, PRESENTATION OR PITCH?
I usually go somewhere quiet and say a little prayer. I pray before every surgery I do and before every important meeting.
WHAT HAS BEEN THE MOST FULFILLING MOMENT IN YOUR CAREER SO FAR?
It was extremely fulfilling to see nearly 40,000 people get preventive healthcare or new patient services in just five months since Louisiana Medicaid expansion occurred. In addition, more than 3,565 women were able to get breast cancer imaging. Another 3,000 patients got colon cancer screening. And among those patients, 786 people had colon polyps removed. These were potential colon cancer cases averted, because patients had access to healthcare coverage through Medicaid. Knowing this makes my work feel very fulfilling. I am so thankful and grateful to get to serve in this role, helping people get access to quality healthcare. It is a privilege and an honor.
WHAT IS YOUR BEST PRODUCTIVITY HACK?
Finding good people. That's my productivity secret! I've been blessed to have amazing staff to work with. People who are committed and passionate about their work. Any successes I've had in the operating room are due to the compassionate nurses, technicians and OR staff who work so hard and go above and beyond for our patients. Any successes I've had in my role as Medicaid's chief medical officer, I owe to the phenomenal staff who work there. Their dedication and talent amazes me. Good people are my productivity hack.
WHAT HAVE YOU LEARNED THE HARD WAY?
WHAT ABOUT YOUR JOB WOULD SHOCK CUSTOMERS OR CLIENTS IF THEY KNEW ABOUT IT?
I do "musical pimping" in the operating room. Surgical culture has a long tradition of something called "pimping the student". Which is where the attending surgeon rapid fires a series of successively challenging anatomy, technique or obtuse surgical history interrogation questions until the medical student is reduced to a quivering mass of incoherent jelly. I'm not very good at medical pimping, so instead I do musical pimping; where I ask the student what song is playing on the radio, and who sings it. Once, my patient who was awake under local anesthesia, joined in on the fun and got EVERY single musical question right throughout the whole surgery! But, he may have had an unfair advantage since he did pick the radio station himself; a golden oldies station that none of my young students knew!
HOW DO YOU TYPICALLY DRESS FOR WORK--CASUAL? PROFESSIONAL? BUSINESS CASUAL? OTHER?
On surgery days, I usually just roll out of bed and come to work in whatever, knowing I'll be in scrubs for the rest of the day. Wearing scrubs is wonderful--it feels like being in your pj's all day! At the Medicaid office I can't wear pajamas to work. So usually I'll stick to something professional.
WHAT PART OF YOUR JOB DO YOU LOVE? WHAT PART DO YOU HATE?
The part I love about my job is knowing that we're truly making a difference in people's lives by getting them access to timely, quality healthcare. The challenge about my work is that as a state Louisiana ranks 50th in the country for overall health. I hate that. But I believe this challenge is an opportunity. We have the chance to seize this opportunity and through a focus on healthcare quality truly move forward to a healthy Louisiana.
WHEN DID YOU REALIZE YOU WERE "GROWN UP"?
The first time I did an E.D. thoracotomy. An E.D. thoracotomy is a last ditch effort done when a patient loses their vital signs. This one was especially heart wrenching; an 8 year boy who had been shot by his father. Cracking open this little boy's chest in the chaotic emergency room, and squeezing this small heart with my hand as we wheeled his stretcher towards the operating room, I knew that I would never forget this day again.
FAVORITE GIFT YOU WERE GIVEN AS A CHILD?
My Bible. Pastor Paulson at Grace Lutheran Church gave me my first bible in third grade, and I still have it. It's dog eared, taped up together, and missing a few pages, but still good.
WHICH TALENT OR SUPERPOWER WOULD YOU MOST LIKE TO HAVE?
I would love to be able to fly.
WHAT'S A NICKNAME YOUR FRIENDS OR FAMILY MEMBERS HAVE FOR YOU?
WHO FASCINATES YOU?
My mother fascinates and inspires me. As my sister and I were growing up, my mom would tell us incredible stories about our family's life in the Cambodian Killing Fields. She shared stories about extraordinary acts of compassion, about having courage in the face of evil, and unwavering faith that enables hope during the darkness of a bloody genocide. My mom, a small, humble woman, taught me so much about courage and hope. She truly has "The Heart of a Tiger"! And as a young girl, she had to fight for the chance to get an education during a time and place when girls were discouraged from going to school. Ironically, it was that same education that she fought so hard for, that nearly cost her life at the hands of the Khmer Rouge in the Killing Fields. Today, my mom helps young girls in a third world country get an education and works to rebuild communities in Cambodia. My mom is a phenomenal woman who inspires me daily.
Later, while I was studying at Yale, I visited the Yale Genocide Project, which made me realize how important it was to write down these stories, so they don't get lost. So in my spare time, I wrote down the stories my mother shared into a book, "The Heart of a Tiger", and wove into them my own experiences as a refugee, a patient, and a surgeon. My goal is that through sharing these stories I can inspire hope and courage. My mom's story is a story of unrelenting resilience. The message of "The Heart of a Tiger" is that no matter how challenging your circumstances are; NEVER, ever give up!
The message of "The Heart of a Tiger" is that no matter how challenging your circumstances are; NEVER, ever give up!
WHICH FICTIONAL CHARACTER DO YOU MOST IDENTIFY WITH?
Anne Shirley from Anne of Green Gables. She so plucky, and never gives up.
WHAT IS YOUR FAVORITE BAND OR SONG?
WHAT IS YOUR FAVORITE MOVIE?
WHO WOULD PLAY YOU IN A MOVIE?
I would love the opportunity to collaborate with Reese Witherspoon! I love her; she’s an amazingly talented actress & producer who creates extraordinary movies about incredibly strong women. It's great to see these intelligently made films that inspire and uplift.
WHAT SCARED YOU AS A CHILD, AND WHAT SCARES YOU NOW?
Spiders. And still spiders!
IF YOU COULD GO BACK IN TIME, WHAT ADVICE WOULD YOU GIVE YOUR 18-YEAR-OLD SELF?
If I could go back in time, I would tell my younger self to be braver about taking chances. When two roads diverge, don't be afraid to take the one less traveled. When I decided to become a surgeon, I had no idea how I would fit healthcare policy into a surgical career. Since I was young, I'd always known that I wanted to work in some form of public service, and after working in Washington D.C., I had a passion for healthcare policy, but I didn't see how those would fit with surgery. However, during my medical school clerkships, I fell in love with wielding the scalpel. There was no place I loved more than being in the operating room. I had no idea how I would integrate these different passions, but I took a leap of blind faith and decided to do what I loved, and went into a surgical residency. However, there was a great deal of doubt and worry as to how it would all work out. If I could go back in time, I would tell my younger self, don't be afraid. Just do what you love, and be brave.
HAVE YOU HAD ANY MEMORABLE CELEBRITY ENCOUNTERS? WHAT HAPPENED?
I'm definitely not cool enough to get to meet celebrities! However, I did meet Dick Guttman, the author of Starflacker, which draws from his sixty years representing legends in Hollywood and shares stories about hard work, humility and compassion--uncommon adjectives in Tinsel town. Dick described how "Clint Eastwood can't stand not being expert at anything he tries, including making the jump from pistols to pianos." Dirty Harry would play the piano until his fingers bled. That kind of passion is truly the differentiator of success; it shows that "luck takes a lot of hard, smart work." Another interesting star that Dick represents is Jay Leno, a brilliant comedian with a quiet humility despite his extraordinary success. When Jay got his star on the Hollywood Walk of Fame, he didn't choose a spot in a posh part of Hollywood. Instead, he chose an inconspicuous location in front of the Ripley's Believe It or Not museum. This was the location where Jay was picked up on charges of vagrancy when he first arrived in California as a poor, unknown, aspiring comic. That night, the police officers drove Jay around all night while he entertained them, until they finally dropped him off without being booked. He's come a long way since his arrival in Los Angeles as a young unknown, but Jay humbly continues to share his talents, now helping veterans such as Corporal Ethan Laberge. Laberge, while on duty in Afghanistan, was seriously wounded by a suicide bomber. Jay surprised the veteran with a test drive in a new Dodge SRT Hellcat and then gifted the surprised soldier the car afterwards. Jay's humility, and his work to draw attention to the needs of our veterans, are truly commendable. Barbra Streisand is another larger than life superstar who uses her celebrity status to bring attention to worthy causes by investing in women's health. Barbra learned that heart disease is one of the biggest killers of women after her friend died from heart failure. Out of her grief grew her compassion; leading her to start the Barbra Streisand Heart Center which plays a leading role in investigating how heart disease manifests differently in women. From Dick's stories about Clint, Jay and Barbra, I learned lessons about hard work, humility and compassion.
WHAT GIVES YOU THE MOST HOPE ABOUT THE FUTURE?
There is so much reason to have hope about the future. I've seen the incredible resilience of the human spirit and the capacity for compassion. And that gives me reason to hope.
I've seen the incredible resilience of the human spirit. And that gives me reason to hope.
WHAT WOULD BE YOUR ADVICE FOR FUTURE FORTY UNDER 40 HONOREES?
My advice would be "Never, ever give up!"
DO YOU HAVE A BUCKET LIST? IF SO, WHAT ARE THE TOP THINGS ON IT?
I would love to one day go on an extended medical mission trip. I've never actually done a real, full time medical mission trip. During the recent flooding in Louisiana, I spent much of my time at the various shelters helping to coordinate medical relief efforts at the shelters. It was the amazing volunteer medical professionals from our community, as well as through the Red Cross and the National Public Health Service who provided direct patient care. But on occasion I'd get to actually sit down with a few people living in shelters and hear their stories. They told about literally losing everything; from family photos to their whole home being gutted by the floodwaters. But what I kept seeing throughout all these stories was a thread of resilience and compassion. One woman in a wheelchair talked about how another person in the shelter helped her get needed supplies, as she had difficulty navigating her way on her own in the shelter. Another person told me how they had lived through Katrina, Gustav and now the "Great Flood", and simply said, "I'm starting over again." These stories of resilience, courage and compassion are what nourish the soul and define our humanity. They also keep me grounded and remind me of where I come from. I myself lived in shelters when I was a young child, after we escaped from Cambodia and the Killing Fields. It was during this time in the Cambodian border refugee shelters that my family was injured by errant RPG explosives. A volunteer Red Cross Surgeon operated on my mother and me, saving our lives. I never learned his name, but that volunteer surgeon inspired both my sister and me to go into medicine. For me, it truly does hit home to see how medical mission volunteers can make such a tremendous impact in people's lives. So one day, from the top of my bucket list, I'd love to join a medical mission trip and work, not as a health official or administrator, but as a surgeon. Second on my bucket list, I'd love to get my book published, The Heart of a Tiger. My goal is to inspire hope and courage through this story of resilience. The message of The Heart of a Tiger is simple. "No matter how tough your circumstances are, never ever give up! Always have hope."
Dr. SreyRam Kuy is a surgeon and Chief Medical Officer for Louisiana Medicaid. Dr. SreyRam Kuy and Dr. SreyReath Kuy are the authors of the book, The Heart of a Tiger, for which they are seeking a publisher. This article originally appeared in Business Report as part of the "Forty Under 40" Award Profile. Read the original article here at Business Report.