In celebration of Hispanic Heritage Month, we speak with Adela Casas-Melley, MD, Chair of Surgery, Nemours Children’s Health. She shares her journey from a young Cuban immigrant in Miami to a leader in pediatric surgery, how her family’s belief in education guided her, the challenges she faced, and the legacy she’s creating through mentorship and advocacy.
Watch the episode on YouTube.
Featuring:
Adela Casas-Melley, MD, Chair of Surgery, Nemours Children’s Health
Host/Producer: Carol Vassar
Announcer:
Welcome to Well Beyond Medicine, the world’s top-ranked Children’s health podcast produced by Nemours Children’s Health. Subscribe on any platform at nemourswellbeyond.org or find us on YouTube.
Carol Vassar, podcast host/producer:
Each week, we’ll be joined by innovators and experts from around the world, exploring anything and everything related to the 85% of child health impacts that occur outside the doctor’s office. I’m your host, Carol Vassar. And now that you are here, let’s go.
Hi everyone. We are teaming up with two Nemours Associate Workgroups, that’s Women at Work and Adelante, to bring you a special edition of the Nemours Well Beyond Medicine podcast. We’re celebrating Hispanic Heritage Month, and joining me right now is Dr. Adela Casas-Melley. She is here to share her extraordinary life, her journey from Cuba as an immigrant to Miami to becoming a leader in her chosen field, which is pediatric surgery. She’s joining us from her office, I believe, in Orlando. So welcome to the podcast, Dr. Casas-Melley. Thank you so much for being here.
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Thank you. Thank you very much for having me. I’m looking forward to it.
Carol Vassar, podcast host/producer:
So you serve currently as the chair of surgery for Nemours Children’s Health, but you were born in Havana and you came to the US as a child. You spent your early years in Miami. What was that like? How did it shape who you are today?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Well, actually, it is very much who I am today because I was an immigrant to Miami at a time when many people were coming from Cuba into the Miami community, and there was actually a growing population of Cuban immigrants that were settling in Miami. And it both made it a comfortable area for us to be because we had other people in the community that shared the same experiences, but also I was able to incorporate myself into the community of Miami and become a very proud naturalized citizen of the United States. So it really formed who I was growing up because I grew up in a very strong Cuban-American family that gave me the desire to really grow and continue to improve myself, to be able to serve that community as well as learning to become an American. It gave me both worlds.
Carol Vassar, podcast host/producer:
You shared with us that your parents instilled that, and I quote, “Education is the one thing no one can take away.” How did that mindset kind of influence your path to medicine?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
So that’s something that I think is very important in my family, and I think it’s important in a lot of immigrant families, because when you immigrate from your country to a new country where you don’t know the community, you don’t know the language, it is very important what you can bring with you. And my mom and dad actually were rather well off in Cuba. My dad worked for his father, who was a lawyer and a judge there, and had a very comfortable life. And when we came to the United States, that was completely lost because he did not have a degree. He did not have anything that he could really work with in the United States, and he had to start from scratch, doing whatever he could do to support his family. The same thing with my mom, and from a very young age, we were told, “You need to make something of yourself.
You need to educate yourself. You need to really work at having a degree because that is the one thing that nobody can take away from you. What you learn, what’s in your brain, what you’re able to provide to the community is something that is always going to be yours. No government, no other person can take that away from you because that’s something that you become on your own and that is yours forever.” My mom really made that important to us that education was very important to your success, and my sister and I both took that to heart.
Carol Vassar, podcast host/producer:
Were you the first in your family to attend college?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
I was. I was the very first person in my family to go to college, let alone medical school. And I really don’t understand what made me want to do that as I was growing up, because I did not have anybody in my family that had ever gone to college that was in medicine. But from a very young age, I can remember as an eight or nine-year-old being asked in school, “What do you want to do when you grow up?” And the answer was always, “I want to be a doctor.” And I don’t know why that was, because I did not have anybody that I could really follow as a mentor. It was just something I wanted to do from a very young age.
Carol Vassar, podcast host/producer:
Did you have challenges when it came to your vision from eight or nine to becoming a doctor? Did you have challenges in high school to get into college, college to get into medical school?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
There were a lot of challenges along the way. I did extremely well in grade school and in high school. I was involved in a lot of activities. I did very well in school, and I got into multiple schools for college. But I was challenged by my financial ability to go to school because I needed to go to a place that was going to provide me with enough financial assistance that I was going to be able to make it through school because I was very, very worried that yes, I could get into Harvard, I could get into whatever, but I wouldn’t have the money to be able to graduate, and I wanted to graduate and go to medical school. So I had to choose a school that I knew I was going to be able to support my way through. And I had to work full-time while I went to college and medical school in order to make it through because I did not have the ability to really depend on my parents to give me financial assistance. So I chose the school that gave me the most money.
Carol Vassar, podcast host/producer:
Where was that?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
That was at Emory University.
Carol Vassar, podcast host/producer:
Nice.
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
At the time, it was a small southern school that I was able to get enough money through scholarships to be able to pay my way through and work enough to be able to pay for the money that I needed for day-to-day existence. So that’s where I ended up. And I went through college, and I applied to medical school straight out of college. I didn’t get in, and I had to wait, and I went to graduate school, and I applied again, and I didn’t get in, and I was actually on my way to pharmacy school to become a PharmD.
And for some reason that year, Medical College of Georgia had accepted some students who eventually ended up getting a scholarship to go to Emory, to medical school at Emory. And then they decided to not go to Medical College of Georgia and go to Emory. And there were about 20 open spots that opened up last minute, like two weeks before classes started. And they called me and said, “Are you still interested? Do you want to come?” And I said, “Absolutely. I’m on my way.”
Carol Vassar, podcast host/producer:
There you go.
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
I quit my job, and got out of my apartment, and got an apartment in Augusta, and started medical school in two weeks. And the rest is history, as they say.
Carol Vassar, podcast host/producer:
You went on to become a pediatric surgeon. Now, not everyone goes into surgery. Not everyone goes into pediatric surgery. And as a woman going into that field, were you facing barriers? Were you facing any kind of issues that might’ve precluded you?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
When I applied to my general surgery residency, I was the only woman in my program when I started. They had only graduated one woman before that, and I was the only one at the time. By the time I finished my residency six years later, half of the intern class was women. So things changed dramatically within the time that I was there. But at the beginning, it was very much a male-dominated specialty, and it still is a male-dominated specialty, but I think women have made significant inroads into surgical fields. There are women orthopedic surgeons, women urologists, and we’ve really sort of gotten into the field, and pediatric surgery because of the fact that we work with children has been much more friendly to women in surgery than other specialties.
I gravitated towards pediatric surgery because I love taking care of children, and it has been a very great choice on my side. And when I applied, actually, there were only 17 spots for pediatric surgery in the country. There are 42 spots now, but there were only 17 back then. So it was extremely competitive, and I was very fortunate to get one of those spots and to make it to where I am today, but it’s been a great ride.
Carol Vassar, podcast host/producer:
Highly selective, highly competitive. When you look at women today who are looking to go into the field, you really do have a wonderful history of mentorship. Has that been important to you across time to kind of give back so you can make it a little easier for up-and-coming physicians?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Absolutely. I think that is one of the responsibilities that we have as women in medicine and women in surgery, is to really pave the road for future generations to be able to get to where we are with an easier path. It’s never easy because it’s still very selective and it’s still very competitive, but it’s a lot easier than it was when we were going through. It’s our responsibility to help them to make those choices that’ll help them to get to the position that we’re in. And I really mentored a lot of women that have come to me and said, “I was told that I really need to think about something else. I really shouldn’t put my eggs into a basket of wanting to do surgery or pediatric surgery.” I’ve always told them, “Don’t let anybody else really determine who you’re going to be or what you want to be.
If this is something that you really want to do, you need to go into it and give it your full force, jump in with both feet, and really work towards doing that. You have the ability to do it. Don’t let anybody else stop you. And if you don’t make it through and you have to change course in the future, then so be it. But don’t determine early on and block yourself from getting to where you want to be by not making the choices that you need to make to get there.” And I’ve been able to really help other women to get into the field and to be successful.
And I think when I leave and I’m done and I retire, that’s going to be the thing that I really want to look back on. My ability to get women into the field because I think women really have a very different way of looking at patient care, looking at surgery, and really provide a different aspect of medical and surgical care that men have. They think differently and bring different aspects to the field that I think are important and that we should be able to provide.
Carol Vassar, podcast host/producer:
What kind of aspects do you think women bring that perhaps men don’t?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Well, I mean, just because you’re a woman and the way that you’re raised and the way that you think, you think about things differently, and I’m not saying it’s better or worse, it’s just different. And bringing in those aspects of when you’re looking at patient care and saying, “Well, maybe we should think about this, maybe we should consider bringing in the mom and the dad and asking them for their input,” or just that more, it’s going to sound bad, but this more family-oriented, gentler way of looking at things that are not just black and white, that I think brings that aspect to the field that makes it a little bit more patient-friendly.
Carol Vassar, podcast host/producer:
As you look back at your mentors, it sounds like your parents were your first mentors, but as you were going through medical school and through your residency and through all your postdoctoral work and internships and all, who were your mentors?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
They were all men.
Carol Vassar, podcast host/producer:
Really?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Absolutely. And they were very, very important in my life and my career development. I had a mentor early on in my surgical career by the name of Ramit Howley, who was a pediatric surgeon who actually was a running back for Kentucky in college and was the first African-American resident at the Medical College of Georgia, who then went on to be a pediatric surgeon. And he was my mentor from very, very early on, was very supportive of my career and my development. We still talk regularly. I did have a female mentor during residency who was very supportive of me when I was later on in my surgery residency, Karen Yeh, who not only supported me as a person but financially supported me because, like I said, I struggled with my finances. And when I finished my residency and started my pediatric surgery fellowship, my mom and dad, my dad had a stroke and had to retire, and they didn’t have the ability to sort of support themselves.
So they moved in with me, and I had to sort of support them while I was doing my fellowship. And she actually loaned me money so that I could go and do my fellowship and have some money to help support us while I was doing my fellowship. So she was incredibly supportive early on. And then when I was a fellow, one of my attendings as a fellow, Steve Dunn, took me under his wing because I really was interested in doing pediatric liver and kidney transplants in addition to general pediatric surgery. And he was a liver and kidney transplanter. He took me under his wing, and I actually joined him as his partner straight out of fellowship. And he and I have been operating together for 27 years and still very, very, very close friends. So many of them, almost all of them, were men. And I’m very appreciative to them to this day.
Carol Vassar, podcast host/producer:
Well, it’s wonderful to have had that support when you needed it and for you to support others. I want to turn the conversation a little bit outward toward patients and families. I’m sure that you can relate to some of the barriers that they face outside of the exam room, housing, transportation, access to food, to healthy food that is. How do you work with patients to support them in overcoming those barriers?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Here at Nemours, one of the things that we are very proud of and that is the reason that many of us come here to work is because we really support a large part of the community that really struggles with what we call social determinants of health or their surroundings and the things that make it difficult for them to actually access the kind of care that they deserve. Nemours really serves a large portion of that community, about 70, sometimes up to 80% of the patients that we serve here at the hospital are supported through Medicaid, which means that they have really struggled with being able to do things like get regular transportation into clinic appointments, access to home health services, access to being able to pay for their medications, etc. And that is something that we deal with on a day-to-day basis. And questionnaires that we ask when they come in, I mean, do you have a car that will be able to get you home after you finish your hospital stay?
Do you have the ability to get back and forth to the clinic? And those things are just as important for us in taking care of them as their care in the hospital or their care in the clinic. And we have determined through lots and lots and lots of studies that only about 30% of what we do, taking care of these patients, is really what is important in the health of that patient and the health of that family. 70% of it is really their surroundings of their ability to care for themselves outside of when we have the control of taking care of them, and it’s their ability to get clean water, adequate food, being able to get transportation to and from their doctor, etc.
That really determines whether they’re able to follow through with the plans that we make or even get to the clinic to get the care that they need. Those programs, those support programs, are very important in not only the care of that one patient but the care of the community and the care of pediatric patients as a whole. And that’s why the well beyond medicine to us is very important because we know that if we can make sure that kids are literate when they start kindergarten, the chance that they’re going to graduate high school, that they’re going to go to college, that they’re going to have children that go to college and graduate high school, that they’re going to have less cardiac disease, less diabetes, less obesity, is all determined by the ability to be literate when they start kindergarten. So all of those things are important to determine the overall health of the community and the overall health of pediatric patients in the community.
Carol Vassar, podcast host/producer:
And you’ve done a lot to raise awareness within Nemours itself, including the COPE poverty simulation. You’ve done conferences on that. Why is it important to raise that awareness amongst your colleagues?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Because I think that as physicians, we get very tunnel vision as to what we do. We come in, we provide good care, and we think that by providing that good care with that patient, that we’re making a difference and we are making a difference in that patient’s life. But the real difference that we can make in the community and improving the health of pediatric patients in the community is really what can we do to keep patients out of the hospital, to keep patients out of our clinic by improving the health that they have on a day-to-day basis. And that really is by changing their ability to have access to clean water, to be food secure, to have access to good education, reading programs, things like that, is what’s really going to change the health of the community that we serve. And by opening up the eyes of the people that we work with on a day-to-day basis, making them aware of through the COPE, right?
They get immersed in what is it like to have an appointment to bring your child who’s got complex medical issues, and you need to be able to get that child to the clinic. But in order to do that, you’ve got to call Medicaid transportation. You’re dependent on Medicaid transportation; you’ve got to call them at least 48 hours before. And then on the day of the clinic, they don’t show up on time. So you show up late to clinic and now the clinic is telling you, “We can’t see you because you’re 30 minutes late.” You’re penalizing that child for something that was out of the control of the parents or out of the control of the child.
So we need to really change our mindset in that our duty is to take care of that child. And if they show up 30 minutes late because Medicaid transportation didn’t show up, we still need to take care of that child because they need the care. And that’s what we’re here to provide. And in order for us to do that and to change our mindset and to say, “I’m going to take care of that kid even though they’re 30 minutes late,” we have to know why it is that those things are happening. And if we don’t see that, we don’t understand what things that they have to live through to be able to follow up with the care that you’re telling them to do.
Carol Vassar, podcast host/producer:
And it sounds like you’re working with many outside organizations. You’re working with Medicaid transportation. You also work with other nonprofits. You, yourself, A Gift for Teaching is one, the Hispanic Chamber of Commerce, which probably gives you a sense of what is happening in each of those communities. Why is it that those partnerships are so important for Nemours and you yourself to be involved with so that we can help with these barrier gaps for kids and their families?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Well, A Gift for Teaching is a wonderful organization. They’ve been around for 25 years now, and they provide supplies for teachers and children that do not have the financial means to get those. So every year, we have an event where people from all over the city get together to pack backpacks for kids that are unable to actually provide those. So you don’t really think about it because for our kids, going to Walmart and filling up a backpack full of pencils and markers and crayons and paper, things like that, to us is just something that we automatically do. But there are families in our community that show up to school with nothing because they cannot afford paper, and pencils, and crayons. And to us, that seems ridiculous. How can you not afford that? But when you have to make the choice between putting food on the table or buying pencils, crayons, and paper for your child to go to school, the choice is to put food on the table.
So we’ve got to be able to provide those things to those children to make them be able to go to school, to not feel like when they show up to school and they don’t have supplies, that they’re different, that they’re lesser because they have to be able to learn. And how are we going to change the community? How are we going to make things better? How are we going to do generational change to these families if they can’t learn, like I said at the beginning, right? The one thing that people cannot take away from you is your education, what you learn, what’s in your brain. And we have to be able to provide that for these communities that are struggling because that is how they’re going to get out of that cycle.
That is how they’re going to be able to provide for their children and their family and make sure that their kids have supplies to go to school, if that is, that they can get that education. So a gift for teaching, I think, provides not only that for the kids, but for the teachers because the teachers are dealing with these kids on a day-to-day basis, and they’re using money out of their own pocket to provide these supplies. A Gift for Teaching provides the ability for the teachers to go and to shop for free, to get these supplies for these kids. I mean, it’s a wonderful, wonderful organization. And then the Hispanic Chamber of Commerce, we live in Orlando. I mean, we’ve got an incredible Hispanic community here that has really done great things in the community.
And being able to elevate the Hispanic community to know what they can do, to know the support that they have, to know that they have support within their community to really move forward and grow and develop businesses is important for us too, because that’s where we live. I mean, we’ve got an incredibly diverse community here in Orlando, which is one of the most wonderful things about the city. So being able to support that through the Hispanic Chamber is wonderful as well.
Carol Vassar, podcast host/producer:
You are a Latina in pediatric surgery. Now that’s a field we’ve talked about historically dominated by men, and your leadership journey has been wonderful. What advice would you offer to a young woman listening today who’s entering the field of medicine, maybe listening today to encourage her to keep going?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Well, I would say don’t set limits. Always think what it is that you want to do and find a way to get there, and find mentors. There are a lot of mentors, and they don’t have to be women. You just have to identify somebody that’s willing to really help you to open up doors for you, to write letters of recommendation, to make contacts so that you can get to where you want to be. It is a wonderful field, a wonderful thing to do for your life, and very, very fulfilling to wake up every day and to come and to make a difference in the life of other human beings, whether it be children or adults. So don’t get discouraged. Find people that will help you to get to where you want to be. They are out there, and they are interested in helping you and opening paths for you, and reach out and ask for help because there are people out there willing to do it with you.
Carol Vassar, podcast host/producer:
We’re celebrating Hispanic Heritage Month. We’re looking to the future. What kind of legacy do you hope to leave through your work in medicine, the community, education, and mentorship, which seems to be a big part of what you do?
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
As I look through my life and the things that I’d done, there are a couple of things that I am very, very proud of that I really want to leave behind. And one is my kids. I’ve got four beautiful, beautiful kid that have all done extremely well. They’re all boys, no girls, but they have turned into really wonderful, nice young men that are… Three out of the four of them are interested in moving forward in healthcare and medicine. So that to me is wonderful that they’ve seen it in their mom and they’re interested in continuing it in their life.
So that’s one. And then another is the people that I’ve been able to mentor through, some of them that have gone into surgery, some of them that have gone into pediatric surgery. And to see those people sort of grow into the field and become the physicians that I know that they could be. And also, what I leave here at Nemours Children, I came here 10 years ago to build the Department of Surgery. I think I’ve been fairly successful in making that happen, recruiting people to see the vision, to see the future, and to really move forward. The vision of Well Beyond Medicine and Nemours Children’s here in Central Florida. And I’m hoping that when I retire, I look back and see that I did something good.
Carol Vassar, podcast host/producer:
Hopefully not retiring anytime soon. Dr. Casas-Melley Adela, maybe, Dr. Adela Casas-Melley is the chair of surgery for Nemours Children’s Health. Thank you so much for being here and celebrating Hispanic Heritage Month with us.
Adela Casas-Melley, MD, Chair of Surgery, Nemours:
Thank you very much. It’s been a pleasure to be with you.
MUSIC:
Well Beyond Medicine.
Carol Vassar, podcast host/producer:
What an inspiration she is. I’m so glad we had a chance to catch up with Dr. Casas-Melley and hear more of the personal story that informs her professional life and achievements as a pediatric surgeon. Inspiring stories and the evidence-based information you need about what happens outside the doctor’s office and affects children’s health, that’s what the Nemours Well Beyond Medicine podcast is all about. Your episode ideas help us cover what’s of interest in that realm. You can let us know what those ideas are in two ways: by using this email, [email protected], that’s [email protected], and by voicemail on our website, nemourswellbeyond.org. The website is podcast central, where all of our past episodes live, where you can subscribe to the podcast and our monthly E-newsletter, and leave a review as well. That’s nemourswellbeyond.org.
Production assistance for this episode comes from Cheryl Munn, Susan Masucci, Lauren Teta, and Alex Wall. Video production from Britt Moore. Audio editing and production by Steve Savino and yours truly. Join us next time as we do our best to figure out teenage boys with help from expert guests, Christopher Pepper and Joanna Schroeder. Do join us. I’m Carol Vassar. Until then, remember, we can change children’s health for good, well beyond medicine.
MUSIC:
Let’s go. Well Beyond Medicine.
