This Globe-Trotting Brain Surgeon Says Doctors Are Doing Medical Missions Wrong

"You can't just go down there, drop some money, do a photo-op, and come back," Rahul Jandial says about doctors who travel to hospitals in poor countries.

VICE Staff

VICE Staff

All photos courtesy of Bil Zelman

Rahul Jandial is one of those people who makes you feel bad about what you've done with your time on Earth. Now 43, Jandial became both a brain surgeon and scientist—an MD and a PhD—close to the age of 30. Last year, he earned a $700,000 grant from the Department of Defense Breast Cancer Research Program for his work studying how breast cancer spreads to the brain. A TV critic (he appeared on a program called Superhuman as a brain expert) once called him "the world's most dashing neurosurgeon." In other words, Dr. Jandial is essentially the human equivalent to the "100" emoji (plus the doctor one, of course).

Employed by City of Hope, a hospital in Southern California, the doctor performs neurosurgery at least two or three days a week, and runs a lab doing cancer and brain research another two days a week. Jandial also regularly travels to children's hospitals in underserved countries like Ukraine and Peru to perform surgical missions he organizes through International Neurosurgical Children's Association (INCA), a nonprofit he founded and serves as the director of. He follows-up on these trips by publishing papers in peer-refereed journals about the ethics of surgical missions, a practice that many doctors engage in but few do right, according to Jandial. Oh, and he's also hosted a National Geographic Channel doc with Bryant Gumbel on brain surgery.

VICE recently talked to him about his travels, the brutal techniques brain surgeons in poor countries have to adopt, and common mistakes doctors make when they go on missions abroad.

A bare-bones operating room in Kiev

VICE: At this point in your career, do you feel like you've made it as a doctor and scientist?
Dr. Rahul Jandial: It's cool being featured on these shows, but that's not really my thing. Helping people is my ambition. I never get that twisted. Recently, I received some recognition from three major institutions ... medicine, surgery, and science. That meant a lot to me. Six months ago, I was accepted as a diplomate [meaning he was certified] of the American Board of Neurological Surgeons, and the US Department of Defense gave me the Breakthrough Award for my scientific work. Most importantly, my employer, City of Hope Cancer Center, promoted me after inviting outside experts to vet my resume.

And you run a nonprofit, INCA. What does that group do?
Well, first of all, it's completely under our control. INCA's out of pocket; it's our money, meaning me and Mike Levy, who's the head of pediatric neurosurgery at Rady's Children's Hospital in San Diego. The idea for the nonprofit came when I was 29 or 30 and started seeing those ads for doctors who were fixing cleft palates abroad. But the twist on that was that the things that were being done... they were elective, or what we call "schedulable." It's important, but it's not always life-or-death. So we're were like, Who's gonna do brain surgery on children? That need pops up all the time.

I came up with this idea that we were gonna go to underserved countries, handle some [brain surgery] cases, give charity hospitals some of our used medical equipment—which, to them, is gold—we're going to teach local doctors certain skills they don't know through surgical collaboration, and then the local doctors will be able to keep crushing it the other 51 weeks we're not there. Our first trip was in 2003 when we went to Lima, Peru.

How did you pick the hospital you worked with there?
I started sending email blasts to cities with notable academic institutions or charity hospitals because we don't want private hospital dudes trying to make money, take our donations into private practices, or take advantage of the services we're offering. I'm not judging them at all; they're under a lot of pressure. They don't make a lot of money.

We started doing that reach out, and after people began responding, we sent them follow-up questionnaires. Then I flew down to Lima on my own dime when I was a resident, and I had to shake hands and see that these doctors we were speaking with were on point. Were they really down to help the poor in these charity hospitals? There's no money, there's no glory. There's just private, personal satisfaction.

So I met this guy named Victor Luis Benllochpiquer [head of neurosurgery at Maria Auxilliador a Hospital] in Lima, and he was down to collaborate. He's a real soldier for the poor. We saw that the neurosurgeons at this hospital had skills, but they didn't have equipment. I brought him the used gear we were gonna throw away in the US, and his eyes teared up. So Mike and I started going down there three, four years in a row, and we ended up bringing him a microscope, drills, teaching him this new camera technique for surgeries. That was the original site, hence the acronym INCA.

What was the state of the hospital like?
The interesting thing about these charity hospitals is you've got the building, but there's nothing inside. The kids in Lima are facing the same medical issues as kids in the States. But if a kid is sick in a place like Lima or La Paz, Bolivia, mom's gotta get the kid on a truck or a bus and bring them to the one hospital, and then there are just a handful of doctors there. So you have all of those sick kids, limited doctors, limited supply—it's a real bottleneck. But it's also, for me, a place where you can have a high impact.

A Ukrainian nurse attends to a sick child.

What are some of the biggest issues facing surgical missions today that you think people should be more aware about?
I always ask , Are you doing the most you can, using the resources you're given? Because you should go on your own time, your own dollar, and when you're there you shouldn't waste a single penny. Or, are you just going to make yourself look legit in the States? This shouldn't be something you do for self-marketing and branding. It's a life journey that sometimes gets shared.

So that's one conflict and another is the follow-up. What happens when you go on a surgical mission for two or three days and leave and then there are issues? Who's gonna handle those issues? Some patients have to go back to the operating room; some patients' wounds open up. This is a structural plan that people going on surgical missions need to consider.

Finally, the host neurosurgeons. Have you really picked the crew that's gonna be perpetuating the largesse and the information? Or did you just pick somebody who's receptive to you going down and taking some pictures? These are all essential questions. You can't just go down there, drop some money, do a couple things, do a photo-op, and come back.

Jandial getting ready to operate under the glow of an operating room light.

What were some of the strangest or most surprising moments from your trips?
When we went to Kiev, they picked us up in a red van with a marijuana leaf on it. And then the super, super tough-looking driver was smoking these super, super slim cigarettes. I sat in the front with him and I buckled up. And he looked at me with his slim cigarette and he was like, "Nah, nah, nah. Real men don't wear seat belts."

And there are amazing stories about how we learn from the doctors we visit in these underserved countries. We learn about efficiency, and making use of resources. For example, I remember seeing a doctor in Lima cut off the heel of a glove to save money because they didn't have rubber bands. The hand drill is the best though. When they're doing brain surgery, they use a hand drill to get to the bone. It's got a ball with a handle like you would see on a hand drill you'd use for home renovation. The doctors there lean on the patient's head and spin the drill as hard as they can, and that's how they make the first few holes to get through to the skull. And then they put a wire through there and saw it open, MacGyver-style. And it can work, though we're obviously donating our equipment for a reason.

What's next for you and your work?
I've worked with about four or five hospital in foreign countries in the past decade, but I have about 20 more on my mind. We're going to beef up these operating rooms and help these doctors become the lifesavers we know they can be once they have the right materials and training. We're going to do this at children's hospitals all around the world, and I'm trying to plough through them as my own life legacy.

To learn more about INCA, Dr. Jandial's charity organization, visit the project's website here and City of Hope's website.

See more photos from Dr. Jandial's surgical mission trips below.

Mike Levy and Dr. Jandial after a long day of operating during a surgical mission.

American and Peruvian doctors discussing details of operative strategy as other members of their team put a patient under anesthesia.

Dr. Jandial outside the operating rooms in Kiev, where doctors change into scrubs