On a Humbling and Priceless Gift

On episode 6 of The Wealth Cast, Chas is joined by board-certified general surgeon and healthcare business leader, Anthony V. Coletta, MD, MBA. Since 2007, Dr. Coletta has been traveling to Haiti, performing general surgical procedures. Following the earthquake of 2010, he has led a team of doctors, nurses, and medical professionals on these missions, traveling to the island annually with medical supplies and performing general and pediatric surgery on hundreds of patients through the years. 

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Hello, and welcome to The Wealth Cast. I’m your host, Charles Boinske. On this podcast, we bring you expert knowledge and show you how to manage your wealth so that you can enjoy the luxury of financial independence and have more time to do the things that you love, like my personal favorite, fly fishing.

On this episode, we shift gears a bit to talk about one of the benefits of being a good steward of your wealth, and that is philanthropy. Today, Dr. Anthony Coletta is going to share his experiences helping patients in Haiti. Dr. Coletta is the CEO and chairman of the board for Tandigm Health, former president of Facilitated Health Networks, a division of Independence Blue Cross, and a former attending surgeon at Bryn Mawr Hospital in the suburbs of Philadelphia. I hope you enjoy the discussion.

Tony, thank you so much for joining me on The Wealth Cast. I’m really excited to have you as a guest, to learn more about Blue Sky Surgical, and what your experiences have been

It’s my pleasure, Chas.

Thank you again. So I think it’s just helpful for people to understand how you got started with Blue Sky. What was the inspiration? How did you develop the mission at the very beginning?

So really, the very beginning goes back to 2007. When I was at that point in my life, I was a highly successful general surgeon, but you know, getting sort of into a routine—I wouldn’t say a rut—but you know,, there always seemed to me like maybe there would be something more. I had just finished getting my MBA and I was just, I guess maybe it was a bit of a rut.

And a call went out over an email system by a nurse, vice president of a firm that I was working with, who asked for a general surgeon who might be interested in working in Haiti, because there they were working in a small clinic outside of Port-au-Prince. And the surgeon who was working there at that time was getting older—he was over seventy years old—so they were looking for someone to continue the mission of this tiny little clinic.

I didn’t even think twice about it—I immediately volunteered. Because it just seemed to me that one of the things that was most amazing things in my life was I had been given the gifts of the opportunity, the education, and then all these years of surgical training, I mean, and then operating for 20, 25 years, you gain this incredible skill set, which is needed. But you know, could I do more with it? And so I went in 2007 for the first time by myself to join an existing team, a missionary team, sponsored by a church here in the United States. And you know, it was that experience was fundamentally transformational, and I could tell a very quick story just to give you an idea.

Oh, please do.

So here I am, never been in the country before, never met the people I would be working with before—the anesthesiologist or anything, and never seen the clinic. The very first day I’m this clinic in Haiti, we’re in this little closet of a room that they call the emergency room—it was like the size of a closet. And the administrator for the mission said to me, “They have an emergency.” I’m like, “Really? An emergency.” And it turned out to make a long story short, this is a 50 year old father of five kids, these are very impoverished people—they’re living in a hut—who had indeed had a surgical emergency related to a trapped hernia, a valve obstruction. And we were able to save his life that day—in that day, in that moment. If we hadn’t been there, I’d said he’d have to go to a hospital, the missionary said there is no hospital. But we used the resources and skills that we had of the anesthesiologist and nurses. We fixed the hernia, we took him home later that day, and he lived, and survived—the father of five kids.

So it was transformational for me, I sat on the roof of the clinic that night, and I just couldn’t even comprehend what had just happened. And it dawned on me that I had been given these gifts, and that this was an opportunity for me to use those gifts in an extraordinary way to change the life of patients, one patient at a time, in a country where healthcare is almost non-existent.

So that was the beginning was just me working with others, and just this internal transformation of my view of myself and the world through that experience.

Yeah, that’s amazing. Can you, for the listener, sort of compare and contrast what you experienced when you walked into that operating room in Haiti, and what the facility was like, compared to what you were used to, I guess, at Bryn Mawr hospital at that point?

Yeah. I mean, it’s very, very, very hard to describe. Right, I mean, for 20 years at that point in time, operating in Bryn Mawr Hospital in the mainline health system, which has all the resources in the world. The zip code that the hospital is in is amongst the top 10 per capita income zip codes in the country. So, you know, I had the opportunity to care for patients from a full socioeconomic strata, but mostly the high end, and suddenly I find myself in Haiti—the first thing that they did, the missionaries did to give us a sense of the country that I was in, and the city of Port-au-Prince, was we went down into something called the Ravine, which is sort of this like, big crater in the center of Port-au-Prince, where it’s considered not the slums, it’s sort of the middle class of Port-au-Prince where one house was built. 50,000 people lived in this Ravine, on top of one another in concrete houses that had no building code, no construct, which later became essentially their burial grounds at the earthquake.

But that experience in the Ravine was my first clear view of abject poverty—the most clear view I’d ever seen. Like my son Nick told me that people only get that close to poverty by looking at pictures in Time Magazine, and here you could see it, you could smell it. And that was the first exposure to where I was, and then when we got to the clinic, just a simple that is not at all a hospital, a simple small, one room with an old anesthesia machine, which luckily, I was with an anesthesiologist who also was around my age, who knew how to sort of rebuild the machine a little bit—lights that go off and on, electricity that was very sporadic, you know—not the type of sanitary conditions at all that we would see in the United States.

But right at the outset, there were no resources. There’s no x-ray, patients can’t get blood, we did have oxygen. But what you learn, and why I learned very quickly, especially with that story the first day, saving life of the father of five kids, was that I had these skills that life had brought to me internally, that I could now utilize in a way that’s very difficult. You just don’t utilize those skills the same way when you have all the resources at the ready. You had to rely on yourself: your intellect, your sense, your gut reaction, the people around you, you know, your stethoscope. Basic doctoring, you know? And that became very appealing to me; it became very gratifying. Not in like a self-aggrandizement way, but just that I had these skills, I was able to use them, and what we did, we really worked really hard to apply the same standards of quality in an American operating room as best we could, in this small little, godforsaken place.

And that also became sort of a mantra of my team, the team we grew down there, was that, you know, we’re not going to take shortcuts. Just because we’re operating in an environment where we don’t have the resources that we need, there are certain fundamental things we could still do to bring excellence to this clinic and bring American surgical excellence to people who don’t even know in many cases where their next meal will be the next day.

It all sounds very dramatic, and in many ways, it really was. And each time we brought teams down, more and more people exposed to that, it became transformational for them to be part of the team.

Yeah, I can imagine how that would be the case. It seems to me that you would have to, you know, shed sort of the support you had of all the systems that you would have in a normal environment and get down to the real basics and core skillset that you would have as a surgeon or as a doctor or as a physician. That must have been terrifying and thrilling at the same time.

That’s it. That’s a really, really good way of describing it. Everything was, I mean, I had to operate on little babies, because, you know, there was no pediatric surgeons, and I was an adult surgeon. Before I went down, I had spent a day with a pediatric surgeon at CHOP in Philadelphia to watch him repair hernias, and I hadn’t done it since I was a resident. And so here they were, these tiny little lives in my hands, and I hadn’t operated on—and this is just for like simple things like hernias for babies and children. They don’t get fixed in Haiti. Little kids can die from a hernia, where in the United States, that’s essentially unheard of.

Right.

And so I really, there were many days I was down there, where I was terrified that I would make a mistake, and, you know, the other part of that is voodoo medicine is, you know, is very prevalent in Haiti and Voodooism. And we were—this was a white doctor in, you know, Western medicine, and they would look for the opportunity if we did something wrong or made a mistake, or someone died, to try and attract people into Voodooism and detract from our efforts. So it was that element of the unknown, which year, after year, I began to get more comfortable with that.

The real turning point for me was, so I started in 2007, but in 2010, I had left my surgical practice to work as an executive in a healthcare system. That was also important, you know, the “rut” bit. So this is three years into working at Haiti regularly, once or twice a year, with these other teams. In 2010, I had just joined as an executive in the health system, and the earthquake hit in Haiti. I knew where it had hit, I knew the people I knew the clinic by that point in time. I also knew the Ravine and knew that would be just a fall like dominoes, you know, a 6 to 6.5 on the Richter scale for 30 seconds. Approximately 200 to 300,000 people died in 30 seconds in the region of Port-au-Prince. I was in San Francisco, at my first conference with my executive team for the first time at a Ritz-Carlton in San Francisco.

The night before we left was when the earthquake hit. My wife, Karen called and said, “Did you hear about Haiti?” I hadn’t heard it turned the radio on. And I knew right away, it had to be probably one of the worst humanitarian disasters in the 21st century—it had to be. Because I knew what that region look like. Just the Ravine, all those people would die, those houses would topple on top of one another. And so from the Ritz Carlton, San Francisco, I packed my bags, I shipped them all home, I got $600 in small bills from a local bank, brought the clothes that I needed on my back, whatever I could carry, and arranged and did fly, from San Francisco to Miami and Miami to Dominican Republic, then was picked up by a missionary who I’d never met before, who drove me across the border into Haiti. And then for the next 10 days, you know, I was in the midst of that disaster.

I’d never been trained in trauma medicine, never been trained in disaster medicine. And, you know, obviously, you can imagine that was incredibly transformational, the fact that we could just bring people that were there, and the Haitians who were suffering so greatly through all of that—if they were in tents outside the hospital, you could go out and do rounds from 10 to 10, have people with horrible fractures, who would thank you for two aspirin and a small container of water.

And that became transformational. That’s really where Blue Sky, our effort began, because I made contacts. I went back again, three months later, where the after-effects of the earthquake were still there—basic health care had been destroyed, whatever there was—and had, in the course of the time that I worked down there, created a huge network of people who were interested in helping. Clinical people helping in Haiti. And I decided that was great for me to have worked with this other mission team, but, you know, I thought we had enough resources to build our own team, and I had enough resources at the time, you know, because of the blessings I had in being a successful surgeon, to take some risk and make and invest a little bit in both time and money to put together our own team, where I would know where we would go, what we would do, how we would do it, who would go with us, that almost every every dollar that we would generate would go into and somehow directly be deported to the patients in Haiti. 

And by building that network and having that experience, and having lived through that entire thing, the other thing is that earthquake disrupted missionaries who had been running that small clinic. There was friction between Haitian NGOs and American NGOs—you know, that type of disaster destroys relationships as much as it does buildings, and so it was time to build my own team, and that’s what we started to do.

And how did you fund it originally? How did you you know, getting the people, getting the various specialties to go along is one part of the journey, right? Then the other part would be using the connections you developed over the years there, but how did you fund it? And how did that all work?

Well, in the beginning, because I’m not the best fundraiser in the world—whenever necessary, I would use my own resources. I was increasingly, you know, by then I had, you know, moved out of the executive job, that health system into an executive role at a large insurer. So now, suddenly, my business or professional career was continuing to sort of, you know, skyrocket in a lot of ways—just lucky to be that way. That’s not meant to be bragging. So I found myself, after all these years now in a financial situation that was better than I had ever been in. So whatever needed to be funded in the beginning, I could do myself if I needed to.

We didn’t create a nonprofit, we didn’t do any of that, in the beginning—didn’t have time to really, you know, we were still working. And we would organize at least one full trip of 20 to 22 people. I recruited a pediatric surgeon so I didn’t have to worry about operating on those little babies anymore: bring an expert. And so myself and another general surgeon, and a pediatric surgeon, and two anesthesiologists—all of the professionals could pay their own way. The nurses actually were willing to pay their own way, and for those who couldn’t, I told them to come to me privately, you know, do whatever they could, but those who couldn’t, come to me privately, and I would pay for them. But we didn’t announce that, because people didn’t want to be embarrassed that they could maybe not afford to do it. 

Of course. 

But I didn’t want money to get in the way. And so we essentially self funded it ourselves, and then went to my contacts at hospitals and health systems, and asked for donations of pharmaceuticals and surgical supplies. Because the way we work now, Double Harvest, even though it’s a much better facility overall than the one we previously had worked at, that small, tiny one, doesn’t have any recurring source of supplies, so you have to bring everything down.

We got donations from a lot of local hospitals and health systems in Philadelphia, and word began to grow about this team, this Blue Sky team, and people at the local health systems, nurses, doctors would want to come. You know, lot of these nurses have come, and many of them have continued to travel with me since we started to develop our own team over many years. Because for them, it has also been transformational. You know, the Haitians are amazing, amazing people. Hheir gratitude is overwhelming when you get to experience it.

And really, quite frankly, not the kind of gratitude that you consistently experience in American healthcare. You know, there’s more, you know, a little bit more of entitlement, right? There, that’s not the case. You know, many felt it was miraculous that we could make somebody fall asleep, and then wake them up again. And when their families would be sitting with them in the recovery room and watch them wake up from the sleep, they just thought it was miraculous. I mean, it’s a very religious country.

And so many of the nurses wanted to just keep coming back, and it wasn’t until maybe three years or so ago where I was introduced to a benefactor who had never gone on a mission but was good friends with one of the nurse anesthetists, and a great, great guy and his wife, who pushed the issue of creating the nonprofit and beginning to start to try and raise some money and, you know, create a sustainability to the effort, which we think is really important.

I feel going back to the same neighborhood—they know us. I’ve met a doctor down there, Dr. Peter Perot, a Haitian doctor, primary care doctor who welcomes us, who sees patients ahead of when we get there, and sees our patients after we leave. So those kinds of local relationships are really important. And the people at the clinic—the Haitians that work there—they know us.

Yeah, the continuity must be really incredibly important. 

It’s just so important. And it’s one of the big shortcomings of what has happened in Haiti and other countries with, you know, NGOs, non governmental organizations, have sort of come in and come out. Come in, you do your thing, and you leave, and you know, we really have worked hard for continuity. I have patients when I go down, and I’m able to see patients who I see my charts on their dossiers, notes on the dossiers, from five years ago. And so these are people I’ve treated previously. It’s like my little surgical practice in Port-au-Prince.

That must be incredibly rewarding.

It is, and the people are so appreciative that we come back. Not only the patients, but the nurses and doctors who work at the clinic. And we’re not the only team that comes back. There are others that come back. And they’ve just very, very appreciative.

But you know, of course, recently, we’ve encountered a lot of problems with safety in the country. And I was there prior to a team traveling in, this past November—maybe it was two  Novembers ago, I don’t remember exactly—and it was a level four travel advisory. There was a great deal of civil unrest in the country. I made it in but not comfortably, you know? I had to have an armed escort, there were riots in the street, there were gunshots outside the hotel that I was staying in, and I realized I couldn’t never bring a team down under these circumstances.

But I was able to get to the clinic to begin to see some patients each day I was down there. Maybe we saw 75 patients in a couple days, and they don’t—even if you give them a diagnosis and say “We’ll be back,” they’re okay with that. You know, they can wait years. I’ve had patients who waited two years to get their hernias fixed. And I was down there in the midst of all this and this one patient, I saw, a gentleman, he had a hernia and he got up and he was laughing. And he was talking to Dr. Perot, and I’m not that great in understanding all the Haitian yet. And I said to Peter, I said, “What’s he laughing at?” He says, “He’s laughing at you.” I said, “What’s he laughing at me for?” He goes, “He says you’re a warrior. He says you’ve come down here under these conditions—the Haitians can’t even get to the clinic—and here you are, you’re a warrior, you got here,” and he was laughing at that. So we had a big laugh about that. So you know, it’s those little things that just make life far more inspirational than it could be.

Yeah, I can’t imagine how good that must have made you feel. And just the good feeling that you’ve got from that.

I think that’s, you know, if I go back to the theme of, you know, “The Wealth Cast”, I think I’ve been blessed in many, many, many ways, and now I have the financial security to even spend more time working in Haiti—which is my commitment, as long as I’m healthy—to be able to continue to do that. I’ve been able to experience life at a level I never would have been able to experience if I hadn’t had the opportunity to develop, you know, the personal and professional resources that I’ve been able to develop over time.

It’s not a dress rehearsal, and the opportunity to experience that part of life beyond the routine beyond the regular days, the regular things, is an extraordinary gift. It’s an opportunity to have it. An opportunity not to be missed. 

Wow. That’s really well said and inspirational, and thank you, Tony, for sharing those experiences. Because I think so many folks who have had the kind of success that you’ve had, are looking for opportunities, looking for ways to give back. You found a unique way that fits beautifully with obviously, with your skillset. What would you say to someone who’s at the same stage, career wise that you are that’s looking for that opportunity, and maybe thinking about pushing the envelope? Do you have any words of encouragement for them?

You know, I think that so many people in that stage in their lives have highly developed intellects and a significant amount of discipline and understanding and, you know, emotional intelligence, and you use that. I would say, follow your heart and take some risks. You got to take some risks. It doesn’t have to be, you know, the reckless risk. You won’t experience this unless you come out of your comfort zone. And I’ve been told by a lot of the people who travel with me to Haiti about how they’ve had to come out of their comfort zone. That’s the part about it not being a dress rehearsal, and you gain and grow in ways that you never would have expected. So follow your heart and be willing to take some risk and keep your eyes and ears open for the opportunity. It likely will come your way—you may not see it right away, but it likely will come your way.

Well, that’s again, well said. And thank you. Thank you so much for sharing that experience with us, Tony, and I hope we have an opportunity to catch up with you after a period of time, after you get back to Haiti and get an update of how things are, and how things progress. So thank you so much again for taking the time with us today. And I look forward to chatting with you next time.

My pleasure. Thank you.

Thank you for joining me and Dr. Anthony Coletta. I’m sure that you found his story about Blue Sky Surgical, and the great work that they do for the folks of Haiti, as inspirational as I did. For more information about Blue Sky Surgical, you can visit the links in the show notes. Thanks for joining us.

About Dr. Tony

Anthony V. Coletta, MD, MBA is a board-certified general surgeon and an experienced healthcare business leader. He brings an exceptional depth of executive and clinical expertise to Tandigm Health, LLC. Since 2007, Dr. Coletta has been traveling to Haiti, performing general surgical procedures alongside others. Following the earthquake of 2010, he has led a team of doctors, nurses, and medical professionals on these missions, traveling to the island annually with medical supplies and performing general and pediatric surgery on hundreds of patients through the years. He is a Fellow in the American College of Surgeons, President of Blue Sky Surgical Inc., Chairman of the Board of Tandigm Scholars, and a member of the Board of Trustees of Cristo Rey High School.