There was a 3 percent chance that the mole on 16-year-old Jacob Rubio’s forehead, which he had had since birth, might turn cancerous. When his mother, Juliann Castillo, noticed some lumps in it, she grew worried and requested a surgery to have it removed.
But Medi-Cal considered the procedure cosmetic and denied it, and Castillo, who is on disability, could not afford to pay for it herself, she said.
Then, on July 20, Jacob received the surgery he needed at no cost, thanks to a collaboration between the Burbank-based nonprofit Mending Kids International (MKI) and Cedars-Sinai. He was one of 18 children who benefited from surgeons who volunteered their time and $50,000 in donations for supplies.
Called a “hometown mission,” because it took place in the United States — MKI usually transports doctors abroad — this event served both domestic and international patients. MKI flew kids in from El Salvador, Ethiopia, Ghana, Guatemala and Kenya to undergo procedures at Cedars.
MKI Executive Director Marchelle Sellers said the organization, which provides surgeries to children worldwide and has in the past brought foreign children to Cedars for treatment, had been questioned in the past about not helping kids in the United States who also need help.
“When we started looking around, we realized that was true. Kids were falling through the cracks,” she said.
It’s hard to deny the need, even for some families who have insurance. One family helped by the inaugural hometown mission was unable to pay the $5,000 deductible required before their insurance would cover a procedure.
Children from other countries generally are referred to the program by parents, missionaries or visiting medical professionals. During their time in the Los Angeles area, the children stayed with host families who accompanied them to appointments and cared for them before and after their procedures, which were either cosmetic or urological.
Jacob and his mother, who live in Bell Gardens in Los Angeles County, were driven to the surgery and necessary appointments by an MKI sponsor, who helped them through the entire surgical process.
Dr. David Kulber, director of Cedars’ Center for Plastic and Reconstructive Surgery and a volunteer with the hometown mission, said the event was partly to give MKI donors a chance to see the organization in action. He called his work with MKI and other charitable foundations “the most gratifying thing I have done as a physician.”
Kulber said one of the biggest challenges is gaining the trust of children from other countries who may be experiencing culture shock after coming to the United States to receive their surgeries.
“That’s the real challenge … to get them to trust you,” he said. “It’s really about building trust with the child.
“The beauty of medicine is we all speak the same language: It’s about the human body and how to fix it. … [This] trumps any other cultural differences we may have.”
Kulber belongs to Valley Beth Shalom in Encino and believes that his Jewish background has affected his medical philosophy.
“Treating everyone equally without any prejudice is a lot of what Judaism is about,” he said.
Although MKI provides all kinds of surgeries, including cardiac and craniofacial, the July 20 event focused on cosmetic and urological outpatient procedures. Performing these surgeries in the context of MKI can present challenges.
Dr. Andrew Freedman, director of pediatric urology at Cedars, said many urological procedures traditionally depend on having access to a catheter. If those will not be available to children when they return to other countries, then he must arrange for their drainage to be different.
“You’re relying on people who work in a very different system. … We can’t put them in a situation where, if something goes wrong, they will get really sick right away.”
Freedman said he is grateful that MKI is generally “very sensitive” to follow-up issues and he looks forward to more such missions in the future.
“Helping complete strangers from the other side of the world … is very consistent with your Jewish values,” he said. “We hope this becomes a recurring event.”
The procedures may be cosmetic, but many of them will have enormous impacts on children’s lives. One patient could not move an arm because of contractures from burn scars. One boy, who is returning for his second surgery with MKI, had tumors removed from his hands so that he could regain some use of his fingers.
The tumors and lumps removed from patients often were uncomfortable rather than dangerous, but as in Jacob’s case, the lumps must be removed and biopsied to know for sure.
Addelyn Del Cid, a 6-month-old dressed in pink and sparkling dot earrings, was brought by her family to remove a lump on her leg. Follow-up tests determined that she has a rare condition that currently poses no threat. The family said they would have been unable to afford the procedure otherwise.
The benefits of an MKI procedure can transcend the medical results.
“We have a boy coming in who has a mass growing on [his] ear, but he is going into kindergarten. … His mom is just desperate for someone to remove it so he does not have to face a childhood of bullying,” MKI’s Sellers said. “Literally an hour in the operating room is the difference between having a normal childhood and one that would be filled with constant teasing.”
Such was the case with Jacob.
“He got bullied a lot,” his mother said, remembering classmates and even family members taunting him about his birthmark.
Castillo is glad that she will not have to spend her entire life worrying that her son might be sick — the biopsy found that Jacob’s mole was benign.
“I am just grateful and blessed we [had] this opportunity,” Castillo said.