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Our advocacy team recently had the pleasure to connect with Dr Esther Chin, who practices in Obstetrics and Gynaecology. She completed her medical school and residency training at McMaster University, where she also currently practices. She also has a master's of Global Surgical Care at UBC, with areas of interests in global surgery and medical education. We were delighted at the opportunity to learn more about her inspiring work in global surgery!Â
CGSTA: What does a typical day in your life look like?Â
My days are "regularly irregular" so in lieu of a typical day, perhaps I can give you a sense of the range of days I have. If I'm outside of Canada, I can typically be found teaching clinical/surgical skills to medical students/interns/residents or nurse-midwives/Clinical or Medical Officers/GPs in English/French/Portuguese. I may also be teaching Global Surgery in an academic setting or alternatively, attending/speaking at a Global Surgery or Ob/Gyn conference. I may also be found in meetings with colleagues regarding Global Surgery partnerships. If I'm in Canada, I may be found in the hospital/clinic undertaking the usual Ob/Gyn activities. On my non-clinical days, I am usually developing Global Surgery or Ob/Gyn curriculum/teaching materials, preparing a Global Surgery talk, or in meetings with partners located around the world regarding partnerships. Most of this work stops when our daughter comes home from school until her bedtime, and then I try to squeeze in a few more hours of work before I head to bed! No matter where I am in the world, I may also be found working on research projects (writing/revising proposals, analyzing data, drafting/editing manuscripts, etc) &/or grant applications.
CGSTA: What is your favourite part about your specialty?
Ob/Gyn is a fascinating specialty that finds itself at the nexus of primary/specialist care, medical/surgical care, and preventive/curative medicine across all life stages from birth to post-menopause. No matter one's opinion on the specialty, the fact stands that every person reading this was birthed...and thus, their very existence was once affected by Ob/Gyn. The practice of this specialty transcends language, borders, socioeconomic strata, and historical era. Despite these great unifiers and the diversity of issues inherent to the field, it often remains an afterthought across all settings worldwide. In 2008, Dr. Paul Farmer stated "Global Surgery is the neglected stepchild of Global Health"; in my humble opinion and from what I've seen, heard, and experienced in this field, Ob/Gyn is the neglected stepchild of Global Surgery. As such, I see many exciting opportunities for growth, innovation, scalability, and improved advocacy in Ob/Gyn in all settings.Â
CGSTA: Why is global surgery important to you?
Global Surgery is a field of study and practice that focuses on vulnerable populations worldwide that is multi-sectoral, involving traditional healthcare/allied health professions as well as engineering, finance, media, policy, infrastructure, etc. Moreover, in lieu of the traditional vertical model whereby the world was viewed through a single-disease or single-issue lens, Global Surgery utilizes a cross-cutting approach that considers issues through a horizontal paradigm. In thinking about the Sustainable Development Goals (SDGs) and their rapidly approaching deadline of 2030, particularly SDG3 ("Good health and well being for all at all ages"), we will never achieve true health equity without consideration of surgical care systems. Specifically, the components of surgical care systems, how these components are interconnected, and the barriers that interfere with these connections. As a result, Global Surgery is indispensable in discussions of advancing health outcomes and improving equity between and within populations around the world. To borrow from the discourse around Obstetric Fistula, we cannot truly "leave no one behind" without Global Surgery.
CGSTA: What are some changes you would like to see in global surgery? Or what are some changes/improvements you have seen that you are excited about?
Ob/Gyn in Global Surgery has primarily focused on Cesarean sections (CS) given that CS are one of the Bellwether procedures, are the most ubiquitous procedure performed, are both life-saving and disability-averting, and were among the first and are the most common "task-shifted" procedure. However, Ob/Gyn goes beyond birth and comprises an array of issues including comprehensive fistula care, cancer care, prolapse care and surgery, and benign gynecologic conditions (BGCs)...to name a few. For example, although it is seldom discussed, the YLDs (years lost to disability) from BGCs are greater than the YLDs from malaria, TB, and HIV/AIDS combined! I am therefore looking forward to improved representation of Ob/Gyn's extensive medical and surgical breadth in Global Surgery discourse/literature and for Ob/Gyn issues to be increasingly audible and visible in this space.
CGSTA: Highlight a recent trip - or your favourite trip
In lieu of discussing a particular trip, perhaps I can highlight a partnership as ongoing relationships are a more sustainable approach to Global Surgery initiatives. I have been very fortunate to have been introduced to and warmly welcomed by the University of Global Health Equity (UGHE) in Rwanda along with the Rwanda Society of Ob/Gyns (RSOG). I have had the privilege and honour of teaching UGHE's medical students, supporting Ob/Gyn clerkship planning, and teaching the Master's of Global Health Delivery students in the Global Surgery track. UGHE has become a regional hub for medical and academic training and I cannot think of many other places in the world where nine graduate students from five countries have the opportunity to gather and cross-pollinate ideas. As they were tidying up name tags around the U-shaped table one day, a student remarked "this feels like the UN...literally!" Similarly, through an ongoing collaboration between the Society of Ob/Gyns of Canada (SOGC) and RSOG, I have had the privilege of supporting the EmONC (Emergency Obstetrical & Neonatal Care) course and have met and worked with nurse-midwives, GPs, and Ob/Gyn colleagues from around Rwanda. I am grateful to have been welcomed so warmly and I continue to learn much from students and colleagues alike. I very much look forward to our ongoing partnership!
We thank Dr Chin for her time and for sharing her insights. We hope this was inspiring to other learners as it was for us!
CGSTA Advocacy Team