Dr. Esther Chin, MD, FRCSC, is Obstetrician/Gynecologist from Hamilton, Ontario, currently enrolled in the MGSC program. She is an Assistant Clinical Professor (Adjunct) in the Department of Obstetrics & Gynecology at McMaster University. Dr. Chin completed medical school and residency at McMaster University in Hamilton, Ontario. She is passionate about global surgical care and has many years of experience in Rwanda, Uganda, Angola, Zimbabwe, and Guatemala. Her interests in global surgery are obstetric fistula, maternal health, medical and surgical education
Read on to find out more about Esther, her background and experiences, what lead her to the field of global surgical care and the MGSC, and more!
What has inspired you to study and work in the field of global surgery?
At the end of my first year of medical school, I was at a rural hospital in the mountains of Rwanda. Two of three Cesarean sections had resulted in pulseless infants. I still recall the deafening silence, punctuated only by the periodic puff of desperation of the handheld bag-mask as staff tried to resuscitate these babies. The absence of the arrival-announcing cries was a familiar scene to the staff but I, only three weeks into my first medical school elective, was stunned. It was inconceivable to me that childbirth, so often a joyous occasion in North America, could culminate in such tragedy.
This experience was the major impetus in shifting my career aspirations away from other surgical specialties toward Obstetrics and Gynecology, with the specific intention of addressing morbidity and mortality in this discipline in low-resource settings. I am encouraged to see that maternal and child health has been at the forefront of conversations in global surgery. However, much work still needs to be done in the realm of obstetric fistula. Currently, only one in 50 women suffering from fistula undergoes a repair. The other 49 in 50 continue to live with this life-altering disability of urinary and/or fecal incontinence, which leads to a cascade of socioeconomic consequences that has widespread ramifications for their families, communities, and countries.
What are some of your hobbies & interests (cooking, sports, travelling, etc?) What do you love to do in your spare time?
Puttering about in our small urban garden is my little escape and I love antiquing – my husband says I have the hobbies of an Edwardian lady. In my defence, I also thoroughly enjoy teaching our 7 year old daughter how to play volleyball, going for family bike rides on Hamilton’s spectacular trails, getting competitive on the basketball court with my husband, or spending a day at the beach and fruit stands in the Niagara region. I also love travelling with my family and have a soft spot for anywhere by the ocean with incredible local food. I adore reading and am currently working through Medical Apartheid by Harriet A. Washington. When time permits, I’m hoping to take up the cello.
What advice would you give to prospective students?
Don’t be afraid to explore global surgery from an early stage. Attend conferences, seek out global surgery groups at your institution, find mentors! Also, don’t hide your interest in global surgery when applying for residency programs or when looking for a job. Programs, departments, and groups of colleagues that are supportive of your passion will be a better fit for you and will permit you to take the time you need to pursue global surgery endeavours in the long run. These individuals will be among your greatest allies. Finally, consider UBC’s Master of Global Surgical Care…or get your feet wet with a course or two. The profound breadth and depth of knowledge you will gain is astounding and will provide a foundational systems-level understanding of global surgical issues that will complement your clinical experiences in such settings. I have found the online forum discussions among my course-mates, who come from a variety of professional backgrounds and settings, to be incredibly enriching.
I understand you have lived and worked extensively in LMICs providing obstetrical and gynecological care. What inspired you to work in low resource settings and what are some of your key lessons learned and experiences that you would like to share with our readers?
From menarche to menopause, Obstetrics and Gynecology in low resource settings present a myriad of challenges, many of which I have witnessed. Care for obstetrical patients is rife with difficult decisions and heart-wrenching outcomes when faced with minimal access to oxytocin, obstructed labour resulting in stillbirth, or septic abortion in the absence of intensive care. Gynecology patients may suffer for long durations due to a lack of access to care. I have seen an undiagnosed molar pregnancy progress to acute thyroid storm with no access to a blood bank nor chemotherapy while an octogenarian on a different continent waited for years for her Stage 4 uterine prolapse (uterus prolapsing outside of the body) to be addressed with a vaginal hysterectomy. This ongoing pain and suffering, alongside the tragic loss of maternal and neonatal life in largely preventable scenarios, has inspired me to work in such settings. In this field, the most basic and often inexpensive interventions can be lifesaving and alter the entire trajectory of an individual’s life, if not an entire family’s.
One case from my time in Angola stands out in my mind. While at a remote hospital that was accessible only by Cessna plane, I met a 20-year-old who had undergone an emergency preterm Cesarean section a few days prior for eclampsia. Her blood pressure had been challenging to control and she had such severe disease that she had become anuric and was now blind. Her baby had also died. Without dialysis or any way to access higher-level care, there was little that could be offered at this remote hospital and her family could not afford to arrange transportation to a larger centre. I recall an immense internal tension; simultaneously wanting to do everything and yet unable to do anything at all. Over time, and through debriefing with mentors, I have learned that it is normal to feel helpless when witnessing such injustices. The desire to want to help every individual and address every systems issue must all be held in balance. It is a journey to figure out where one can best contribute but identifying where these needs exist is a start. No one will be able to do everything and be everything to everyone, but we can each play our part with our individual skills and interests within the spheres of influence we inhabit. Every little bit counts towards alleviating suffering, giving voice to those who have none, and addressing policy so that wide-sweeping change can and will continue to occur.
Is there any work/document/article that you are currently working on that you’d like to promote? Our community would love to find out what our students are currently working on. How can our community learn more about you? (Website, LInkedin, Youtube, etc)
Thank you for reminding me that I ought to have more of a social media presence professionally. I am on Twitter but am embarrassingly inactive on the platform (@estherchinmd). I am currently working on my Master’s project in which I am investigating global surgery interest among trainees at McMaster University. I am excited about my upcoming elective course through Johns Hopkins University entitled “Essential Skills for Women’s Leadership in Global Health”. My next steps are to explore how I might work to help eradicate obstetric fistula.