Global Engagement Spotlight: Charles Liu

By Mohammed Al Kadhim

We caught up with Dr. Charles Liu, a general surgery resident at Stanford University, to asked him about a novel rotation he participated in during his third-year of residency. The rotation is a general surgery elective with obstetrics that focuses on teaching general surgery residents the techniques that are required to perform cesarean section and other common obstetric and gynecologic operations in settings where there is no other surgeon available. In the US this might be a rare scenario, but it is common in resource-variable settings.

Tell us about your interest in global surgery.

Charles Liu: “When I was in medical school I took a research year between the 3rd and 4th year and I spent it with a global surgery research group at Harvard. I spent most of that year in East Africa (Uganda). My advisor was an anesthesiologist and we worked on a project to study surgical outcomes in that hospital in Uganda. It was my first serious international experience and I learned how challenging it is engaging in global health work and trying to drive a project forward in a resource limited setting. I learned how important it is to pick a project that is sustainable and consistent, rather than something that just makes us feel better when we put on our CVs. Global work that we chose to do should have an impact that is real and that could last after you leave.”

What did this OB rotation mean to you? Why did you choose to take it?

Charles Liu: This rotation was extremely important to me because I had already been interested in global surgery. When I came to residency, I knew that I want to continue being involved in global surgery work. In my professional development period, I was more focused on domestic US health policy research projects but when I heard that there’s this opportunity to do an OB/Gyn elective rotation in my third-year residence I was very interested. As a general surgeon I think that if you truly practice in a limited resource setting then having basic OB/Gyn surgery skills could be lifesaving. I am lucky because when I started my rotation, the department decided to make it a formal rotation rather than an elective, so I had a role in creating a more structured curriculum together with Dr. Rachel Seay (Clinical Associate Professor in the Department of OBGYN), the attending who started this at Stanford. She had done a lot of work with MSF, and was the rotation director at that time. I was the first resident to do this rotation.

During my week rotation I scrubbed in 8-10 C-sections and probably did 3-4 of them primarily. I feel much better equipped now to do a C- section in an emergency situation, not as an expert for sure but doing it in the third year of residency enables me to realistically conduct actual steps of that particular surgery in detail. I feel that after that rotation I have way more exposure to obstetrics and gynecology surgery scenarios than the average American general surgical resident. Its an incredibly important skill you will need if you are going to practice in a resource-limited setting, its lifesaving, especially as C-sections are the most common surgery done worldwide”.

Does this rotation also give you skills and insights into how you can prevent infections and other surgery related complications?

Charles Lui: Not necessarily, we do learn how to deal with bleeding and infections that may be associated with any type of surgery, but if you are in a situation where you are the only surgeon available and the mother has no other option than to get a C-section such in obstructive labor, it could be more risk if not doing the surgery and could lead to death if not done as soon as possible.

Tells us a bit more about the rotation itself. How was your time structured, what were you doing? And why was it important to you?

Charles Lui: The rotation it was combination of taking care of actual patients as well as simulation sessions. During the three week period my schedule was to do 3 days a week in labor and delivery where I participated in doing C-sections. I also saw some cases of post-partum hemorrhage and learned how to manage them. I also had two different simulation sessions, one was a pregnant women with a cardiac arrest and the other was a whole set of situations of post-partum hemorrhages and complications from vaginal delivery and C- section delivery. So, I got to see real situations and also do simulations that are rare and not seen very commonly in real life but are very important to manage quickly and efficiently. These techniques are crucial especially for those who are interested in doing global surgery collaboration programs or participating in clinical rotation overseas, it is a key tool and might be lifechanging certain circumstances. I encourage medical students and residents to seek such experiences and build a skill package that makes them capable to perform what is needed at any situation they might be exposed to.