Spotlight: General Surgery Resident Dr. Kathryn Taylor

General Surgery Resident Dr. Kathryn Taylor was the first Stanford Surgery resident to participate in a formal international clinical rotation since the COVID-19 pandemic.

We spoke with her about her experience and the motivations for participating in such an experience.

Q: Kathryn, tell us how you developed your passion for global health?  

A: I’m originally from Cincinnati, Ohio. After graduating from Ohio State University, I was debating between enrolling in a PhD program in a science related field or applying for medical school, but after I volunteered to assist in a free health clinic at my hometown, I realized how passionate I am about working with people and providing healthcare to the community, so I applied to medical school. I took a year between undergrad and med school and lived in Honduras where I participated in a research project with a group called Helping Babies Breathe, which is a neonatal resuscitation program.

I went to Harvard for medical school, and right after my first year I spent the summer at a Cancer Center of Excellence in Rwanda called the Buttaro Cancer of Excellence with Partners in Health. I did some research with them on pediatric oncology as I initially thought that is what I would specialize in when I got into medical school. Then in my third year I decided that I wanted to do general surgery instead.

I went back to Rwanda between my third and fourth years and was part of a group call the Program for Global Surgery and Social Change. In that role I worked on improving my non-technical surgery skills and with the Ministry of Health to create some baseline assessments for its national surgical plan.

So, would you consider that the first engagement with global surgery?

Yes, that was my first engagement with global surgery, but my first engagement in global health in general was when I worked in my undergrad in a program called Project Nicaragua through which I travelled at least once a year with other undergrad students to support an agricultural school.

I was very interested in going back for a clinical rotation in Rwanda, because the first time I went as a medical student it was research focused, and I didn’t then want to take away time from the clinical experience of the local medical students there, so I didn’t scrub in much in the OR to see what surgeries are like. Therefore, I was interested in going back and have a clinical role this time.

I also I met my husband who is from Burundi while in Rwanda, so I had both professional and personal reasons. On the professional side, I wanted to see what it’s like to operate there and get a better sense of what kind of cases they were doing, the resources they had, and the things that I didn’t experience as a medical student. While on the personal side, my husband hasn’t gone back to visit his family since he moved to the US in 2018, it was an opportunity for his family to meet our son for the first time.

Around this time I connected with Dr. Yihan Lin, who recently joined the faculty in cardiac surgery. She was trying to set up a bidirectional surgery rotation for general surgery residents in Rwanda. We had worked together when I was a medical student in Rwanda, and she was a resident at that time. We worked on research projects together, so we already had a prior mentorship relationship.

The timing was perfect, as Dr. Lin was interested in establishing the rotation and I was at the same time willing and able to go. We then reached out to see who a mentor for me would be.

Tell us about the clinical rotation in Rwanda. You were there from May 29th through June 24th, 2023.

I worked with Dr. Ainho Costas-Chavarri,  she’s one of the general surgeons in the Military Hospital in Rwanda. She was trained in the US, but she practices full time there and she maintains her US board certifications, so she was able to be my mentor for the rotation. This was important for gaining permission for such a rotation outside of the US.

Dr. Costas-Chavarri does a lot of breast surgery and surgical oncology in addition to operating on general surgery cases as they come in. It was great to see how she does breast and surgical oncology cases as well as the whole spectrum of general surgery. I spent my rotation at the Military hospital which has relatively more resources than other district hospitals. They have two operating room days per week while other days of the week were clinic days. I spent a fairly good amount of time at the general surgery clinic and the breast surgery clinic. I would also attend tumor board on other mornings before going with the on-call surgeon and resident to rounds on the hospital wards.

I also spent one day at a district hospital to work with a friend who is now an attending but was a resident when I was there the first time as a medical student. That was a good experience, to see how they operate in a lower resource center compared to the Military Hospital. They really created a great culture at that district hospital where everyone was working together as a team and the turnaround was quick and we did a lot of cases in one day.

I still wanted to see more, so I spent a day at a private hospital to see what it’s like there and get the experience in the private health system. There were a variety of cases that I saw between trauma and general surgery like feeding tubes or small masses that needed to be removed, some gastric cancer cases, esophageal cancer patients that were too advanced to have surgery but needed a feeding tube.

Can you reflect on the differences you noticed from what you are used to here in the US?

Unlike what we see here in the US where tumors and breast masses are usually detected by mammogram in early stages, there they didn’t have mammograms or regular screening programs. So patients used to come to the clinic just when they feel the mass, and in such cases the masses are large enough to be felt manually. Many of them were breast cancers in advanced stages.

Another thing I noticed is that they have no outpatient surgeries, so patients need to be admitted to the hospital the day before and many times they couldn’t find a vacant bed to admit they patient which adds another obstacles and delays patient care. The post-surgery recovery had just a limited number of beds, so soon after surgery patients are moved to the inpatient wards to recover there. The limited beds also reflect on the number and kinds of cases that could be done.

Another thing that’s different there is that when there’s a resident scrubbing in a surgery, the scrub-tech doesn’t scrub in because they want to conserve the gowns and gloves. So, the resident will additionally act as a scrub-tech and set the Mayo-stand and the instruments by themselves while doing the surgery.

The Military hospital has one CT scanner, and it was down when I was there, so for any CT scan they had to send the patient in an ambulance to another hospital. Getting the transportation arranged might take another 24-48 hours. All that adds time and the operation could sometimes be urgent.

For trauma cases, here in the US we see more of penetrating gunshot wounds, while in Rwanda I saw different cases such as a couple spear stabbing cases and also there was one patient that had a severe injury from grenade left over from the genocide, it exploded on him in the woods.

What do you see as the benefits of international bidirectional clinical rotations?

Residents who are interested in getting experience doing surgery in lower-resource settings will definitely benefit from a clinical rotation. It will help them learn how to think differently and what kind of resources you need for working up a patient or providing them with surgery.

At Stanford, there are 10 different kinds of G-tubes, for example, and you can get a CT scan at any time of the day. All the resources are readily available, but it’s not the same there. It could take you 24 to 48 hours to get a CT scan, and that won’t help when you have a patient who needs immediate intervention. The physical exam and health history won’t always give you all the information you need, but you need to rely on it much more.

Patients there have to purchase many of the supplies that they need for surgery by themselves, like feeding tubes for example when the hospital doesn’t have enough of them stocked. These things totally change your perspective about how work is done in other places of the world. It really makes you more appreciative of we have here, yet also makes you more creative about finding alternatives to solve a problem.

At the same time, if this becomes a routine bidirectional relationship, and international residents from LMICs come to Stanford either to participate in a clinical rotation, research rotations, observation visits or even workshops, it will give them access to educational resources that might not be available to them in their residency program. The benefit will double.

To clarify that, when I was there as a medical student, I learned that there are a lot of residents who were interested in being mentored in research because at the end of their residency they had to present a thesis project, but they had a limited number of faculty that they could use as mentors for how to go about their projects. There is a lot of interest in learning how to do research and publishing and describing what they see and opportunities for improvement.

Tell us a bit more about Rwanda.

Rwanda is an amazing country, but when I tell people here that I’m going to Rwanda they often immediately think about the genocide. The reality is that the country has progressed so much since that time. I’ve been there before but every time I come back there’s so much change. Rwandans are so nice, and they welcomed me warmly each and every time I came to visit, they’re so proud of their culture and how much their country has progressed.

The scenery of Rwanda is breathtaking. It is called the land of a thousand hills.

For me the best memories were spending time with my husband’s family. We spent every evening at their house with their big family. That was so precious, especially since we’ve been away for so long. My son was so happy to interact with his cousins there.