Humanitarian and Global Surgery with Kathryn Chu, MD

• Raised in the Midwest, Chu attended Stanford University for her undergraduate degree, and attended University of California, San Francisco for medical school, where she also completed her surgical residency. 
• Her early exposure to global health included teaching English in China and working in India at an eye hospital. Other experiences in medical school in Central and South America and Africa solidified her interest in global surgery.
• Chu received a Fulbright scholarship to study at the London School of Hygiene and Tropical Medicine, where she gained skills in epidemiology, biostatistics, and public health, particularly focused on Africa.
• She worked with Médecins Sans Frontières (Doctors Without Borders), conducting operational research to provide immediate practical solutions to improve patient care in Southern Africa. 
• After her colorectal fellowship at the Leahy Clinic in Massachusetts, she went to Zambia as a missionary surgeon and later transitioned to academic medicine, taking a position at Johns Hopkins, then as a surgical educator in Rwanda. 
• As the inaugural director of the Center for Global Surgery at Stellenbosch University, Chu focuses on improving surgical access and influencing health policy in South Africa and globally. The center conducts research aimed at informing policy and improving surgical care.
• Chu highlights the importance of working closely with policymakers to include surgical care in universal health coverage. She stresses the need for bilateral student exchanges and long-term commitments to foster mutual understanding and collaboration.
• She currently lives in Cape Town with her South African husband and twin children. She advises young people interested in global health to gain firsthand experience abroad, leveraging opportunities provided by academic institutions and programs.

[00:00:00] Rob Murphy, MD: Welcome to the Explore Global Health Podcast. I'm Dr. Rob Murphy, Executive Director of the Havey Institute for Global Health here at Northwestern University Feinberg School of Medicine. Today we have the pleasure of having Kathryn Chu, MD on our podcast. She's a general and colorectal surgeon who is a leader in the field of global surgery with a research focus on surgery delivery during humanitarian disasters and equitable access to surgical care. Born and raised in the United States, much of her career over the past 18 years has been based in Africa, where she has held several positions we will discuss today, including four years with Médecins Sans Frontières, Doctors Without Borders. Currently, she is director of the Center for Global Surgery at Stellenbosch University in Tygerberg Hospital in South Africa. The university is a hub of excellence in global health. We welcome her to the show today to talk about her career in global health and how it has evolved into the global south. Welcome, Kathryn.

[00:01:09] Kathryn Chu, MD: Thank you for having me, Rob.

[00:01:10] Rob Murphy, MD: Could you start by describing your upbringing to me? I understand you have a Midwest connection here, but you are also a first generation Chinese American. I would love to hear what your younger years were like and the foundation that you had before you launched a career in global health.

[00:01:26] Kathryn Chu, MD: So I was born in the Midwest in a small town called Columbus, Indiana. My parents were both immigrants. They were both born in China in the 1940s during the Communist Revolution. And both their families moved from China to Taiwan where they did their high schooling and their undergraduate degrees. Back then Taiwan and the U. S. had very good political relations and the U. S. was looking for graduate students in engineering. So they both came to the States, one for mechanical engineering and one for chemical engineering. My father ended up in Columbus, Indiana because it has a diesel engine company, and so I was born and raised in Columbus. When I was a child, I spent two years in Southeast Asia, my father was transferred to the Philippines when I was nine, and then Singapore. And I think those years were quite formative for me because Columbus had very few persons of Chinese descent, in fact, very few non white people. So it was quite eye opening, one, because there were a lot of people of Chinese descent living in the Philippines and Singapore, but also just for me to be able to see diversity in the world. So to me, that was very eye opening in terms of seeing people of other cultures. And I think that's how the passion for global, I think that's when the bug hit.

[00:02:44] Rob Murphy, MD: You received your undergraduate degree from Stanford University, and attended medical school at UCSF, University of California, San Francisco, and also completed your surgical residency there. At what point during this time did you decide you wanted to focus on global health? Most people we've had on the show say there was like one particular experience that ignited the spark to go into the field. Did you have anything like that?

[00:03:09] Kathryn Chu, MD: So I think the passion to work outside the U. S. came from the time in Southeast Asia. Then I was an exchange student in Mexico in high school. And then I spent one year between undergraduate, before I went to medical school, teaching English in China. And in part, of course, it was to explore my heritage. But I think after that I realized through a series of events there including meeting cousins whose family had never left China during the communist revolution that somehow me being raised in the Midwest sort of as an upper middle class person was really an accident of birth. I could have been raised in a country much less fortunate and I felt at that point that I needed to do something to give back to the world and I know that sounds selfless, but actually it's for purely selfish reasons. I just thought it would be really interesting to work in another place. And I also felt like growing up within the U. S., it wasn't something that I earned. It was just something that happened to me. So I think I was already exploring that thought. And then when I was an undergraduate, I had the experience of working in Switzerland at a women's hospital where I was the research assistant to an obstetrician and my job was to go to the cesarean sections and harvest the placenta for some research studies. And nobody in my family had gone into medicine. I was interested in science, perhaps human biology or genetics at that point. But I met some Chinese patients. And they needed a translator and I spoke Mandarin. And I participated in conversations between the obstetrician and the Chinese patient about the fact that her baby had a cardiac defect and what were the best choices for her baby. And I realized that medicine really combined the human element, working with people as well as science. And so at that point, this was part way through my junior year at Stanford where I went to undergrad that I decided I should go into medicine. So it took me an extra year to just apply. And as you said, I went to UCSF medical school. Then, in medical school, the best way to work abroad was to choose infectious disease as a specialty. And so I went into my first year of medical school thinking that. I found an infectious disease doctor who had a project in India. So I spent the summer between first and second year working at an eye hospital in India. And that was probably my first exposure to surgery because a lot of the ophthalmology is about operations. So I saw there how dramatic the effect of surgery was. Also, this hospital, Aravind Eye Hospital, it's actually quite well known. Intraocular lenses, which are placed in some people after cataract surgery, that implant is usually quite expensive if it's made in high income countries, but Save the Foundation taught the Aravind Eye Hospital how to make this themselves. And they were making it for less than a dollar a day, which that meant that their patients could get that at a much lower cost. And then they sold it to other countries of low and middle income countries. And so I think I became interested in what is now called global health after that experience. Then in medical school I decided that I wanted to see how medicine was practiced in other countries. I spent a year in South and Central America as well as in Africa and those places were Kenya and Lesotho and that's where I really saw surgery and its role in low and middle income countries because back then, this was the late 1990s, HIV was very prevalent in Africa, but there was no antiretrovirals back then. So that meant that the internists and the general doctors could do very little for the patients, at least 30 percent of patients were HIV positive that were coming to the hospital. However, the surgeons who were treating injuries, traumas, acute abdomens from other types of infectious diseases, typhoid perforations, they could still do a lot for their patients. And patients would come in half dead and then walk out a week later completely cured because the surgeons had addressed their sort of acute abdominal emergency or infection. And so that really struck me that surgery could do a lot of good in low and middle income countries. And so then I went back to medical school, determined that I was going to go into surgery, but then go back and work in now what is called global surgery, but back then it was just called working abroad as a surgeon.

[00:07:25] Rob Murphy, MD: Let's talk about the London part of your story. You received a Fulbright scholarship to study at the London School of Hygiene and Tropical Medicine, a very famous school, and you pursued a master's in public health and developing countries. What skills did you gain from this program that helped you with your career as a surgeon researcher?

[00:07:43] Kathryn Chu, MD: I went to UCSF for general surgery residency, as you mentioned, and most everybody took the career path, or I think it was required, of doing research. And I wasn't quite sure, at that point, how to marry my interests in working abroad in surgery. Most surgeons worked in translational labs or basic science labs stayed at the institution. I realized that one possible way of exploring this would be to go to the London School of Hygiene and Tropical Medicine because they had the MPH in developing countries and that was a fantastic master's degree because half of it was epidemiology and biostatistics, but the other half was really public health, mostly focused in Africa. And so I was able to learn all about conflict in health, about HIV, TB, Malaria. And so it really gave me the skillset of global health having only really learned about public health within the U. S. health system. The other thing that it really connected me to was persons that have been working in global health. Most from the NGO sector. The NGO Doctors Without Borders or Médecins Sans Frontières had several of their long term employees at that course at the time. There were also folks sent from the government of Zambia, for example, the government of Senegal who were public health specialists in those countries. And so I really learned a lot about what they did. And that was really inspiring. And also eventually offered me the career path to becoming long term in Africa, because the first job I took when I left the U. S. was with MSF or Doctors Without Borders .

[00:09:13] Rob Murphy, MD: During this time, in the late 1990s, as you mentioned the field of global health was really in its infancy. And, there weren't any established programs like the one you have at Stellenbosch University and ours here at Northwestern. So a lot of opportunities to do work internationally were tied to missionary trips. Many faith based organizations were sponsoring all sorts of programs around the world. After your colorectal fellowship at the Lahey Clinic in Massachusetts, you went to Zambia as a missionary surgeon. And you realize that type of work wasn't exactly what you wanted. Can you tell us about this particular experience and this kind of shift in your goals? This is an issue that is constantly comes up in the field, particularly among students. Whether you're doing mission work, you're doing academic work, you're doing research work there's a lot of confusion and there's a big difference between the three of them.

[00:10:13] Kathryn Chu, MD: Excellent point. First of all, mission hospitals and NGOs like MSF do amazing work and service delivery and they have for decades. And I think that they don't get enough credit because before the academic field of global health, they have been doing the work, but not really publishing or talking about it. So I think maybe just to say that off the bat. So my time as a missionary surgeon was fantastic. However, that mission hospital at the time functioned in isolation. So it was doing amazing work, but the government hospitals around it did not offer the same level or quality of services. And I felt that every patient we treated was one life helped or saved, but what was happening in the larger context in the government, like as a health system I didn't feel that I personally was contributing. For example, you know, we had pathology specimens that we would send to the University Teaching Hospital in Lusaka about six hours away, but it would take about three to six months to get those specimens back, and we didn't have any influence or say in the speed of the because we weren't really influencing the larger health system so I think that my time there made me more interested in trying to work for a larger health system where perhaps, the central influence could still have an impact.

[00:11:31] Rob Murphy, MD: I see that this experience that you had, led you to academic medicine. And early on took a position at Johns Hopkins, and you received a grant to study inflammatory bowel disease in Africa. And then you left to work at MSF, Médecins you said, in Southern Africa. Can you tell me about this part of your career and how it led you to focus on humanitarian surgery aspects?

[00:11:55] Kathryn Chu, MD: Yeah, so Hopkins had a fantastic position there, but it was U. S. based. And I think that my heart was really wanting to work full time outside of the U. S. And, I felt that working as a missionary surgeon, you could do great work, but you're really isolated to that hospital. I should mention, I think things have changed now since then, but at the time, if I was a missionary, surgeon, I would be at that hospital and not as aware of what was happening outside. The position with Doctors Without Borders or MSF was to do operational research in Southern Africa for the organization. And they had about 30 to 50 different projects going on in Southern Africa. So I could take a little bit more of a bird's eye view of the different programs, the medical conditions they were treating. And the research with MSF was practical. We looked at, for example, CD4 tubes that could withstand high temperatures and bumpy roads in Mozambique as they were being transported across. We looked at forming ARVE support group so that not all patients had to travel far to get their antiretrovirals, but the patients that were stable, one person could go bring the drugs for their whole community and only patients that were experiencing potential symptoms of relapse or biologic failure would then need to go into the hospital. And so our operational research was designed around immediately improving care. At the time we didn't do clinical trials, we didn't test new drugs or new products. And I found this type of research extremely rewarding because we had multiple programs and so you could look across several programs and see the impact of a change that was being made. Eventually, I focused on surgical care Because I'm a surgeon, and nobody had been really looking at that data, and at the time we had also about 30 surgical programs all over the world, and we held a database for many years collecting the same information across MSF, and it's the largest sort of humanitarian surgical delivery organization in the world and so that was sort of my entry into global surgery.

[00:14:00] Rob Murphy, MD: After leaving MSFyou stayed in Africa and you worked for Harvard Medical School as a surgical educator in Rwanda. What were the main challenges and successes during this particular period?

[00:14:12] Kathryn Chu, MD: Yeah, so this was a program that was funded by USAID. I think it was originally a PEPFAR money that the government of Rwanda actually applied themselves for human resources for a health grant, which they got. And the idea was over six years to bring specialists from the US to train their faculty to start or expand their postgraduate programs. After the genocide in 1994 they had restarted a medical school, but they didn't have. residency programs in public health or in surgery, pediatrics nursing. And so this was the gap that they wanted to fill. I really liked the method of the program. So they wanted faculty to come long term, a minimum commitment of a year, ideally even longer and the idea was to twin with the faculty in Rwanda. So not do direct teaching of the residents, but to teach their faculty how to teach and how to create residency programs. The challenge of the program was that there were very few faculty at what is now the University of Rwanda. And so they were often very busy clinically, and they weren't always available to be taught. And I think that's a consideration. You know, I think this whole concept of global health, which took off as an academic field in the US and other high income countries, has been to be interested in improving healthcare and teaching around healthcare in low and middle income countries. But sometimes they feel that we and I say we, because I'm from the US, had a bit of a colonialistic and a bit of a simplistic view that people, clinicians, faculty, students on the other side are always really interested in what we have to say whenever we feel like saying it. And I think that part of the program was the realization by the U.S. faculty, including myself, that yes, while they welcome this partnership, it is a partnership and they're not always available exactly when we want them to be. And they don't always agree with every teaching method that we have. That being said, I think it was a very successful partnership. And we also learned that, directly talking to the residents or teaching the residents was also a really valuable part of the program because I went back to the University of Rwanda to be their external examiner for their final surgical exams in the last couple years, and 13 of their faculty members, their general surgeons, I had helped train. They were interns or residents during my time there. And they definitely have established their own careers, but they've also picked up some of the teaching styles from the U.S. that I think have been quite beneficial like mentoring their trainees in the operating room by allowing the trainees to operate. That wasn't always the case before. So the stereotypical African training method would be that the surgeon would operate and the assistant would watch. But I saw that they were also doing a lot of, allowing the trainees to be supervised, but let them operate. So that was fantastic.

[00:17:11] Rob Murphy, MD: Now, as the inaugural director of the Center for Global Surgery at Stellenbosch University, you are bringing your skills and experiences together to lead one of the most prolific global research surgery units in Africa. Tell me about that center, its goals and objectives.

[00:17:27] Kathryn Chu, MD: We are a research center, and our main objective is to improve surgical access for persons living in Africa, but globally as well. We do all types of research. One of our aims, of course, is to be useful to influence policy. So in South Africa, like many African countries, there isn't a dedicated surgical plan within the National Health Plan. And so we have been trying to report to the baseline data the number of operations and the case mix done in different hospitals, the surgical workforce and what are the gaps and ways to increase and fill in the gaps of human resources and the operations happening. During COVID in particular South Africa was struck very hard. I know all around the world operations came to a standstill, but we already had large backlogs of surgical procedures and it got much worse during COVID. And so I think some of that has come out politically. And I think that it's in some way helped our cause. And so we've tried to capitalize on that in order to ensure that the government prioritizes surgery.

[00:18:33] Rob Murphy, MD: Another important part of your focus today, and you've alluded to this in some of your comments already, is working closely with policymakers to ensure surgical care is included in universal health coverage. Can you tell me more about the importance of this work?

[00:18:49] Kathryn Chu, MD: So right now is a pivotal time in South Africa because a few years ago, the government created the National Health Insurance scheme. So like the NHS in the UK, the idea is to have a set of conditions that are covered for all people in South Africa. The type of surgical conditions that will be covered and how it will be covered has not yet been defined. So I think that this is a pivotal time for the Center for Global Surgery at Stellenbosch to get involved so that surgical conditions that are more prevalent can be a part of this NHI. We're also working with the provincial government to try and define what type of surgical conditions, including operations, should happen at which levels of government hospitals. So here in South Africa, like other African hospitals, we have district hospitals, regional and tertiary hospitals. The vast majority of surgeons are concentrated at the tertiary hospitals and then followed by the regional hospitals. And the district hospitals, which are closest to the people who live in rural areas, don't have surgeons or anesthesiologists, thus making surgery very difficult to carry out and making the quality of surgical care even harder at those hospitals. So we are trying to figure out ways where a package of surgical care can be delivered at district hospitals, especially the most common operations. Cesarean section is the most common operation worldwide and accounts for almost a third of all surgical procedures. And being able to access safe cesarean care, for example, is very important. And while many of our district hospitals already do C sections, many don't. But there are other procedures such as hernia repair or incision and drainage of an abscess that are very common but patients are traveling hours or days just to get those procedures. And so we're trying to improve that as well.

[00:20:42] Rob Murphy, MD: While capacity building in the Global South is an important part of your center's efforts, there are opportunities for students from the Global North to partner with your center for research training. Can you tell me about these potential opportunities?

[00:20:56] Kathryn Chu, MD: Yeah, so we welcome students from all over the world who are interested in coming to work with us. One of the requirements is that the student is able to come for a minimum of six weeks, ideally longer. We are quite sensitive to past experiences of students and faculty coming for just a couple days taking data sometimes and then disappearing with it. We just had recently an experience where we saw a publication on our data without our knowledge or any credit to anybody in South Africa. So we're quite sensitive about making sure that the student is here for a length of time. Also, it's a better experience for the student because they also then appreciate the health system in which the information or data came from. So oftentimes data is just data can be found in a spreadsheet, but understanding the context from where it's from, if a student's interested in global health, I think that's quite valuable. So we do welcome undergraduate students. They often like to come in their summer, which is June, July, August. We also accept residents. Sometimes they're able to come for longer for an entire year during their research years. We have just started a Master's in Global Surgery, which is a research degree that can be done remotely, or the student can come to South Africa and do a project within South Africa. So we're quite excited about that. We're hoping also to get African applicants where they might want to analyze or conduct a project on their own surgical health system from their own country, but certainly U. S. students would be welcome to apply for that.

[00:22:35] Rob Murphy, MD: Those fabulous opportunities, and I echo your concerns about the visiting students. We have a policy ourselves at Northwestern that the students, the minimum is four weeks. my experience with Stellenbosch University, not surgery in particular, but including surgery was, it was a very popular place for our students to go.

Matter of fact, one of our parts of our agreements is that everything has to be bilateral and we actually even have scholarships to support the students from Stellenbosch come to the U. S. and it's really helped us help the students and I think everybody has benefited from that.

[00:23:10] Kathryn Chu, MD: I just want to echo that I think programs like Northwestern that emphasize that bilateral aspect are really important because oftentimes the Global North Universities come with the feeling of what can we get do for the Global North students, but they don't really think what can we also do for the Global South students. And oftentimes the limitation for the Global South students is the funding, the students here really just don't have the money to go to the U. S. even for four weeks. And so the fact you offer scholarships, I think it's absolutely fantastic, and I think that is the way forward in global health.

[00:23:45] Rob Murphy, MD: I have a personal question for you, if you don't mind. I understand that you and your husband have 11-year-old twins, a boy and a girl. Can you tell me about raising them in Africa and the family life you've created as an American living abroad? This is a big question that comes up with especially couples. And one person is interested in a global career. The other one may or may not. And they're concerned about having children and everything. You've been through all that. Can you tell us a little bit about that?

[00:24:12] Kathryn Chu, MD: Yeah. I guess living in Africa, there's 54 different countries. And so depending on where you live, the context would be very different. you know, someone says, what is it like in the US? And depends on which city in which state you're talking about. Of all the places that I've lived in Africa, South Africa, in particular, Cape Town is quite easy to raise children. The infrastructure is very good in Cape Town. We have multiple excellent schools to choose from, including an American school, international schools. Both my children go to South African schools, English medium schools. We do still have some challenges. We have electricity shortages. Often a few years ago, we had a very bad water shortage here. We are still living in resource limited conditions, but overall, it's quite easy to raise a family here in Cape Town. There are Americans that live in this town, but I have to say that. I think I'm thus far fairly integrated into the South African system. My husband is South African so that might be different than the experience of some of your students who might be going abroad with an American spouse. My husband is a wildlife veterinarian, and so his main interest is to stay in South Africa. And at the moment doesn't have a huge interest in moving to the U. S., especially not in urban area. The first two years of life, my twins were raised in Rwanda. And I do have to say that whilst the resources were much less there, that environment was very easy to raise children. It is a stereotype, but I believe it's true that Africans love children, and they were very tolerant of me bringing the twins to the hospital when needed oftentimes somebody would take one or both of them and disappear and take care of them and safety was never an issue in that type of environment. So I found it very easy to live in Rwanda when they were toddlers as well.

[00:25:58] Rob Murphy, MD: That's really a great experience, and thank you for sharing with us. I have one final question for today, and I ask this of all my guests, the same question. What advice do you have for young people listening who are just now embarking on a career in global health?

[00:26:13] Kathryn Chu, MD: So first of all, it is an exciting time to be interested in global health because 30 years ago there was no academic field for global health. There was no way to study at your university or you're in medical school or a public health program. So now places like Northwestern, very well established and have excellent partnerships around the world. And I think, as a student, you must take advantage of that. I think the first thing is if you're interested in global health is to go abroad with your university or a different program or on your own to see what it's like for yourself, because the idea of living in another place might sound great, but once you get there you could find out for better or for worse, things that you hadn't expected. If you're sort of ambivalent, you might find you love it. But you can also kind of envision for yourself if I did this as a career, how would it look for me? Because it will be different for everyone. There will be some people who go the academic route and who go overseas sort of two to four weeks a year and more in a sort of research role. Some will go into more teaching roles. Other folks will work for a NGO and maybe work abroad full time or travel a lot more. There are a lot of government opportunities now, or you might be like someone like myself who decides to move overseas and stay there and have your career at the other side. There are many rewarding careers in global health. In particular, if someone's a clinician, there's also the opportunity to be a clinician in another country as well.

[00:27:35] Rob Murphy, MD: Kathryn, it's been a great pleasure to have you here today and to listen to all your experiences, which are really so incredible. And I think you've really helped us a lot in your perspective in global health. And I just can't thank you enough. I'm so appreciative of what you've done.

[00:27:54] Kathryn Chu, MD: Thank you for having me.

[00:27:55] Rob Murphy, MD: Follow us on Apple Podcasts or wherever you listen to podcasts to hear the latest episodes and join our community that is dedicated to making a lasting positive impact on global health.