Stephany Kim, M.D., Reflection – Pilot survey for developing a resident global surgery clinical and research rotation in Cuenca, Ecuador 

Stephany Kim, M.D., a MUSC general surgery resident, was awarded a Center for Global Health Student & Trainee Travel Grant to pursue a global health project in Cuenca, Ecuador. View more photos of her time in country in this Flickr photo gallery.

Traveling to Macas, a small town on the outskirts of the Ecuadorian Amazon, with the Cinterandes mobile surgical team turned out to be more than just an opportunity to provide surgical care to underserved communities. It became a transformative experience that deepened my understanding of ethical complexity, cultural respect, and the true meaning of surgical service in a global surgery setting.

The Cinterandes mobile surgical unit's long-awaited return to Macas, Ecuador, was met with profound gratitude and warmth from the local community, who greeted us alongside the prefectorial mayor and honored our arrival with an inaugural ceremony for their newly renovated Center for Specialties for Health Services. After the ceremony, we immediately began our preoperative clinic, evaluating over thirty patients for surgical candidacy.

Over the next several days, we performed a wide range of procedures, from vasectomies to hernia repairs to soft tissue excisions. These “bread and butter” cases, typically routine and accessible in the U.S., highlighted the profound disparity in surgical access in many parts of the world. The absence of regular surgical access underscored the stark disparities in global health delivery and brought into focus the ethical ambiguity of temporary surgical missions. Although we provided meaningful and tangible care to the patients we encountered, I could not help but reflect on the many other patients we could not see and on the broader, pre-existing systemic inequalities that necessitated such episodic, fragmented care rather than healthcare delivered through sustainable infrastructure.

One moment that encapsulated this tension came on our final day, when a man arrived from deep within the Amazonian jungle, having journeyed for hours in the hope of being seen. He had not been previously evaluated, yet his growing elbow mass had become so debilitating to the point that it was affecting his work and only source of income. We found a way to make room for him as our final case that stretched late into that evening. After his procedure, he was immensely grateful to our team for the care we provided. His profound gratitude reminded me of why I chose to pursue a career in surgery, but his case also challenged me to confront the privilege and power dynamics deeply intertwined with global health. Would he have had any other options had our team not been there? How would surgical care be provided to the next patient from his village? What would follow-up care look like if he developed any complications?

Despite coming on this trip to provide our technical skills and clinical knowledge, I left this trip impacted by the resilience of our patients and the hospitality of the local community. This experience deepened my sense of humility and reinforced the complexity of providing care in global surgery. Healthcare in such settings is rarely straightforward, demanding careful clinical judgment, cultural sensitivity, and a patient-centered approach that considers not only their medical or surgical needs, but also the broader social and cultural factors that shape each individual's care. As I continue along the path toward becoming a global surgeon, I hope to be continually challenged to see my patients not as problems to solve, but as people whose lives I am privileged to enter, however briefly.