Addressing global health and surgical care disparities

by Roxanna Van Norman
January 24, 2023

Access to safe and affordable surgical care is a challenge worldwide, particularly in low- and middle-income countries. An estimated six billion people - about 75% of the world’s population - have no access to cardiac surgical care, due to the short supply of surgeons, equipment, and facilities in many under-resourced communities.

The issue is near to the heart of one of Stanford’s newest faculty members, Yihan Lin, MD, MPH, who joined the Stanford Department of Cardiothoracic Surgery in August of 2022 as a clinical assistant professor and currently works at Stanford Hospital and the Veterans Affairs Palo Alto Medical Center. 

Lin has devoted much of her career to addressing global health equity and surgical disparities and is excited to continue her work by teaming with world-class researchers, physicians, and healthcare experts at Stanford.  

"I see this as an opportunity to highlight the massive deficiencies in the workforce and improve resources for surgery worldwide,” Lin said. “There wasn't a better place for me than at Stanford to achieve these goals."

Having worked in several low- and middle-income countries, Lin has seen first-hand the effects of the scarcity of healthcare workers and surgical resources in communities with little to no access to safe and quality healthcare. 

"True access to surgical care must include key elements of timeliness, capacity, safety, and affordability. When you take all these into account, a shocking 6 billion people lack access to cardiac surgical care around the world,” said Lin.

Recent data shows North America has approximately 27 cardiothoracic surgeons per one million people, accounting for 42% of the world's cardiothoracic surgeons. In Africa, for example, there is only one cardiothoracic surgeon per four million people. Cardiovascular disease is a major health issue worldwide, Lin noted, with rheumatic heart disease contributing to a significant amount of mortality and morbidity in low- and middle-income settings.

"There is a huge disparity [in surgical care, access, and resources] between high-income countries compared to low-income countries," Lin said. "In Rwanda, where there is a population of 13 million people, there are only two cardiothoracic surgeons. And before 2020, there were none."

"Until we understand that everyone deserves health care, which includes surgical care, we will continue to perpetuate these inequities and disparities," she further noted.

Global health work

Prior to her arrival at Stanford last summer, Lin completed her cardiothoracic surgery fellowship at the University of Colorado (CU) School of Medicine and obtained a Master of Public Health from the Harvard School of Public Health. Before that, Lin spent many years abroad in Africa, where she worked with local and national organizations to build and expand surgical programs.

Dr. Lin oversees a surgical training session (photo courtesy of Dr. Lin)

Lin has been active in surgical work and global health education since she was a medical student at CU. Early in her training, she directed and oversaw weekly health clinics for the homeless in Denver and, from there, started broadening her work abroad. She arranged for women's health education workshops in Ecuador, provided surgical and clinical care in Uganda, and worked with local surgeons in Haiti.

Lin is a former World Health Organization intern and a Paul Farmer Global Surgery Research Fellow at the Harvard Program in Global Surgery and Social Change. 

During her fellowship, she worked with the Zambian and Rwandan Ministries of Health to increase surgical capacity and infrastructure through National Surgical Health Plans. Since 2015, Lin has been working in Rwanda to help the local healthcare communities develop their surgical infrastructure, research capability, and cardiothoracic care and education. 

More recently, she is supporting Rwanda’s first cardiothoracic surgeon, Maurice Musoni, MD. “He is building Rwanda’s first independent cardiothoracic program in the country. It is a challenging task, but I have been lucky to witness its development with key partners in the Ministry of Health and non-governmental organizations such as Team Heart and the American College of Surgeons," said Lin.

The late global health pioneer Paul Farmer, MD, has been one of her major influences. “Dr. Farmer always said that the key reason for inequity is the belief that some lives matter more than others,” said Lin.

Expanding surgical education

Lin attributes her deep interest in global health and surgical education to her mentors and peers, who motivated her to continue her clinical and research pursuits in academia. To address the shortage of cardiothoracic surgeons globally, she has been developing academic partnerships and resources to support surgical skills training and education for under-resourced communities.

Most notably, Lin worked with collaborators from the University of Pennsylvania, the University of Virginia, and other institutions to create a portable and affordable surgical simulator, the GlobalSurgBox.

"It [the GlobalSurgBox] allows the practice of surgery to be affordable and accessible," said Lin. 

Trainees practice with materials inside the GlobalSugBox, a portable surgical simulator (photo courtesy of Dr. Lin)

This simulation curriculum is being implemented in educational programs around the world, including CU, the University of Global Health Equity in Rwanda, and a surgical training program in Kenya.

At Stanford, Lin plans to continue her work on health access issues and surgical education at Stanford.

"I'd like to help build the presence of global health both at Stanford, as well as in the field of cardiothoracic surgery," Lin said. She will continue working in Rwanda, with this year being her ninth consecutive year conducting clinical and research activities there.

"It is a privilege to be here, and I want to do my part in training the next generation of surgeons," said Lin.

Dr. Yihan Lin