Note: This story is a preview of the next issue of Pathways, which will focus on global health

Dr. Esther Chin, adjunct professor in the UBC Branch for Global Surgical Care (BGSC), still remembers the first time she saw a mother die in childbirth.

“I was in Rwanda on elective after my first year of medical school. There were women hiking to the hospital for 10 hours while fully dilated in active labour,” she says. “I saw new mothers dying because of post-partum hemorrhage [uncontrolled bleeding after childbirth]. It completely changed the trajectory of my career.”

The experience had a profound effect on Dr. Chin, who had been planning to specialize in cardiac surgery or neurosurgery. She changed her focus to obstetrics and gynaecology, vowing to work in global health equity.

“When a postpartum hemorrhage happens, there’s no time to think — you just have to act.”

– Dr. Esther Chin

After completing her medical residency in 2016, Dr. Chin joined the faculty of McMaster University’s Obstetrics & Gynecology, dedicating many weeks each year to women in the global south. As her experienced deepened, so did her desire to learn more. In 2021, she enrolled in UBC’s Master of Global Surgical Care (MGSC), a two-year online graduate degree program that prepares surgeons and surgical care professionals from around the world to provide effective care in low-resource clinical settings. The program is delivered by UBC’s Branch for Global Surgical Care, which focuses on closing gaps in surgical care around the world through professional training and by contributing innovations that improve surgical care on the ground.

Throughout her training, Dr. Chin, who now helps teach the MGSC, never forgot about her formative experience in Rwanda — or the heavy toll that post-partum hemorrhage (PPH) takes on women around the world.  Each year, PPH affects 14 million women and claims the lives of 70,000, the majority in low- and middle-income countries.

“It’s still the leading cause of maternal death everywhere in the world,” Dr. Chin says.

During a PPH, a woman can lose close to a litre of blood in just a few minutes, which means clinicians must act quickly to stop the bleeding. Surgical intervention is often necessary when medication and other available options fail — and mastering it requires practice.

“The problem is that many clinicians have been learning these lifesaving procedures on patients, when massive bleeding is happening and time is of the essence,” says Dr. Chin. 

She often asked herself: What if there were a portable, low-cost device on which to learn and practice these surgical techniques, the same way pilots train on flight simulators?

“I saw this huge gap, but didn’t know how to bring it to life.”

Her experience in the MSGC program would spark a new collaboration that changed everything.

STITCH in time

In 2023, just months after graduating from the MGSC and joining the UBC faculty, Dr. Chin partnered with UBC’s Engineers in Scrubs — a postgraduate program at the UBC School of Biomedical Engineering — to create STITCH. Developed using 3D-printing and silicone materials, the device mimics the look and feel of a postpartum uterus and surrounding tissues, and can be used repeatedly to practice surgeries.

“We set out to have a direct real-world impact, to create something that can quickly get into the field and get lots of hands-on use,” says Noah Stewart, a second-year Master’s student in Applied Science in Biomedical Engineering at UBC and one of the five student co-creators of STITCH.

STITCH (which is short for Surgical Trainer for Interventions to Control Postpartum Hemorrhage) is already being used in Rwanda, Tanzania, Cameroon and South Sudan.

“We’ve trained people from all over the world, who are actually treating patients in the field,” says Stewart. “It’s been amazing to see them gain confidence and get significantly faster at these procedures.”

Bridging the maternal health gap from Rwanda to Canada

The training device is also applicable in high-income countries like Canada, where PPH occurs in five percent of deliveries and results in 1.6 deaths per 100,000. Canadian women in rural, remote and Indigenous communities have higher rates of PPH and PPH-related mortality than those who live in urban areas.

“There’s room for improvement here at home, too,” Dr. Chin says. In Canada, most trainee doctors are only exposed to PPH surgeries when the emergency is occurring, rather than in the classroom. The benefit of more training opportunities is clear.

“When a postpartum hemorrhage happens, there’s no time to think — you just have to act. If the procedure takes you five to 15 minutes before you train on STITCH, and then under two minutes after the training, you’re preventing a huge amount of blood loss,” she says. “We know we have an opportunity to address needless deaths here at home and around the globe.”

While it’s still early days, STITCH is gaining support in Canada. It’s being used by the Society of Rural Physicians of Canada for surgical skills training across the country, including in B.C., and it’s been embraced by a number of rural and urban medical training programs.

STITCH isn’t the only innovative, low-cost tool with global potential to emerge from the UBC Faculty of Medicine. Faculty and students in the BGSC and SBME’s Engineers in Scrubs have developed a surgical training simulator for neonatal small bowel atresia, a life-threatening birth defect, as well as a portable orthopedic traction kit that allows surgeons to safely realign potentially debilitating leg fractures. 

“Necessity truly is the mother of invention,” says Dr. Chin. “We need to continue to build bridges and inspire interdisciplinary collaboration. That’s how we can get more affordable and accessible innovative solutions out into the world to save more lives.”