Interview by Sarah Polzer

Dr. Costas-Chavarri, you have been working in Rwanda for several years now. What makes the work there so special for you?
Every day is different here. There are always new challenges waiting for you. This requires different skills, which I acquire and develop every day anew. It includes flexibility and creativity, but patience is also always in demand. I particularly enjoy helping as a trainer. To teach and thus support medical education in the country and to witness the progress of trainees is something that is incredibly fulfilling for me.

For those who want to support low- and middle-income countries like you. What qualities should you bring with you?
You should be open-minded, try to speak the language of the country and be able to react spontaneously at times. Languages are of particular importance. Creativity is required every day to compensate for non-existent equipment and to face unusual problems. Calmness and patience are necessary as well as understanding that some processes take longer.

Since 2016 you are part of the research network GlobalSurg, which has contributors all over the world. How do you rate the cooperation here?
I have been part of GlobalSurg since 2016. I especially liked the idea of doing research together across countries, facing problems and supporting each other. COVIDSurg was created in pandemic times, so it was not my main project, but it was an important part of GlobalSurg. Doctors, especially surgeons, are often said to be constantly in a bad mood and tired from the many operations they perform. However, the many representatives of COVIDSurg prove the opposite. They are open, friendly and always ready to help. This spirit motivates you to keep giving all and at the same time it gives you the feeling that you can make your contribution to evidence-based medicine.

Rwanda is among the low- and middle-income countries in East Africa. What was the response to the pandemic there?
The government has acted excellently. Measures were taken immediately. The population was quickly informed, and masks were made compulsory. Citizens quickly took up and implemented the government's instructions. In general, it can be said that trust in doctors is very high in this country.

In recent months, there has been a rush for vaccines against the virus all over the world, especially in Europe and America - is vaccination also an aim in Rwanda?
Yes, in any case, this is also an important issue in Rwanda. Here, the problem is more that there are fears that there might not be enough second vaccinations. A lot of work is being done on this.

You are not only involved in the COVIDSurg team, but you also advocate for women in all professions. From where did you get support to follow your path into medicine?
I was a lucky one. My family has always supported me. My colleagues were behind me and what always drove me was my inner passion for medicine. I want that it is possible for women to reach for their dreams like it was possible for me. If you have a dream - go for it, whether you want to become surgeon or something else.

Where did the inner desire to gain a foothold in medicine come from for you?
I come from a family of doctors. There was always a medical environment around me. I used to visit my father in hospital and bring him something to eat. Little things like that have shaped me. I was very open to general surgery, but also to neurology. This is also related to my father's sudden Parkinson's disease. My parents were and still are a great role model for me. Being a surgeon also means being passionate about your work, and that's what my parents taught me.

Was there a special experience in your career so far that left its mark on you?
I still have a very young career behind me. Therefore, it is difficult to speak of a particularly drastic experience. The Global Surgery Fellowship meant a lot to me. Developing new concepts, taking care of patients and upgrading old structures - that's what I do in my job and what makes it special for me.

In 2016, The Guardian published an article by you in its international edition titled "We must fight sexism to get more female surgeons in developing countries." In this article, you point out the systematic obstacles young women face on their way to a career in low- and middle-income countries. At the time, you appealed to the surgical community to align with the Sustainable Development Goals. You referenced the fifth goal, which seeks to achieve gender equality in developing countries by 2030. That was six years ago - what has happened during that time?
The article was written together with my colleague Sristi Sharma, who is also a doctor and convinced me to point out the abuses against female doctors in low- and middle-income countries. She is also the main author and thus the driving force behind the words of the article. A lot has changed since 2016. Even though not all inequalities have been eliminated, positive developments can be observed. The speed of these developments is slow and has taken place within the last ten to fifteen years. One example is the female Surgeons Africa group, which is supported from America.

What is your advice to women in low- and middle-income countries who want to pusue a career in the medical field, particularly as a surgeon?
Women can be surgeons! If you have the dream of becoming a surgeon, look for support. Find other women with the same goal, network with them and build a community. Especially the internet can be helpful to support each other. My family has also helped me a lot as well as my colleagues. All you need is inner passion and a supportive environment.

I am also a mother of a son. It is important to accept that not every day is in balance. Between all the work and with a small child at home, it is necessary to remember not to do everything alone. Always take quality time for yourself to recharge your batteries. Get support from a partner or a nanny - even as a single mother you have the right to a little time out. What helped me to cope with all this was an understanding a flexible work environment.