The Humanist Surgeon: The Art of Creative Surgery—Dr. César Ramírez ( 3/4 )

December 19 • Circlo Podcast

Circlo Podcast

The Craft: Creativity Where Resources End

This is the third article out of four parts of my interview with Dr. César Ramírez.
If you would like to read the introduction and backstory, start with The Humanist Surgeon: The Boy Who Watched Over His Brother. To continue the sequence, read The Humanist Surgeon: Medicine as a Way of Living.

We shared a thoughtful, podcast-style conversation in which he educated me — and will hopefully educate you — on a range of topics. The purpose of this interview was simple: to grow both personally and technically.

Above is the full video for this section of the interview. The complete interview with all sections is available below.

Complete Interview: The Humanist Surgeon — Dr. César Ramírez

To guide this interview I divided our conversation into four sections: Personal Life and Childlike Vision, Vision and Path, Creativity, and Reflections. In this article I focus on the Creativity section. Circlo stands on the idea of becoming a better human surgeon — someone who connects, empathizes, and understands human needs while having the knowledge to save them. This section brings to light the creativity required in the operating room, how medical teams — especially in low-resource settings — improvise to solve unseen problems, and how that lateral thinking strengthens practice when they return to high-technology hospitals. Creativity is essential.

A unique story that will educate you in his vision of medicine and his path.

From textbooks to theatre: where medical creativity starts

“Creativity is intelligence having fun.” — Albert Einstein

I asked: from the outside we usually associate creativity with engineers, designers, or artists — but do doctors and surgeons need to be creative? How is that creativity born and put into practice, especially when resources are limited? I tied the question to his charity, Fundación Bisturí Solidario, where twice a year he and his team travel to central African hospitals to operate and help thousands of patients. I wanted to know how creativity appears there.

Dr. César Ramírez opened a whole new world: medical creativity. All doctors study the same material, but experience makes that knowledge practical. Through patient work, surgeons adapt, refine, and develop their own operative style. That lived knowledge is where creativity comes from.

Many imagine medicine as rigidly rule-bound, but emergencies and unexpected postoperative complications often demand inventive thinking. That improvisation must never be reckless: clinical safety and evidence remain central. Still, a surgeon’s judgment — how they change timing, technique, or choice of therapies when a patient is not improving — is where real differences appear.

Creativity is not exclusive to the operating room. Non-surgical specialists are creative in research, prevention strategies, and treatment design. Technological advances — smaller incisions, new suturing methods, robotic assistance — are the result of continuous creative work applied to clinical problems.

Improvisation where resources end

What happens when you operate in low-resource settings and face cases unlike those seen in Europe?

Dr. César Ramírez explained that the same diagnostic labels can hide very different realities. A “thyroid goiter” in a high-resource hospital might be a small, early lesion found by ultrasound; in some African hospitals it can be massive because of delayed access to care. The name is identical, but the challenge is not.

With fewer diagnostics, higher infection risk, and limited postoperative support, surgeons must adapt techniques and decisions to reduce complications and match local realities. That kind of creativity is practical and cautious: it aims to get safe, reproducible results with what is available.

Experience in those settings also yields valuable lessons to bring back home. Techniques adapted for scarcity can inform simpler, more resilient approaches in high-tech hospitals — and sharing that experience is essential.

Technology vs. education: where to start

As a future engineer — and with biomedical engineering as another focus of this blog — I wanted to understand what role technology could play in solving the problems he encounters in Africa. I asked what kinds of tools are truly needed on the ground, and whether there are challenges where engineers could begin designing practical solutions.

I often read about university engineering teams successfully developing biomedical devices for low-resource settings — simple, robust tools designed with context in mind. One example is a point-of-care bilirubinometer that allows clinicians to measure total serum bilirubin in neonates without complex laboratory infrastructure. I wanted to know where medicine and engineering could meet in the operating room, and how thoughtful design might help surgeons like him extend care where resources are limited.

He explained that many regions simply lack medical schools or specialist-training programs. Without postgraduate training systems like Spain’s MIR ( Spain's national, competitive test for medical graduates to access specialty training ), there are few pathways to create the surgeons and anesthetists needed to use donated equipment safely. In practice, training must come before—or at least alongside—technology and infrastructure.

He summarized the three essential pillars for developing surgical care in low-resource countries:

Investment in training and education (undergraduate and postgraduate).
Investment in technology.
Investment in infrastructure (operating spaces, ventilators, basic perioperative equipment).

Dr. César Ramírez emphasized that foundations and visiting teams can help narrow the gap — by teaching, supporting local practice, and improving facilities — but the larger structural change depends on global health priorities and geopolitics. Today only about 10% of the world’s surgeries are performed in low-resource countries, far below what population needs would predict; changing that requires political will as much as medical goodwill.

Multiplying impact through teaching

Experience alone isn’t enough: the lessons learned must be shared. Training local staff, adapting curricula, and building sustainable educational programs amplify the effect of short-term missions. That is why Dr. César Ramírez’s work with Fundación Bisturí Solidario focuses heavily on education and on projects that leave local teams stronger.

Lesson

Speaking with Dr. César Ramírez made it clear that creativity in medicine is practical, cautious, and indispensable. Whether refining a high-tech surgical technique or adapting an approach in a rural operating room, clinicians must think laterally while keeping patient safety paramount.

Innovation without education has limited value; teaching turns individual ingenuity into system-level improvement. Creativity, humility, and a commitment to share knowledge are what extend surgical care where resources end — and that combination is what saves lives.