American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

International Café: Ever Considered Global Surgery? A Glimpse into the Life of a Missionary Surgeon

Malawi, Africa Have you ever wondered what global surgery or missionary medicine would be like? Do you harbor reservations that global surgery might be too exotic or will have a negative impact on your family or career? As surgeons, we feel a calling to our profession that fulfills and defines us. However, we may become so entrenched in our career paths that sometimes it seems as though our lives are fixed and we cannot deviate off that path. Fortunately, there are opportunities for us to experience global surgery through others or, if we feel adventurous, to plan a short trip into this world.

Recently, I had the chance to interview a general surgeon, Ryan Hayton, MD. Since completing residency in 2010 at St. John Hospital in Detroit, MI, he has committed himself and his family to missionary surgery in Africa. Dr. Hayton enjoys the scope of practice that general surgeons in the U.S. had 50 years ago and performs abdominal, thoracic, urologic, gynecologic, orthopaedic, vascular, and trauma surgery. In addition, as an assistant professor for Loma Linda School of Medicine, he trains U.S. medical students and surgical residents who wish to do a global surgery elective where he works at Malamulo Hospital in Malawi, Africa. He also is the program director for the Malamulo-Pan-Africa Academy of Christian Surgeons (PAACS) General Surgery Residency to train African surgeons. He hosts trained surgeons from around the world to experience the rewarding life that he pursues. This interview will give you a glimpse into the world of global surgery. Perhaps you will feel the call yourself to serve on an international level.

Dr. Hayton, I know you felt called to do this medical mission. Can you explain to the readers how this calling came about and if your childhood affected your decision?

I grew up as a missionary kid watching my father, Bill Hayton, MD, an OBGYN, perform surgery. It is no surprise I ended up being a missionary surgeon, as I’m a fourth generation missionary to Africa. My great-grandfather was an ENT surgeon and a missionary to South Africa in 1887. I believe that everyone deserves quality health care, and I’ve dedicated my life to help the people of Central Africa who have little or no access to surgical care.

Why did you pick Malawi?

In 2010, we chose Malamulo Adventist Hospital in Malawi because it was well established and it was suitably situated for educating the next generation of doctors and surgeons for Africa. I believed it would be a good place to build an educational program. Malawi has the world’s worst doctor to patient ratio (approximately one practicing doctor per 80,000 people), and there are 1.2 million Malawians per surgeon. Malamulo has been providing health care for more than a hundred years as a large, rural, referral mission hospital.

What is your daily life like, both at work and at home?

I live with my wife, Sharlene, and our three sons 100 yards from the hospital. I can easily walk to and from both home and work. Malamulo is a large rural hospital, and we enjoy the beauty of the area where we live. Sharlene homeschools our three children and keeps our family connected with friends in and around the mission.

The work of being a surgeon, educator, mentor, and administrator at Malamulo never seems to end. We start each day with hospital worship at 7:00 am, followed by teaching rounds, lectures, surgery, clinic, and meetings, depending on the day. I’m lucky if I make it home for lunch, but sometimes I run up the hill to our home between cases for a bite. I’m usually home by 6:00 pm and able to spend some time with my family before answering e-mails after the kids go to bed.

Dr. Ryan Hayton and hysterectomy specimenCan you explain what a missionary general surgeon is called to do in terms of different cases and work load?

I’m a general surgeon in Malawi, where there are few, if any, sub-specialty surgeons. I operate on “the skin and its contents” and perform a broad spectrum of surgeries, including obstetrics, gynecology, urology, orthopaedics, plastics, ENT, pediatrics, thoracic, and some neuro-trauma as well as general surgical cases. I perform everything from radical hysterectomies, prostatectomies, ORIF and IM SIGN nail rodding, esophagectomies, and thyroidectomies to all sorts of trauma surgery, burn care, hernias, mastectomies, cesarean sections, GI cancer operations, and endoscopies.

I work in a team that includes Arega Fekadu, MD, a general surgeon from Ethiopia who trained in a PAACS program in Kenya. He is one of the most amazing surgeons I’ve ever worked with based on his technical skills and the broadness of his surgical capabilities. Casey Graybill, MD, is an OBGYN who works part-time at our hospital. We have four African surgery residents, one Loma Linda University (LLU) rotating resident, and students from several different programs who rotate through our department.

What happens when you are asked to do something that you have not trained for?

Fortunately, these situations are becoming less common for me, but I often read about cases that I haven’t previously seen or trained for. I also send an e-mail to friends in other specialties to get help on cases, and their step-by-step description of cases often gives me guidance in difficult and complex situations.

What are living conditions like?

We live in a three-bedroom house with a one-and-a-half-acre garden and yard. We have electricity much of the time and running water most of the time.

Ryan, Sharlene, and their three sonsWhat effect does this mission have on your wife and sons? Can we hear their perspective? Perhaps Sharlene would like to give her thoughts.

Sharlene responds, “The transition to Malawi was difficult. The first year we were trying to make our mission home livable, acquire a car from Japan, and figure out how to make a meal at home three times a day, seven days a week. It was survival in a primal sense! However, after deciding not to let ‘Africa win’ (we have a saying when things get unnecessarily complicated in Africa: AWA, or Africa Wins Again) the boys and I really have come to enjoy our life here. We are comfortable in our home, have fun shopping in the local markets, enjoy time with friends, and take family escapes to the nearby mountains, game parks, or Lake Malawi. It’s humbling to have never felt so poor and yet be considered so rich by those around us. Living in Malawi helps me to remember the important things in life: health, education, and time with the people you love."

Dr. Hayton, how are you financially compensated?

The Seventh-day Adventist church pays me to work here as a missionary. We live comfortably with our salary.

Can you explain how you interact with your patients spiritually?

We pray with each patient at admission, before and after surgery, and at discharge. We, in fact, have a “spiritual vital signs” sheet in the charts that we use to record how the patient is doing spiritually. It helps us continue to focus on caring for the whole person, which we believe should include the body, mind, and soul.

As a professor at Loma Linda, how has this relationship been helpful to your mission?

Malamulo is the International Field Station for Loma Linda University, and we’ve used this collaboration to bring students and residents to Malamulo through the years. In 2012, the surgery department received Accreditation Council for Graduate Medical Education (ACGME) accreditation for the Malamulo site, and the surgery residents have been coming for two-month rotations ever since. This program has been a huge success in helping the LLU surgery residents gain more experience and independence, which is often difficult to do in the U.S. About 80 percent of the LLU surgery residents do this two-month rotation in their fourth year, and it has consistently ranked as their favorite rotation of residency.

How often do you have students rotate with you, and what is their experience like?

Loma Linda fourth-year medical students also have an opportunity to do a four-week mission elective rotation with us. Many have reenergized their goals of serving internationally

Malamulo Hospital, Malawi, AfricaAre you establishing a training program for locals to be become surgeons in Africa?

In 2014, the Pan-Africa Academy of Christian Surgeons (PAACS) helped Malamulo start a fully accredited general surgery residency for African doctors. The American-style residency is a five-year, postgraduate training and is accredited through Loma Linda University and the College of Surgeons of East, Central, and Southern Africa (COSECSA). Our goal is to train and mentor the next generation of compassionate and competent surgeons for Africa. Now in our third year of the program, we are gaining momentum and stability, and we truly feel this is the next step toward improving the health care of the underserved people in Africa.

During residency, how should trainees prepare if they are interested in a similar career?

They should take the opportunity to be involved with a broad spectrum of cases. Intentionally ask to scrub in with other specialties to get experience in a wider area of care. I have helped Loma Linda University start a clinically focused Global Surgery Fellowship as a one-year training program for American general surgeons to prepare them to work in low- and middle-income countries and low-resource settings. This new fellowship is a great step to preparing surgeons to be capable and competent to function in mission hospitals around the world.

How should general surgeons who are already in practice prepare?

They should join us and volunteer for two to four weeks. Malamulo welcomes surgeons, general and sub-specialty, to volunteer at our mission hospital and help us improve our services for the Malawian people. The process for surgeons to volunteer for two to 12 weeks is quite simple, and we encourage all who are interested to become involved in bringing better health care to those who need it most here in Malawi.

From the Author

For example, Cheryl Wesen, MD, FACS, a Governor from Michigan, spent several weeks with Dr. Hayton a few years ago. I reached out to her to learn more about her experience. She explained, “I had the amazing opportunity to visit Dr. Ryan Hayton and his wonderful family for two weeks in the summer of 2014 at Malamulo Adventist Hospital, Malawi. I was accompanied by my son who had completed his first year of medical school. He is now completing his first year of surgical residency as a urology resident. It was quite humbling to work with Ryan, who had been a surgical resident at my hospital. I had worked closely with him during his five years of general surgery training, but in Africa, he was more familiar with the surgical procedures performed there (open prostatectomy, rectovaginal and vesicovaginal fistulae, orthopaedic procedures, to name a few). It was fun to discuss the challenges of some difficult procedures and participate in decision making. HIV status was regularly checked on every patient because of the high incidence of AIDS. There is an extremely limited supply of blood products. Often, if there was a patient need, a call would go out to the staff for donation. Anesthetic management was frequently regional blocks or local anesthesia. The constraints of postoperative care and post-discharge management were always an important aspect of care. Family members were expected to provide food and blankets for patients and be present at bedside to assist. Patients travel largely by foot and often very long distances. Preventative care is largely unheard of there.

My time in Africa was a very special and life-changing experience. I am grateful for the hospitality extended to me and our son by the Haytons and the missionary community. I admire the work that Ryan does daily and the ingenuity required to manage and thrive in a low-resource community. I look forward to a time that I can return and hopefully for a longer visit. Ryan will be inducted as a Fellow of the American College of Surgeons this October in San Diego, CA. I plan to congratulate him in person at the Convocation ceremony.”

If you would like to explore the world of missionary surgery in Malawi, visit the following websites:

Dr. Hayton also captures daily activities on his Facebook page and welcomes you to join him for a visit someday.

Dr. Ryan Hayton