General surgery residents at Washington University School of Medicine in St. Louis have a growing array of options for participating in global surgery. Since 2016, WashU Medicine has deployed a resident to Malawi each term to train under tutelage from Charles Park, MD, a permanent onsite instructor from University of Cincinnati College of Medicine. There they train alongside on-location medical officers on an eight-week rotation in Mzuzu, Malawi to experience what it is like to provide care in a community lacking in resources.
In October 2024, Hailey Shepherd, MD, a PGY-4 resident, went on the Malawi rotation at Mzuzu Central Hospital (MZCH) where she provided care to patients for a variety of conditions. Having returned to her regular work routine back at Washington University Medical Campus, she shares some insights from the rotation abroad.
What personal pursuits led you to consider the Malawi rotation?
Hailey Shepherd: I have had an interest in global surgery and global medicine since my time in medical school. I’ve traveled to several places and every time I’m able to participate in those experiences it further solidifies my enthusiasm to provide care. I’m always excited for a chance to immerse myself and to serve these communities. Whenever I participate in these trips, it allows me to practice medicine and operate in a way that is fully focused on the patient – it strips away everything that normally separates us from being with our patients in the US like electronics and paperwork. I find that aspect really re-energizes me and reminds me why I do what I do.
Tell us about your previous experiences providing surgical care outside of the US. What is unique about the Malawi rotation?
HS: I have participated in global health programs, both during surgical training and even before medical school. I have also provided surgical care in the Dominican Republic, El Salvador and Belize with a St. Louis based non-profit. What was unique about Malawi was the level of immersion—you’re there for two months—as well as the level of resource-scarcity. Things like soap and sterile gowns were a luxury and an uncertainty on a daily basis, and often you had none of the instruments you needed for the operation you were doing. It was really eye-opening providing surgical care in a setting like that.
In Malawi, we would see between ten and fifteen cases in a day for minor procedures, such as lipomas or inguinal hernias. For major operating days, we would perform three to eight operations which were all open cases since there is no laparoscopic surgery. All patients got a full incision from chest to pelvis – and most of the time we were going in blind without any pre-operative imaging. That was an entirely new experience for me. We’d perform appendectomies, cholecystectomies, colectomies, gastrectomies, splenectomies – you name it! I even performed some craniectomies, which was certainly not in my skillset previously.
How did you mesh with the onsite team?
HS: The best part of the experience was the people I worked with. In Malawi you get to work with clinical officers – who are also training to become independent surgeons – and take them through cases as you would a junior resident. Being a part of that process was so fun and also very special – I became very close with a lot of them, and we still keep in touch. Working with Dr. Park was also a life-changing experience. His ability to verbally guide trainees through operations—without ever taking the case away from them, regardless of how junior they were—was very inspiring and impactful. He represents the teacher and leader I hope to embody myself someday.
What was the most enjoyable part about your time in Malawi? What was the most difficult part?
HS: My favorite part of being in Malawi was definitely the people—immersing myself with the locals, making connections with the medical officers and staff, and learning from everyone. This experience as a chief resident was enlightening. Not having the equipment that you take for granted back home and having to find a way to make it work taught me to think quickly under stress and find innovative solutions to the surgical problems at hand. I have carried that back with me. Getting to hone my own skills and gain confidence in myself, while also refining my ability to take juniors through difficult cases, was really encouraging.
The most difficult part was the patients I lost. There was one patient – a teenager – who died in the post-op unit. Another was an infant with gastroschisis – which is a fatal condition in Malawi, since there is no TPN or tube feeding. Those are not things you witness in the US.
How has this experience impacted your perspective for the future of your career?
HS: This experience has certainly solidified that my fulfillment is fueled by global surgery. I envision myself continuing as a surgical educator and participating in global surgical work. I am also passionate about heart and lung transplantation and cardiothoracic research – although I haven’t yet reconciled how everything fits together in my future career. I am a firm believer that as long as you are pursuing your passion – what feels ‘light’ to you – everything will work out exactly as it is supposed to.
How did mentorship impact your experience on the rotation?
HS: A major highlight of my Malawi experience was working with Dr. Park. The way he is able to verbally instruct trainees through an operation without having to take over was incredible. He always had complete faith and confidence in trainees and never took any maneuvers away, even in the diciest operations. His manner with patients was also very impactful and inspiring. Dr. Park is definitely a mentor who embodies a teaching style that I hope to carry forward in my practice. For example, whenever I asked a question in the OR, he would ask, “what do you want to do?” Then, we would do it! If I suggested a different strategy or technique during an operation, he would let me run with it. There was a level of trust and respect that was really rewarding and encouraging. I hope to instill that feeling upon other trainees one day.
What recommendation would you give to residents considering a global surgery experience?
HS: I have spoken with other residents who are interested in global surgery, but they don’t know how their specialty aligns with that kind of care. I would offer the same advice that I give to anyone considering surgery as a career path: if it calls to you and if you’re passionate about it, then it is 1000 percent worth it. It is the most fulfilling experience. Malawi is no different. It is long hours, there’s no AC, you’ll sweat through your scrubs, you transport your own patients, you have to run to the blood bank to see if they have blood, but at the same time that’s what makes it so fulfilling.
You’re on the ground, doing the work, seeing the patients yourself and it completely removes that filter that we have here in the US, where you just show up and the patient is there, all ready for you. You get to distill down all of the elements that it takes to actually do that surgery. You get to decide what instruments you need, what labs do you really need to get, how much blood do you really need to have available. Knowing that it’s going to be really hard in the most fulfilling way is really important. I already want to go back.
What was the most rewarding aspect of getting to go on this rotation?
HS: Going to Malawi helped me build confidence in my ability to practice independently one day. I was able learn to do operations in multiple different ways—ways that I had never seen before—which familiarized me with techniques that are different from those taught at my home institution. The most rewarding part was seeing the patients recovering postoperatively and knowing that my decision was the right call.
Growing International Offerings
The general surgery residency program allows trainees to pursue properly vetted global rotations with accredited programs outside the country. To gain global experience, trainees may join the eight-week rotation in Malawi, in conjunction with University of Cincinnati College of Medicine. WashU Medicine general surgery residents are providing essential services globally as core components of a team.
General surgery residency program director, Jennifer Yu, MD, MPHS, applauds bridge-building efforts by her predecessor, Paul Wise, MD, now Vice Chair for Education, to evaluate access for trainees and establish relations with onsite faculty and hospital staff at Mzuzu Central Hospital in Malawi.
“We’ll continue to improve our offerings to support the professional growth of our trainees,” says Yu.