Catch up with Gillian Seton, MD
In 2013 I finished my residency with an incredible group of residents. For the next 6 months, I participated in a specifically designed program, Transition to Practice, alongside the indomitable Rob Wrona. Under Dr. Nelson’s supervision, we worked independently as faculty, with support when needed. This allowed me time to also work with gynecology, neurosurgery, and urology, and get some informal echocardiography training. Then, in January of 2014, I moved to Africa to follow a lifelong dream.
I arrived in Liberia, a small country in West Africa, that no one (myself included) heard of before 2014. Liberians are amazing, welcoming, and resilient, despite trauma, grief, poverty, and corruption, and I was lucky to work with incredible people at a small faith-based hospital in the capital Monrovia. If you ever wondered what it would be like to practice medicine in a rural hospital in the 1950s, I have stories for you. I had a few months to settle in, learn a little culture, learn how to treat malaria, perform a c-section, and get malaria myself before their fragile healthcare system was rocked by Ebola.
It was both surreal and horrible; I had limited internet access (too expensive) and there was little information via Google on how to screen for Ebola. My hospital staff, with an amazing show of bravery, decided to remain open for non-Ebola emergencies as most hospitals in the city of two million had closed. The other two doctors left and I was alone with a wave of critical non-Ebola patients. I lasted about two weeks before I begged for help; and Loma Linda University sent supplies and other American doctors with extensive experience in Africa.
Sadly, things worsened even after the crisis passed as people were too afraid to seek medical care for other problems such as hypertension, stroke, and HIV. Most district hospitals didn’t have oxygen or patient monitors in the ORs; they did have a long history of poor outcomes due to few trained surgeons and even fewer anesthetists. It took a few years for the rumor mill to convince people to allow me to operate and even then, they often presented days to weeks too late to do any good.
There were some amazing bright spots in the following years. Our staff, always smiling at the day’s start, provided amazing support for me, even willingly participating in extra training. We started a free breast cancer screening program; the midwives and I learned better neonatal resuscitation together and put the skills to work with good success for many babies. In mid-2014, there was a 32-week-old baby who repeatedly turned apneic and bradycardic after birth, requiring six hours of intermittent CPR. As his very young mother was admitted with complicated malaria, I took care of him and absolutely fell in love. For a long time, I was his “aunty” and took care of his medical costs, caring for him on weekends, and eventually, when his mom and aunt had repeated difficulties, had him live with me. I really wanted him to live. After several years and multiple conversations, they asked me to formally adopt him. Divine kept me human during difficult times as well as extended my family in Liberia. He is an incredibly sweet boy who loves cars, people, and food. He denies any intention of pursuing medicine as a career, despite his constant curiosity; he learned CPR in our nurses’ classes at the age of three and, just recently, watched my PALS training videos with lots of follow-up questions.
I could never regret the years in Liberia, but they were hard. Lots of death, failures, and grief. Lots of support from local friends and friends far away. Many thanks to all the advice and support from our Utah faculty—your excellence is still my quality measure. And my undying gratitude to the Burn Unit and the OR staff for keeping my OR supplied for years. This generosity has made a big difference in many patients’ lives.
After six years in Liberia, I was exhausted and needed a change. A permanent return to the US wasn’t possible as Divine’s immigration process was repeatedly delayed. There was an opening in a sister hospital in Malawi, which included a PAACS (Pan-African Association of Christian Surgeons) residency program. We moved in January of 2020, ironically, just in time for the next pandemic. At least I had plenty of experience in Infection Control and making handwashing buckets, as all doctors now have that experience in pandemic protocols. It was a positive change, as I was able to do only surgery, work with some incredible residents (including one from Liberia who has since graduated and returned to work in the large referral 400-bed hospital as one of only two surgeons), and get more subspecialty experience in gynecology, urology, head and neck, and orthopedics. We worked long hours, as we were usually only two faculty to cover call and approximately 50 cases per week, but there was also the opportunity to explore the country with some of the other ex-pat physicians and their families stationed at the rural hospital in southern Malawi. Malawi is very cash-poor, and we faced great challenges with malnutrition and a high rate of cancers, especially esophageal cancer, but I was very proud to work with residents and add to the lasting impact of training another generation.
We returned to the US in 2021, two weeks after suddenly getting Divine’s visa (we were close several times in the previous 18 months). I then turned my attention to getting an Oregon license (my family had moved from Colorado to Oregon while we were overseas) and finding a job. However, I really needed a break and enjoyed spending some time with Divine and my extended family. Eventually, I got a job in a critical access hospital in eastern Oregon with approximately 7500 people in the entire county. We moved to John Day in 2022; I’m still the only surgeon with a great support team. Every year, I take trips back to Africa, to support surgical programs, and sometimes Divine goes with me.