Pursuing palliative care in Malawi: A Ryan Wilkins Q&A

Ryan Wilkins, a MUSC College of Medicine student and recipient of a Fulbright-Fogarty Fellowship in Public Health, is spending the next nine months in the east African country of Malawi for palliative care research. Ryan will be blogging on occasion for the Center for Global Health, sharing her experiences abroad, both in helping patients and of living in Africa.

Get to know Ryan in this introductory Q&A.

Q: Tell us a little about yourself – your personal and professional interests and where you are at in your tenure as an MUSC student.

A: Hi there! My name is Ryan Wilkins and I’m a medical student in the College of Medicine (COM). I’ve just finished from third year, am taking a break to complete my Fulbright-Fogarty fellowship, and then will come back and finish my fourth year of medical school. I don’t quite know what specialty I’ll apply to yet, mostly because I’ve loved everything so far! My professional interests are pretty broad, but I’m passionate about mental health, LGBTQ+ health, reproductive health, palliative care, and healthcare advocacy and policy. In terms of personal interests, I’m a little boring and like the typical things like baking, movies, puzzles, running, etc. Though I have started getting really into street dance battles in preparation for the breaking battles at the 2024 Paris Olympics!

Q: What led you to apply for the Fulbright-Fogarty Public Health Fellowship Award and what was the process like?

A: I have been interested in global health, and more specifically global health sustainability, since doing an education abroad to Japan in undergrad looking at public health initiatives. I knew I wanted to explore global health more while in medical school and the Fulbright-Fogarty fellowship seemed like a great way to explore sustainability through global health research. The process for Fulbright-Fogarty looks a little different than the process for other consortia related to the Fogarty Center; Fulbright selects five to six international research locations with PIs interested in accepting students for projects. From there, I found mentors with research interests that aligned with mine and created a project proposal to submit. They say starting medical school is like drinking from a fire hydrant—I think starting my project in Malawi will be much the same! But I’m excited to get started, even if it will all be overwhelming.

Q: You’ll be spending nine months in Malawi as part of this fellowship award. Can you share the focus of your research project you intend to complete in the east African country?

A: Yes! I’m hoping to do palliative care research while I’m there, specifically looking at palliative symptom management and quality of life for breast cancer patients through translation and cultural validation of the African Palliative Outcome Scale (A-POS) for use in Malawi. I think palliative care is a specialty that is often misunderstood but is critical to quality patient care, and the WHO has even recognized it as an essential part of any medical infrastructure. However, the majority of the patients who require palliative care live in low- and middle-income countries (LMICs) where such care might not be well-established. Not to mention that the majority of palliative care research is done in high-income countries, which means the results might not be as applicable for patients living in LMICs. So, we want to make sure that the A-POS is culturally relevant and applicable for the Malawian population so that these patients are getting effective and reliable palliative care for their wants and needs.

Q: How has your experience at MUSC helped prepare you for this project?

A: In a lot of ways! I got to take advantage of the global health track that’s available in the curriculum of the COM, which helped me explore global palliative care from a new lens—I partnered with a palliative care NGO in Delhi, India, to write a policy draft for palliative care implementation that the NGO could submit to the government of the state of Delhi. I wouldn’t have been able to do that without the time, resources, and support MUSC gave me! There are also so many incredible healthcare providers at MUSC who do amazing global health work that I’ve been able to meet, from across all colleges, and being able to see the wonderful opportunities people at MUSC do was a great point of motivation for me preparing.

Q: Why are you passionate about global health?

A: Global health is all about collaboration, which is so important to all aspects of healthcare. The best way to ensure collaboration is to ensure that there is sustainability in the work being done and that there is reliable communication, as well as doing longitudinal work and establishing great connections with your partners across the world. And what we learn from our partners in other countries working with their specific populations can absolutely be used to help our patients here, as well as vice versa. That idea of collaboration is part of why I love medicine and it’s amplified so wonderfully in global health that I can’t help but be passionate about it!

Q: How have you been preparing this summer for the trip?

A: As is typical for me, by stressing about everything! My rotations finished in June, and I had to take Step 2 (the second big standardized test medical students have to take) directly after, so I didn’t have much time to prepare before July. And then, right after that, the different Fogarty fellows had a week-long orientation out-of-state. So I’ve just started trying to get everything together before I leave! Right now I’m trying to focus on moving out of Charleston and to Malawi, getting IRB approval, and the other little details like malaria prophylaxis and outlet adaptors. I’m also trying to spend as much quality time as possible with Charleston and the people in it who I care about. You never know how much things might change in nine months, so I’ve got to soak it all up now!

Q: You intend to occasionally blog for us over the course of your project, sharing your experience while in Malawi. What do you most hope to achieve, personally, from this experience? What are you most apprehensive about?

A: I’m hoping to achieve a better understanding of the workflow of global health research, as well as getting a firsthand look at what a career in medicine and global health might look like. On a more superficial level, I also want to make sure I see as much of Malawi and southern Africa as I can before I leave! In terms of apprehension, I’m worried about the timing aspect of global health. Government structures move slowly in the U.S. but they can move even slower in LMICs. Things like IRB approval or visa applications can take a long time. Nine months will fly by in no time if I let it, so I’m apprehensive about making sure my project is able to be completed in a timely manner. I’m also apprehensive about driving! Malawi drives on the left-side of the road, so I’m going to have to get used to all those little changes in driving habits if I want to get to the local grocery store.

Q: Any thoughts, advice, or words of wisdom for current MUSC students who are interested in global health?

A: Global health can be done in so many different ways! Sometimes it’s clinical work, sometimes it’s research, sometimes it’s policy. MUSC has a lot of great professionals working in all kinds of different fields within global health, so try to find a mentor, an area of interest and dip your toes in! And remember that global health isn’t just about traveling. Sometimes it’s done domestically, too. Working with refugee populations, immigrants, or foreign nationals are all a part global health and are essential parts of healthcare for us all. So global health is important for everyone to get involved in!