Pursuing palliative care in Malawi: Achieving IRB approval

Ryan Wilkins, a MUSC College of Medicine student and recipient of a Fulbright-Fogarty Fellowship in Public Health, is completing a nine-month palliative care research grant project in the east African country of Malawi. 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.

View photos of Ryan’s stay in Malawi in this Flickr gallery. Read previous blogs from Ryan: August Q&A, September blog, October blog.

I finally have IRB approval!

This past month has been a lesson in movement, whether it be forwards or backwards, fast or slow. I finally have approval for my project, but that approval has come with several hiccups that have slowed its actual commencement. There were hiccups in getting official approval letters, hiccups when trying to hire research assistants, and hiccups when communicating with all members of the team. But, as with all research, things won’t go according to your initial plan and it’s all about how you respond to the roadblocks. Right now, I’m just so happy to have IRB approval. Step one down, several move to go.

I’ve also been getting lessons in movement outside of research. I traveled to Zomba, a mountainous region in the southern part of the country, for a scientific writing retreat. Over five days, 20 of us – trainees of different levels and institutions – were given the time and space to work on our personal scientific writing projects: manuscripts, protocols, ethics proposals, literature reviews, etc. It was a productive week and a wonderful way to network and explore a different area of Malawi.

We did go on another hike this month (see a trend?), but just a little one near the hotel in Zomba. It still kicked my butt—hiking in Malawi is not for the faint of heart, cardiovascular-ly speaking. We also had a monkey visit our conference room during the retreat. The mama monkey opened the door like a human, baby attached to her belly, stole as many snacks as she could handle, and then hustled out of the door to eat her treasured food just outside the window of the conference center. According to Esther, one of the scholars at the retreat: “I’m telling you, it’s a war between humans and monkeys here in Zomba.”

Unfortunately, I got very sick during the retreat, and then got even sicker the week following. One step forward, two steps back. I’ve more or less recovered now, but it definitely has not been my best month in terms of health, or for anyone else in the guest house for that matter. We’ve had two people go to the hospital this month to get IV fluids and antibiotics because of the stomach bug rampaging the house. I was the “guardian” for one of the students and it really showed me what being a caregiver in the Malawian healthcare system might look like. It’s a lot of waiting: in lines, at bedsides, in waiting rooms. But thankfully everyone’s gotten back to full health by the end of the month.

Rainy season is quickly approaching, for better or worse. But it’s not quite here yet, which means the heat is high without any signs of relief. The weekend of Malawian Mother’s Day in mid-October saw record highs and heat advisories. These are normal in Charleston, but it’s a lot harder to handle here where ceiling fans aren’t a commonality and A/C is a luxury. Not to mention that potable water isn’t as easily accessible like it is in the U.S. (I’m missing drinking from the tap!), so there’s a subconscious thought that you are constantly dehydrated, even if you are not.

Last month I bought a car, which is recommended for anyone staying in Malawi longer than a month or two. It was a hassle acquiring it, but I’ve been grateful for the extra independence and freedom it’s given me. Unfortunately, my car has been a drama queen this month. There was a (second) fuel crisis at the start of the month that required me to hire a man to sit in my car for 20+ hours to get a full tank of gas. And then, a few weeks later, the front tire went flat for no reason. It took four of us to change the tire but when I took it in to see what the problem was, it was completely fine! Luckily, that mechanic visit only cost me about $3, so I wasn’t too upset, but I’m just glad it’s happening now, before the rains wash out the dirt roads I have to drive to get to the mechanic!