Pursuing palliative care in Malawi: Shadowing in the cancer clinic

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.

We’ve made it to two months!

Time is stuck in that weird warp. I can’t believe it’s already been two months (I only have seven months left!) but I also feel like I’ve been here for the full year already.

Part of the time slump is focused on the fact that I’m still waiting on IRB approval. Always waiting. It’s normal here for IRB approval to take a while, but it’s hard to wrap my brain around it when I don’t have my usual clinic duties or classroom commitments to distract me. I’m here for research, and the research is stagnant. It’s hard.

But I’ve finally been able to shadow a little in the cancer clinic, where I’m hoping to implement my research once I get IRB approval. It’s helpful to shadow there to understand how my project’s outcomes might fit into the workflow of the clinic. But it’s eye-opening, in a lot of ways.

Global health work, whether that be research, clinic, etc., is rewarding. But it’s also tiring, and sometimes it’s not terribly helpful. I think my research could be helpful for the clinical team once I can figure out how to fit it into the workflow to lessen their workload, but right now I am just in the way. What they need is more money to buy chemotherapy drugs, or more trained radiologists, or more infrastructure to get patients back to clinic. It takes four weeks to get a CT scan read. Four weeks. In the US, a patient who really needs a scan can get it done and read in less than a week, sometimes even day-of depending on the necessity and severity of the case.

Here, patients die because it takes too long to get a scan. One of our patients was diagnosed with breast cancer but couldn’t get started on tamoxifen until she was staged via CT scan. It took two weeks to get her an appointment for the scan and another two weeks to get an official read. She had died, from disease progression, by the time the read was completed. And this is relatively common. Patients present at such late stages of their diseases because of so many different reasons, and suddenly it’s too late.

It’s hard, in that way. To know what the right answer is for a patient but not be able to treat them accordingly, either because the system is too slow or the system has no money or the infrastructure just isn’t established yet. But the practitioners here are good at their job and do the best they can within the system. It’s good learning for me. Definitely a great lesson in flexibility. And Global Health is all about flexibility, something I remind myself every day!

I’ve been able to do a lot of great things outside of research this past month! UNC Project-Malawi hosted their annual Cancer Symposium, a two-day event focused on the work on cancer being done in Malawi and the exciting future for oncology care happening in the future. Seeing all the great work being done by researchers and teams here was wildly inspiring.

We went on a hike at Bunda Hill, a local mountain that is both a good, easy hike, as well as a religious pilgrimage. At the top of the mountain, there are many people conducting sermons, gospel circles, solo prayers. It was a wonderful hike with a beautiful view, and a very interesting experience to see the religious emphasis of the summit.

I also went to Liwonde! Liwonde is the largest game park in Malawi and has a number of safaris available, including drive and water safaris. We got to see so many incredible animals up-close, like hippos, elephants, and lions. It was truly an amazing experience, one that I would love to repeat in the future, and one that I would highly recommend to anyone visiting Malawi! 

My Malawi tourism checklist still has the Dedza pottery village, the Chingoni rock paintings, and the Satemwa tea plantations. Rainy season starts in November, though, so we’ll have to see if the roads are stable enough for me to explore!