Pursuing palliative care in Malawi: Settling into Lilongwe

Center for Global Health
September 20, 2023
Ryan Wilkins and friends at the summit of Nkhoma Mountain near Lilongwe in Malawi, Africa. 

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.

And so it begins!

I’ve officially arrived in Lilongwe, Malawi! Getting to Malawi was a journey in-and-of-itself. My total trip time was ~52 hours, inclusive of a 15-hour flight and a 19-hour layover in Johannesburg. Anyone who has flown through LMIC airports know that they all have their own version of “normal.” The Johannesburg airport does not announce gates or call for passengers during boarding, which meant I had been sitting at the wrong gate for an hour before realizing, with seven minutes to go before boarding, that I wasn’t where I was supposed to be. But luckily, I and all my bags made it to Lilongwe safely!

Ryan Wilkins, two other Fogarty research fellows, and three UNC Pharmacy students, attending the UNC Pharmacy students’ preceptor’s brother’s wedding.

Ryan Wilkins (second from right), joins two other Fogarty research fellows and three UNC pharmacy students for a local wedding reception.

 In terms of the country, Malawi is beautiful and truly has something for everyone—I went snorkelling at the beach at Lake Malawi one weekend and mountain hiking at Nkhoma Mountain the next! The country’s slogan is “The Warm Heart of Africa” because of how kind the people are, and it definitely lives up to its name. Who else but the people of the warm heart of Africa would invite me and my friends to a wedding last minute? Everyone has been so incredibly kind and welcoming, but the newness of it all can still be very overwhelming!

A picture of the WakaWaka Market just outside of Lilongwe.

They say you experience culture shock in stages: honeymoon, disorientation, mental isolation/hostility, and adjustment/integration. I felt like I’ve been through those stages pretty quickly while here, maybe out of necessity due to the length of my stay. My honeymoon stage was during the taxi ride from the airport, with the beautiful openness of the country. Then I skipped quickly to disorientation and hostility on Day 2 because of jet lag, meeting 30+ new people in one day, and the general newness of it all. But after Day 2, I feel like I’ve settled into Malawi pretty well! There are still things I’m adjusting to, like haggling at markets, the necessity of having a car, or the wild bureaucratic system (my three-hour wait at the immigration office was widely considered to be pretty short). But, joining regular fun activities like salsa night and beach volleyball has made the transition a little easier!

I’ve been here for over a month but I’m just starting to register how long I’ll be in-country. A lot of the people living at the guesthouse with me are short-term, staying for a few weeks or so, and it makes my brain think that I must be leaving soon, too. I feel like I have to rush to get work completed or explore as much of Malawi as quickly as possible. I feel like I have to fit in visits to the famous rock paintings of Chongoni, the pottery village of Dedza, and the safaris in Liwonde, all before the end of the month when rainy season is supposed to start. But I’m also starting to settle into the longevity, slow down a little in my thought process, and breathe. After all, Africa time is all about waiting, and patience is a virtue I should try to learn!

Now I just have to be patient with the Malawian IRB process. One month down, another two or three to go for that approval…