Pursuing palliative care in Malawi: Approaching the end of a special experience

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, October, November, January and March.

The end is (almost) here and I don’t think I’m ready.

A lot has happened/is happening since the last blog post, as is the way with wrapping up projects and prepping to move.

Recruitment for my project picked up slightly in the past few weeks after the last blog post, but has slowed to its usual crawl this month. Some of that is patient-factored, with many patients that I’ve already recruited coming back for their three- or six-month check-ups. Some of it is team related, as my research assistant took time off to prepare for exams for her graduate school classes and I traveled to Zimbabwe to bask in the beauty of Victoria Falls.

I spent a week in Salima, a city on Lake Malawi, for another scientific writing retreat. Much like the writing retreat in Zomba in October of last year, this one was focused on giving protected time for scientific writing, whether it be a manuscript draft, an IRB application or a literature review. Even though my project isn’t fully finished with recruitment and data collection, I was encouraged to start a draft for a manuscript with the data I had already analyzed. This kept me busy throughout the retreat and I found the dedicated time to be immensely helpful. Not to mention it was a great week at the Lake, even if the winds kept the waves too strong to swim in.

Tourism-wise, we traveled to see the Gule Wamkulu, the Chewa traditional masked dancers of Malawi, at the Gwirize Cultural Village for a friend’s last weekend in Malawi, which was an amazing cultural experience. And I managed to finally make it to the tea estates in the south. A friend and I decided to do a whirlwind, last minute trip to Thyolo, Malawi, where the Satemwa Tea Estate is located, one of the oldest tea estates in Malawi. It is a massive, beautiful property and Huntingdon House was a stunning place to stay while we roamed the tea fields. So I’ve officially checked off all the main components of my Malawi tourism bucket list!

But now I’ve only got two weeks left in Malawi and I’m having to wrap everything up. I’m trying to get as many recruitments in before I leave, trying to see the medical wards at the hospital, trying to get my souvenir collection sorted, trying to find a home to move into in Charleston, trying to sell my car. The car has been the most stressful of all—Lilongwe has a relatively bustling used-car market but it’s always a little bit of a roulette draw as to whether your car will be snatched up immediately or passed on for weeks.

When people hear I’m leaving so soon they often ask, “How are you feeling?” I think most people are expecting to hear “Excited!” If you asked September Ryan this question, she would respond with an enthusiastic, if slightly exasperated, “Ready!” But over these past nine months I have really come to love Malawi. I’m not sure when, if ever, I’ll be able to come back and the idea of maybe never coming back, due to work or life or distance or cost, is heartbreaking. It feels disingenuous to Malawi and the wonderful people in it. It feels like betrayal. So now, when people ask me, “How are you feeling about leaving?” I can’t help but tell them the truth: devastated.

I’ve entered the “Farewell Phase” of the grant period, where everything is seen with the rose-tinted hues of hindsight and future nostalgia. Ants in the couch? Good thing I like the smell of the Doom insecticide spray. Brown water coming out of the bathroom tap when I want to brush my teeth? Builds my immune system. Sudden changes in road construction making a 15 minute drive into an hour-long one? More time to revel in the weird, wonderful vibes of Lilongwe. I find myself craving things from the U.S., like pesto or sidewalks or sweaters in fall, and feeling guilty about it—I’ll be back soon enough, so why should I crave such things right now? Shouldn’t I be trying to soak up the current “normalcy” I’ve created here, while it still lasts? But you can’t control cravings and you can’t stop time from passing. So I’m doing my best to get everything done, in both work and life, in the two weeks I have left.

That is, if my flights go according to plan. Knowing Malawi, there’s strong potential something goes awry as soon as I arrive at the airport which would be a true Malawian sendoff.

I could ask for nothing less.