Pursuing palliative care in Malawi: Culture and the economy 

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 and November blog.

When coming to Malawi in August, I was told about the three separate exchange rates for the Malawian kwacha (Mwk):

1. The government set exchange rates (usually used when using a credit card or pulling from an ATM) was ~1180Mwk to 1USD;
2. The ForEx exchange rate for physical currency (i.e. what you would get by exchanging physical USD at the airport) was ~1650Mwk to 1USD;
3. And the black market rate was ~1900Mwk to 1USD. The differences in the rates are vast, and it means that physical USD, or any foreign physical currency, gives you more bang for your buck, literally.

On November 9, the Malawian treasury stated that their government set exchange rate would now follow the ForEx rate, effectively raising the official exchange rate from 1180Mwk per 1USD to 1700Mwk per 1USD. This meant that the Malawian kwacha was devalued 44% overnight.

There is a lot of speculation as to why this was done—some people say it was to try and knock out the black market, some people say it was to entice international buyers into the Malawian economy, etc. As an American on a grant that is paid in USD, this wasn’t hugely impactful to my overarching time in Malawi. But for the typical Malawian, paid in Mwk, their wages will likely not adjust to match the devaluation, which means that they can’t pay their rent, they can’t pay for gas to get to work, they can’t buy maize flour to make nsima.

The initial days of the devaluation were hectic, to say the least. Stores shut down for entire days to adjust their product pricing, unfairly increasing prices beyond the 44% devaluation; certain companies (like South African Airlines) completely pulled out of the Malawian economy last-minute, effectively severing employee contracts without prior notice and drastically impacting customer plans; the government vowed to crack down on unfair price increases and held press conferences about spending less money on “unnecessary international travel,” while the president immediately traveled abroad. Everything was in flux and no one felt secure.

But then, life became normal again, in a way. The prices went up, but they settled and became newly ingrained. I have to pay 74,000Mwk for a half-tank of gas rather than 50,000Mwk and that’s just how it is now. Patients still came to clinic, the guesthouse dogs still find woodland creatures to howl over, my project is still (slowly) moving forward.

On that front, there’s been some good progress! I got IRB approval in October but moving officially forward with recruitment was slowed by the process of trying to hire a research assistant and finishing translation of the survey into Chichewa, the local language. I finally hired and trained two research assistants the first week of November and started recruitment during the last week of November. We’ve been able to recruit and interview a few participants so far, though December is a notoriously slow month in Malawi. Most work stops completely during the last two weeks of the month, and the beginning of the month is largely spent prepping for the lack of work during the final weeks. Honestly, I would love if the U.S. would follow a similar model, but it was personally frustrating to finally start recruitment only to have it stopped just as suddenly.

Recreationally, November was a busy month for me! Weekend one was the Tumaini Festival, a cultural festival hosted at and benefitting the Dzaleka refugee camp in Dowa, Malawi. Then I (finally!) went to Dedza, Malawi the next weekend, which is famous for the Dedza Pottery shop, the Chingoni rock paintings, and Dedza Mountain, the second tallest mountain in Malawi. My favorite part of the trip was the Mua Mission Museum, a museum focused on preserving the culture and history of Malawi and famous for its wood workings. The next weekend I went to the fabric market to buy some chitenje, the local fabric, and have some made into a skirt and top. The final weekend saw us going back to Senga Bay in Lake Malawi to celebrate a friend’s last “free” weekend in Malawi. I’ve checked a lot of things off my tourism bucket-list so far (and before the rains, too!); I’m shooting to visit the tea plantations in Thyolo in March or April, and am scheming a trip to Zambia to see Victoria Falls sometime in the spring as well.

In mid-December, I got to go to the annual Christmas party for UNC Project-Malawi, a great celebration of the accomplishments of the institution over the past year. A few days later, I left for Cape Town, South Africa, with a friend to celebrate the holidays and explore a different part of sub-Saharan Africa. Cape Town was wonderful to explore, full of beautiful views, great (cheap!) food, and amazing weather, especially in relation to the 90+ degree heat I was leaving behind in Lilongwe at the time. My friend and I met up with my Dad for the holidays, which was lovely to be able to have a bit of home, even for a short time. My Dad brought some stuff from the U.S. for me, including a “gift” from my Mom of 20+ pounds of pretzels! I had told them that pretzels were one of my most missed foods (they’re available in Malawi but very, very expensive (about $15 for one medium bag) and she apparently did not want me to run out of pretzels before the end of the grant! I’m grateful for the gift, but I might have to start throwing pretzel parties to get rid of them all before May.

I was a bit overwhelmed by the reverse-culture-shock I experienced going from Lilongwe to Cape Town. Cape Town is much more akin to a major city in Europe or the U.S.—as one friend put it, “Cape Town is the L.A. of South Africa, maybe of all of sub-Saharan Africa.” Driving on full highways, walking through big shopping malls, and being able to use my credit card everywhere were all jarring experiences, to say the least. I fell back into such “normalcy” relatively quickly, but a big part of me couldn’t quite get over how stark the difference between the two cities were. The abundance in Cape Town felt almost excessive, especially when I reflected back on what I was going back to in Lilongwe. I think I knew I was going to feel some of these things when I get back to the US at the end of the grant, but I didn’t fully understand how strongly the feelings were going to hit until this brief interlude in Cape Town seemed to give me a little foreshadowing. It’s going to be an interesting transition back to Charleston, that’s for sure.