Pursuing palliative care in Malawi: The rainy season and recruiting patients

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 and January.

The rains have come! Well, sort of.

We’ve officially entered rainy season here in Malawi. I was really nervous about rainy season when I first moved here because I thought it would significantly impact getting places—most of the roads in Lilongwe are dirt because they are constantly under construction, and the roads not under construction are more pothole than asphalt. When I first got to Lilongwe, I interrogated my coworkers about rainy season, trying to load up on knowledge so I could be as prepared as possible. What I found out was: the rains are supposed to come every day, usually suddenly and in the afternoons, last a few hours with heavy downpour, and then clear up just as quickly; the heavy water makes dirt roads into muddy, bumpy terrain and asphalt roads sprout bigger and meaner potholes; and there isn’t a flu season but there is a cholera season, so be cautious of vegetables that you haven’t washed yourself.

Well, we’re smack-dab in the middle of rainy season and it’s not quite how I imagined. The rains definitely come suddenly and heavily and help lighten the heat a little when they arrive. The roads are definitely much worse after a heavy rainfall and the mud covers my car like a completely new paintjob. The country is gorgeous, blooming green and fertile, even with the particularly dry February we’ve had so far that’s kept it hot and dry and threatened the corn growth. We’ve still got another 1-2 months left in rainy season, so we’re all hoping for a couple more weeks of downpour to keep the fields growing and the days cooler.

Research has been moving at its usual slow-but-forward pace since coming back from the holiday break. I’m continuing with recruitment and interviews for my project but we’ve had a number of hiccups along the way. The Breast Cancer Cohort I’m working with was initially sold to me as “a cohort of 200+ patients.” Coming here, I realized that meant 200+ data points, with the active cohort actually closer to only about 50 patients. The original grant for the Breast Cancer Cohort included a travel stipend for patients to be able to afford to come to their appointments, but the current funds have dried up so the patients no longer get travel stipends. This means that, of the 50 active cohort patients, not many actually show up for their appointments because they can’t afford to travel. There’s also no telling if or when patients will show up. In the US, there’s a computerized schedule of patients and patients are often sent many reminders prior to their appointment to make sure they show up. Here, one of the nurses creates a schedule of potential patients that might show up for the week and you won’t know if they actually show up until well into the potential recruitment day. Often I am just sitting, waiting in a spare room in the clinic, hoping the nurses will come in with a patient file of someone I haven’t seen yet who’s willing to sit for an hour interview.

I had thought I would easily be able to get 25 patients recruited by the end of March but it’s been a slow struggle to get nine patients recruited and interviewed in three months. It’s not the end of the world (nine is a pretty good starting point!) but definitely makes the process a lot more frustrating. Global health and research are all about flexibility but it’s hard to remember that idea when I have an inflexible, hard deadline to return to the U.S. and I need to finish recruitment before I leave. May is right around the corner but the patients are not and I’m not entirely sure what I should do.

In other news, I’m starting to feel really settled in Malawi. I think it struck me hardest after coming back from Cape Town because I felt like I was returning home. It’s been a wonderful feeling, to feel secure and comfortable. To feel like I know where I am and what I’m doing and what is expected of me wherever I go. That comfort has absolutely transcended into my weekend habits—I haven’t been doing anything terribly exciting the past few months, in terms of extracurricular activities. In the U.S., medical school has made me a grandma and a homebody, so I’m usually very content to chill at my apartment during my day off, maybe go out to a brewery with friends. Now that I feel settled here, I find myself doing much the same. I have a lot more free time here and a lot more energy than usual after work, but I’m not actively exploring the tourism hot spots as often as I was in the first three months of the grant. Now, I find myself going to my favorite cafes and restaurants to read, playing social volleyball at The Shack on Saturdays, taking a relaxing walk in the forested Lilongwe Wildlife Center. All simple, regular comforts. And I’m loving it.

I did manage to sneak in a cheeky last minute weekend safari trip to South Luangwa in Zambia with a few friends at the end of the month. And I definitely still have a few tourist goals left: I’m planning on visiting Victoria Falls towards the end of March and I would love to visit the tea plantations in the south and/or visit the northern region of Malawi. I don’t have much time left, at all (time is flying by so quickly!!!), but I think I can squeeze in a few last trips before I leave.

Here's hoping I can squeeze a few more recruitments in before then, too!