Pandemic cuts short MUSC student's Fulbright-Fogarty fellowship

Note: Shannon McGue planned to write about her work in Malawi after completing it, but the coronavirus pandemic has cut short her time there. Her work continues from a distance. Here, the College of Medicine student recounts her time in Africa, including what the coronavirus pandemic is doing to public health research.  

Since August 2019, I have been in Malawi working on cervical cancer research. I was lucky enough to receive a Fulbright-Fogarty fellowship to fund my year of research abroad. This grant provides funding for M.D. or Ph.D. students to spend nine months doing research at one of five international research sites, including in Malawi in southeastern Africa.

Cervical cancer is the most common cancer among Malawian women. Globally, 90% of cervical cancer deaths occur in developing countries. This disproportionate burden can be explained by unequal implementation of cervical cancer screening and preventive treatment. 

In sub-Saharan Africa, poor access to cervical cancer prevention strategies is compounded by a high prevalence of HIV/AIDS, which increases susceptibility to cervical cancer. Women living with HIV need more frequent screening, which is a daunting requirement for countries with limited screening services. Context-appropriate strategies are urgently needed.

This year, I have been working with University of North Carolina researchers Jennifer Tang, M.D., Lameck Chinula, M.D., and Jennifer Smith, Ph.D., among others, who are investigating human papillomavirus (HPV) self-sampling for primary screening. Self-sampling is less resource-intensive than other forms of screening because it does not require an examination table, a speculum or even a provider. The sample is then sent for HPV DNA testing, with results available in one to two hours.

Working on these projects in Malawi allowed me to understand the detailed work involved in implementing large research studies. I learned how to move projects forward in global health, where research tasks can be more complex. Multiple ethics boards need to grant approval, supplies are usually shipped from “out of country” and participant materials have to be translated into the local language.

Because I was in country, I was able to witness the importance of our work. I shadowed my research mentor, Dr. Chinula, in his weekly clinic, where he saw women referred for suspected cervical cancer. He estimated that only one in ten of his patients is eligible for surgical treatment because most women present at a late stage, after they already have symptoms. 

Later-stage cancer is treated with chemoradiation, which is not currently available in Malawi. The lack of adequate preventive care and huge burden of the disease inspired his research into novel approaches to cervical cancer prevention. As a future doctor, I found his work ethic incredibly inspiring. I am extremely grateful to have had the chance to work in person with his research team.

My global health leadership and research experiences at MUSC helped prepare me for my year abroad. I am thankful to the MUSC Center for Global Health for providing a network of students and professionals interested in global health. In particular, CGH helped me connect with research mentors at MUSC and provided advice on my Fulbright application.

As I am writing this, I am no longer in Malawi. Fulbright asked all U.S. participants to return home due to the coronavirus outbreak and related travel restrictions. I will be helping my research team remotely, though it is likely that the projects could be put on pause to minimize transmission risk. This is a sobering reminder that the coronavirus outbreak is impacting a broad swath of public health priorities. I am proud that I got to participate in cervical cancer prevention research, and I look forward to seeing how the projects in Malawi advance the field.