“Timing is everything” --- and Malcolm Molyneux, Malawi and malaria came together at the perfect time in 1986.
TT and MEM, Research Ward, 2006
Malcolm had spent the previous ten years as the Malawi’s Senior Medical Specialist, and he was seen as a sort of Renaissance Man there. He was an excellent clinician (he frequently had a mobile microscope with him on his ward rounds to identify blood dyscrasias and malaria on the spot). He was the Principal Conductor of the Music Society and had arranged many memorable performances, including Handel’s Messiah and Orff’s Carmina Burana. He spent many weekends on Mount Mulanje, and introduced multiple visitors (including a British MP with only one remaining lung) to its majesty.
Malcolm and Liz Molyneux moved back to the UK in 1984, and he began to metamorphose into an academic at Liverpool School of Tropical Medicine. His reputation in Malawi was an asset in terms of launching the research phase of his career. The Malawi Ministry of Health identified ‘severe malaria in children’ as their main research priority, and the platform was established when Dr. Ankie Borgstein welcomed Malcolm and me into her Department of Paediatrics at the Queen Elizabeth Central Hospital in the summer of 1986.
Over the next ten years, Malcolm toggled back and forth between Malawi and the UK. The research focused on bedside observations of children with cerebral malaria — the Blantyre Coma Score was developed and is now used throughout the malaria-endemic world. Studies on intravenous quinine and the new artemisinin-based antimalarials were undertaken, and important eye findings in patients with cerebral malaria were described for the first time. Outside of the research ward, Malcolm was involved in helping with the launch of the University of Malawi College of Medicine in 1991 and laying the groundwork for what would become the Malawi/Liverpool/Wellcome Trust Clinical Research Programme (MLW).
Malcolm and Liz returned to Malawi in 1995 – Liz to teach in the College of Medicine, and Malcolm to serve as the founding Co-Director of MLW. On the research side, we were involved in an arduous autopsy-based study of malaria pathogenesis. Malcolm went above and beyond the call of duty, even rousing our participating pathologists out of bed or, on one occasion, out of church so that the postmortems could be accomplished in a timely fashion. His traditional role in each autopsy was to return to the lab with the first brain smear. Malcolm would fix and stain the sample, examine it under the microscope, and then return to the mortuary to let us know if there was any evidence of sequestered parasitized red cells in the cerebral microvasculature.
He was also a reliable source of goodwill and hilarity, never failing to miss an occasion for a pun or literary allusion. Names in Malawi can be in Chichewa or English (both are official languages there) – so patient names can be Mphatso (“gift”), Chimwemwe (“happiness”), Mtendere (“peace”), Kennedy, Nixon, or, as for one set of twins, Skirt and Blouse. One weekend, we had a very sick young boy – his name was Time, and as we scrambled to address one issue after another with him, we would ruefully note that we were “just in time”, “in the nick of time” … and we hoped that we wouldn’t be “out of time”. Malcolm joined us for the ward round on Monday morning, and we handed him the very thick chart as we walked over to see young Time. Malcolm hefted it, knew that there would be a lot to say, and said to the team, “OK … please just give me “A Brief History of Time”.
The autopsy study was fascinating and generated quite a few papers — Malcolm was THE master editor: precise, articulate and nuanced. AND, after reading through our drafts, he would very often come up with startling new insights, or suggestions for additional analyses. He would put these forward tentatively, so as not to dent our nascent scientific egos. His brilliance did not have that effect, though — rather, we found it inspiring.
He was splendid company away from work, too, although we all quickly learned to object strenuously whenever he would suggest a short cut, whether it be on a hike, a bike ride or in a vehicle.
Malcolm and Liz returned to Liverpool in 2015, but Malcolm stayed connected with work on the Research Ward and was a valued, valuable source of advice and feedback.
His caution and his ability to appreciate many different sides of any story tempered my enthusiasm and impulsivity — he opened all kinds of doors for me in Malawi and I loved having him as a colleague and a confidant.
We signed off in letters and e-mails with “CN, MEM” or “CN, TT”. “Chibwenzi nkuonjezera” is a Chichewa proverb that translates to “Friendships grow and deepen in themselves”.
Terrie Taylor
17 November 2021
