Spotlight Interview with Dr. Racky Wade

“I understood that if we act on the environmental factors of schizophrenia, we can improve the prognosis of the disease”

Location: Dakar, Senegal

Bio: Dr. Racky Wade is currently an assistant professor in anatomy with a clinical option in psychiatry at the Cheikh Anta Diop University in Dakar (UCAD), Senegal where she has responsibilities ranging from lecturing to providing mental health care. Her scientific publications focus on translational research, more precisely on neuroanatomy applied to schizophrenia and depression, and she has published on individual representations in Senegalese people living with HIV (PLHIV). She is married with 3 children: two girls and one boy. Dr. Wade was awarded a prize of excellence for best oral communication on the cingulate gyrus and depression by the Anatomical Society of Paris in 2015. She was also awarded funding during the third year of her doctorate from the Support Project for the Promotion of Female Researchers (PAPES) of the Ministry of Higher Education, Research and Innovation of Senegal in 2017.

Mental Health and Schizophrenia Research

Dr. Wade’s interest in mental health and schizophrenia research began with her first clinical training position in psychiatry at UCAD at the end of 2010. It was during her training that she was able to apply course content to in-patient clinical cases. She explains: “I began my training in psychiatry and I received my first patient who hospitalized, and it is with him I learned the first symptoms of schizophrenia… all symptoms I read about in the books or I learned in my courses, I found with this patient. It was desperate for him and for the medical team.”

Following the first years of training, she was able to understand the effects of external factors on prognosis of the illness: “I can receive someone who has schizophrenia but with a different socioeconomic resource or means. These patients have good socio-professional integration and less severe symptoms than my first patient because their socioeconomic means are better. I understood that if we act on the environmental factors of schizophrenia, we can improve the prognosis of the disease.”

Educational Journey

Thus, following medical graduation from UCAD in 2011, Dr. Wade went on to obtain her master's degree in morphological and clinical anatomy in 2013 and eventually qualified as a psychiatrist in 2015 after completing residency at the Fann University Teaching Hospital in Dakar, Senegal.

After earning her master’s degree, Dr. Wade embarked on a four-year long educational journey to obtaining her doctorate in neuroanatomy from UCAD. The program follows a classic structure in which students begin by drafting a research proposal before acquiring funding. Obtaining a grant in the early years of the program can be difficult, so students are often supporting their research through their own means. For this reason, Dr. Wade self-funded her first three-month research stay in Paris, where she was able to receive additional training in “Morphology and Imaging of the Central Nervous System” at the University of Paris VI, now known as the Sorbonne University, with the aim of strengthening the methodology of her doctoral thesis.

Dr. Wade was able to obtain a grant in the third year of her PhD from the Embassy of France, which supported her travel to Paris for a four-month research stay. She visited the closed psychiatric unit of the Sainte-Anne Hospital in Paris as a trainee observer and the Anatomy Laboratory at the University of Paris 5 as a visiting researcher.

After a research topic has been approved, students in the program begin their training. Training at the university is transversal, meaning that teaching units are not topic specific and include courses such as methodology, verbal communication, bioethics, leadership and management of data. Most anatomists, like Dr. Wade, also complete dual basic and clinical training in both the laboratory and hospitals respectively. Students then begin data collection and analysis. In the process of completing the final manuscript, Dr. Wade stressed that it is necessary to disseminate study findings through various means. “Our department organizes a congress for doctoral students every year and the students have the opportunity to present their work, step by step. It’s a requirement.” In the final stage of the program, the manuscript title and abstract are shared widely within the school to assess its originality and students complete an oral presentation of their thesis. Dr. Wade had two directors for her research mentorship: Co-Director Dr. Odile Plaisant, an anatomist-psychiatrist from University of Paris 5, and Co-Director Prof. Abdoulaye Ndiaye, an anatomist-orthopedist from UCAD. They granted her a doctorate in neuroanatomy as applied to neuroscience clinic (psychiatry, neurology, neurosurgery and 3D neuroimaging) in 2018 at UCAD. 

Practicing in Senegal and France

Following a university career with very limited resources in a lower middle-income country, Dr. Wade managed to establish a professional and social career through passion and perseverance. During and after her doctoral program, Dr. Wade spent time practicing in hospitals in Dakar, Senegal and training in Paris, France. In comparing clinical practice by the income level of each country, Dr. Wade made note of similarities in attending to the needs of patients: “You must listen. You must have empathy for your patient. And you will have the same difficulty when the patient has no insight and refuses to take her or his medication. You must use, for example, psychoeducation.” In the field of mental health, patient adherence to medication remains difficult. In her experience, Dr. Wade suggested attempting to compromise with patients by proposing an occupational activity that the patient might like in agreement that they will take their medications. Sometimes, an educated patient with schizophrenia can more easily adhere to treatment based on a simplified neuroanatomical and neurophysiological explanatory model.

Dr. Wade also observed several distinctions in her practice when training in Senegal compared to France. For example, she stated: “We have no digitalization of our medical data in Senegal, and I think it's very important because we can do research with [digital records] and we can safely keep medical records of all the patients.” Dr. Wade mentioned that policymakers in Senegal are making strides to address this issue and provide financial means for appropriate software. Additionally, lack of technology, staff, and medication such as second-generation neuroleptics in hospitals across Dakar create difficulties in meeting patient needs. Despite these limitations, Dr. Wade states that her practice emphasizes positive aspects of Senegalese culture through the use of “institutional accompaniments” that play a similar role to that of the family; they help, guide, and discuss issues with patients so that they don’t feel alone during their hospitalization. Patients are also followed in the same inpatient unit after clinical stabilization, which is beneficial both to the patient and to the psychiatrist in evaluating the care provided.

Challenges in Practice and Room for Improvement

Throughout her time as a hospital practitioner in Senegal, Dr. Wade noted the importance of improving patient coordination after an inpatient stay. She has observed the difficulties that patients face returning to their jobs, and that families are tired and do not have the financial means to pay for medication. Dr. Wade suggested implementing therapeutic appointments with family members in the form of a sustained program as a method of addressing this problem. “Sometimes when they are in the big houses, there is more difficulty with other members of the family. Some members of the family don't understand the illness, and it is difficult for them to live in this big family.” She noted that ultimately, a larger responsibility rests on policymakers in the country.

Despite certain challenges, Dr. Wade recalled many fulfilling experiences as a practitioner. In one fond memory, Dr. Wade told the story of meeting a patient at her practice, a medical student with depressive disorder. A few months later, Dr. Wade received a call from the student’s mother at 3 a.m. to say that her daughter had attempted suicide. The student was alone because she had relocated to Senegal from Cameroon. Dr. Wade made her way to the university campus and spent more than three hours there until she was reassured that the student was well and had a medical team around her. Seven years later, she met the student again, now a physician and doctor. Reflecting on the moment, she said: “I was happy for her because it was the beginning of my career and I had the common belief that if you have a psychiatric disorder, you cannot continue your training. But with her I saw the result. And now I have other patients who are students that continue their training.”

Future Directions

Dr. Wade has several plans for the future as she returns to Senegal following a rewarding visit to Boston Medical Center (BMC). She looks forward to raising awareness of the need to improve the conditions of hospitalization among psychiatric patients as well as the working conditions of mental health professionals. Additionally, she would like to incorporate elements of the BMC Wellness and Recovery After Psychosis (WRAP) Program in her practice: “I want to propose a program like the WRAP program to other members of our staff in Dakar. I think it’s very, very important because it comes after the inpatient stay, and patients need all of these supports to continue to have good social integration after they have psychosis.”

Closing Thoughts

Dr. Wade concluded with a wish for improved equity in patient care around the world and emphasized the important role policymakers play in achieving this. She stated, “And at last, do not forget the culture aspect. Without this, there is no efficient care. Always consider the culture, it's very important.”

“Finally, I would like to thank everyone at Boston University, and especially those at the BMC Department of Psychiatry, for the enriching exchanges and warm welcome I received during my stay. You are welcome in Senegal!”

By Krisztina Baltimore, December 2023