A Heart for the Work: Journeys through an African Medical School is a book written by Claire Wendland that details the cultural dissonance resulting from the presence of European biomedicine in Malawi. As one of the required readings for my Health, Healing, and Medicine in Africa seminar, this book in particular struck a chord with me. It exemplifies the not-so-great aspects of biomedicine (American/European medical practice) that we tend to forget. Wendland discusses the medical experience as it pertains to Malawian citizens: the impact of the medical school, the progression from student to doctor, the contrast between the Malawian and European medical systems, and the expansive duties and expectations of Malawian doctors. I, however, will briefly discuss implications of European biomedicine in Malawi and the lives of the Malawian medical students.
Under the facade of biomedicine was the “[justification of] oppressive and exploitative European rule”; the colonists basically used biomedicine as an excuse to impose themselves in Africa and further their imperialist agenda (41). The cultural nature of biomedical practice rendered it an incomplete field within the context of Malawi’s health system, which focused on the public state of health rather than the individual person and his illness. Sanitation and nutrition issues that were so significant in the health of the Malawian population could not be solved by biomedicine alone; public health and socioeconomic initiatives must be taken to really improve Malawian well-being. It was clear that, in Malawi, “hospitals, doctors, and medical schools at best [slapped] superficial and inadequate bandages over the deep wounds of inequality, interfering with oppressed peoples’ capacity to perceive and address the injustices of global exploitation” (11). I am not by any means saying that biomedicine is inefficient; in more developed countries, it fits in seamlessly. I think the primary issue is that we falsely regard medicine as an isolated field; there is much more to healthcare than just science, as advanced and capable as it is.
Malawian medical students and practitioners had experiences much different from those of American or European students. Their resources were so limited that they had to share library books on rotation, and access to a microscope was almost impossible to obtain. This translated to the inability to treat patients and the increased likelihood of contracting diseases. Evelyn Kazembe’s (a medical student Wendland interviewed) account of medical practice illustrates her disappointment with the overwhelming amount of patients each doctor had to treat, which disabled her from performing quality work. “And sometimes instead of offering or delivering the best you can, you end up just doing what you can do, to make sure that everyone is being managed. There are so many patients waiting for your care and all that” (66). In the US, we almost never have to worry about not reaching all the patients who come to the hospital or clinic; we have all the resources and labor that we need, and American doctors most definitely don’t spend every day of their lives working under the fear of acquiring AIDS.
Within the medical schools, students were subjected to what is called “homogenization.” Essentially, it is a process of natural selection, except regarding personality traits and behaviors. They learn from each other how to act like a proper doctor and began to exhibit the more favorable characteristics while eliminating the unfavorable ones. The most important quality of a doctor in Malawi is empathy; the biomedical stereotype of the cynical, emotionally detached doctor is the exact opposite of what Malawian medical students aspire to become. “The intimacy with the body reflects a distinctive perspective, an organized set of perceptions and emotional responses that emerge with the emergence of the body as a site of medical knowledge”; in Malawi, the emotional aspect was integral to the comprehensive understanding of medicine (147). It seems that only now has empathy become an admirable quality in European and American doctors, and even then, they are still required to maintain a certain level of detachment.
Another difference between Malawian and European physicians was the focus on patient care rather than medical treatment since there were almost no resources with which to treat patients. Specifically, their goal was to treat patients as a whole rather than relegating them to a carrier of disease. Wendland argues that European doctors, however, “sacrificed their hearts” for the callous efficiency of their biomedical practice. On this basis, she reasons that, though medical science may be universal, medical practice is distinctly cultural. Though most medical students converted to the European understanding of medicine, some hoped that “as medicine in Malawi ‘matured,’ there could be a melding of the best aspects of Western science and the ‘best’ aspects of Malawian medicine” (p110). It is important to recognize the value of all medical practice; biomedicine’s strength and efficiency should not overcome the Malawian “heart for the work,” the genuine and nurturing desire to help the community the best they can.
I will end with story Mkume Lifa, a medical student whose story exemplifies that of the ideal medical professional, not directly due to his experiences but because of his purpose.
“I started seeing that in life you don’t only have to be yourself, you live with other people around you. And I saw that I wouldn’t do much for them if I chose to enrich myself and not find ways of helping. I could get a million kwacha per month. But I wouldn’t be able to help them, because my needs would also increase with that amount of money. But if I became a doctor, I could help a lot of people. And that thought is what drove me to change my priorities. I came to find that life isn’t in order- basically, we’re all part of the same big mess, really- and that I should do something for everybody… I could see very poor people struggling for basic necessities. And there was a way in which I could reach out to them and help them, if I had the knowledge. And I just had that burning- that burning will within me to acquire that knowledge that I should be able to help, that knowledge with which I could reach out to those very needy people. Because, for example, we would go- my father, my uncle, and I- and these two guys would carry with them groceries to give to the numerous old people. Because we have very extended families in Malawi! So you give to numerous people. But you discover that the things they give them will only last two weeks, a week at most. But I thought; I could give them something which would last them longer than two weeks. Life is not only to make it financially. We should not only think about what we shall get but what we shall give unto others” (33, 35).
Author’s Note: Claire Wendland is currently an anthropologist working at the University of Wisconsin-Madison, studying biomedicine and its impact on Malawi. She has her medical degree with a specialty in Obstetrics & Gynecology, which she studied in both the US and Malawi before receiving her Ph.D. in Anthropology. Her book is incredibly interesting and insightful; you should definitely give it a read!
Wendland, Claire L. A Heart for the Work: Journeys through an African Medical School. Chicago: U of Chicago, 2010. Print.
Written by: Shreya Singireddy
Edited by: Daryn Dever