Final Paper

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A Heart for the Work: Journeys Through an African

Medical School

- Chapter 3-

Today’s Outline

1. Paths to Medicine The circumstances in which Malawians choose to become doctors

2. Final paper prompt

Chapter 3: “Paths to Medicine”

Paths to Medicine

• In this chapter, Wendland is taking us through the next step of the story of students becoming doctors in Malawi.

• The first step was to set the stage: acquaint us with the historical and sociocultural context of Malawi.

• Now, she is showing us why people choose to go to medical school in Malawi: where they come from, what their reasons are, and what they and their loved ones believe about this life trajectory.

Paths to Medicine

• One of Wendland’s overarching points is to show us how this journey for these students was both like — but in large part unlike—the ‘typical’ journey of medical students (i.e. the journey of medical students in the Global North).

“They brought with them to school social distinctions, personal histories, and motivations for

medical work that mattered for their trajectories through training” (67).

• The “call” to study medicine as “vocation” (74-78)

• “‘Healing Malawi’”(81-83) as a major motivator

• Ambivalent family support (76-81)

Paths to Medicine Main themes

• Medical students all part of the “tiny educational elite” (73)

• The “call” to study medicine as “vocation” (74-78)

• “‘Healing Malawi’”(81-83) as a major motivator

• Ambivalent family support (76-81)

Paths to Medicine Main themes

• Medical students all part of the “tiny educational elite” (73)

Medicine was one of the very few post- graduate paths possible, and really the only one teachers saw as worthwhile for the best performing students

Medicine as Vocation • Many students that Wendland studied felt a

spiritual calling to become a doctor.

• For most, the calling originated in an “encounter with poverty of suffering” (74).

• As Wendland points out, almost everyone in Malawi grows up having loved ones get sick and die, or getting very sick themselves.

• It seems that Christians more than others were in positions to feel and heed the call to medicine.

“The language of the call curiously combines a sense of moral rightness and certitude with a sense of passivity. A vocation is felt, experienced, imposed upon one by the supernatural. One’s choice is simply to accept or resist. The experience of vocation was especially common among students for whom the calling to medicine took an explicitly religious form, who heard God calling them to be doctors…” (75)

Medicine as Vocation

Medicine as Vocation

• Wendland suggests that it was also due to the “context of unpredictably short lives” (76) that pulls people into medicine. (Life expectancy in 2002: 50 years)

“Young doctors for whom medicine was a calling, a mission, what they were ‘supposed to do,’ could feel sure they were using their limited

time on earth well” (76).

Ambivalent Family Support

• The long training, expense of school, low pay, and risk of infection, all in the context of great poverty and short life expectancy, made some families hesitant to encourage their child/family member going to medical school.

• However, “more often than not they were neutral or encouraging” (78).

Ambivalent Family Support

• The status of having a doctor in the family was important to many families (“‘We have a doctor in the family’” [79])

“Some explanations will be recognizable to readers from wealthier countries, while others take on a distinctly Malawian cast” (79).

• Guaranteed income (full employment & job security).

• Doctors have“extensive social capital” (80): facilitating a good standard of living/opportunities for their family.

• Medical access for families

“Healing Malawi” • Many saw the inadequate care at clinics/local

hospitals as calling them to make a difference.

• Aware of the doctor-to-patient ratio, many saw the very act of becoming a doctor as helping to move Malawi forward.

“Educated Malawians with access to media know their country by its statistical measures and understand its degree of development as a

function of those measures” (82).

“Healing Malawi”

• Additionally, rising to the rank of doctor, instead of caring for the suffering in another way, carries very important wait in the postcolonial era.

• This is a status that local Africans were excluded from during the colonial era.

“Africanization of medical schools and medical practice has come to be seen as a crucial

component of decolonization” (83).

“Healing Malawi” “[M]any students (…) felt the opportunity to become

doctors to be a validation of their intellectual capacities and a step toward development for

themselves and for their country” (83).

“The nationalist impulses that drove students (…) into medicine would have a profound impact on their experience of medical training and their ultimate

career choices.” (83).

Not exactly like American pre-meds, right?

Summary (84-85) “[M]any of these students positioned themselves in relation not only to their profession but also to their religion and to their nation. Medicine was not always a choice: some saw it

as the only realistic option available for a Malawian with science aptitude. [M]ost accepted medicine as a vocation or

chose it more actively, out of religious or nationalist impulses. Simply by becoming doctors, some assumed

identities as conduits for God’s healing power. Many saw themselves as agents of development for the country as a

whole. (…) Doctors, by virtue of their deep scientific knowledge and international recognition of their professional

role, were evidence of Malawi’s modernity” (84-85).

Thinking back to the main claims

• One of Wendland’s major points here is that these “paths to medicine” are just as biomedical as the ones from the Global North.

• These are not “alternative” ways of becoming a medical student, this is just an aspect of what biomedicine is and what it means that hasn’t been brought to light.