Final Paper


A Heart for the Work: Journeys Through an African

Medical School

- Chaps 2 & 3 -

Today’s Outline

1. The Sociocultural & Historical Context of Malawi

2. The Path to Medical School in Malawi

In Chapter 1, Wendland claims that:

In Malawi, the values that doctors-in-training take on are related to (24):

• The continual absence of fundamental biomedical technology

• The entwinement of biomedicine with “spiritual or political mission”

• The structural violence shaping both their lives and those of their patients

In Chapter 2, Wendland aims to show how the way that students become doctors in Malawi is deeply situated in the particular

sociocultural context of contemporary Malawi and Malawi’s history.

In Chapter 3, she shows us how particular individuals emerged from within this

sociocultural context to become medical students.

Chapter 2: “Medicine and Healing in a

Postcolonial State”

The Sociocultural/Historical Context of Malawi

Overarching point:

“When Malawi’s new doctors began studies at Malawi’s new medical school, they brought with them concepts of

medicine and healing, some shared with medical students in the global North and some not. When they left at the end of their internships more than six years

later for postings around the country, they faced regionally distinctive challenges as well as challenges common to physicians elsewhere in the world” (36).

The Sociocultural/Historical Context of Malawi

The main themes that Wendland traces throughout Malawi’s recent history are:

• “Malawi’s history is notable for the blurring of spiritual, medical and political power” (36).

• Malawi is a place “of dire poverty and entrenched health problems [that] create both enormous needs and enormous obstacles to meeting those needs” (37).

• “[T]he contradictory legacies of vernacular healing, colonial healing and mission medicine that shape what being a doctor means” (36).

The Sociocultural/Historical Context of Malawi

• Malawi has long been a “crossroads of Africa,” (36) a place where many different healing traditions intermingled.

• “Healing practices in southeast Africa are (…) famously innovative and open to outside influences (…) They are so pluralistic that nearly any generalization about African healing risks being an overgeneralization” (37).

• Biomedicine is only one particular form of healing in this context, and thus represents a particular choice that is imbued with particular social meanings.

Medical Pluralism

The Sociocultural/Historical Context of Malawi


• “In Malawi, all forms of healing have complex legacies” (36).

• Wendland specifically follows the trajectory of biomedicine throughout the eras of Malawi’s history to show how it is complexly intertwined with contradictory forms of power.

• Her claim is that the context she is laying out is the one out of which Malawian students decide to become doctors, and the one they face when they attain that status.

The Sociocultural/Historical Context of Malawi Power in the Colonial Era

• Wendland does not describe a neat and tidy narrative about how biomedicine fit into the era of European colonialism and missionization in the region. Rather, she shows that its history is full of ambiguity and contradictions.

• For example, on one hand, colonial medicine could be “oppressive,” used to control African subjects; on the other, it was a path to power for some Africans who managed to procure medical training.

• Just like other forms of healers who were active in politics, some Africans working in biomedicine used their power to fight against colonization, others to support it.

The Sociocultural/Historical Context of Malawi Power in the Colonial Era

“[During the colonial period], then, healing movements and healers themselves sometimes reinforced authority, sometimes changed it, and often challenged it outright. Institutions of healing (whether biomedical or not) stood in tension with other structures of power, a tension that

was to continue into postcolonial times” (44).

The Sociocultural/Historical Context of Malawi

Post-colonial Power

• When Malawi won its independence in 1964, the man who became head of state (Banda) was a biomedical doctor.

• However, he ended up being a power-hungry, ruthless leader who held the people of Malawi back in many ways, including: he “put barriers in the way of other Africans seeking to become physicians” (47).

• By the 1970s, “simply being an educated Malawian was extremely dangerous: surgeons, teachers and lawyers languished in jail” (48).

The Sociocultural/Historical Context of Malawi

Post-colonial Power • Many of the choices that Banda made in the 1980s (specifically

in regard to structural adjustment) plunged Malawi into the public health and poverty crisis that it is still in today.

- “health and nutritional status deteriorated” (50)

- healthcare became complete privatized

- salaries for healthcare workers dropped off

- there was no longer any way for clinics to afford drugs/supplies

“[M]any medical staff fled to places they could make a living wage, left clinical work in despair, or died” (50).

The Sociocultural/Historical Context of Malawi

Malawi today (p.52-54)

• “Indicators of biomedical services and staffing [are] bleak” (54)• Hugely supported

by foreign aid

• Active medical pluralism

• Relatively small biomedical infrastructure

• Very poor

• “the highest population per physician and the lowest annual per capita health care expenditures in southern Africa” (54)

The Sociocultural/Historical Context of Malawi

“Malawi’s doctors-to-be, then, decided to attend a medical school in a region where the power to heal was a force for both good and harm, where healers

propped up but perhaps even more threatened state authority. They learned at the intersection of global

curricula and local exigencies, the intersection of power and technology” (58).

“They became doctors in a part of the world where biomedicine was a colonial tool, sometimes even a

weapon—but also a force wielded by Africans moving toward independence and self-regulation. They began their practices in a setting in which the

‘physician’ as signifier was unusually multivalent and even contradictory: social and political elite,

humanitarian, authoritarian, colonizing influence, activist, dictator” (58-59).

The Sociocultural/Historical Context of Malawi

Break for insane photo showing how gorgeous and idyllic Lake Malawi is

Chapter 3: “Paths to Medicine”

• Wendland claims that the medical students she followed were very aware of this sociocultural and historical context.

• While she describes diverse paths to medicine, she traces the explanations medical students gave of how they came to be at the Medical College as emerging from different aspects of this shared context.

Paths to Medicine

“They positioned themselves in stories of their nation’s advancement in ways that help us to understand both the

pleasures and frustrations they would feel in the years ahead” (67).

Paths to Medicine • One explanation for why the medical students Wendland

studied placed themselves in these grand narratives is that they were “all part of Malawi’s tiny educational elite” (73).

• This means that they were well-versed in their nation’s history and their nation’s place in the world.

• It also means that they were among the most privileged of all Malawians: “Both the privation of the many and the privilege of the very few were evident in the accounts students gave about how they came to medicine” (73).

• These students saw themselves as being some of the elite few who had the opportunity to help a country that they had been educated to see as much in need of help.

Paths to Medicine

• Many students saw the “call” to study medicine as “vocation” (74-78), which speaks to

a) the complex entwinement of biomedicine, colonialism/ missionization and spiritual power in Malawi,

b) the way in which the Malawian context pushed young people to find a calling,

c) the way in which the Malawian context made suffering visible to elite young people

• Many of them spoke of “‘healing Malawi’”(81) as one of the reasons they became a doctor, which speaks to

Paths to Medicine

a) how medical students see themselves as part of a history of healer-leaders,

b) their understanding of their country as needing healing

• Many of these students families supported—but others cautioned against—medical school, demonstrating

Paths to Medicine

d) the enduring ambiguity of the role of biomedical doctors in Malawi

a) the perceived power and status of biomedical doctors

b) the need for personal connections to access medical care

c) the fear of enduring poverty

a.k.a., Reasons we in the global North recognize, and reasons that have a “distinctly Malawian cast” (79)