“I thought the poverty, chaos, and sadness I saw there were products of my Northern vision, that of a doctor used to abundance, order, and the systematic concealment of suffering and death in hospital settings. Again and again, my journal recorded a plaintive question: “What kind of a hospital is this?””

Claire L. Wendland (p. 121)

Imagine yourself in a country where millions of people die daily due to the lack of medical help. With every passing day more and more people join the increasing number of deaths in the afterlife due to the lack of inactivity from the government. In A Heart for the Work, Claire L. Wendland explores the spiritual and physical journey that Medical Students in Malawi go through throughout their training. She illustrates the increasing obstacles in their paths, as well as how the heart plays a major role in the treating of a patient. Wendland does an excellent job in differentiating between doctors in training in America and in doctors in training in Malawi. She beautifully addresses the issues that most doctors go through in a typical city like Malawi, and how they tend to the problems that no one seems to be able to solve.

As a current biology major I found it increasingly startling to find out that most Med students share a book for every dozen or more in a class. Most people in America don’t realize the circumstances that these people learn under. I can barely make it in my basic classes and I have a book for each of my classes. Yet these students seem to have an undeniably great amount of perseverance and determination when it comes to their studies. In Malawi there seem to be little titles of occupations. The way some people described it in her book was, either you became a doctor, a lawyer, or continued the life your family had before. Yet despite the competitive and small amount of supplies most of these students stayed in this profession regardless of the negative outcomes. In the beginning of her book she describe the third year medical student and how she had “…to make a diagnosis without most of the laboratory tests in the pathology textbook and to treat an illness without most of the drugs in the pharmacology book.” (p.4) Regardless of all the negative obstacles it was “Time to learn to be a doctor.” (p.4)

A Heart for the Work was a great example of a Medical Anthropological issue. It discusses the unfortunate circumstances that the Malawians have to go through due to the lack of inactivity from their government. Medical Students go through hardcore training in five years in order so they could be prepared to deal with the epidemic HIV cases in their country as well as the horribly malnourished mothers and children who suffer from Anemia and other awful illnesses. Yet when they get to the hospital instead of performing the tasks they learned from the long shared Biology book they must perform tasks under pressure and with limited resources. “Nothing is wrong with high-tech medicine, except that there isn’t enough of it to go around”. (p. 10) While medical students go through their training in America they don’t have to worry about the same issues that med students in Malawi have to worry about. They know that regardless of their financial stability they will always have the medical equipment they need at their disposal because they are in America and America provides only the best. Malawian students can’t say the same because the government can literally care less about the supplies and the increasing amounts of deaths and illnesses.

I found the student testimonials to be very effective. I loved the way she structured her topics of discussion from beginning to end. I found it very helpful to hear the voices behind the surgical masks. Having student testimonials from the beginning of their medical years to the end was amazing. I found it interesting to see how much their perception had changed. Many of these students were called Doctors by many people for just being accepted to med school. I found it amazing how some women actually stood up to their male classmates and professors. Of course women were still stereotyped and many had admitted that many male students told them to go learn about nursing and to leave the big role of Doctor to the men. I grew interested when she interviewed students about their beliefs before medical school and how that had changed over time. “Even when they seemed to feel a twinge of regret for their lost beliefs and protective mankhwala, as a few did, students did not question that as doctors they would be capable of understanding the real truth of human health and illness better than traditional healers could.” (p. 110) Wendland provides wide consistent examples to back-up her statements by then explaining that “Laboratory training was supposed to teach students “how things are everywhere, anywhere, always” (p.114-115) not bringing religion into the equation in any shape or form.

I was awed to find out that through that extensive autopsies of the cadavers they learned how to “suspect AIDS in the thin woman with telltale white deposits of candidiasis in her throat, and to recognize the ravages of malaria in the red-spotted gray of a child’s brain matter and in his grossly swollen spleen.” (p.92) While the anatomical dissection for North American and European students proved to be the stage that they began to harden and start realizing they were the doctors, this part arrived early for Malawian students. Wendland touches the issue by assuming that because of the “high death rates and a strong cultural emphasis on funeral attendance give Malawian students a much greater previous exposure to death and corpses than most First World students could be expected to have.” (p.113) making them feel more like doctors sooner.

I think most Americans know what is going on in other countries with low medical resources. They just don’t really know the depths of the situation. After reading this book, my respect for these Doctors skyrocketed. I knew things were bad but I didn’t realize how badly. I always thought that doctors from other countries like Malawi and Kenya just weren’t trained well enough. When in reality they are trained similarly to American doctors they just don’t get to test their knowledge in depth due to the lack of x-ray machines, CT scanners, etc. What really surprised me were the conditions of the hospitals and the condition of the medical supplies. My jaw dropped when Wendland described the hospital wards “the most acutely ill patients fit eight to a room.” (p.117) What was more startling was the fact that “In the open area, iron cots lined each side of the bays, sixty to eighty patients crammed into a space designed-at least according to the place-marking numbers painted on the walls-to be tight quarters for forty.”(p.117)  They had bathrooms that had to be shared by everyone and throughout the hospital the moans and screams of the sick were heard constantly.

First year students began with a hope that could change the world, if only they had the resources. They moved throughout the years with determination that most won’t ever feel. The occupation they started with a shining light however became a depressing dark undertone by the end of their studies. They began their clinical training in a hospital that did not resemble the idealized one in their textbooks at all. A startlingly “80 to 90 percent of the patients were hospitalized for complications of HIV/ AIDS” (p. 120-121). The worst part was that “the pharmacy stocked only 46 percent of the country’s already quite limited list of “essential drugs.” (p. 120). Others lacked the essentials of iodine or methyl alcohol, which meant surgeries were done without antiseptics.

Interns usually had too much of a workload. Usually their care consisted of “twenty-eight beds, 106 patients, and one nurse.” (p.121) What began as something to change the world and help people, became somewhat of a repetitive routine that left little time to give a full diagnostic to patients. Wendland described doctors seeing patients for two minutes at the longest barely having time to give them a full diagnostic much less a smile or acknowledgement. It was interesting to see the difference between Northern American students and Malawi students when it came to failure of their work. Northern American doctors tended to blame the patient because they could never seem to do enough for them. While in contrast Malawi doctors blamed lack of resources and to a political system. They never talked horribly about their sick dying patients. The only anger they had was directed to the medical profession that allowed devastation.

I found this book to be a very helpful read for any Medical or Anthropological student. Wendland talked about relevant topics of discussion that are a major topic in Medical Anthropology. She described thoroughly the devastating amount of deaths because of HIV/AIDS, the hardships medical professionals go through, the lack of care from the political system, the few financial opportunities for people, and the lack of resources to conduct successful medical executions. Doctors have no option but to seek occupational opportunities out of the country because they have no future helping people who regardless of their efforts will end up dying. Yet even despite this, I found a trait of heroism for those who stayed and continued to try to help and develop ways to put up with the restrictions. Putting out “a heart for the work” (p.177) seemed to be the way to go in Malawi. Being bright and intellectually gifted in your course of work did little if you were a horrible doctor to the suffering and dying people. “In all years, love for patients ranked far above objectivity or technical skill. Clinical students often claimed that heart was more important than technical capacity or intellectual brilliance.” (p. 178).

I definitely enjoyed this book and as my studies continue on I will seek knowledge and strength to continue in the path of medicine. I will never forget the stories Wendland successfully delivered in A Heart for the Work or the hardships that patients and doctors alike went and continue to go through. If anything this book has sparked a sort of determination in me to provide a type of aid to the people in Malawi. May I dedicate my time and love for medicine to one of these hospitals and its patients in the near future. All I can hope for today is that the information of this book be known to all who can provide aid economically and physically.

Reference:

Claire L. Wendland. A Heart for the Work: Journeys through an African Medical School. Kindle Edition.

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