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A Heart for the Work: Journeys through an African Medical School
Burnout is common among doctors in the West, so one might assume that a medical career in Malawi, one of the poorest countries in the world, would place far greater strain on the idealism that drives many doctors. But, as A Heart for the Work makes clear, Malawian medical students learn to confront poverty creatively, experiencing fatigue and frustration but also joy and commitment on their way to becoming physicians. The first ethnography of medical training in the global South, Claire L. Wendland’s book is a moving and perceptive look at medicine in a world where the transnational movement of people and ideas creates both devastation and possibility.
Wendland, a physician anthropologist, conducted extensive interviews and worked in wards, clinics, and operating theaters alongside the student doctors whose stories she relates. From the relative calm of Malawi’s College of Medicine to the turbulence of training at hospitals with gravely ill patients and dramatically inadequate supplies, staff, and technology, Wendland’s work reveals the way these young doctors engage the contradictions of their circumstances, shedding new light on debates about the effects of medical training, the impact of traditional healing, and the purposes of medicine.
352 pages, Paperback
First published September 15, 2010
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Displaying 1 - 7 of 7 reviews
December 29, 2014
School's out for the summer (yay!) and this was the 1st book on my reading list. I recommend this book to anyone studying medicine, better yet, to anyone connected to the field of medicine. This book is a medical anthropology following the paths of Malawian medical students as they journey their way through med school. Their experience of medical school is very different than that of students from materially wealthier nations. These students learn to cope, daily, with sorely lacking technology, limited basic supplies, and very few medicines to help them diagnose, care for, and heal patients. However, they make up for this lack with amazing resourcefulness, creativity, and hope.
Claire Wendland writes beautifully, too. I loved the narrative pieces interspersed throughout the book.
"I'm walking on to the obstetrics and gynecology ward, but my student companion is headed for the main hospital block, and we say our goodbyes as she turns off toward the big double doors. She quickly peels her remaining tangerine and pops the cool, juicy pieces in her mouth before she reaches the entrance. It's always tough to leave behind the smoky, faintly eucalyptus-scented air of Chipatala Road for the bloody, bleachy, sweaty smell of the hospital; the residual fragrance of tangerine helps, I know. My watch says it's a couple of minutes before half seven. It will be time for her to find the other students and the consultant for morning rounds. Time to stand quietly at the edge of the group and try to soak up the knowledge she will need soon when she's sent out to run a district hospital, time to figure out how 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. Time to learn to be a doctor."
Also, in the "notes" section, at the end of the book, Ms. Wendland thoughtfully includes, at the top of each page, the page numbers the notes are referenced to, which makes it much easier and painless to follow along, keeping up with the notes, while reading.
I'm sure this book will encourage more doctors to truly cultivate "a heart for the work".
Claire Wendland writes beautifully, too. I loved the narrative pieces interspersed throughout the book.
"I'm walking on to the obstetrics and gynecology ward, but my student companion is headed for the main hospital block, and we say our goodbyes as she turns off toward the big double doors. She quickly peels her remaining tangerine and pops the cool, juicy pieces in her mouth before she reaches the entrance. It's always tough to leave behind the smoky, faintly eucalyptus-scented air of Chipatala Road for the bloody, bleachy, sweaty smell of the hospital; the residual fragrance of tangerine helps, I know. My watch says it's a couple of minutes before half seven. It will be time for her to find the other students and the consultant for morning rounds. Time to stand quietly at the edge of the group and try to soak up the knowledge she will need soon when she's sent out to run a district hospital, time to figure out how 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. Time to learn to be a doctor."
Also, in the "notes" section, at the end of the book, Ms. Wendland thoughtfully includes, at the top of each page, the page numbers the notes are referenced to, which makes it much easier and painless to follow along, keeping up with the notes, while reading.
I'm sure this book will encourage more doctors to truly cultivate "a heart for the work".
June 20, 2012
The author is a physician and anthropologist and much of the book is like an anthropological research paper. She follows a somewhat amorphous group of medical students at the College of Medicine in Malawi using interviews; she also worked and studied medicine in Malawi.
The style is academic and not something you would read for pleasure. I was very interested in the topic so slogged my way through. I spent three weeks in Malawi at the University of North Carolina Tidziwe Center in Lilongwe setting up a medical/public health library; the nursing school and university of health sciences were essentially next door. I was also able to travel to the the University in Zomba. The names and places in the book were very familiar and many of the student names made me smile - I didn't know them personally but they were familiar.
I was particularly interested in her assessment of the "clinical officers". The university of health sciences trained clinical officers, what I would call physician assistants, and a good number worked at the Tidziwe Center - along with two American doc and 2 Malawian docs. I was very impressed with the clinical officers - it was interesting that the author saw such discrimination against them. I found the Malawian docs fairly unimpressive and arrogant by contrast. But I was only there 3 weeks.
I was also disappointed to only find one hidden reference to the UNC work in Malawi. The author pointedly talked about the lack of public health approaches and lack of infrastructure; public health was the exact approach being taken at Tidziwe. I do think she is correct that the hegemony of Malawi and many developing countries works against an effective public health approach.
Another thing that kept me reading the book was her overarching theme that medicine and science are very much determined by cultural beliefs and systems. I wish that had been an even stronger component of the book.
The style is academic and not something you would read for pleasure. I was very interested in the topic so slogged my way through. I spent three weeks in Malawi at the University of North Carolina Tidziwe Center in Lilongwe setting up a medical/public health library; the nursing school and university of health sciences were essentially next door. I was also able to travel to the the University in Zomba. The names and places in the book were very familiar and many of the student names made me smile - I didn't know them personally but they were familiar.
I was particularly interested in her assessment of the "clinical officers". The university of health sciences trained clinical officers, what I would call physician assistants, and a good number worked at the Tidziwe Center - along with two American doc and 2 Malawian docs. I was very impressed with the clinical officers - it was interesting that the author saw such discrimination against them. I found the Malawian docs fairly unimpressive and arrogant by contrast. But I was only there 3 weeks.
I was also disappointed to only find one hidden reference to the UNC work in Malawi. The author pointedly talked about the lack of public health approaches and lack of infrastructure; public health was the exact approach being taken at Tidziwe. I do think she is correct that the hegemony of Malawi and many developing countries works against an effective public health approach.
Another thing that kept me reading the book was her overarching theme that medicine and science are very much determined by cultural beliefs and systems. I wish that had been an even stronger component of the book.
August 13, 2018
I read this book prior to working in Malawi for a summer. It's a great preview into the medical system as well as the sociopolitical dynamics affecting health in the country. It's a must read for anyone doing healthcare work in Malawi, but it's also an eye opening book for any medical student. Its fascinating to understand how medical socialization is so different and similar based on the setting/curriculum of one's training.
November 2, 2014
In the United States, I have often heard students, residents, and practicing physicians say of a colleague, "He may be an asshole, but he's a really good doc." (In years past, I have said it myself.) I never heard anything similar in Malawi and have come to believe that it would be heard as nonsensical there. The work itself, for these students, required heart. (178)
The beginning and end of the book felt a little slow, but the in-between is fascinating and full of ideas. Wendland walks through the stages of medical school in Malawi, in part comparing to Northern* experiences of med school and in part charting students' changing ideas and ideals. I'm just a curious layperson, but I highly, highly recommend reading the endnotes; they add a great deal.**
No proper review, but notes on the text:
Goal to have doctors' training be on par with (and thus 'competitive' with) training in more developed countries (56) -- makes a great deal of sense on many levels, but because resources are so different, training to Northern ideals has the unintended consequence that Southern doctors are trained in many things that may not apply -- in many situations they end up having the knowledge but not the technological capabilities (or even basic resources) to apply it (130). 'Students learned about diseases of the elderly but had almost no elderly patients. They learned about neuroimaging and fluoroscopy and care of the extremely premature neonate, but had access to none of the equipment necessary.' (131)
Cost of medical school in Malawi ($263 per year) sounds incredibly low in a higher-income country, but when you consider per-capita income, PPP, etc., it's the equivalent of $56,500 per year in the U.S. (80)
Resource limitations are not exclusive to the practice of medicine -- Wendland notes one case in which 87 students were sharing one copy of a textbook, although she qualifies that by saying that that was an unusually low textbook-to-student ratio. (90)
Relevant patient case info is not limited to the strictly medical, as it is in the North -- if a patient is poor, or her husband is away much of the time, or she has twins on the way, that is likely to affect the kind of treatment she'll be able to access.
Disposable latex gloves are among the things in relatively short supply, and they're consequently washed, dried, and reused (91) -- have any manufacturers aimed for reusable gloves, which might stand up better to multiple washings, etc.?
Much higher risk of physician exposure to diseases than in Northern medical settings; interesting calculation of occupational exposure (127-129). Not just a matter of higher numbers of patients with (e.g.) HIV/AIDS, but also less advanced equipment, lower lighting, etc.
Common theme of (Northern) med-school memoirs is coming to terms with the reality that some patients will die; students in Malawian med schools are much more likely to see high levels of death both in med school and after. (130-131)
Common assumption that Northern doctors are practicing 'real' medicine while Southern doctors are not (134)
'Indeed, most students felt that they were being held to high standards of self-sacrifice by donor countries, by the college administration, and by their own government: they were expected to practice in very poor conditions, for long hours, and with little remuneration.' (159)
*Wendland uses 'global North' and 'global South' in the same way that many use 'first-world countries' and 'developing countries'.
**Not to mention the bibliography. Doctors for Democracy, African Pioneers of Modern Medicine, Death in Abeyance, The Birth of the Clinic, The Modernity of Witchcraft, Asylums, East African Doctors, The Quest for Therapy in Lower Zaire, The Story of Medicine and Disease in Malawi, Jesus in Our Wombs, Life Exposed, When Experiments Travel, The Body Hunters, Street Dreams and Hip Hop Barbershop, Some Spirits Heal, Others Only Dance
The beginning and end of the book felt a little slow, but the in-between is fascinating and full of ideas. Wendland walks through the stages of medical school in Malawi, in part comparing to Northern* experiences of med school and in part charting students' changing ideas and ideals. I'm just a curious layperson, but I highly, highly recommend reading the endnotes; they add a great deal.**
No proper review, but notes on the text:
Goal to have doctors' training be on par with (and thus 'competitive' with) training in more developed countries (56) -- makes a great deal of sense on many levels, but because resources are so different, training to Northern ideals has the unintended consequence that Southern doctors are trained in many things that may not apply -- in many situations they end up having the knowledge but not the technological capabilities (or even basic resources) to apply it (130). 'Students learned about diseases of the elderly but had almost no elderly patients. They learned about neuroimaging and fluoroscopy and care of the extremely premature neonate, but had access to none of the equipment necessary.' (131)
Cost of medical school in Malawi ($263 per year) sounds incredibly low in a higher-income country, but when you consider per-capita income, PPP, etc., it's the equivalent of $56,500 per year in the U.S. (80)
Resource limitations are not exclusive to the practice of medicine -- Wendland notes one case in which 87 students were sharing one copy of a textbook, although she qualifies that by saying that that was an unusually low textbook-to-student ratio. (90)
Relevant patient case info is not limited to the strictly medical, as it is in the North -- if a patient is poor, or her husband is away much of the time, or she has twins on the way, that is likely to affect the kind of treatment she'll be able to access.
Disposable latex gloves are among the things in relatively short supply, and they're consequently washed, dried, and reused (91) -- have any manufacturers aimed for reusable gloves, which might stand up better to multiple washings, etc.?
Much higher risk of physician exposure to diseases than in Northern medical settings; interesting calculation of occupational exposure (127-129). Not just a matter of higher numbers of patients with (e.g.) HIV/AIDS, but also less advanced equipment, lower lighting, etc.
Common theme of (Northern) med-school memoirs is coming to terms with the reality that some patients will die; students in Malawian med schools are much more likely to see high levels of death both in med school and after. (130-131)
Common assumption that Northern doctors are practicing 'real' medicine while Southern doctors are not (134)
'Indeed, most students felt that they were being held to high standards of self-sacrifice by donor countries, by the college administration, and by their own government: they were expected to practice in very poor conditions, for long hours, and with little remuneration.' (159)
*Wendland uses 'global North' and 'global South' in the same way that many use 'first-world countries' and 'developing countries'.
**Not to mention the bibliography. Doctors for Democracy, African Pioneers of Modern Medicine, Death in Abeyance, The Birth of the Clinic, The Modernity of Witchcraft, Asylums, East African Doctors, The Quest for Therapy in Lower Zaire, The Story of Medicine and Disease in Malawi, Jesus in Our Wombs, Life Exposed, When Experiments Travel, The Body Hunters, Street Dreams and Hip Hop Barbershop, Some Spirits Heal, Others Only Dance
March 4, 2012
A Heart for the Work...Journeys through an African Medical School by Claire L. Wendland. I read this book for my Medical Anthropology class. I am not really a big fan of this subject. So I delayed reading the book a week before the review was due. I wish I hadn't because I liked the books. Although a little boring in the beginning, it picks up its momentum from the second chapter.
Claire Wendland asserts that despite the material and technological strain if you have A Heart for the Work then you can always find a silver lining and help your patients. Medicine is considered to be neutral and beyond any cultural influence. Wendland says, "If anything lends itself to globalization, medicine does (7)." The book is an argument on how cultural, political and economic factors affect the medical training and motivations of students.
The book fascinated and depressed me at the same time. The things I learnt were very unsettling. For instance, the medical books used in Malawi are the same as used in North America and Europe but many of the medical techniques showed in the books remain only theoretical concepts for the medical doctors in Malawi. Even if they prescribe a drug or a test, they lack the resources to provide the patients with the help they need.
With students transitioning into clinical years, they experience anger and resentment against their government. They are demoralized by the workload and the lack of resources in the hospital and forced to compromise with their own ethics. Facts like doctors earn a lot and patient privacy is of highest concern are not true in Malawi. Also, a lack of protective equipments such as gloves and masks puts the doctors at risk of infection from blood and other body fluids. The students are frustrated because they are "charged to heal yet unable to do so (133)". The word resource is just a verb for them.
I think Wendland did a commendable job describing the situations that affect the personal values of medical students in Malawi. Her manner of ending each chapter with a subject story kept me intrigued throughout the book. At last, I agree with Wendland that biomedicine is influenced by culture and the studies done in the North does not represent the situations worldwide.
Claire Wendland asserts that despite the material and technological strain if you have A Heart for the Work then you can always find a silver lining and help your patients. Medicine is considered to be neutral and beyond any cultural influence. Wendland says, "If anything lends itself to globalization, medicine does (7)." The book is an argument on how cultural, political and economic factors affect the medical training and motivations of students.
The book fascinated and depressed me at the same time. The things I learnt were very unsettling. For instance, the medical books used in Malawi are the same as used in North America and Europe but many of the medical techniques showed in the books remain only theoretical concepts for the medical doctors in Malawi. Even if they prescribe a drug or a test, they lack the resources to provide the patients with the help they need.
With students transitioning into clinical years, they experience anger and resentment against their government. They are demoralized by the workload and the lack of resources in the hospital and forced to compromise with their own ethics. Facts like doctors earn a lot and patient privacy is of highest concern are not true in Malawi. Also, a lack of protective equipments such as gloves and masks puts the doctors at risk of infection from blood and other body fluids. The students are frustrated because they are "charged to heal yet unable to do so (133)". The word resource is just a verb for them.
I think Wendland did a commendable job describing the situations that affect the personal values of medical students in Malawi. Her manner of ending each chapter with a subject story kept me intrigued throughout the book. At last, I agree with Wendland that biomedicine is influenced by culture and the studies done in the North does not represent the situations worldwide.
November 1, 2011
I just finished this book, with mixed feelings.
I am African and hoping to be in an African medical school soon. I have hung out with frican medical students, African house officers (I call them baby doctors, lol), African residents, and African specialists.
I have been a patron of public hospitals in Africa, and I have observed the public health system at work.
But I am from West Africa, not East/Southern Africa, where Ms. Wendland did her research. Our situation is rather different from theirs, but similar enough that I know exactly what Ms. Wendland is talking about and I know what her students/interviewees are talking about.
I might not agree with the spin she put on all of it, but I think it is a solid effort to represent the journey to becoming a health worker in Africa as well as the challenges of working in the public health sector in Africa.
I am African and hoping to be in an African medical school soon. I have hung out with frican medical students, African house officers (I call them baby doctors, lol), African residents, and African specialists.
I have been a patron of public hospitals in Africa, and I have observed the public health system at work.
But I am from West Africa, not East/Southern Africa, where Ms. Wendland did her research. Our situation is rather different from theirs, but similar enough that I know exactly what Ms. Wendland is talking about and I know what her students/interviewees are talking about.
I might not agree with the spin she put on all of it, but I think it is a solid effort to represent the journey to becoming a health worker in Africa as well as the challenges of working in the public health sector in Africa.
June 3, 2015
Fantastic overview of medical anthropology - questions the biomedical normative paradigm while telling a super good story. Wendland's a pro.
Displaying 1 - 7 of 7 reviews