A Heart for the Work: Journeys through an African Medical School

by Claire L. Wendland

Overview

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.

Product Details

ISBN-13:	9780226893273
Publisher:	University of Chicago Press
Publication date:	10/01/2010
Pages:	352
Product dimensions:	5.90(w) x 8.90(h) x 0.80(d)

About the Author

Claire L. Wendland is assistant professor in the departments of Anthropology, Obstetrics and Gynecology, and Medical History and Bioethics at the University of Wisconsin-Madison and honorary senior lecturer in the Department of Obstetrics and Gynaecology at the University of Malawi College of Medicine.

Table of Contents

Acknowledgments ix

Abbreviations xiii

Prologue: Arrival Stories 1

1 Introduction: Moral Order and Medical Science 6

All Part of the Same Big Mess: Mkume Lifa 32

2 Medicine and Healing in a Postcolonial State 36

Serving Our Nation: Joe Phoya 59

In the District: Evelyn Kazembe 63

3 Paths to Medicine 67

Welcome to the College of Medicine 85

4 Seeing Deeply and Seeing Through in the Basic Science Years 89

Welcome to Queens 115

5 The Word Made Flesh: Hospital Experience and the Clinical Crisis 119

Complications: Johnson Chisale 148

On the Ward: Enelesi Nyirenda 150

6 Resource is a Verb: Realities and Responses 154

Someone Else in This World: Duncan Kasinja 186

As Human as Everybody Else: Zaithwa Mthindi 189

7 Doctors for the People: Theory and Practice 195

Epilogue: Departure 222

Technical Appendix: Research Methods 225

Notes 245

Glossary 293

References 295

Index 319

Editorial Reviews

Claire Wendland provides a compelling account of medical training in Africa in A Heart for the Work. In her analyses of the socialization of Malawian physicians and the practice of African biomedicine, Wendland makes a valuable contribution to the literature on medical power/knowledge, particularly in poor and postcolonial contexts, and provides an all too rare example of anthropology ‘studying up’ in Africa. Herself a Northern-trained obstetrician-gynecologist and anthropologist, Wendland uses her case to argue that biomedical professionals everywhere are shaped as much by the social, cultural, and material conditions in which they train and practice as by the characteristics of biomedicine in hegemonic form. This coproduction, then, has important consequences for individual physicians and, through their medical practice, for their patients and their nation.

African Studies Review - Rebecca Warne Peters

This engaging and at times contentious book explores the lives of Malawian medical students and, through their stories, questions our assumptions about medicine, Africa, colonialism and globalization. . . . A fascinating work.”

Times Higher Education

Drawing on an impressive amount of original, empirical research and written in an engaging style, A Heart for the Work is an extremely interesting look at medical training in Malawi. Claire Wendland argues that trainee doctors, facing an enormous gap between the ideals of their training and the conditions of medical practice, forge their own set of practical ethics and their own professional culture. Though this creativity is largely born of necessity, it is remarkable.”

Megan Vaughan

Wendland delivers a tour de force on the culture of biomedicine and biomedicine as African healing. A Heart for the Work details how the clinical experience for Malawian interns yields a very different outcome than in the global North, despite similar courses and curricula. Rather than emotional detachment from their patients in a stance of scientific objectivity, they commit to ‘love, passion, and spirit’—‘having a heart for the work, for their patients’ in a moral economy shaped by extensive kinship ties, religious ideals, the need for hope when medicines are scarce, Umunthu— humanity—and political engagement. Wendland argues for the cultural understanding of all medicine, including that in the North driven by high-tech, pharmaceutics, and ‘objective’ science.”

John M. Janzen

Claire Wendland provides a compelling account of medical training in Africa in A Heart for the Work. In her analyses of the socialization of Malawian physicians and the practice of African biomedicine, Wendland makes a valuable contribution to the literature on medical power/knowledge, particularly in poor and postcolonial contexts, and provides an all too rare example of anthropology ‘studying up’ in Africa. Herself a Northern-trained obstetrician-gynecologist and anthropologist, Wendland uses her case to argue that biomedical professionals everywhere are shaped as much by the social, cultural, and material conditions in which they train and practice as by the characteristics of biomedicine in hegemonic form. This coproduction, then, has important consequences for individual physicians and, through their medical practice, for their patients and their nation.

— Rebecca Warne Peters

African Studies Review