Journeys through an African medical school

In a time when so many Americans wonder what our healthcare system will look like in a couple of years, it’s also important to consider what it will feel like. In some instances, it often seems doctors have thrown their bedside manners out the window, acting more like mechanics working on broken machinery than human beings treating patients.

That’s when “illness becomes a mater of biology,” said Claire Wendland, a doctor and an anthropology professor at the University of Wisconsin. Wendland, who has spent several years studying the concept of medical socialization, is trying to understand the shift in mindset that occurs in North American medical students between the time they enter medical school, to when they graduate.

“Students quickly learn to accept death,” she said. Many students enter school as a heterogeneous group with a common idealism, but what happens is what she describes as a “blending process,” often even dressing alike. And, “by the time they finish medical training,” she said, “they have increased cynicism.”

The notion of medical socialization, Wendland explained, had only really been studied in North America and Western Europe, so she set out to Malawi, located in southeast Africa, to see if geographic location, culture and wealth play a role in the development of this mindset.

It is an understatement to say that a hospital in Malawi is different from one in the U.S. According to Wendland, in Malawi, nurses earn $3 a day, and medical interns earn $4. It was not uncommon at Queen Elizabeth Central hospital to “run out of soap, iodine or Tylenol” she said.  Additionally, public hospitals in the U.S. tend to have a 75 percent occupation rate, while Queen’s rate was about 150 percent, with patients often lying on the floor.

Wendland spent a total of about a year and half living and working in Malawi. She noticed that students there often studied the same text books as American medical students, in fact some of the same books she studied while earning her M.D. at Michigan State University, but the difference was that with a frequent shortage of supplies, they could rarely put their education to use. So instead, she said, “they expanded their definition of what they could give to the patients.” Perhaps they could not give them Tylenol, but they could give them love.

Malawi doctors showed less detachment from their patients than American doctors and shared the “we are all humans” perspective, she said.

In Wendland’s first book, “A Heart for the Work:  Journeys Through an African Medical School,” she shares her experiences working both as a doctor in Malawi as well as an anthropologist. And one question that remains unanswered in Wendland’s mind is: “If poverty has an impact on our practice, does wealth?”

Claire Wendland shared her experiences with Northwestern University students on February 23.

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