Colonialism

A group of medical students from the UK arrived in mid-July. The medical education system is different than in the US, so even though they are between 20-22 they are the equivalent of 4th year medical students in the US. As I spent more time talking with them I was amazed to learn that their orientation prepared them to come to Malawi to function as doctors to provide help the “desperately understaffed medical system”. They are looking forward to their experience because they are not allowed to do much in their own hospital because of liability concerns (because they are students). It also comes out that their faculty supervisor/mentor from the UK has never been to Malawi.

This kind of arrogance really gets to me. Yes, Malawi is poor. Yes, there aren’t enough health care providers in the country. However, it is completely unethical to send medical students to work as practicing doctors in a poor country without supervision. Working here can be an amazing learning opportunity, but the proper role of a student needs to be remembered, and the bigger impact on the health care system here is often overlooked. Every expat who goes into the operating theatre means one Malawian intern can’t participate. Malawi is relying on these interns to get the training they need to go out into the district health centers the following year.

Yesterday I ate lunch with another ex-pat physician from the UK. He said he had a frustrating morning because he wasn’t able to communicate with his patients effectively. After more discussion, it turned out the problem was that his patients were not answering the questions he asked. For example, when he asked when the symptoms started they answered “Yes”. I suggested that they probably didn’t completely understand him and that this was a great example of where a few basic chichewa words (like being able to ask “liti?” to clarify to the patient that he means “when?”) might be very useful. Then I mentioned that I was surprised that he was able to see patients on his own at all, without a translator, so I asked him what proportion of the patients he was able to see by himself. He said about half he could ask basic questions to in English but complained a much smaller proportion could actually give him a detailed history. He then complained, “I’m really surprised at how few people can speak English.” 

He continues, “It really is quite surprising considering this was a British Colony and all.”

It goes on, “It’s so different in India, everyone speaks English there. They all have their own languages, but English binds everyone.”

I’ve never been to India and I don’t pretend to know much about India, but I wonder, is that true even among all economic strata? What about those who don’t go to school? Also, Malawi is very different than India for many reasons, not the least being it’s per capita GDP is much much lower (one of the lowest in the world). Some of my questions were answered during a BBC broadcast I listened to later. The broadcast focused on poverty in India and growing income inequality. Young, 20-somethings dancing at a club in Mumbai were interviewed in English but all of the interviews representing the “poor” were done through a translator.

I also learned last week that the main international school in Lilongwe doesn’t allow Chichewa to be spoken at all during the school day. That’s very sad to me...this is why even among long term ex-patriots so few are able to communicate in the dominant language of the country.

These attitudes upset me more and more the longer I am here.  I think part of the reason they bother me so much is I think, who am I to be critical? I am just another mzungu taking way more from this country and its people than I will ever give back.