The Simplicity of Difficult
Training in Malawi adds unique dimension By Devin D. Mehta, MD
The CCAP Nkhoma Synod Hospital sits upon a hill, approximately 60 km south of the Republic of Malawi’s capital city, Lilongwe, in Sub-Saharan Africa. The brick and mortar hospital is surrounded by lush rolling hills and maize plantations. Unless you stand on the outskirts of the hospital grounds, you forget the sky blue horizon is accented by small mountains. It is hard to believe that a location so beautiful places the burden of life in hands that are tied by limited resources. But, alas, that is the story of everyone I met in Nkhoma during a February 2012 medical mission there.
My first impression of Malawi—based on paved roads, a central market, and few panhandlers—was that of a developing country with an upward trajectory. But first impressions are often rushed, and Malawi hides its poverty well. The average Malawian is poor by world standards but residents have carved out an existence where less is more and more is too much. Malawians make do with what they have. This simple principle withstood the test of time while I was there, and is worth remembering because we often lack this guiding concept in our own lives: making the best of what we have.
Staff of Life
The Malawian diet is a clear example of simplicity. Maize, a staple of the diet, is the primary agricultural product. It is often charred and sold on makeshift roadside grills, or ground into flour and boiled to make nsima, a thick starch consumed at mealtime with relishes, boiled pumpkin leaves mixed with tomato and onion, and if lucky, protein from chicken or egg. Nsima fills the belly, and is relatively inexpensive and readily available.
At the hospital, all inpatients must have a guardian present to attend to the patient’s needs, which include preparing the patient’s meals. There is an outdoor area where smoke rises from large pots and families combine their flour to make nsima. When one cannot afford food, Malawians share and make do with what they have. The always smiling and generous hospital interpreter, Pearson, told me that nsima is never to be made just for oneself.
The simplicity of the difficult life led in Malawi is not by choice, but a forced adaptation to the environment. Electricity is a luxury; the service can be interrupted for days without notice. Cooking was sometimes confined to a single propane tank shared by a house full of volunteers, but this was a first-world problem compared to the hospital’s loss of power. While I was training at Nkhoma Hospital, the back-up generator was in and out of repair, so when the power went out and the generator failed, patients could not receive oxygen. Pediatric cerebral malaria is a challenge for Western-trained physicians to manage, but it’s an even greater battle when children don’t have oxygen to limit cerebral ischemia. No power meant no x-rays, and the only imaging modality available was ultrasound, for which there was no skilled operator. When power was present, another obstacle presented itself—the processor for the x-ray machine needed repair. Patients had to travel 1.5 hours by vehicle to another hospital for their x-rays, a trip often made unfeasible because of the cost.
My training in Malawi added a unique dimension to my medical education. Having to rely on my clinical judgment in a resource-limited setting was a life-changing experience. I also witnessed the strength of the human body in the presence of disease.
But the most important thing I learned at Nkhoma Hospital is that in spite of many challenges and their myriad causes, Malawians in general do the best they can with the resources they have. There is no time to complain when people are dying. You wake up, smile, celebrate life, value human relationships, and make the best of what you have. Our line of work is not easy. Dealing with other people’s problems can be draining, and being a physician is arguably no longer as financially rewarding as it once was—but the choice to serve others was our choice to make. If we choose to grow with our patients, we are given the opportunity to heal and to be healed.
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