Making doctors in Malawi: Local exigencies meet global identities in an African medical school
When a biomedical curriculum is exported from the First World to the Third, what embedded cultural values come along? Do locally specific historical, political, religious, or socioeconomic associations of the “physician” as signifier shape the professional values students take on? Or is professional identity, like most of the rest of the curricular content, imported from the North?
To date, empirical research on professional socialization has been restricted almost completely to North America. In the twenty-first century, when biomedicine is learned and practiced worldwide, the universality of socializing processes cannot be assumed. The project described here was collaboratively designed to assess the socializing function of medical education in Malawi. This cross-sectional qualitative research explores the acquisition of professional identity in students at a new medical school in Malawi, documenting changes during medical training in the values and norms that make up professional identity. I used a sequential research method involving focus group discussions, interviews and a questionnaire, moving from open-ended and general to more specific questions. This method was supplemented by archival research and “observant participation” at the university's teaching hospital.
The homogenizing process of basic science education during the first two years of medical school in Malawi appears similar to that found by researchers in North America. When students reach their hospital training, however, their nascent scientist doctor identities crash into a clinical reality in which the tools of science are largely unavailable. Responding to the resulting crisis, they may preserve the Northern doctor-scientist identity by seeking a geographic or occupational location in which its execution is possible. They may also reject the identity of detached technocrat to claim instead the dual roles of political activist and loving witness to suffering. I address historical and economic conditions that shape these responses, and discuss their implications for health in Malawi, for medical pedagogy, and for anthropological research on identity in an era of globalization. I use Gramsci's notion of contradictory consciousness to show how discrepancies between hegemonic cognitive frameworks of identity and real conditions of work have the potential to create a revolutionary new consciousness among doctors working in poverty.
0350: Health education