The past week was the Silver Jubilee (25th Anniversary) of the founding of the College of Medicine (COM) of the University of Malawi. The first class had their 4 pre-clinical years in UK or Australia and returned to the COM in Blantyre in 1991 for their clinical 5th year, prior to beginning their 18 month residency. The COM has its own teaching, research, and administrative campus, complete with hostels for students, a large modern library, research labs, a large computer lab, and a large, new sports complex. It uses the sprawling 1200 bed Queen Elizabeth Central Hospital as its primary clinical teaching site, although students rotate through the newer Kumuzu Central Hospital in Lilongwe, as well.
I’ll try to capture some of the quality of the celebrations, as they say a lot about Malawian culture. To begin with, a theme, “Excellence Yesterday Today Tomorrow”, was chosen, logos designed, and miles of cotton fabric were printed. The fabric was then turned into drapes for stages, chitenjes for the women to wear, ties, scarves, and, most remarkably, skirts, dresses, and shirts. It seemed everyone bought some material and took it to their tailor, who fashioned a unique garment from it. I purchased a tie but gave it to an elder statesman (Hell, I’m 76yo. Am I a Young Turk?!), a Brit who had started a large malaria and infectious disease research program which is continuing, funded largely by the UK Wellcome Trust. He had to give a speech and hadn’t a stitch of commemorative garment. I then bought a scarf.
There were speeches, some celebratory (“We have been excellent, we are excellent, we shall be excellent forever.”), some visionary (“Only change is constant and we must continually adapt.”), to sobering (“We are successful at educating doctors. We are not so successful providing them with employment, so many leave for Botswana and Lesotho. We must change that.”) It wasn’t, honestly, so different than the lofty rhetoric I heard at my Harvard 25th Reunion. Harvard was more successful in raising funds from the alumni on that occasion, I’ll warrant. The COM Alumni Association was just founded 5 months ago, speaking to the sorry state of the economy and doctor’s wages here.
There was astounding syncopated drumming and dancing. The dancing was so sexual, such pelvic thrusting to the delight of the dancers and audience, it isn’t surprising the birth rate is so high! I imagine that the modesty of dress (no pants worn or short skirts above the knees for women) is what we’d call “reaction formation”, an expression of that sexual disinhibition in a reverse expression in an attempt to both express it and contain it. Lake Malawi sits in the Rift Valley, where we all started. Freud had it right in thinking that sexuality is a very fundamental motivator, as we could all see during the celebrations.
There were a lot of award ceremonies. For excellence in studies, in research, and in sports (intramural during the week) and a set for longevity of service. My experience of awards ceremonies, and I am a child of the ‘50’s, is that they are somber, even sometimes funereal, events. These were the opposite, with running, dancing, acrobatics, singing and other joyful expressions by the winners and the audience.
There were two skits, one performed by medical students and the other by COM staff members. Each took place of the back of a flatbed truck, each truck draped in commemorative cloth (blue, white, gold and black) and complete with props. The smaller was a family planning skit in which a mother is asked if she wants birth control and she says, essentially, “Why? I already have 11 children.” There was a husband, a large stuffed bear representing a child, and an assortment of medical students and doctors. It went on for awhile, all in Chichewa, to great hilarity. The other skit was to honor the skills of all the departments in the hospital. A mother enters in labor. The baby is too big and she has a c-section by the Ob-Gyns. The baby requires resuscitation by the Pediatricians. Meanwhile, the father is so upset he has a cardiac arrest and needs CPR with defibrillation. The poor mother, seeing what has happened with her baby and husband, becomes depressed and needs Mental Health services. There was a surgical procedure, as well. The family was happily and healthily discharged to home. It was a scream!
Last night was a banquet, modest by our standards but lavish by theirs, in the gymnasium of the Sports Center, all dressed up. My bike chain broke on the way over so I was a bit greasy, wondering about getting home. We volunteers are not to walk around the streets at night; I thought I could ride home across campus so swiftly I’d be fine. Change of plans, it seemed. There were vodka fruit drinks—I am perhaps the cheapest drunk around and I couldn’t detect a bit of alcohol in mine—and a buffet supper and lots and lots of awards and speeches, including one by the former first vice president of Malawi after independence. A band of medical students and members of the COM played and crooned, the volume always too high for good conversation as is usual at banquets. I spoke with a government finance guy who asked if I’d be voting in the US election. We got off on Trump and how Malawians who thought about it were unable to grasp how we could have a candidate so crass and unsuited for the office of president. I said my GHSP commitment was only for a year but if The Donald was elected, I should remain 4 more.
In characteristic fashion, I didn’t get a formal invitation to the banquet, although the Master of Ceremonies made a point of telling me he had been looking forward to seeing me there. I didn’t even know about it until 5PM the night before. Linda had planned to go to Zomba for the weekend, as I needed to work preparing lectures and exam questions, the latter a very exacting process. All questions go through committees for approval or not. So she wasn’t at the banquet, which was too bad for me.
After the last award and the last speech, the last bit of dessert enjoyed, and the final bit of conversation concluded, we all moved to a large balcony and watched a tremendous display of fireworks on the sports field in front of us. Judging from their ability to fashion those displays, I do think the Chinese are in ascendancy, even if their factories occasionally explode, killing all inside. I was offered a ride back by some kind staff in a Range Rover when I found that my shortcut across campus was blocked by a locked gate and I’d have to walk the bike home via a long, circuitous route.
The Jubilee grew on me. I was at first skeptical of the self-congratulations that accompany such events, knowing the health care conditions in Malawi. But I now am amazed at the vision, persistence, and creativity exhibited by so many that is required to create a genuine quality medical education training center in a country of such modest means. In their 6 week rotation through Psychiatry the medical students have a much more thoughtful and well-executed exposure to mental health issues that I received at Columbia University College of Physicians and Surgeons. I realize it isn’t 1964, but it is impressive.
A psychiatrist in Malawi 