Malawi for absolute beginners

Six months ago I knew very little about Malawi. I knew more or less where it was – kind of in the middle of Africa somewhere, that it had a large lake, and that is was very poor and thus very cheap for tourists. It is close enough to South Africa for odd words and impressions to have seeped into my consciousness while growing up, enough to create a sense of familiarity without knowledge. Some friends had told me about camping on the lakeshore for $2 per night, watching sunsets while drinking cheap beer. I’d seen one or two smiling posters during the apartheid years, promoting Malawi as “The warm heart of Africa”. The incongruity of an African country trying to attract white South Africans at that time was completely lost on me, but that’s for another post.

 
 

So it might be a good idea just to orientate readers as I have had to orientate myself!

 

 

Malawi is indeed a small country – about one and a half times the size of Scotland but with almost three times the number of people. Its southern half sits embedded in northern Mozambique, with Zambia to the northwest and Tanzania to the north. It thus sits snugly in the middle of south-eastern Africa, 10 hours flight from London and just over two hours from Johannesburg.

 
 

 
 



 
 

 
 

As the map shows, it is completely landlocked, yet fully 20% of its surface area consists of water. “How can this be?” I hear you ask. Well, the Great Rift Valley cuts down the middle of east Africa, and cradles three Great Lakes. Lake Malawi, running down the eastern border of Malawi, is the southernmost of these Great Lakes, drained to the south (where I’ll be working) by the Shire River. Guidebooks say it is like a sea, with white beaches and palm trees, which I hope to check out. It dominates the country, and hosts more freshwater species than the whole of Europe combined, including some rather unique species of “cichlid”, well known to keepers of tropical fish. The snorkelling and even diving in the lake is apparently excellent. Unfortunately a high concentration of bilharzia-hosting snails means that one’s chances of infection with bilharzia are rather high – up to 80% according to the Edinburgh Western General Hospital’s Infectious Diseases Unit. So swimming in the lake is potentially risky, but many travellers do swim (perhaps most, judging by online discussions) and there are ways of reducing the risk. We shall see…

 
 

The country is very poor, even by African standards. The average per capita annual income is $800. (Scotland’s per capita income is $39,000, South Africa’s $10,000.) This low figure may be misleading as it does not take into account the subsistence and informal economy which are significant. Nevertheless, it’s poor. This affects medical and psychiatric resources – not only the availability of medicines and equipment, but also human resources, as trained nurses and health-workers frequently migrate elsewhere to better paying countries1. This of course happens all over Africa, including South Africa which has been known to lose doctors as far afield as Scotland.

 
 

Historically, Malawi has been free of major conflict for over a century, due in part to its lack of major mineral wealth worth fighting over. Livingston and other British and Scots missionaries first arrived in the mid 1800’s and helped bring down the slave-trade which was decimating the country at that time. It became a British Protectorate and was under British colonial rule until 1964. From 1964 Malawi was under the dictatorship of Hastings Banda, who insisted on always being called by a fabulously long title which I can’t remember now – though it unsurprisingly included the words “Life President”. He was exceptionally conservative and morally dogmatic and oppressive, insisting that women wear dresses to below their knees and that men had short neat haircuts. (During his dictatorship men with unacceptable hair, touching their collar perhaps, were compulsorily neatened up at the border posts by an ever present barber.) Banda also had a disturbingly cozy relationship with the apartheid South African government, who paid for the building of the new capital city just next to the old Lilongwe.

 
 

There were multi-party elections in 1994 and since then the country has been reasonably democratic. More on this in another post I think. The relevance of this history to me is that as an ex-British colony, (1) they use the same electric plugs as the UK… and (2) the official language of government is English and most Malawians speak some English as a second language. Great for visitors and great for doctors who must take histories from patients! I imagine however that many patients, especially when psychiatrically unwell, will be unable to express themselves adequately in English, and then an interpreter will be necessary. The main first language of most Malawians is Chichewa, a Nguni language related to Xhosa and Zulu. I’ve been erratically trying to learn the basics of Chichewa on the train to work each morning, and recognise some similarities to Xhosa in a few words, but it’s been hard going. Hopefully this will improve when I’m working there.

 
 

I hope that helps put the country in a bit of context.

 
 

 
 

  1. Kauye F. (2008), Management of Mental Health Services in Malawi, International Psychiatry, 5(2)29-31


 

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1 Comment »

  1. Tom said

    I have some very fond memories of Malawi and will be eagerly following your blog. During 1994 I was there twice, we swam in the lake on both visits but never caught bilharzia. I also managed to dodge malaria, although I know a few people who were less fortunate. I did however end up with a terrible stomach bug from either water or food but recovered soon enough.

    From what I can however remember it is an exceptionally beautiful country with extremely friendly people and brilliant weather.

    Good luck and enjoy.

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