A Reflection on the Past, Present and Future of Critical Health and Medical Humanities in Malawi

by Chisomo Kalinga

On 2426 August 2017, the University of Malawi’s Chancellor College in Zomba hosted its first international medical humanities conference, which was funded by the Wellcome Trust. It was an honour to be part of the team that helped support this initiative with our hosts. Scholars, creative practitioners, policymakers, NGOs and members of Zomba’s arts community converged to showcase their creative outputs, programmes, research findings and interventions that examine how health intersects with the arts, humanities and social sciences. It was a warm and generous introduction to the world to the various approaches to interdisciplinary health studies in an African context.

An exceptional exchange occurred on the opening night after Helen Todd, director Art and Global Health Center Africa (www.aghcafrica.org) had introduced a documentary titled MAKE ART, STOP AIDS, which addressed the social, cultural and structural barriers to HIV testing, treatment and care in Malawi. Sharifa Abdulla, Lecturer in the Department of Fine and Performing Arts at Chancellor College, led the actors of the film—several of whom are persons living with HIV—into an intimate performance followed by a Q&A forum between the audience. Immediately after, the performers led the audience outside the Great Hall where the conference participants sang, danced to local drum beats and enjoyed each other’s company for the rest of the evening.

I keep reflecting upon this moment in trying to understand why it left such a strong impression upon me. It was the combination of the aesthetic expression to convey the lived experience of not just HIV, but navigating love and sex after diagnosis. I was also moved by the ability of the actors to use performance to engage the audience in their individual stories and the culture of their community, the interweaving of the performed arts and the philosophical articulation of umunthu (humanity) in their approach to dealing with HIV, and the capacity for storytelling to inform, educate and explore key concepts relating to health and wellbeing.

Scholarly attention to the critical health and medical humanities has expanded significantly in the 21st century; however, globally, this is dominated by Western discourses and thinkers. Malawi’s own scholars—particularly the late Professors Steve Chimombo and Chris Kamlongera—were pioneers in the early 1980s in bringing the arts into conversation with health, community and development. Though a formal platform to support interdisciplinary inquiry would only emerge in recent years, the AIDS epidemic spurred the necessity for integrated and multifaceted approaches to grappling with the health crisis, particularly in the absence of a biomedical intervention. One year before Professor Chimombo passed, I asked him why he became so involved in writing about AIDS during the 1990s and he simply said, ‘at the time, there was not much else I could do except write about it’.

This sense of urgency to wield the power of the creative arts to negotiate spaces of health is a shared response across cultures. It is a trusted mechanism which informs, builds trust and communicates ideas between individuals and communities. In Malawi, particularly during the formative years of the AIDS epidemic, the creative arts became a critical tool to circumvent severe censorship laws that prohibited express acknowledgement of the virus’s existence in the country. It emerged as a critical line of defence to challenge censorship laws and advocate for the right to understand how the virus was transmitted and what the people could do to protect themselves and their communities. To produce art and/or write about AIDS was a political act of resistance, as it sought to address inadequacies in governance, power dynamics, social and structural inequalities and injustices.

What the 2017 conference showed is how far Malawi has come. HIV and AIDS dominates health discourses, though non-communicable disease, cancer and chronic illness are also emerging as major fields of interest. More Malawian scholars are incorporating indigenous knowledge systems into a praxis of care that reflects the nation’s rich cultural history and reverence for the integration of healing and the arts in society with biomedicine. In precolonial times, the ‘land of fire’ or the Maravi empire as it was known, held the healer in the community with great reverence. Shortly after the arrival of Dr David Livingstone, a Scottish missionary, the colonial engagement in the region was initiated by medical doctors from the Church of Scotland in 1874, who sought to establish the British Protectorate of Nyasaland as a medical missionary colony. Their sphere of influence dominated until the mid-1960s, when Dr Hastings Kamuzu Banda, a USA and UK trained medical doctor, became the leader of an independent Malawi with his authority unchallenged until 1994. Malawi presents a fascinating case study where health and healers have featured prominently not only in the formation of national identity during precolonial, colonial and postcolonial eras, but also as fronts for political resistance.

Although the current climate of biomedical research has yet to meaningfully engage Malawi’s rich cultural past into the curriculum of medical education, there is an increasing shift to understand how these systems of knowledge can influence systems of care.

Professor Megan Vaughan’s expansive research in the history of medicine continues to cross disciplinary boundaries to produce a clearer historical analysis of health representation in Malawi. Dr John Lwanda, a historian, artist, social scientist, and physician is a leading and prolific authority on the study of the social, political and cultural development of health systems and practitioners in Malawi. Professor Adamson Muula is leading the African Centre in Public Health and Herbal Medicine (ACEPHEM), which fills a necessary gap in the lack of engagement of traditional healing practices in Malawi. Tumaini Malenga, a College of Medicine CARTA PhD fellow with the Majete Malaria Project, studies the life cycle of malaria, examines how communities understand how the vector survives and the social, political and economic, processes that guide the transfer of knowledge within the community. Mzati Nkolokosa, a PhD student at the College of Medicine, focuses on indigenous knowledge of wellness and illness, health and treatment seeking behaviours and health promotion including mental health. Chimwemwe Phiri, recently completed a MA in museum anthropology at the University of Oxford, which investigated how African medical collections are represented in Western museums; she advocates decolonising museum spaces to better represent indigenous health practices and African bodies.

What is striking about the emerging studies in Malawi is the interest in interdisciplinary and/or transdisciplinary research—combining multiple disciplines to generate new knowledge creation. The future of Malawian health research is paying attention to where and how creative enterprise, social science methodology converges with health. These methodologies are sometimes rooted in the culture itself, drawing from long neglected philosophies and approaches to indigenous concepts of health and wellbeing.

Landlocked Malawi has also historically suffered for being ideologically confined due to political constraints. My hope for the development of medical humanities is for expanded collaboration and outreach that includes and extends beyond the modern Western-donor model. In the past year, I’ve been greatly privileged to be in contact with exciting scholars such as Dr Esther Jones (African American literature, race, gender, and bioethics in science fiction), Dr Chelsea Bond (Health Worker and researcher in Australian Aboriginal health), Dr Sherine Hamdy (medical anthropology, Egypt, health and, bioethics) and Dr Zoe Todd (colonialism, human-animal relations, legal-governance

between Indigenous peoples and the Canadian State), who have informed my research practices in regards to the relationship between (post)colonial states, colonized bodies and health.

Increasing exposure to such discourses will provide Malawian scholars with an opportunity to approach questions more critically about what it means to effectively decolonise health spaces and to advocate for health interventions that will respect the histories, multiculturalism and socio-political and religious dynamics of localities and regions. This includes acknowledging power dynamics in systems of knowledge production and redressing the erasure of language, oral histories and creative expression as a tool of political control from colonial and postcolonial governance. Greater exposure to the medical humanities research taking place globally should inspire new canon of scholarship in Malawi that will improve the delivery of health services.

African and indigenous bodies have made painful sacrifices for the sake of informing biomedical science in public health. Their (in)voluntary participation in health interventions should not only be used as a plea for improved documentation, collaboration, knowledge sharing and partnership programmes within the African continent, but also to address and redress the painful histories of exploitation, humiliation, and experimentation that were conducted on black bodies in the name of biomedical research. Africana medical humanities researchers must also resist the desire to speak on behalf of the marginalised, the oppressed and the poor; but they must, as Paolo Freire advocates, actively work to address these injustices at a local level. Additionally, contemporary African health scholarship should not just be a means of empowering its own communities; rather, the knowledge generation and the methodological innovation that combines the humanities, action research, indigenous theory and biomedical inquiry can enlighten global health studies. It should not be so far-fetched to ask whether the successful initiatives of southern-Malawian community actors to address HIV/AIDS stigma can be used as a model to implement health interventions in coastal Californian towns with low public confidence in vaccinations.

My hope for the medical humanities in Malawi is that it will have greater capacity to share its lessons with the world, to allow others to recognize and foster appreciation for the challenges of making it through the greatest health crisis of the 20th and 21st centuries: the AIDS epidemic. The lessons to be learnt through creative representation are exponential; healthcare is not just symbolic of the relationship between the patient and the healer, but during these crises, we rely on extended family, local leaders and governments to make critical decisions to care, to cope, to grieve and to survive. By engaging and absorbing the real and imagined representations of the experience of illness, we must acknowledge and understand the roles of empathy, care, love, pain, failure, resistance, tenacity, rejection, fear, resilience and gratitude in the decision-making process over our bodies.

Author: Dr Chisomo Kalinga, Wellcome Trust Medical Humanities Postdoctoral Fellow, University of Edinburgh, Centre of African Studies, School of Social and Political Science, 22a Buccleuch Place, Room G.3, Edinburgh, United Kingdom, EH8 9LN, Chisomo.kalinga@ed.ac.uk Twitter: @misschisomo

Bio: Dr Chisomo Kalinga is a Wellcome-funded postdoctoral fellow in the medical humanities at the Centre of African Studies at the University of Edinburgh. As part of her fellowship, she is also collaborating with the Art and Global Health Centre Africa and the University of Malawi to launch the first medical humanities network for Malawian studies. Her research interests are disease (specifically sexually transmitted infections), illness and wellbeing, biomedicine, traditional healing and witchcraft and their narrative representation in African oral and print literatures.

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