On being a woman: Men are from Mars, Women are from Venus

I have been asked to comment about how I have been received here as a female physician? Especially given concerns about how women are traditionally viewed in sub-Saharan Africa. What we have heard  about life for women in rural Malawi is discouraging.  Admittedly, we have mainly been hearing about local culture in conversation with other non-Africans who live here. They say that the women do all the hard labor, raise the kids, cook, often work a job, keep a garden, etc.  And that they cannot refuse their husbands or they will be beaten. In this culture, they also cannot refuse the advances of any male relative. But, I have not heard this directly from a local woman. Though, I do hear it from trusted sources. As I build local friendships and start to have my own clinic, I am will be able to have these conversations with women myself. (It is disheartening as we see the number of patients in the hospital with HIV/AIDS and try to prevent further spread of the virus. For example, we heard of the case of a man with HIV but his wife was negative…apparently it was not going to be the case that the man would be expected to abstain from unprotected sex with the wife to avoid transmission to her.)

But I digress. The question was for how I have been received here as a female physician. Actually, there are already many female physicians working here. From various ethnic backgrounds: mainly African, European, & Asian, but also some from the US & UK.  In fact, the head of internal medicine department at the gov’t hospital and the medical directors of both Malmulo Mission Hospital and Blantyre Adventist Hospital are all three women (1 European, 1 American, 1 Philipina). So, the many women physicians who have come before me have paved the way already.

How I am treated actually varies by location immensely. I spend most of the day for this 6-week orientation period at the gov’t hospital, where in general, I think rather than being viewed as a man or woman, I am viewed as a complete alien. But a privileged alien. I might as well be from either Mars or Venus. I am mostly ignored as I walk through the halls, but I can walk anywhere I want. During most hours, the corridors and wards are open. But even before lunch or in the afternoon when the guards are blocking others from entering a ward or a corridor, they always let me pass. Without asking me who I am or where I am going, or why. As I approach the door or gate the crowd (if there is one) stands aside, and I am given a free passage. Perhaps they assume I am a doctor? But I actually don’t think they even care about doctor or about gender…I think it is as a Mzungu (foreigner) I am a considered to be different.  Once out on the wards with the patients, no one talks much to me. Some of it is undoubtedly because they don’t speak English and thus there is often a language barrier. Most of the families in the wards speak very little English. I try to tell the family results of an echo or something that I have done, but just get blank stares. I have learned basic phrases in Chichewa, but even when I say something to them in their language, they do not engage me very much. Maybe my accent is so bad they don’t know I am trying to speak their language. Or maybe they realize I wouldn’t understand their questions or comments if they made them in response to me. Seeking out a translator and sitting down with a patient to ask questions sometimes improves the odds of getting good interaction, but not always. Maybe because the nurse, intern, or medical student procured for the job is also busy with other things and rushing it. Maybe because the questions are not interpreted accurately (the official interpreters in the clinics tell me there is no word for “fever” in Chichewa…so they struggle to interpret that question…interesting in the setting of the majority of admissions being for infectious diseases. And I doubt some of the cardiology diagnosis and issues are translated very easily ... it's hard enough to explain to patients in hospitals in the US who speak English as a first language!).  Maybe because they often minimize symptoms and hardships and avoid socially taboo topics (HIV/AIDS is mostly a taboo topic, and yet they say on average 80% of the in-patients in that hospital are HIV positive). Maybe they say what they think I want to hear. Maybe they are suspicious of a Mzungu. Maybe they are frankly too sick or in too much pain to engage. But the end result is that I often feel I do not have the whole story, I have not been allowed in, I am still a stranger and alien not to be trusted with the whole story. I doubt that my gender plays much of a role in that setting.

Out on the streets in Blantyre, it is a different story. People do look at us, but not usually to stare or point. There are many other light-skinned people around Blantyre, so we don’t gather unusual attention, though we still do stand out! We are often greeted and people usually smile. Children will come up asking for money and food. At first, an occasional vendor tried to sell us souvenirs, but even that is becoming less frequent (we’ve been here 5 weeks now). In general, there is friendly interaction and likely nothing to do with gender or profession, though I am almost always with Darryl and undoubtedly their interaction with us is biased by our skin color. I have not felt unsafe while walking in town, but do not walk alone or at night. No one (except the guy who sold us souvenir postcards at an exorbitant rate) seems to have cheated us or charged us extra money for being Mzungu. I am not sure how we would know for sure that we weren’t getting overcharged though…

Once we get home, there is a definite gender bias held by the workers helping renovate the house. They insist on referring to my husband as “doctor” and not me. It amuses me. He tried for a while to correct them, but with little effect. In the hospital setting it is easier, as I have a stethoscope and am introduced as the doctor. But when we are not inside the hospital, it is usually presumed to be Darryl that is the doctor.

In the private hospital and clinic, I have not noticed any issues about being a female and I am not treated as if I am from Venus. People are glad to meet an American Cardiologist. The majority of patients here are middle and upper class and speak English or have brought a family member who speaks English to be with them. Being the only cardiologist in the country I think ends up trumping most other things in the hospital setting.  Most people are thrilled to have a US-trained cardiologist here and don’t mind saying so to me directly.  Of course, I would love to have a Malawian cardiologist come back to Malawi to work! Or an anesthesiologist. There is no residency training in Malawi, so post graduate medical training must be done out of country. Best I can tell, few, if any, Malawian physicians return to Malawi after an external residency program. There is clearly enough heart disease here for several cardiologists! There is enough for one at each hospital in town! Certainly more than I can deal with on my own. But why is there is such a shortage of physicians in Malawi? Why has there been no cardiologist here for years? Questions without great answers. And Malawi still has one of the lowest doctor-to-patient ratios in the world. I wish I knew why there is such a shortage and how to obtain residency & fellowship training for Malawians who will ultimately return to practice in Malawi.

So, that is my round-about way of saying I have not yet felt much of a gender bias against me for being a woman physician. But, I am surrounded by other women physicians and I am a specialist…and thus viewed as a rarity here. I do hope over time to find out on a more personal level what it is like to be a Malawian woman living here…(-Tiffany)