Adam Bernstein, a fourth-year doctor of pharmacy student, spent a month in Malawi as a 2015 Global Pharmacy Scholar. His trip was funded by a $100,000 pledge from pharmacy professor Dhiren Thakker and his wife, Kailas Thakker, to the UNC Eshelman School of Pharmacy.
As I reflect on the past month in Malawi, I realize the depth of knowledge I gained about life, culture and myself. The goal of this rotation was to learn about medication supply chain management, however, pharmacy practice was only a small piece of the growth I experienced. This journey removed my comfort zone and challenged me to adapt. It introduced a new culture, way of thinking and friends that will last a lifetime. I developed tools to live a richer and fuller life, as well as expand my potential as a health-care professional.
One of the biggest differences between America and Malawi is access to resources. Clean water and limited transportation were just a couple of the new challenges. Coming in with an open mind made the transition much easier. The most difficult adjustment was standing out in public. Nicole and I would be stared at because of our skin color, resources and language. Yet, being singled out did not carry a negative connotation, but instead brought an immense feeling of guilt. Large groups of people sat on the ground, many with children wrapped around their backs, waiting hours at the clinic. Every day I passed them as I left an oasis of amenities that was given to me. An oasis I did nothing extraordinary to deserve.
My journey with the Home Based Care (HBC) program to a rural village redefined the meaning of poverty. The first home had no electricity, running water or doors. We cared for patients with TB, HIV and multiple chronic illnesses who could not travel to the clinics. Seeing the poverty of this village demonstrated the difference between human rights and societal capabilities. Prior to this visit, I assumed they went hand in hand to some degree as in America. Everyone deserves access to clean water, education and an adequate standard of living regardless of where they live. My expectations and reality diverged when their society did not have the means to provide this.
It comes as no surprise that Malawi is nicknamed “the warm heart of Africa” because the culture is extremely beautiful and welcoming. The immense joy felt by the community was contagious regardless of the economic conditions. A strong sense of connection provided the foundation for this happiness. A simple wave to anyone walking on the side of the road would make their faces light up with a smile as they emphatically waved back. The universal language of happiness made up for not knowing Chichewa. Waving to children became one of my favorite activities during car rides. During a trip to Zambia, we stopped on the side of the road for a lunch break. One of the passengers in our van befriended a nearby group of children playing on the side of the road. The passenger asked the youngest boy if he wanted to listen to music as he put large headphones on the child’s small head. We stared waiting to see his reaction to hearing music from an unfamiliar device. After a moment of silence, he crossed his arms and smiled in approval. The children laughed as a second set of headphones was passed around.
This recipe for happiness translates to my life back in North Carolina. In a world full of anxiety and deadlines, why can’t I enjoy every moment of it? I’ve been reading a book called Do It Well. Make It Fun by Ronald P. Culberson that teaches the process of simplifying daunting tasks into manageable, enjoyable pieces. I enjoyed every day in Malawi because their culture is built upon this principle and it will shape my approach to professional and life goals back in America.
Observing Malawian practitioners connect with patients enhanced my potential as a future health-care professional. Participating with HIV and blood glucose screenings in a different health-care system added a new dimension to patient care. I learned from the HBC coordinator that the primary problem of most patients in Malawi is psychological, not physical. Ask any newly admitted patient what troubles them, and most will not mention HIV or TB. The patient will tell you about their daily struggles. They discuss how they cannot afford for their child to go to school and the toll this takes on their daily lives. Providing complete care is about more than just treating illness. It is about providing a support system. It is about enabling the community to thrive outside of the hospital.
On a microscopic level, it may not be possible to achieve empathy, but we all can attempt it at a bird’s eye view. It is the depth of our experiences that determine how high the bird is flying.
One of the major themes of the Global Pharmacy Scholars (GPS) program is developing cultural competency, and I owe much of my newfound perspective to the people accompanying me on this journey. My preceptors and housemates became my second family and most nights were spent sharing meals and conversation. They were essential to this experience and taught me the difference between seeing a culture and experiencing one. Assimilating to the new surroundings strengthened my proficiency within the new environment; however, even a month is not enough time to fully experience all that Malawi has to offer. Despite my life being much different than it was in America, it was still vastly different than that of the average Malawian. The beautiful intricacies of any culture may be too deep to fully grasp.
This principle of complete experience translates to the health-care field by examining the art of empathy. The importance of empathy has been emphasized over the past three years, but the distinction of attempting versus achieving it has never been distinguished. To me, empathy means understanding another person’s situation from their point of view. But if all paths are different, can anyone achieve true empathy? Even something as common as the flu may not be completely relatable. I can recall how terrible it has made me feel and reassure the patient it will get better. Yet, the disease’s true burden is more than physical. What if they don’t have insurance and sacrifice groceries to pay for the clinic visit? What if coming to the hospital means no one is able to pick their child up from school? These are situations I can’t truly empathize with because I have never lived them. But, does achieving empathy versus attempting it matter? This is what the HBC coordinator meant about the importance of support. People may not need someone who has already lived their life to make every unknown known. Possibly all we need is a connection to feel we aren’t enduring the unknown alone. On a microscopic level, it may not be possible to achieve empathy, but we all can attempt it at a bird’s eye view. It is the depth of our experiences that determine how high the bird is flying. Malawi rewarded me with new experiences to strengthen this connection with my future patients.
The month has finally come to a close and I’m not ready to leave. To say it passed in the blink of an eye would be an understatement. I learned so much about life and built new friendships. Everyone should have the opportunity to challenge the definition of normal by seeing a new region of the world. Leaving Malawi doesn’t mean my cultural journey has finished. It means the next journey is about to begin.