Students — 14 June 2013 at 6:19 pm

From Mzungo to Rafiki in Malawi

Amy Gray / Edinburgh University Medical Student

If you are interested in this article, you may be interested in these others relating to work within the African healthcare system:

A Truck Crash in a Volcanic Desert (and other stories from Ethiopia)

Beyond the Kei

Emergency Medicine in the heart of Zululand

Malawi is frequently referred to as the ‘warm heart of Africa’ and with good reason. The local people are friendly, open and very welcoming to all who visit. ‘From Mzungo to Rafiki’ means ‘From Foreigner to Friend’ and that was absolutely how it felt. In addition to being a great place for the novice African traveller, it also has many draws for the medical student.

I spent my elective at Kamuzu Hospital in Lilongwe. The hospital was split into four main departments: adult female, adult male, paediatrics and obstetrics & gynaecology.

Healthcare in Malawi

The healthcare system in Malawi is completely different to the UK. Resources are limited, funds are lacking and the staff members are stretched. There are approximately two physicians per 100,000 population and so the hospitals can be a little overwhelming.

My first day was spent in awe of the queues of hundreds of people all over the hospital. Once over this initial shock however, the big numbers became a positive learning experience, as I honed my skills in a more highly-pressured environment than anything I will be likely to experience in the UK. This is an exceptionally valuable and transferable skill for my future career.

Over half of Malawi’s 13 million inhabitants are under the age of fifteen. This was a great incentive to an aspiring paediatrician. I was able to gain plenty of experience and practice my clinical skills in a very busy department, including many resuscitations, which are thankfully rare in the UK. These experiences were fraught, scary and often frustrating, but also incredibly useful to develop my confidence and abilities in such life-threatening scenarios.

The acceptance of death, especially of children, felt quite shocking to me and in addition, many of the deaths felt preventable. My eyes were openned to the alarming poverty and illness in Malawi and we from the UK felt lucky in comparison.

The experience

Despite these harsh realities, the positive experiences far outweighed any negatives. There was the chance to gain a wealth of knowledge of tropical diseases, as well as improved confidence in my own abilities and decision-making skills. Teaching opportunities were plentiful, as many of the Malawian medical students were keen to learn from us. We worked in hugely diverse teams, made friends along the way and learnt how to cope when the chips were down.

I loved my elective and have since found even the moments of frustration to be of use, as I practice to be a doctor. Malawi was a great place to explore, with stunning scenery, super-friendly locals and a unique vibrant atmosphere. I would thoroughly recommend it to any medical student embarking on their own elective journey.

The details

Destination / Kamuzu Central Hospital, Lilongwe

Time of Year / January – March

Weather / Warm but rainy (a mixture of waterproofs and shorts recommended)

Religion / 80% Christian. 15% Muslim Shoulders and knees should be covered

Money Spent / Approximately £100 per week

Vaccinations / Hepatitis A, Typhoid, Tetanus, Hepatitis B. Consider Rabies, Cholera, Yellow fever.

First Aid Essentials / Malaria prophylaxis, PEP, mosquito net, anti-bug spray (Avon Skin So Soft)


Kamuzu is a general hospital. More specialised experience can be found at the tertiary-level Blantyre hospital in the south.

Contact staff before you visit to find out about any resources you may be able to bring over for them from the UK. Things like a box of gloves, alcohol gel and NG tubes can go a long way.

Travelling in a group can be beneficial, as on the wards it can be a little overwhelming. Having the support of another student greatly impacts upon your experience and helps you to be more involved.