- Politics, Culture and Medicine in Malawi: Historical Continuities and Ruptures with Special Reference to Hiv/Aids
Malawi struggles with one of the highest HIV/AIDS burdens in the world, with nearly one out every seven adults infected with the virus. HIV incidence in Malawi is growing fastest among young people, most starkly along gender lines: adolescent girls are several times likelier to be infected than boys of the same ages. Nearly every avenue available through Western medicine has been exploited in fighting the epidemic, including the behavior-change campaigns favored by the United States government (policies that promote abstinence, faithfulness, and condom use) and a nationwide rollout of antiretroviral treatment for HIV in an effort to save lives and livelihoods, particularly among productive adults.
Along the way, traditional cultural and healing practices have been alternately criticized as contributing to the spread of HIV in Malawi—for example, through practices such as unprotected sexual initiation for youth—or held up as a beacon of hope in overcoming the epidemic because they promote spirituality, collective support for sick neighbors and orphans, and alternative forms of treatment with local medicinal plants and herbs. John Lwanda's thesis, Politics, Culture and Medicine in Malawi: Historical Continuities and Ruptures with Special Reference to HIV/AIDS, presents a thoughtful and significant contribution to our understanding of the historical underpinnings of medical practices in Malawi. He asserts that the underlying assumption of Western medicine—that humans will almost always choose health-seeking behavior or, in his words, "become saints" (p. 53)—is fundamentally incomplete. Additionally, Malawians' responses to HIV/AIDS must be examined from the perspective of traditional cultural, medical, and political beliefs and practices, in so far as they have mixed with the influences of the world outside. His contribution to the debate, published through the Kachere Theses series of books on Malawi, has implications beyond the country's borders to other nations in Africa and perhaps around the world.
Lwanda presents an eclectically and meticulously researched meditation on the history of medicine in Malawi before, during, and after British colonial rule, tinged by local politics and sociocultural norms. He uses an array of methods to explore the thesis that we must move beyond Western medical constructs to understand the cultural contexts of politics and medicine in Malawi and make sense of the country's response to HIV/AIDS. To fill in a sparse written literature on the subject, these methods include a review of the literature, an archival search for music and pictures, oral interviews, and oral data collection.
Lwanda outlines the trajectory of Malawi's recent history, illustrating how traditional cultural and medical practices were driven underground but stubbornly survived during colonial rule and, in some cases, fueled the anticolonial resistance. Then, after Malawi achieved independence and during [End Page 122] the thirty-year dictatorship of Hastings Kamuzu Banda (who not incidentally was a foreign-trained medical doctor), Malawi developed an aspiration to Western medicine without the means to achieve it (p. 117). This shortcoming still affects the country's health sector today—a weakness that HIV/AIDS has exploited by overwhelming hospital systems and severely constraining human-resource supplies.
Lwanda rightly points out that, in this context, the vast majority of Malawians can do little more than live out their day-to-day lives seeking care from a cadre of traditional healers who receive their calling in dreams and channel the spirits of dead ancestors, or resorting to the machinations of witch doctors (afiti). He goes on to explore the economic contributors to the spread of the epidemic, arguing that, when faced with the choice of unsafe sex practices leading to the distant possibility of AIDS versus the imminent threat of economic hardship and starvation, the only rational choice is to prioritize immediate survival. He discusses how decades of political repression and an education system that produces rote learners, combined with the belief that forces much larger than oneself determine one's health outcomes, have led to what Lwanda calls...