From med school to Malawi: student's transformative African elective

Fraser MacKinlay arrived in Malawi after a 38-hour journey by plane to find his ride from the airport broken down. This was the first in a series of major adjustments, which included becoming accustomed to regular flooding, as many as ten daily power and WiFi outages, and living without water for up to a day at a time.

He was forced to quickly acclimatise to life in Africa, where he would spend the next two months working in hospitals for his Bachelor of Medicine and Bachelor of Surgery (MBChB) sixth-year elective – a trip made possible thanks to the support of the Zachary Gravatt Memorial Scholarship, which he was awarded in 2023. “Going to Malawi alone was certainly a challenge,” he reflects. “Fortunately, the organisation that hosted me, Medic to Medic, had prepared me well in advance for the difficulties I might face. It also helped to remind myself that I had chosen this adventure and that every challenge was part and parcel of the wider experience.”

Fraser worked in two hospitals during his time in Malawi: Blantyre’s private Mwaiwathu Hospital and Mzuzu’s semi-private St John’s Hospital. His role included a combination of paediatric and adult medicine, which primarily involved clinics and ward rounds, plus several weeks in the emergency department. Arriving in the middle of the rainy season, he found malaria rife, along with other conditions including pneumonia, asthma, tuberculosis and schistosomiasis.

The experience was a learning curve that required him to confront challenges head-on, from language barriers to feeling out of depth. He recalls being asked to conduct a full paediatric ward round by himself due to the absence of clinical officers and doctors. “At that moment, it was crucial for me to recognise my own limits and take on only as much responsibility as I could safely manage,” he says. “I was there as a student, after all.”

The diminished state of Malawi’s healthcare system was immediately apparent. As the seventh poorest country in the world, Malawi is plagued by extreme poverty exacerbated by political corruption and natural disasters. Healthcare is difficult to access, with private hospitals unaffordable for many and the public system overrun (waiting a full day to be examined is not unusual, Fraser notes). This, combined with a severe lack of resources and a need for basic health literacy, has led to devastating health outcomes.

Witnessing this first-hand gave Fraser an appreciation for New Zealand’s healthcare system. “While our health system is not perfect, and we often complain, there's so much to be grateful for,” he says. “In Malawi, people often face the impossible choice between attending the hospital or having enough to eat, and the healthcare they receive falls well below global standards, often lacking even basic tests we take for granted at home.” He was also shocked to learn how little junior doctors in Malawi are paid – NZ$250 a month is typical.                                                                                                                  

Shining above the country’s devastating poverty was the beauty of its culture. “I found the Malawian people to be extraordinarily resilient, loving and community-centred,” he says, detailing the kindness and generosity with which he was welcomed. On an overnight stay in the remote village of Ndala, which was nearly destroyed during 2023’s Cyclone Freddy, he met residents enduring significant daily hardships.

Food insecurity was a major issue, and many locals were still living in tents after losing their homes. Despite this, they showed him warmth and hospitality, ensuring he was well-fed and introducing him to their unique traditions. A highlight of his travels was learning how to prepare the staple food nsima (porridge made from maize) and play the traditional board game bawo in Ndala.

When he fell ill near the end of his trip, Fraser came to understand exactly why Malawi is known globally as ‘The Warm Heart of Africa’. After experiencing a sore throat and fatigue, he developed rigors and a fever. Visiting St John’s Hospital, this time as a patient, he discovered he had contracted a rare strand of malaria. While hospitalised for three nights on intravenous medication, he was visited by numerous nursing students, cleaners and health workers, and even brought home-cooked food by one of the nurses. “The kindness of this gesture will forever stay with me,” he says.

Fraser is extremely thankful to have received the Zachary Gravatt Memorial Scholarship, which enabled his transformative trip to take place.  The scholarship commemorates the life of Zachary Gravatt, a medical school student who overcame dyslexia to pursue his studies before tragically passing away in his fourth year. “An overseas elective is highly valued in medical school for its potential to bring about personal and professional growth,” he says. “Without the scholarship’s support, I would have been unable to fund such a life-changing experience. I am incredibly grateful to the donors for making this opportunity possible.” 

As for other students embarking on overseas electives, they should consider Malawi, he says. “It is a hugely underrated destination with an amazing culture and people, and plenty of opportunities to get involved in teaching younger students while learning about tropical medicine. I could not recommend it enough.”