Everyday I walk from the house I’m renting to the College of Medicine. My neighborhood is safe to walk in during daylight hours and the guards and gardeners greet me as I pass by homes hidden from view by 8-foot high walls with glass shards or electrified razor wire adorning the tops. The guard’s job is to sit inside the locked gate ready to open it when the boss or madame (yes, I am a “madame” here and I cannot get used to that) approaches. But at 7am they are all standing outside the gates – kind of on break, I guess.

I thought I was seeing amazing diversity along my pathway to the College – men and women in business suits and dresses (women almost never wear slacks), barefoot people with huge loads on their heads, gardeners bent over at the waist “mowing” with machetes, children in school uniforms, SUVs, bicycles, pickup trucks, minivans packed to the gills, men and women selling cellular air time, men selling mops, women selling ears of corn and little bags of peanuts, and as I approach my destination, students and staff. There are very few fellow azungus (white people) and most people greet me with “Hello and how are you madame?”

Well, today I walked to the city center. Wow. It was about a 50-minute heat-soaked (too vivid?) walk from my house and I have never seen so many people walking to so many different destinations within such a small area. I left my house around 11am, and at noon on a Saturday, the central business district is the place to be. The city center is about 4 square blocks—all paved roads (though treacherous potholes abound both streets and sidewalks). There are 3 main roads: Victoria Avenue, Glyn Jones Road, and Haile Selassie Road. A key aspect of being on foot is quickly realizing that pedestrians are seen as too poor to have transportation and as such have no right of way. But there are strengths in numbers so I try to find people crossing my way…Oh, and no one looks behind when reversing – why should they? They are maneuvering something weighing well over a thousand pounds. People would be foolish not to get out of the way!

On a lovely Saturday the streets were filled with pedestrians – mostly adults with business to take care of: banking, tailoring, cooking, buying, selling, and begging. Many were sitting on the sidewalks with canes and crutches nearby. One man with flip-flops on his hands was using his arms to propel his upper torso over severely polio-deformed lower limbs – he was in front of me “walking” away and at the base of his pelvis I could see a foot with toes facing “due right.” He was getting around this moderately hilly and very inaccessible town remarkable well. I wondered what his life must be like and where he came from—not only today, but where was he born? In town? In a village? Where does he sleep? And in what position? Could he benefit from a wheelchair? I’m not sure. It’s unlikely he could use it in a town filled with huge potholes, uneven paved surfaces, deep trenches between the roads and the walkways, high thresholds, and stairs. But in the village…maybe.

When so many need so much I have to remind myself what I can do here as a visiting physio professor. Writing this blog today has helped me answer that – teach aspiring physios to ask questions about people like the man I observed. Once they begin to tackle individual’s needs, advocating for societal change (accessibility and other serious issues facing so many with physical impairments) will be a natural evolution of the impact physiotherapy will have in Malawi. I think one of the courses our curriculum committee is proposing will likely help promote this evolution: Health Promotion and Advocacy for Individual and Societal Change.

Lastly, a lizard update…they have been relatively few and far between this week. Oh, except the little one who shocked the daylights out of me as I blindly (very blindly but not THAT blind) opened my medicine cabinet one morning…GAH!

By Dr. Cathy Peterson
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