On Tuesdays there is diabetes clinic at the hospital. Anywhere from 30-80 people with diabetes, mostly above the age of 65 congregate in a small room of concrete benches. Looking around, you can see the logo of the Diabetes Association of Malawi and old diabetes education posters speckling the walls. Bread, butter, and tea are sold in the back of the room. Soon a scale is brought out to the aisle between the rows of benches and patients line up. One by one they slip off their shoes, hand their health passport to the man in front, and step onto the scale, holding a support pole to minimize unsteady wobbles. Simultaneously a nurse, identified by a small white hat pinned to the crown of her head, came out with a blood pressure cuff and began winding her way down the rows.

At some invisible signal the patients were shooed back onto the concrete rows with a few Chichewa phrases of instruction and mild laughter. Moments later, descending into our crowded room, came suit-clad representatives from the World Diabetes Foundation in Denmark. A Chichewa welcome song rang out received by ten iPhones in front of ten foreign smiles. The “honorable visitors” were instructed to sit in the back row and soon commenced the formal exchange of statements from spokesmen on both sides.

What happened next was the play. The Empires, two Malawian men in their late twenties, emerged at the front. One had wrapped a chtengi around his waist the other sported a pointed hat, like you would see in a rice field, and had stuffed a soccer ball underneath his shirt. Dramatically they acted out a conversation in English that examined the challenge of treating diabetes in a culture where a larger stomach is equated with success.

[Important note, there are many people around the world with diabetes, even type 2, who are not obese. Research however suggests that diabetics who do have a high BMI often find their symptoms lessen if they loose some weight.]

While I’ve been here I’ve reflected on how difficult it is to get very obese without eating processed foods or snacks- even if you’re eating a ton of carbs- rice or nsema (maize) and a fair amount of fat- fried donuts or “chips” aka french fries. It will be interesting to see what happens to the obesity rates as processed bags of chips and other snacks continue to grow in popularity and the types of jobs people do continue to decrease in physicality. Is there a way for a country to develop while avoiding the associated problems of affluence?