Last year, a crop of skilled female novelists used African countries not just as backdrops to their novels, but as characters — they let those countries suffuse their work. Chimamanda Ngozi Adichie's Nigeria ("Americanah"), Taiye Selasi's Ghana ("Ghana Must Go") and NoViolet Bulawayo's Zimbabwe ("We Need New Names") rang true on the page because each depiction felt like reproduced color from lived experience rather than cribbed passages from a travel guide. Now, with "The Strength of Bone" (Biblioasis, 312 pages, $16.95), Canadian-born Lucie Wilk takes the reader deep into the heart of Malawi. Wilk practiced medicine there, and her novel — about a Western doctor grappling with personal loss as he heals Malawi's sick — is authentic, with both country and content steering the narrative while also infusing it.

Henry Bryce flies into Africa from Toronto, brimming with idealism for what he can achieve and saddled with grief for his dead daughter and a failed relationship. The staff at the hospital where he works includes Ellison, an Australian and old-pro ex-pat, and Iris, a Malawian nurse whose "education" has distanced her from her family. The overstretched medical team does the rounds treating hordes of patients suffering from malaria, tuberculosis and AIDS, with Bryce struggling to adopt the dispassionate approach required to stay sane. During a trip to a remote village he unravels and disappears alone up a mountain, only to find himself wrenched from his comfort zone and pushed to his psychological limit. Self-recrimination leads to self-discovery and the sober realization that while he may be able to help the country's sick, he can't effect change.

The novel's medical and Malawian strands are its strengths. Wilk chronicles hospital life starkly and without sentimentality. Those unable to be admitted are forced to buy knock-off medications at markets or overpriced and ineffective elixirs from charlatan healers, or they simply place their lives in God's hands. Wilk expertly captures the country's traditions, superstitions and language, together with the city's dust, heat and diesel fumes, and the flora, fauna and unforgiving peaks of its off-the-beaten-track environs. Her characters convince, mainly because she exposes their vulnerable flanks but also because she resists giving them tidy happy ends: The majority of patients go to the hospital not to get better, but to die, and an initially frosty Sister Iris thaws but not enough to kindle a romance with the curious new white doctor on the wards.

As a result, "The Strength of Bone" feels original. Wilk eschews cliché just at the moment when we expect doctor to fall in love with nurse or foreigner to go off the rails in a strange land. However, she also sidesteps plot, the closest we get being the daily grind in the hospital bookending Bryce's off-the-reservation self-quest. Fortunately, all three sections are packed with enough drama to keep us immersed and, at times, gripped, even if they appear as isolated episodes rather than links in a chain.

"Adaptation is the death of progress, he thinks. Getting used to something is the reverse of evolution, it is devolution, it is our undoing." Wilk enthralls the reader in smooth and unsparing prose as her starry-eyed protagonist learns the hard way that sometimes acceptance is the only way forward.

Malcolm Forbes has written for the Times Literary Supplement, the Economist and the Daily Beast. Born in Edinburgh, he lives in Berlin.