Her campaign convoy consists of a single small mini-bus. Her political aides and close supporters are old family friends and relatives. Campaigning in a noisy market in central Kuala Lumpur, she struggles to be heard, a small, quietly spoken doctor in a white headscarf. When she was studying eye surgery in Dublin, her Irish neighbours, nonplussed by her kindly manner, Islamic dress and Malaysian accent, called her "the Chinese nun".
In Monday's general elections, even her most loyal supporters do not expect her party to win more than a handful of seats. But in the last few days Ms Azizah has suffered a battering that would bring tears to the eyes of the most experienced political bruiser. Opponents have accused her of being in the pay of foreign governments. Anonymous videotapes, photographs and pamphlets have been circulated smearing her 19-year-old daughter, and accusing her husband of sodomy and adultery.
Rumours about her marriage were aired on the the front page of a national newspaper yesterday and the party of the Prime Minister, Mahathir Mohamad, has run full-page ads making similar insinuations as well as accusing her supporters of supporting violence.
Foreign diplomats, government supporters and many within the opposition itself expect the National Front to win a comfortable majority tomorrow, confirming Dr Mahathir's status as Asia's longest-serving democratic leader.
So why, with so little at stake, should he feel the need to resort to such tactics, the political equivalent of using a flame-thrower against mosquitoes?
The truth is that it all has very little to do with the gentle Ms Azizah and everything to do with her husband, Anwar Ibrahim, Dr Mahathir's former deputy prime minister. Last year, in a sensational turn of events, Mr Anwar, a charismatic Muslim regarded as the natural successor to Dr Mahathir, was sacked, arrested and charged with corruption and sodomy. The debacle occurred at a crucial time, not just for Malaysia, but for East Asia generally.
Like its neighbours, Malaysia's steady economic growth had been hammered by the economic crisis. New governments had come to power in Thailand, South Korea and - most strikingly - in neighbouring Indonesia, where the long-serving authoritarian President Suharto was driven from power by street demonstrations and riots. When Mr Anwar's supporters took to the street in protests of their own, it looked for a while as if Malaysia was in the throes of sudden and unexpected change.
But this was to underestimate the achievement of "Dr M", one of the most brilliant and ruthless of democratic leaders. Since coming to power in 1982, he has presided over one of Asia's most notable success stories - transforming a small, former British colony of 20 million ethnically diverse people into a model for developing countries all over the world. Malaysia has had steady economic growth but it also has a strong sense of national identity, symbolised by prestige projects and events, like the hosting of last year's Commonwealth Games and last month's Formula One motor race, the first to be held in South-east Asia.
Nor has Malaysia suffered the indignity of resorting to handouts by the International Monetary Fund. Figures released last week show that in the last quarter the economy grew by 8.1 per cent, apparently vindicating Dr Mahathir's controversial decision to freeze foreign exchange rates for the ringgit. For many Malaysians, there is little obvious need for change. Even Ms Azizah herself admits that "the status quo is not so bad".
And yet, the country is changing, whether Dr M likes it or not. The timing of the election suggests that he knows as much. Constitutionally, polls did not need to be held until next year. But on New Year's Day, 680,000 new voters will join the electoral roll. None of them have known any other prime minister. To many, reared on the internet or educated abroad, the trappings of his rule are wearisome - the toadying press, with its relentlessly pro-government line, the intolerance of opposition, the periodic arrests of opponents under a draconian "security law".
By holding the elections early, Dr M avoids facing their judgment, although it will be delivered in the next election when the 73-year old Prime Minister, who has suffered from heart disease, is unlikely to be a competitor. Which of his lieutenants will succeed him is unclear - certainly, none possesses his respect and authority. Meanwhile, Mr Anwar shows no signs of giving up the fight from inside jail - even if he spends years there, he will remain a formidable political power for the foreseeable future.
Even if it does win, the National Front is expected to be returned with a reduced majority, perhaps even losing the two-thirds necessary for constitu- tional change. Perhaps this explains the vehemence of Dr M's assault, its meanness and excess - that, for all the successes of the past, he knows that the mosquitoes are massing and that they are coming in for the kill.