Frankly there are times when I feel completely overwhelmed; when I stop to acknowledge the enormity of the challenge we are addressing with our work.  One day this December while I was in the office, an elderly grandmother entered to request our assistance.    While she waited for the nurse she dozed, bent forward, her arms cradling a baby on her lap, and another baby strapped to her back.  Her daughter had been hospitalized and she had come to care for her daughter – cooking, feeding, bathing her daughter who no longer recognized her surroundings or even her infants.  She also came to care for her three month old grandsons – feeding, changing, bathing, and soothing them.  As poor relatives of patients all over Africa, this grandmother would stay beside her daughter’s hospital bed day and night for the duration of the hospitalization.

I became a mother this year to an amazing beautiful boy and now I know experientially about the joys of motherhood, as well as about the sleep deprivation.  I now know what it feels like when someone depends on you to be fed every couple of hours.   I also spent five horrible nights sleeping on a wooden stool next to my baby when he was hospitalized with malaria, and I know the exhaustion of caring for a sick loved one without rest in an African hospital.  I looked at this dozing woman who was twice my age caring for infant twins and a critically ill daughter; it was a burden I could not imagine carrying.  My heart ached for her and I felt overwhelmed.  At an age when her daughter should be helping care for her mother, this grandmother was again the life line for her family.  The baby in her arms woke crying with hunger and shook me into action.  I made some formula as Nitta (one of our nurses) spoke with the grandmother.  As I fed the crying boy and as he became satiated spoonful by spoonful, I realized his grandmother was laying down her life day after day for her daughter and her grandbabies.  She was exhausted but she was not complaining, she was asking for a small assistance.  She was willing to take on the burden of raising two infants in the village, she just needed milk, instruction on how to care for them, and visits by a nurse to monitor their growth.  I watched Nitta carefully assess and weigh each twin and I felt grateful to be a part of such amazing work and to be witness to such deep love.  Please join me this year in offering support and holding out hope to the mothers and babies we care for and the families caring for them.

Happy Holidays and Happy New Year.

Joanne Chiwaula

Director of AMHI

The nurses went to find the village chief, and spoke with him about finding neighbours or other village women to assist the patient with cooking, washing, and cleaning until she improves. He agreed and found a couple of women to help.  It will be important to follow up with this woman soon in order to assure that the assistance has continued.  She has suffered great psychological distress at the loss of not only the baby, but also for the news that she will not be able to have any more children – a fact that she has not shared yet with her husband, and will need support to do, since there is a great chance he will abandon her and her 4 year old when he finds out, leaving this patient in even further danger of poor recovery and future health problems.

While most maternal health programs in Malawi focus on ensuring a healthy pregnancy and training caretakers to ensure a normal delivery they neglect to address the women who have suffered a “near-miss” and continue suffering postpartum with severe morbidities.  These are the women our programs target to offer additional support and advocacy until they have regained their health.

Unfortunately this story is not uncommon.  Many of the orphaned infants we care for were born to mothers who died soon after delivery in the back of an oxcart.  These women live in villages which are remote from health facilities, where access to transportation is minimal, and where roads are rough and unpaved.  Various strategies have been employed to prevent these deaths  – including: training traditional birth attendants, advocating for hospital deliveries (that women should camp out at hospitals a few weeks before their due date), training and supplying hospitals to ensure that they can provide emergency obstetric care – but these “cheap” deaths are still occurring too frequently.  Perhaps if Joyce had been accompanied by someone who knew how to deliver her placenta and slow the bleeding, her life would have been saved.  Perhaps she truly needed access to an ambulance to carry her quickly along a paved road to a hospital with emergency obstetric care.  Our greatest wish would be to stop the deaths completely.  Our focus is caring for the infants left behind but we play a small role in improving care for women by working with the communities of deceased mothers to educate and create emergency plans, which will implemented for women and children in the future.

Mrs. Beatrice Namaleu identified the infant and girl this morning after checking with the nursery for any new orphans.  The girl presented to the office with the baby moments later.  She was given 5 tins of formula, a measuring cup and a feeding cup as well as a demonstration and instructions on formula preparation, hand-washing and hygiene.  The baby was weighed and assessed and seems to be in good health, drinking easily and heartily from the prepared cup of formula.

A patient attendant came to alert us that the ambulance going to her village was leaving, so we quickly finished, gave the girl a sandwich  since she had not eaten since yesterday), as well as a small bag of baby clothing from our donation box.  Our hearts were heavy as she swept out the door, not only a grieving daughter, but suddenly a new “new mother” of five as well.

In 2010, Alice gave birth to her third child. This child was severely underweight at only 2.5 pounds, and the baby was admitted to the nursery at the hospital. Alice also experienced complications during delivery- she experienced eclampsia, seizures during pregnancy. Because Alice and her husband are young and were not given much information prior to childbirth, they didn’t know what to do about the condition. Alice and her husband are very poor, and live with six others in a very small house. Due to these living conditions, their household has poor sanitation.

CU nurses helped to check up on Alice to treat her after childbirth. In addition to making sure that Alice was not experiencing any further complications after childbirth, CU nurses provided advice to Alice and her husband about proper nutrition for the child and
sanitation for their household.

Although Tiyanjane went to the local health center to treat these problems, she has to sometimes wait several hours before she can speak with health representatives, and they are often not helpful in treating her condition. Also, since there is no transport to the health center, she often feels very weak by the time she arrives.

To help relieve her condition, CU nurses have been checking up on her. CU nurses have helped to treat Tiyanjane’s condition and her health has improved. Tiyanjane is very thankful because CU nurse visits have been much easier and more effective than visiting
the local health center.

In 2010 Chrissy gave birth to her 9th child and experienced severe hemorrhaging after this most recent birth. After giving birth, Chrissy felt very weak and was unable to care for her newborn child. Unfortunately, Chrissy’s husband didn’t know what to do to help Chrissy.

CU nurses visited Chrissy after she was discharged from the hospital. The nurses checked up on Chrissy’s health, which has since improved. CU nurses also gave her advice on nutrition and sanitation to ensure that Chrissy and her family will stay healthy. CU nurses also recruited friends and neighbors to help Chrissy and her family- she now has friends who draw water for her from a better water source. Finally, CU nurses have advised her husband on how to better care for Chrissy’s health after delivery. Chrissy and her family are now much healthier, and are optimistic about the future.

Maureen successfully gave birth to twins, both of whom were very small- less than five pounds. Due to childbirth complications, Maureen was sick after being discharged: she was vomiting and had pains and diarrhea, so she went back to the hospital. Not only was Maureen worried about her own health, but she was also having problems feeding her children due to these conditions.

After Maureen was discharged from the hospital, CU nurses went to visit her. CU nurses advised Maureen on how to feed the children, and told her to regularly visit the hospital for the weeks following her childbirth. Due to the counseling she received from CU nurses, both Maureen and her twins have both improved and are now healthy.

Since that time, unfortunately, Hawa has experienced severe problems with childbirth. She delivered stillborn children in 2004, 2006, and 2008. Due to the complications experienced during childbirth and the trauma of giving birth to stillborn children, Hawa is very worried about her ability to have children, and her overall health.

Hawa became pregnant for a fifth time and gave birth in 2010. Due to very high blood pressure, Hawa gave birth by caesarian section. The child survived after childbirth but was very small- just over four pounds. After birth the child lost some weight, and Hawa continued to have problems with high blood pressure and severe headaches. To further complicate things, Hawa’s husband is upset with her for having so many problems with childbirth, and he married another woman and left Hawa.

Nurses from CU visited Hawa after her most recent childbirth, and were able to talk with Hawa about her health problems. CU nurses offered guidance and help to Hawa for her newborn child, and the child’s health has improved in recent weeks. CU nurses also spoke with Hawa’s husband, who has returned to live with Hawa.

In February 2006 a distressed woman in labor traveled forty kilometers alone to the hospital – walking, then on the back of a bicycle and then in a minibus. Soon after reaching the hospital her daughter – a healthy girl, her fourth child – was born, and moments later she died.

Chikumbutso was left to the care of her father and maternal relatives. Before Chiku was discharged from the hospital I met her grandmother and father, nurses taught them how to safely prepare formula for their baby and I made plans to visit Chiku and her family in their village.

Over the next few years Joanne Jorissen then Chimwemwe mu’bereki provided formula, food supplements, and served as her advocate when she needed hospital care. CU is still following Chiku and her family, but now on the cusp of her forth birthday she is a success story.

During Joanne’s most recent visit to her village her grandfather expressed his profound gratitude saying that the family would have never managed to keep her alive without our support.