Mrs. Maseko, the mother care program manager, accompanied one of the locum mother care nurses for follow up to the home of a recently discharged patient.  The woman had had a ruptured uterus requiring an emergency hysterectomy, and she lost the baby as well.  The visit required first long minibus ride to the correct area, and a subsequent 21km bicycle taxi ride in order to reach the home.  Upon arrival, the nurses found the woman lying on a sac on the ground in the corner (there is no bed). She was weak, pale, and alone.  Mrs. Maseko said “She was so happy to see me, because she recognized me from the hospital where I enrolled her last week before discharge. She has no one to assist her to cook or go to draw water.  The husband had left to find piecework for food.  There was a 4 year old child in the house, also alone.” 

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.