Takindwa Black

Takindwa Black

Takindwa’s mom started her labor at the District Hospital in Malawi.  She had had a previous cesarean section so it was important that she labor at a hospital with an operating room.  Many women in Malawi labor in rural area which are far from any health facility.  And even when there is a clinic nearby, many times they lack an operating room and staff capable of performing a C-section.  The national C-section rate in Malawi is about 6% this compares with a US C-section rate of about 32% (WHO 2013).  According to the World Health Organization, the percentage of women who will require a C-section in order to birth safely is about 15%.  This means many Malawian women are not receiving necessary C-sections, which as a result jeopardizes their lives and the lives of their babies.

Takindwa’s mom was in the right place to access emergency obstetric care and after many hours it became apparent that she would again require a C-section in order to deliver safely.  Takindwa was born on April 13th by what initially seemed to be an uneventful C-section.  However, within a few hours her mother became short of breath, collapsed suddenly and was pronounced dead.  There is no capacity to perform an autopsy, so the cause of her death will never be know with certainty.  However, considering that her mother was a healthy 19 year-old woman, it is likely that her death was related to a surgical error.  Tragically in Malawi, both poor access to care and poor quality of accessibly care threaten the lives of many women.

Takindwa’s family was immediately referred to Joyful Motherhood and our nurses have been following her ever since.  Today she is a health 7 month-old.


Niya is only 16 years old, but several weeks after the birth of her first baby she had surgery for a total hysterectomy. Niya took care of herself during her pregnancy and grew a 8lb 9oz baby.  Unfortunately her baby was too big for her to birth naturally and she ended up with a C-section.  C-sections, though common in the US, carry significant risks in Malawi and increase the risk of serious life-threatening infections.  Days after giving birth, Niya became increasing ill, her abdomen swelled and she returned to the hospital.  Clinicians there did a laparoscopic surgery to determine the cause of her swollen abdomen and found that her uterus was necrotic.  The infection was so severe and had continued unchecked for so long that her uterine muscle had completely died as was beginning to decompose inside of her.  She had an emergency hysterectomy.  Soon after the second surgery she experienced severe nausea and vomiting and was diagnosed with a bowel obstruction.  She underwent additional treatment for the bowel obstruction.  It was a traumatic and life changing birth experience.  She would need to learn to care for her new baby, care for her wounds, and strive to accept the loss of her fertility. Joyful Motherhood nurses have been following her, supporting her as a new teen mom, counseling her about her hysterectomy and encouraging her. Her baby is growing well and she is planning to return to school soon.

September 2018 Activity Report

In September…

  • 9 babies were enrolled. 6 orphans (including a set of triplets), and 3 whose mothers were not producing any breast milk.
  • Nurses visited 139 babies in their homes.
  • Joyful Motherhood is currently following 249 babies
  • 4 women were enrolled, 2 with severe infections, and 2 whose uteruses ruptured and required hysterectomies
  • Nurses visited 25 women and are following 30 women.

Mother Care Admission Story

26-year-old Nazilinga went into labor on September 14th, she had had two previous c-sections, but this time she had a normal delivery. Her daughter weighed just under 4lbs and so Nazilinga and her baby were admitted to the kangaroo ward.  Kangaroo care is a low cost alternative to conventional intensive neonatal care.  Mothers are taught to keep baby wrapped skin-to-skin between their breasts for as many hours of the day as possible and to exclusively breastfeed.  Kangaroo care has been show to improve temperature control, decrease rates of infections and generally improve survival of low birth weight babies. Ten days after her delivery Nazilinga started to have trouble breathing and complained of chest pain.  She was admitted to the critical care unit, there she was told that she had fluid in her lungs and around her heart. She was diagnosed with a severe infection in her blood.  Finally on October 6th she was discharged and able to return to be with her baby.  Our nurses will continue to follow mother and baby at home.

Baby Care Admission Story

24-year-old M. Develias was pregnant with her second baby.  She received regular prenatal care and believed that she knew what awaited her, having experienced a normal pregnancy and delivery two years previously.  In late June she felt that her water was leaking and she went to the clinic.  There she was told by the midwives that all was well, but they admitted her to await her delivery in the health center.  One week later she started bleeding, initially she was just spotting but the volume increased over the following three days.  Finally the midwives decided to transfer her from the health center (there are no operating rooms in health centers) to the district hospital.  Unfortunately she delivered on the way to the hospital and bled to death before arriving.  This story illustrates the tragic fact that even when a woman seeks care in time, she is not guaranteed to receive the care she needs.  Her family was sent home with her body and her newborn.  They managed to provide for baby Chimwemwe until the end of September when they ran out of money for formula.  They sought help at a rural hospital and were eventually referred to Joyful Motherhood.


Faith was born January 28, 2018.  Her birth was uneventful and the next day her 23-year-old mother, Salimba, took her home to meet the rest of the family.  On February 14th Salimba became ill.  Her family says her face and feet were swollen and she started vomiting.  On February 18th they took her to the closest health center.  She died there before she was ever evaluated by a clinician.  Faith’s grandmother was then directed to Joyful Motherhood.  Overwhelmed and grief stricken she told the nurses she didn’t think she would manage.  She had five other children at home to raise.  With support from Joyful Motherhood nurses, Faith’s grandmother has done a wonderful job; today she glows when talking about her granddaughter.


In the face of this beautiful woman you can see lines of grief, determination, and quiet joy.  She is holding her grandson Precious who was born on the day her daughter died.  Her daughter delivered Precious and then as she lay back to embrace her new son she began to bleed.  The bleeding continued despite efforts of those with her to slow it down.  Her life washed away in a sea of red. Her mother clung to her newborn grandson and gave him a name from her heart.  She worried about her ability to keep him alive and well, without breast milk and without money for formula.  Within the week after telling countless people her story, she was directed to Joyful Motherhood for support.  Precious is now 8 months old.



Nineteen year-old Juliet was nearing the end of her pregnancy.  She had gone for her prenatal visits at the Mitudu health center, she had taken the antimalarial medications as instructed by the midwife, had the necessary blood work, and regular blood pressure checks.  Everything seemed to be going well until the day she collapsed and started seizing.

Pre-eclampsia is one of the most dangerous diseases of pregnancy.  Even as our knowledge about it continues to grow, our ability to predict who it will effect remains limited.  The onset is often sudden and occurs towards the end of pregnancy.  One of the warning signs is a rising blood pressure.  Pre-eclampsia can affect all the major organ systems, damaging the liver and kidneys, resulting in bleeding in the brain, seizures and death.

Those around her took Juliet immediately to the health center and from there she was transferred to Bwaila, the district maternity hospital.  Without a well organized EMS this process of just getting her to a place where she could be helped took several hours.  When she arrived at Bwaila, Juliet was unconscious and still seizing.  The midwives – familiar with this presentation – quickly administered magnesium sulfate, the only medication shown to help control and prevent eclamptic seizures.  Even with the medication, the only cure for eclampsia is delivery.  Once a woman reaches the point of seizing her life is in grave danger and if she is not delivered within a relatively short period, both she and her baby will die.  Unfortunately even delivery does not guarantee that the mother’s life will be saved.  The clinician at Bwaila delivered her 5lb baby by C-section and Juliet was sent to the ICU, where she remained unconscious for 4 days.

This is where our nurses found Juliet. After talking with her family, she was enrolled in our Mother Care program.  Juliet regained consciousness and after a short period she was discharged from the hospital. The nurses planned to visit her six times in her village.  During their first visit, nurses found Juliet still swollen and convalescing, still struggling to care for her baby.  This picture is from their second visit.  As part of her home based care, nurses will counsel her on the disease and help her community members create an emergency plan for such events in the future.  They will also provide some education on the care of her baby and help set up an income generating project.

August 2018 Activity Update

In the month of August, 10 infants and 4 women were enrolled in our programs.

Of the 10 babies, 5 were orphans, the mother of 1 was critically ill in the ICU, the mother of another prematurely stopped producing breast milk, and the remaining 3 were underweight.  Nurses visited 144 babies this month and are currently following a total of 245 babies.  Seventy-five babies are on formula and 230 tins were distributed.

Of the women admitted, one had eclampsia, two had severe infections, and one experienced a ruptured uterus. Twenty-three home visits were made this month to sick women.

Here are a couple stories:

Baby care story: Jean was 19years old and having her first baby.  On July 15th she began to bleed spontaneously.  Luckily she made it to the hospital in time for an emergency C-section.  Her baby boy cried as he was lifted from her body; he was a strong healthy baby weighing 5.5lbs.  Soon after the surgery, mother and baby were deemed stable and transferred to the postpartum ward where they would remain for the next several days.  On July 18th Jean complained of heart palpitations.  In the capital city, in the district hospital, in the ward, Jean died before a nurse responded to her complaint.  Jean’s death tragically illustrates the inadequacy of the health care system.  She may have died from an infection or from internal bleeding or something else.  No one will ever know why she died at 19.  Her son will never again feel her warmth, taste her milk, or hear her voice.  Nurses directed her relative to the office of Joyful Motherhood, located on the same campus as the hospital, and they were admitted to our program.

Mother care story: On 21st August, 2018 Juliet started convulsing.  Staff at the rural hospital where she was, started her on medication to try to stop her seizures then transferred her to the referral hospital in the capital city.  When she arrived her baby was delivered by C-section. The baby took his first breaths but did not cry.  On August 26th her baby died. On August 28th, Juliet was discharged home to her village.

Each of the remaining 12 admissions for the month of August has an equally heart-rending story.  For many, these stories include the death of a baby or a mother.  These tragedies indelibly mark the lives of family members left behind. However, they (the sister or mother of the woman who gave birth) make a conscious decision to continue forward and care of the vulnerable survivor.  They do this at great personal cost. And, thanks to you, those who find their way to Joyful Motherhood are granted the necessary support to multiply their efforts.  Sacrifice + support = hope…. and later joy.

Stella, Eunice, & Joseph

Triplets Stella, Eunice and Joseph each weighed about 2lbs at birth.  Their parents were already struggling at the edge of survival and now suddenly there were three additional children to feed. It was not uncommon that an entire day would pass with no food.  Life -which involved fetching water, washing clothes by hand, and farming with hand tools – demanded great daily physical exertion regardless of the fuel or lack there of in their bellies.

As a midwife in the US, I often have patients tell me they struggle to produce enough milk for their babies.  Here, with well nourished patients, we talk about reducing stress, increasing the frequency of feeds and/or breast stimulation; and we talk about specific foods that may help increase supply.  Here this support and advice works at times, and at times women start slowly supplementing with formula and eventually stop breastfeeding all together. Women may experience anxiety, guilt or frustration at times, but there is always a way to sustain the life of the baby.  In the case of Elizabeth, her body was being pushed to its physical limits on a daily basis in multiple ways.  Though the milk any woman produces is always beneficial for her children, the volume Elizabeth produced could not adequately sustain her triplets. Without Joyful Motherhood, she would not be able to purchase the formula needed to supplement her babies.

Joyful Motherhood enrolled the babies bringing supplemental formula and encouraging Elizabeth as she continued to nurse.  And yet, for months their weights hovered below 5lbs.  At six months of age they added the enriched porridge brought by Joyful Motherhood to their diet and finally they began to gain weight steadily.  They are now 13months old, two of the three are walking.  Stella weighs 15lbs, Eunice weighs 15.5lbs and Joseph weighs 19lbs.

Nkanzo & Pemphero

Six month old twins Nkanzo and Pemphero are healthy beneficiaries of Joyful Motherhood.  Years before their birth, their Malawian parents moved across the border to Mozambique in search of a better life.  They settled there and had five children together. These twins were their sixth and seventh children.  Their land provided what they need to sustain their large family but it was located in a remote area, a long journey to the nearest health center.  In spite of the distance, their mother made it to the clinic for prenatal care four times during her pregnancy (this is the recommended number of prenatal visits in Malawi).  However, when her labor started there was no question that she would labor at home.  Without transportation many women deliver their babies at home in rural areas.  Given the circumstances, this is a rational decision, and most of the time births are relatively uneventful.

Nkanzo and Pemphero each cried spontaneously after being pushed into the world, but within moments their mother began to bleed profusely.  The women with her alerted other community members who quickly loaded her in an ox cart to take her to the clinic.  But long before their destination sat on the horizon, she died.  Rather than returning, the group continued to the woman’s home village in Malawi with her body and her babies.  The remainder of the journey was marked by the slow plodding of the ox, a woman’s weeping, and the occasional cries of hungry newborns.

Upon reaching the home village, maternal relatives immediately assumed care of the babies and tried to provide for them as best as possible.   Without breast milk or formula the babies quickly began to deteriorate.  Guardians took the babies to a clinic for treatment and from there they were connected with Joyful Motherhood.  The JM nurses recount that they were not optimistic about the survival of the tiny sick babies.  Still, they provided medication, formula, and education.  And, after several weeks they returned to find the babies improved.  Joyful Motherhood has been following the twins over the past several months.  At this point the twins are bright and curious little babies who bring joy to those around them.  This is another example of the difference we are making together in Malawi.

Ana Andrew

When her daughter married and moved to a village some distance from her own, Ana Andrew’s grandmother said goodbye with a mixture of joy and sorrow.  Neither owned a phone and so time passed without any communication.  After almost a year someone from her son-in-law’s family came to tell Ana’s grandmother that her daughter had died shortly after delivering a premature baby girl.  She was told that her daughter died from asthma.  The story was vague.  Apparently the young woman had become ill and went to the hospital where she delivered and died.  Lingering unanswered questions regarding untimely deaths are often the norm in Malawi.  Irrespective of the story, Ana’s grandmother knew the tragedy and horror would remain unchanged.   She collected her 2lb 10oz granddaughter, looked in her bright and hungry eyes and decided that she would be the focus.

She brought Ana to Bwaila Maternity Hospital where they were admitted to the kangaroo ward.  Kangaroo care has shown to improve survival for premature and low birth weight babies in low resource settings.  It involves tying the baby skin to skin between the breasts of the mother or guardian and keeping them in this position day and night, except when feeding, bathing or changing.  Women stay in the ward while nurses teach and supervise the condition of their babies.  Ana was discharged home weighing 3lbs 3oz.  At this point nurses from Joyful Motherhood stepped in and began their regular visits – building a relationship with Ana’s grandmother and extended family. assessing Ana, providing formula, and later porridge.  Ana is now 1 year old.  She is not yet walking, but she speaks clearly, calling people by name and asking for food when she’s hungry.

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