November 2018 Activity Update

November 2018 Activity Update

In the month of November…

– 9 babies were admitted, including one set of triplets, 4 newborns with critically ill mothers in the ICU, 1 premature baby with a sick mom, and 1 baby whose mother’s milk had dried up completely

– 7 women were admitted, 3 with a recent history of ruptured uterus and hysterectomy, 1 with eclampsia, 2 with severe anemia, and 1 with a severe infection and vaginal fistula

– Nurses visited a total of 136 women and babies

Mother Care Admission Story

Domisa was expecting her third baby. She had two normal deliveries but her third labor was long and difficult, she was ultimately referred from her health center to the district hospital where she was delivered by c-section. Three days later, when she should have returned home with her newborn son, nurses noticed pus oozing from her surgical wound. She returned to the operating table and found that the first surgery was done incorrectly, a lip of her uterus had been sutured to her bladder. At that point the infection was so severe that they removed her uterus, her bladder was damaged in two places and a fistula. Her wound was left open to continue to drain. A month after her labor started she was sent from the first district hospital to a fistula center to await surgery for fistula repair. Joyful Motherhood nurses met her in early November and continued to follow her and her baby once she was discharged home.

Baby Care Admission Story

Joyce was pregnant for the 6th time, she attended her prenatal visits as recommended at the clinic closest to her home. Her belly swelled quickly and about one month before the time she expected to deliver, she started contracting and felt a small pop followed by slowly leaking fluid. She made her way to the district maternity hospital and soon delivered four live but small babies vaginally. She was admitted to the kangaroo ward with her four newborns but within the first week her last baby boy died (the probable cause would be infection contracted from the hospital). She was then referred to Joyful Motherhood. Joyful Motherhood nurses have been visiting Joyce at home and supporting her in the care of her babies since November.

October 2018 Activity Report

In October 2018….

  • 8 babies were enrolled, including 4 orphans, 1 set of triplets, and one newborn whose mother was critically ill.
  • 6 recently delivered moms were enrolled (their birth experiences include: eclampsia, pulmonary edema, ruptured uterus, and severe infection)
  • Nurses conducted 149 visits to beneficiaries.

A Woman’s Story.  Lonely Harold was enrolled in October.  She was 20 years old and pregnant with her first baby.  She started labor at home and then made her way to a health center. When it became clear that the labor was not progressing, she was sent to the district’s maternity referral hospital.  At some point her baby girl died inside of her, but it was not until after her c-section that she learned that she would not return home with a baby at her breast.  While still in the operating room, Lonely experienced a heart attack and required resuscitation, her lungs filled with fluid and she was sent to recover in the ICU.  Twenty days later she was discharged home without her baby.

A Baby’s Story.  Tikhale was 23 years old.  Her first baby was a stillbirth.  Her second labor was difficult and finally, on October 10th, resulted in a c-section.  Her newborn daughter was distressed and needed resuscitation but they were both discharged home in stable condition after a few days.  Several days later Tikhale returned complaining of stomach pain, she was hospitalized and given a transfusion.  She stayed in the hospital for two weeks and died there.  The woman who took in her baby, named her Memory and was referred to Joyful Motherhood for support.

 

Enes Foster

This is Enes and her baby Vincent.  In October 2018 Enes started laboring for the fifth time. She already had five little ones at home (including a set of twins) and all her previous pregnancies and deliveries had gone well, but her labor with Vincent was different.  With four previous births, Vincent’s birth should have been relatively easy, but the pain continued hour after hour for two days without progress.  She spent those two days she at a local hospital without an operating room.  After two days midwives transferred her to the district hospital and she ended up with a c-section and a large healthy baby boy.

C-sections in Malawi carry significantly high risks than in the US; infections leading to a loss of fertility, loss of a woman’s uterus and ovaries, or even death are not uncommon.  Four days after her c-section, a nurse noted pus coming from the wound.  The initial treatment of IV antibiotics did nothing, and so Enes returned to the operating table.  The surgeon who reopened her wound found a severe infection and decided that to save her life he would have to remove her uterus and ovaries. This time the surgical wound was left open to heal gradually.  Nurses cleaned and repacked the wound daily with sterile gauze.  Enes’s critical condition improved gradually over three weeks. Three weeks after Vincent was born she returned to her family.

Enes did everything she was taught by her midwives during her prenatal care.  Rather than delivering at home, she labored at a hospital under the supervision of trained birth attendants.   Evenso, she did not have immediate access to emergency obstetric care and there was a delay in the provision of the needed c-section.  Because the infection began within days of the surgery it is probable that the infection was caused by poor surgical technique. These weakness in the healthcare system put Enes’ life at risk as well as the lives of her children.

During her hospitalization she was too sick to nurse and so her milk dried up – most families are too poor to afford supplemental formula and many children in Vincent’s situation die.  As for her children at home, young children who are not in the care of their mother experience an automatic increased risk of illness when compared to their peers.  Now four months after Vincent’s birth Enes is weak but able to care for her children and she is breastfeeding.  Unfortunately, her milk supply does not yet match Vincent’s appetite.  Joyful Motherhood nurses started following Enes when she was at the district hospital and have been providing supplemental formula for Vincent while also working with Enes to increase her milk supply.