Activity Updates

During March, 9 newborn orphans were admitted and one set of abandoned twins. Nurses visited 134 babies and distributed 504 tins of formula. There are currently 236 babies in the program.

Baby Story. Tadala was one of the babies admitted in March. Her mother, Esnart, died shortly after delivery. The second tragedy compounding the loss of her mother, was the lack of a clear cause of death. In Malawi, many times the cause of death is not established. Family members are left with hazy memories of complaints and a quick deterioration. Why should an otherwise healthy 35 year old woman die suddenly? Esnart went to the hospital in active labor, her delivery was difficult and after many hours a clinician assisted her to deliver with a vacuum extractor. Her baby girl came into the world already stressed. Her limp body was massaged and gradually her condition improved. Two days later all seemed well and mom and baby were discharged. However, Tadala soon developed a high fever and was readmitted for a severe infection. She was treated with antibiotics and discharged again. Then, a few days later, Esnart began complaining of chest pain and diarrhea. She was readmitted to the hospital. She began seizing. She was admitted to a critical care unit but within two days her condition deteriorate and she died. The family was referred to Joyful Motherhood by a nurse at the hospital.

In the month of February 7 babies were enrolled, 3 of whom were orphans, 2 critically ill babies with cerebral palsy, 1 baby whose mother suffers from psychosis, and 1 baby whose mother was critically ill and unable to breastfeed. This month nurses visited 140 babies and distributed 369 tins of formula.

Baby Story. Efrida and baby Hekima.  23-year-old Efrida is a diabetic, there is minimal medical support for diabetics in Malawi and her hospitalizations throughout her life have been frequent. Still she was happy about her pregnancy and attended a clinic for prenatal care. Then on November 9th she became unconscious and her family took her to the nearest health center. From there she was referred to the district hospital. Once her blood sugar was stabilized, she regained consciousness and her baby was delivered by C-section. Efrida and her new baby Hekima were discharged within a few days. After days of trying to breastfeed, days and nights of hearing Hekima cry and watching her baby lose weight, the family realized Erida’s milk was not coming. Efrida’s husband, though poor, started buying formula for his baby and they were managing. However on January 18th Hekima’s father was tragically killed in a car accident. No one else in the family had the financial capability to purchase formula. Hekima’s paternal aunt heard about Joyful Motherhood and brought mom and baby to Lilongwe to be enrolled in our program.

In January…. • 11 babies were enrolled including, three orphans, one baby with a mother in the ICU, one baby of a woman with severe psychosis, two sets of twins, and two babies whose mothers were not producing breast milk. • 7 women were enrolled including, three for a ruptured uterus with subsequent hysterectomy and four for severe abdominal infections following their deliveries. • Nurses visited 170 women and babies. Mother Care Admission Story. At 18 Chimwemwe was pregnant for the second time. Her first child died as an infant and with that loss ever present in her mind she was praying for a healthy strong baby this time. She began laboring on December 22nd and reported to her health center. Two days later midwives determined that the baby was too big and sent her to the district hospital where a c-section would be possible. Chimwemwe delivered a healthy baby boy by c-section that same day. She was overjoyed with her baby but the pain from her surgery only increased over the following days. Clinicians at the district hospital noticed the deterioration of her health and sent her to the region’s high risk maternity hospital. There she underwent an exploratory laparotomy, they drained a half liter of pus, inserted a drain and started her on antibiotics. On January 12th she appeared greatly improved, the drain was removed and she was sent home. Joyful Motherhood nurses started their visits. Baby Care Admission Story. 22 year old Monica had a normal healthy pregnancy, she delivered her baby boy in the hospital. After his birth she began to hemorrhage, the bleeding was not stopped in time and the requested blood products were not available. Monica died quickly. Her mother left the hospital with a grandson, one tin of formula and her 22 year-old daughter’s body. She was referred to Joyful Motherhood for continued support.

This December…. – 10 babies were enrolled in our program, including three orphaned newborns, one set of triplets, one baby with multiple congenital anomalies, one baby who was abandoned in a public space, one baby’s whose mother was not producing breast milk, and one baby whose mother was on chemotherapy. – 7 women were enrolled including five with ruptured uteruses and subsequent hysterectomies, and two with severe infections following c-sections and subsequent. – Nurses visited 138 women and babies Baby Care Admission Story. Mary was pregnant with her fifth child when she tested positive for HIV. She attended prenatal clinic and was able to receive anti-retrovirals to lower her viral load and decrease the risk of transmitted the disease to her baby. She went into labor a bit earlier than expected but delivered a healthy five and a half pound baby boy. Mary’s health seemed stable but she had developed a sore on her leg which, despite herself care, only seemed to get worse. The midwives who attended her delivery determined that the wound was severe enough to refer her to the regional hospital. There clinicians biopsied the wound and diagnosed her with cancer. Mary soon began chemotherapy but was forced to stop breastfeeding. At this point Mary and her baby boy were referred to Joyful Motherhood. The World Health Organization recommends that HIV positive women exclusively breastfeed their babies to six months. WHO recommends anti-retrovirals during pregnancy and breastfeeding to decrease the risk of transmission. The risk of death from malnutrition or diarrheal illness for a young baby in Malawi outweighs the risk of HIV transmission from his mother. Formula is used as an absolute last resort, for babies who do not have access to the breast milk their need to sustain their lives. Joyful Motherhood nurses are visiting Mary and her baby, providing formula, monitoring his health, growth and development and providing health education to Mary. Mother Care Admission Story. Sakina felt some early painful contractions on October 15th. She was a healthy 17 years old, expecting her first baby. Her mother accompanied her that day to the nearby health center to ensure that she labored under that watchful eyes of trained midwives. Soon after their arrival Sakina began seizing. She had developed eclampsia. Sakina was transferred to the district maternity hospital for high risk management. Pre-eclampsia is a life-threatening disease of pregnancy. Even in 2019 our knowledge of pre-eclampsia is incompleted. We know risk factors but cannot predict who will be affected. When a woman suddenly develops high blood pressures and has protein in her urine she is diagnosed with pre-eclampsia. Delivery is the only cure. In the US a woman with pre-eclampsia is monitored carefully and delivered as soon as possible. In Malawi these early signs are often missed. There is often not much time between their onset and the quick acceleration of the disease. Pre-eclampsia may affect all the major organ systems and ultimately lead to death. Seizures indicate an advanced disease process (eclampsia). On October 30th Sakina finally delivered a six pound baby boy. She was critically ill but clinicians believed she was well enough to go home and discharged her on November 4th. Sakina’s body was struggling to heal from the eclampsia and the c-section and she did not produce any breast milk. Her mother anxiously and loving tended Sakina and the baby, she saw them both struggling, but how could she leave Sakina to seek help for her grandson? She feared Sakina would deteriorate if left alone and where would she even go to get milk. Within one week Sakina’s baby boy wasted away and died. On November 11th Sakina’s mother could wait no more, she decided that to save Sakina, they would go to a mission hospital. She would have to pay for care but she would worry about that later. At the mission hospital doctors diagnosed Sakina with a severe infection and referred her to the region’s high risk maternity hospital. There Sakina was diagnosed with severe peritonitis and a necrotic uterus. On November 12th 17-year-old Sakina was taken to the operating room and underwent a total hysterectomy. Weak and critically ill Sakina stayed in the hospital for over a week. On November 20th when it was noted that her condition was not improving, she returned to surgery. Her wound was reopened more purulent material was washed from her abdomen, four drains were placed. For the next month she stayed in the hospital, her wound slowly healing. On January 4th Sakina complained of leaking urine and a fistula was noted. She was referred to the fistula center where she was taught about dressing changes and discharged home on January 6th. She was still leaking urine but would have to wait until her body was strong and healthy enough to undergo the first repair surgery. Joyful Motherhood nurses first met Sakina while at the high risk maternity hospital. They followed her after discharge and will continue to visit her, monitoring her health and offering emotional support to her family until she returns for her fistula surgery.

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.

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.

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 21^st 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.