Activity Updates

In April we admitted 11 babies (10 orphans, which included one set of twins) and one baby without breast milk.  The 9 mothers died from: 5 from postpartum hemorrhage, 3 from unknown causes and 1 from postpartum sepsis.

We are following 233 babies and 21 women. Nurses conducted 155 visits to babies and women in their communities this month. 477 tins of formula were distributed.

We lost baby Matness this month to a case of severe malaria. The baby girl developed a fever and died within 48hrs, despite care in the hospital.

Mother Care Admission. 22 year-old Martha started labor on March 28th, three days later she had not progressed and midwives noticed that the baby was experiencing distress.  From an outlying maternity clinic she was transferred to the District Hospital for a c-second.  Once she arrived, her baby boy was promptly delivered by c-section and they were discharged three days later.  On April 8th, Martha returned to the hospital, she felt dizzy, her abdomen was swollen, she was feverish and nauseous.  The clinicians opened her wound and found a severe infection, the purulent fluid was drained and she received a blood transfusion.  Martha was discharged home on April 20th.  She was enrolled in the Mother Care program by Joyful Motherhood nurses and they will visit her six times at home to check on her wound and to assess the progress of her healing.

Baby Care Admission. When 18-year-old Laina progressed into her third trimester of pregnancy, midwives at her clinic told her to wait for her labor to start at the hospital.  As a first-time mother they knew it would be safer for her to labor close to a hospital where emergency obstetric services including an operating room would be available.  Even though her belly appeared to be the size of a complete pregnancy, she was only 34 weeks when her labor started and Laina went directly to the District Hospital.  She had an ultrasound in early labor and was told that she was expecting twins.  The baby boys delivered without complication even though her second baby came out bottom first.  Then immediately following their birth Laina began to bleed profusely.  Thankfully the midwives were able to stop the bleeding and stabilize Laina.  Laina and her babies were discharged the following day.   At home, even with the support of her mother, the first days were very difficult and then her condition seemed to worsen rather than improve.  After a week at home her family took her back to the District Hospital.  Clinicians who admitted her knew that she was suffering from severe anemia and they admitted her but she did not receive a blood transfusion.  Finally, thirteen days after the birth a transfusion was ordered.   Blood was available but they did not have a blood transfusion set. Two days later, previously healthy 18-year-old girl died leaving orphaning her twin boys.  She died because there was no blood transfusion set at a District Hospital, where she had gone following the advice of her midwives specifically so she would have access to expedient emergency obstetric care.

In March 6 babies were enrolled including 4 orphans and 2 babies without access to breast milk.  (The four infants lost their mothers to postpartum hemorrhage, sepsis, possible cardiac myopathy, and gastrointestinal illness.  So many times when a woman dies in Malawi the actual cause is never identified which compounds the tragedy, this is the case with the story of Violet below. 

This month we lost baby Prisca, she was a 22-month-old triplet.  She developed pneumonia and was admitted to the hospital.  After three days in hospital, she died. 

This month 2 women were enrolled in the Mother Care program (one had experienced a severe postpartum infection and the other was suffering from severe anemia). 

Nurses are currently following 23 women and 241 babies.  This month they made 187 visits to women and infants in their homes.  560 tins of formula were distributed.

Baby Admission Story. Violet was only 21 and pregnant for the first time.  She attended her prenatal care visits but we are not sure how far along she was when she became sick.  At some point in her third trimester, she contracted a severe diarrheal illness and sought care at the district hospital.  She was given medications and sent home but nine days later she returned to the hospital feeling worse.  At that time they admitted her and she received a blood transfusion.  She continued to deteriorate and three days later her baby boy was delivered by c-section.  Violet died the following day, October 28th.  Violet’s family did everything possible to care for her surviving baby, they sought donations for formula, sold items to purchase formula, fed him watery porridge when formula was not available.  Finally in March Violet’s family learned about Joyful Motherhood and brought her baby for enrollment. 

Violet was a healthy young woman. The loss of her life is not only emotionally devastating for her family, the loss of her life also has financial implications.  First her family lost a productive adult who was actively contributing to the overall well-being of the family and second, after her death her family used scarce resources to care for her orphaned infant.  The loss of a single woman of reproductive age sinks a family deeper into poverty.  The tragedy of her death is compounded by the fact that her family will never really know why she died.  It is hard to imagine losing a loved one and not understanding the cause.  This is terrible for any family, and certainly this is also terrible for the clinicians who cared for her and even the Ministry of Health. The clinicians who treated her do not have the diagnostic tools to determine the true cause of her illness and cause of death.  Therefore, the ability to improve practice and prevent similar deaths in the future remains limited.   

We at African Mothers Health Initiative and Joyful Motherhood, are intervening and addressing a small part of a large problem.  We are now supporting Violet’s family as they care for her son in his first years of life.  Our goal is to see him through early childhood and ensure that his family has the knowledge and support needed to protect his health. We know the efforts, funds and support spent on these fragile newborns are worthwhile and life-saving.  Still, it is important to remain aware of the greater context, the complexity and interconnectedness of maternal and child health.

During the month of February we admitted 6 infants (5 orphans, and 1 baby without breast milk). Nurses visited 155 infants and distributed 550 tins of formula. We currently have 237 babies and 22 women in our care.

Baby Admission Stories.

(1) Twenty-year-old Alice’s first pregnancy ended in a normal delivery on September 25th.  Her small healthy girl went home with her two days after the birth.  Alice has flat nipples and her 5lb baby could not open her mouth wide enough to latch well.  Alice was determined to breastfeed, but the improper latch created pain.  Over the first week the pain worsened, sores developed on her nipples, the sores opened and bled with each feed.  Still, Alice knew there was no alternative to breastfeeding; her family could not afford to sustain a baby on formula; her daughter’s survival depended on her milk, so she continued.  Nursing did not go well.  Alice’s baby lost weight, neither she nor her daughter could adequately extract the milk from her breasts.  Her breasts swelled and hardened, they were exquisitely tender and she developed a fever.  Infections in the milk ducts grew into abscesses, which eventually ruptured through the skin of her breasts.  She returned to the hospital where midwives cleaned the wounds and taught her to hand express her milk, but the pain did not improve. 

Alice did not sleep. Her baby cried constantly from hunger. The unremitting pain and sight of bleeding breasts caused physical and emotional trauma. Her family continued to seek support.  As time went on Alice’s milk dried up and she became increasingly despondent.  In early February Alice was admitted to a psychiatric ward and her baby was taken by a family member to the hospital.  The nurse who met them in the hospital directed the relative to seek support with Joyful Motherhood.  JM nurses enrolled the baby and began instructing the relative in how to prepare and provide formula. Slowly, as her body healed, Alice’s mind also began to improve.  Quality postpartum care is necessary for all women. It is not often than we recognize the link between nursing care, lactation support, and accessibility of formula to maternal well-being and infant survival.  But, these elements should be included in discussions of maternal and infant health. Sometimes seemingly simple issues have life changing consequences.  

(2) Lolita lived in a community just outside Malawi’s capital city.  She was 21 and healthy.  On February 18^th she started feeling contractions and her family took her to the closest health center.  Midwives there checked her cervix and told her she was still in early labor, they instructed her to return home and come back once the contractions were stronger.  Lolita continued to contract through the night.  The contractions continued the following day, but she feared the nurses would again turn her away, so rather than return to the health center, she went to a prayer service with her family.  Much to everyone’s surprise her baby girl was born during the service.  Those around her immediately began to seek transportation to take her to the health center, but before they were able to move her, Lolita hemorrhaged and died.  Our dear secretary, Trust Kachala, happens to be a neighbor to the family and she was the one who told them to come and seek help from Joyful Motherhood.

We enrolled 14 babies in January! 3 sets of triplets, 4 orphans, and 1 baby whose mother had no breast milk. This month nurses visited 160 babies, 580 tins of formula were distributed and 261 women and infants remain in our care.

Baby Admission Story. Anna already had four children and she hoped that the fifth would be the last.  With five pregnancies she was considered a grand multigravida and all the midwives she saw during her pregnancy reminded her that her delivery might be difficult. She was told again and again that she would need to deliver at a health facility, with a skilled birth attendant.  Anna’s belly grew quickly and on August 2nd she arrived at the health center planning to stay through her delivery.  [Health centers are staffed with midwives, but do not have facilities necessary to handle true obstetric emergencies.] Finally, on September 21st Anna’s contractions started.  The midwife who met her that day at the health center told Anna that she was in labor with twins and encouraged her to  quickly make her way to a larger hospital with an operating room.  That same day, soon after arriving at Nkoma Hospital, Anna quickly delivered two babies.  Thirty minutes passed and rather than the placenta, Anna delivered a third baby.  The babies were premature but Anna was attentive and breastfed as frequently as possible.  Unfortunately, Anna could not keep up with the needs of her three infants and their health began to deteriorate.  Anna’s family could not afford supplemental formula and so a nurse at Nkoma Hospital posted a plea for support on Facebook.  Joyful Motherhood nurses saw the post and enrolled Anna and her babies. The nurses will continue to support Anna with her breastfeeding an provide enough formula to ensure that Tiyamike, Tiyanjane and Tikondane all thrive.

In December nurses admitted 4 infants (2 babies of mothers with severe mental health issues, 1 orphan, and 1 baby whose mother was not producing breast milk). Baby Stella, who was enrolled in program along with her twin last month, died this month following one hospitalisation for diarrhea and a second visit to the Health Center for malaria. Nurses also admitted one postpartum woman who experienced a severe infection. Nurses visited 165 women and infants and distributed 640 tins of formula.

Baby Admission Story. JS is 16.  She has struggled off and on with seizures for most of her life.  At times they are better controlled, at other times, no matter how many pills she swallows, the seizures keep coming.  As a result of the frequent seizures over many years, JS is developmentally delayed.   Earlier in the year someone identified JS as an easy target.  He attacked her, raped her, impregnated her and – as it was later discovered – infected her with HIV.  Thankfully she was able to communicate the identity of her attacker, and he is currently imprisoned.  But for her, there is no return to life before the attack.  JS will struggle with the psychological and physical effects of this trauma for her personal eternity.  This December JS gave birth to a 3lb baby boy.  She had no desire to see, hold or feed the baby and so her relative took in the baby and brought him to Joyful Motherhood.  After delivery JS’s health deteriorated again and she is suffering from uncontrolled seizures. 

This is a story with multiple layers of tragedy.  At times the problems which lead a family to our doorstep, eclipse all the aid we can possibly offer.  Our team cannot heal JS.  We cannot heal her family.  Our team will continue to bear witness, to listen, to validate, and encourage. Our nurses will support JS’s relative as she cares for and raises the baby.  It takes immense courage to remain present and attentive in the face of such deep suffering, but it is important.  We know from experience that giving someone a set of eyes to lock into, or a hand to steady them, is often in itself enough to save a life. Please donate to support our work.

In the month of November the nurses enrolled 9 infants (including 8 orphans and 1 whose mother was experiencing postpartum psychosis). They enrolled 2 women after traumatic births, both who had their uteruses and ovaries removed due to severe infections. The team visited 203 infants and women and distributed 662 tins of formula.

Baby Admission Story. The year doctors told her that the problem with her leg was cancer, TG was 20.  This was the same year she became pregnant.  She experienced one body growing inside, gaining substance, gaining movement, gaining strength.  While simultaneously experiencing her own slipping strength and increasing fragility. It would be reasonable to believe that the vitality of the life growing within would spread to the life of the woman who was its source and its vessel.  But, that is not what happened.  At best, TG experienced days when she tolerated the pain in her leg; when the sick pain was almost eclipsed by the pressure in her pelvis and the kicking in her ribs.  Her family brought her to the hospital again and again, but the treatments offered did not stop her suffering nor the progression of her disease.  Her family watched her belly grow and worried about TG and the fate of her child.  On September 24^th she delivered her daughter by cesarean section. They had a few good days together but in early November, the progression of her disease and the pace of her decline peaked.  TG died on November 10^th.  Unable to bear the cost of purchasing formula, her grieving family sought desperately for help for her orphaned daughter.  Ultimately it was TG’s grandfather who heard about Joyful Motherhood and it was he, who lovingly bundled his six week old great-granddaughter and traveled the distance to ensure her survival.

Mother Admission Story. Eighteen year old Maligelita’s birth experience started with pain and imagined visions of a baby in arms. The middle involved great suffering, a cesarean section provided too late, a hemorrhage, and a blood transfusion. The end involved a dead baby and then the removal of her uterus and ovaries. Nurses will never return her baby or her uterus but they will be with her. They will monitor her physical healing and guide those around her in their support, to give her the best chance to begin to heal emotionally. Donate

In the month of October…

• 11 babies were enrolled including 8 orphans, 2 babies of moms with no breast milk and 1 baby whose mom was experiencing psychosis.
• 2 critically ill women were enrolled after difficult deliveries
• 203 babies and postpartum mothers received home visits by nurses
• 626 tins of formula were provided to infants without access to breast milk.
• nurses are following a total of 242 babies & moms

Baby Admission Story.

Benita had a cough. It wasn’t new.  For years she would feel the need to cough to clear her throat.  Sometimes it was worse and would wake her in the night or steal her breath when she laughed too hard.  Other times it was just an annoyance a small tickle in the mornings that would not resolve.  Her mother encouraged her to go to the hospital but Benita insisted, I am not sick, it is just a cough.  What would they do at the hospital anyway?  Maybe that would give her a medicine or maybe they would just tell her to drink warm liquids.  She could certainly live with it and life in the village was too busy to spend a day walking to the waiting at the hospital for something as banal as a cough. Benita had three children and was pregnant with her fourth.  She attended prenatal care regularly but even there no one though much of her cough.  On July 12, 2020 she delivered a healthy baby girl and returned home on the 13th.  In September her cough worsened and on September 29th she died.  Her mother did not have the resources to care for a newborn, where would she find milk? how could she purchase formula?  By circumstance she met a woman who lived in a neighboring village who was caring for an orphan and enrolled in our program and the grandmother found her way to us.

[No one will ever know what caused Benita’s death.  There are no autopsies for the poor.  In fact even the death itself might not have been registered. It is possible that Benita had asthma and then died of covid.] Donate

Mother Admission Story.

When Rhoda showed up to the prenatal clinic at a rural clinic with a small bump of a belly, the midwives told her that she would need to deliver at the District Maternity Hospital.  She was only sixteen and they foresaw a difficult birth.  It would be risky to attempt to deliver her in a facility that had minimal capacity to offer emergency obstetric care and no capacity to conduct a cesarean section.  They reminded her each visit and when her labor started on October 23^rd, she made her way to Bwaila (the District Hospital).  The labor was indeed hard. With no pain medication, Rhoda suffered the onslaught of her contractions without progress.  Finally in the afternoon of the follow day she delivered a baby boy by cesarean. Her son had experienced a great deal of stress during the labor and his condition was poor. Rather than stay with his mother he was sent to the nursery. On the 25^th Rhoda’s abdomen was painfully distended and nurses observed green discharge oozing from the wound.  She and her baby were transferred to the Regional Hospital for better care.  On the 26^th clinicians reopened the wound and her abdomen was irrigated.  She did not improve.  Nor did her son.  On November 4^th she had a total hysterectomy – uterus, ovaries gone.  On the same day, her baby died.  She was discharged home on November 11^th. 

Statistically, Rhoda is a success.  She is not counted among the many African women who die in childbirth. But when we move from the macro-statistics and focus on Rhoda; when we hear her story, we can only count it as a tragedy.  There are so many more women like Rhoda on the continent who struggle to go on after traumatic births, which leave them both physically and emotionally wounded. Join us to support the re-empowerment of Rhoda and women like her and to bring attention to their lives. Donate now

This month nurses enrolled 12 babies (5 orphans (including a set of twins), a set of triplets, 1 baby whose mom is in the ICU, and 3 infants whose moms are not producing any breastmilk). One mother was enrolled due to severe infection. Nurses visited 213 women and babies and delivered 589 tins of formula. There was one death this month – Stefano was a 10-month-old triplet, he was hospitalized for a diarrheal illness and died during his hospitalization.

Baby Admission Story. At 33 years old, Chamjira, was pregnant for the fifth time, this time with twins.  She attended her prenatal visits, but after birthing four healthy babies, she felt calm about the delivery.  Chamjira lived in a rural area.  Her home, that of her parents, and those of her siblings sat huddled together on a bare well-swept patch of land.  Around the homes were the fields which sustained the family through the year.  And, within sight of their homes were others of community members. Though the fields sat empty in September, they still required work – hoeing, tilling, preparations for the planting season.  Halfway through her pregnancy Chamjira had stopped participating in the hard labor. She stayed near the homes, where the work was also plentiful but less physically grueling. 

On September 9^th Chamjira was alone in the house when her labor started.  The contractions came on strong and fast.  There was no way for her to walk out to find or call for help.  No one had a phone.  Chamjira was focused.  The babies came quickly, a daughter then a son.  She picked them up and cradled them in her arms.  She pushed to birth the placenta, but instead of the placenta there was only blood, so much blood.  Chamjira tried to focus on her babies; the feel of their bodies against hers.  She focused on keeping them warm, but the bleeding continued, and she started to drift in and out of consciousness. 

Her mother walked through the door at 10am.  She found Chamjira there in the pool of her blood, gasping her last breaths, but still holding her babies.  Screaming, Chamjira’s mother ran to get help, and within a few minutes a small group gathered, but it was too late for Chamjira. The women cried with her mother, but told her to quickly take the babies to seek help, they would stay, clean Chamjira’s body, the house, and keep vigil until she returned.   Everyone knew that without a mother, the chance of the twins surviving depended completely on finding help to purchase formula.  If help were unavailable the babies would surely follow their mother in death within days.  

With tears clouding her vision Chamjira’s mother bravely took up the assignment to save the two fragile lives that remained.  Within an hour she arrived with the babies at the nearest health center.  There midwives examined and weighed the babies (a healthy girl and boy of 4lbs 13oz and 6lbs 6oz) and referred the grandmother to Joyful Motherhood for support.  Filled with grief, embattled by anguish, fear and hope she continued her journey.  A few hours later, with two hungry newborns in her arms, she crossed the threshold of Joyful Motherhood. (Chamjira’s mother is pictured above with babies Maureen and Moffat on the day they were enrolled.)

Mother Care Admission Story. AM is 21 years old.  Though she had always felt healthy, she tested positive for HIV in her pregnancy.  The diagnosis was devastating and it took time for her to assimilate the information, but the midwives gave her hope.  She took medicine every day to reduce her baby’s risk of contracting the virus from her.  She did everything she was supposed to – going to her prenatal visits, taking iron supplements, anti-malarials, and the anti-virals.  She made it to nine months before labor started. 

She knew labor would be hard, but she never anticipated the impossible. The contractions tore through her, one after another, but her baby did not drop into her pelvis.  She felt the baby was not correctly positioned inside. She cried to the midwives in desperation and after three days of labor she was sent from the health center to a neighboring hospital where she could deliver her baby by c-section.  Thankfully, her baby boy tolerated the prolonged labor and was born alert and healthy on July 4th. 

Mom and baby stayed in the hospital; AM convalescing and learning to breastfeed.  (HIV positive women may transmit the virus to their babies via breast milk. But, the risk of the baby contracting and dying from HIV is lower than a risk of a baby dying from starvation or diarrheal illness when a family cannot afford to purchase formula. For this reason, the World Health Organization continues to recommend that HIV positive women breast feed their babies for one year.)  After three days nurses noticed that AM’s abdomen was swelling and the wound reopening.  AM received antibiotics and rather than closing the wound, nurses assessed it, cleaned it, and changed the dressings daily while it slowly healed from the inside out.  Finally on September 25th, AM’s wound was healed sufficiently that she and her baby were discharged from the hospital and told to follow up at the health center for the remainder of her wound care.  Joyful Motherhood nurses met and visited her during her hospital stay and will also continue to visit her in her home over the next several months to ensure her complete recovery.