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.

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.

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.

Brightwell was born just across the border in Mozambique.  His mother died silently at home moments after his birth.  Understanding the fragility of the life in their hands, her relatives brought Brightwell to the closest hospital that very day.  The hospital happened to be a small community hospital in Malawi, where on admission he weighed 4lbs 3oz.

His maternal aunt stayed with him in the hospital for several weeks, an act demonstrating enormous love and self-sacrifice.  In Malawi when anyone is hospitalized they must be accompanied by a guardian – usually a female relative – who will feed them, bathe them, wash their clothes, and advocate for them.  Because there are so few nurses in the hospitals, these tasks fall to relatives.  This in turn, places a significant strain on most families since this person must leave their own responsibilities back home unattended for an indefinite period (i.e. the care of their own children, the care of their fields).  And, if they have come from a significant distance, they must now pay for food, firewood and sometimes medicine to care for their patient.  Families may sell their own food for the coming months in order to have cash on hand for such a stay.

Brightwell’s aunt did all of this without question, knowing that the baby faced certain death in the village without a mother.  She hoped that the hospital would provide the needed support and they would eventually return home together.  Unfortunately over those weeks, Brightwell lost weight.  Day after day he continued to deteriorate, but unaware of a better option and still placing her hope in the health care system, his aunt stayed on.

One day a woman visiting the hospital from another village in the area saw Brightwell and his aunt and asked about their story.  His aunt told the woman about her sister’s death and her need for support for the baby.  This woman making the inquiry came from a village where Joyful Motherhood had previously supported the care of an orphan and she immediately told the aunt about us.  The aunt packed their belongings, tied Brightwell to her back and boarded a minibus to Bwaila Hospital, about an hour’s drive away.

When they reached Bwaila they found the office of Joyful Motherhood and within minutes someone was preparing formula while a nurse began the intake and assessment.  Brightwell was severely emaciated that day, his weight was just above 3lbs, his eyes were deeply recessed in his skull and his breathing was shallow.  His situation was dire but finally there was hope.  The nurses instructed his aunt on how to prepare formula, taught her when and how to feed him, told her how to prevent illness, and what danger signs to look for. Finally based on her instructions they drew a map to Brightwell’s home.

Within a few days nurses were in the village for their first visit.  They met with the chief and the extended family, they watched the aunt prepare formula, asked about feedings, health, and looked for a bed net.  They provided additional education and formula.  Once they felt satisfied, they said their goodbyes and promised to return again in a couple weeks.  This picture is from the second visit by Joyful Motherhood nurses.  Although Brightwell is still small for two months, his health has improved dramatically and he now weighs just over 7lbs.

This story perfectly illustrates the precarious line between life and death in Malawi, the lack of resources even within the health care sector, and the important role that Joyful Motherhood plays in creating a net beneath existing gaps.  This story involves one tragedy but without JM it may have included several others.  Without JM, Brightwell would have died within a short period of time, and his aunt’s family (including her mother, her children and the orphaned children of her sister) may have faced more significant hunger due to the financial strain on their extended family and the absence of the two adults in their prime.  It is hard to read these stories, but it is inspiring to recognize the extent of sacrifice and love individuals make in order to care for the most vulnerable members of their communities. And, it should give you great pride knowing that the support you offer is enough to turn these stories around and transform lives.  Thank you.

Takonda is pictured here with Nitta’s (one of our nurses). Takonda’s mother bled to death just after delivering her, leaving Takonda and two other young children motherless.  Takonda and her two year old brother now live with their maternal aunt.  Currently, Takonda is thriving in her aunt’s care with the support from our nurses, and the donated formula.  However, the family lives in desperate poverty and the addition of one small belly to feed is more than they can manage.  Takonda’s brother has deteriorated significantly since his mother’s death and our nurses are seeking additional support for him.  In Malawi, a mother’s death puts the lives of all her children at risk. We need your support to help him.

Faith Kapanga was born on 21st Oct 2016.  She was a healthy baby.  She was her mother’s first child.  When she was just one week old, her mother who was only 20 years old herself, died from a severe postpartum infection. In Malawi even babies born in excellent health face a high probability of dying when their mothers die.  Families are too poor to afford formula, wet-nursing is frowned upon due to the risk of HIV transmission, and the government offers no support. Lucky for Faith, a neighbor had heard about the support offered by Joyful Motherhood and told her grandmother. At two weeks of age Faith’s grandmother arrived at the doorstep of Joyful Motherhood, and she was enrolled in our program.  From that point forward, Joyful Motherhood nurses visited Faith in her village,  supporting her and her grandmother by bringing formula and porridge, offering health education, and serving as a personal resource for their health needs. At the end of each visit, as eyes filled with joy and awe focus on Faith, her grandmother expresses her gratitude to the nurses and her pride in herself for the long road traversed.