Stories
January in Malawi
I’ve always found colors to be more vibrant in Malawi, particularly in rural areas. As we drive away from town, I touch my face to see if the effect is from my glasses, but I am wearing none. Perhaps it is the humidity or a horizon where earth touches sky and buildings rise from the fabric of the land. Red earth births red bricks, which are topped with thatch and the occasional tin roof reflects sun and sky. Along the road, a string of kiosks, simple thatched shelters, their hand-painted signs distinguishing one from its neighbors. “Dine Fine.” This morning a young woman peers into a pot and stirs in her roadside café. The rains are late, but they have arrived, and from a distance the damp earth seems to bear its first fruit – bright colors are grouped together among the tilled rows. Men and women – mostly women – in vibrant prints, bend at 90-degree angles with hoes raised then thrusting downward. A landscape of sienna and green against a blue-purple sky. Six bunches of bright green lettuce stand alone in the open window frame of a small teal-painted village store. A woman’s red skirt catches my eye from where she stands in a field of black soil. Men herd cattle and swat at two bulls whose flaring tempers blind them to their surroundings. As they butt heads one suddenly shoves the other into the road. Our driver swerves in time and chuckles. The beguiling beauty leads your mind’s focus away from the poverty. This is a season of hunger. Food stores are low and without irrigation all hopes rise upwards, coalescing in the heavy clouds. Perhaps hope alone becomes heavy, each thought a particle drawing in moisture and culminating in the thunderous precipitation.
Today we visit five homes, six orphans, and their aunts and grandmothers who care for them. Down a dirt road we stop in a rural trading center. (Trading centers are areas along a main road – some paved many not – with a few shops and sometimes electricity.) The first home is set back a few feet from the road in a cluster of buildings. We enter and sit on a grass mat. The only other items within the 6 x 8ft room are the items for the baby that we previously provided (a thermos for clean water, a bucket to keep the cup and spoon, and a tin of formula). Through an open doorway, I see into the other room in the house. It is no larger than the room we are in. I see stacked bags in the shadows, likely containing the family’s clothing and food. Like the homes of all of those in our programs, there is no running water here, no toilet, no kitchen. The woman who joins us on the mat and unwraps a baby from her back is the grandmother. She looks no older than 40. The baby, now four-months old, was the first born of her 18-year-old daughter who died in childbirth. The young grandmother has three school-age children who are not in school because she has no money for school fees. Her husband died last May, and she now rents this tiny house, earning money by washing clothes. Nurse Verina chats with the grandmother, asking about their situation and the baby’s health. Verina’s energy is warm and the grandmother’s receptive. Verina assesses the baby and gives more formula. The grandmother expresses her gratitude, and then we leave.
Next we visit Chikondi. He weighed just under 3lbs at birth. His mother and twin brother died during the birth and his grandmother was so fearful that he would die in her care that she begged Verina to take him. Verina says that in the early days, they would have the same conversation at each visit and she would have to repeatedly assure the grandmother that she was capable and that we would support her. Today he is 19-months old. He is walking, and his grandmother playfully tells Chikondi that his grandmother Verina is here to see him.
We visit Chisomo whose grandmother meets us in another trading center. Verina says the house is very far away so they only occasional visit in the home. Chisomo is eight months old, she is still taking some formula but should be eating food at home as well. Her hair is thin and Verina asks what they ate before leaving today. Chisomo’s grandmother says there no food in the house and asks for K200 ($0.25) to buy a little. Verina checks Chisomo’s inner eyelids, notices she is a bit pale and asks if there is a mosquito net in the home. (Malaria is a major cause of childhood anemia in malaria-endemic countries.) The grandmother says there is not. Mosquito nets are often distributed for free at health centers, but frequently they wear out before next distribution date. I hand the grandmother money for food and for a net. Verina gives them formula and porridge and we leave.
We visit Julie who is being cared for by her father and paternal grandmother and then Ganizani and his grandmother. Our day ends on the front porch of an aunt with her beautiful twin nephews. What is clear at the end of the long day is that we are not coming close to solving all the problems of the families in our programs. But, we are ensuring the survival of their most vulnerable members. Care is provided with deep compassion and respect. And when hope is reignited, its natural companions, joy and gratitude follow.
Material Donations Needed
For those of you who like to give items, we have a couple specific needs (thermoses and graduated beakers) and an organization (www.MalawiProject.org) which is generously donating shipping to Malawi. Please note the shipping address on the wish list and clearly ship to African Mothers Health Initiative. Donations received by the end of the month will be sent to Malawi.
Why thermoses and beakers? About a third of the babies enrolled in our program at any one time are orphans and they need formula to survive. The homes of our beneficiaries are basic and families live well below the poverty line. Many households cannot afford soap. Most of the homes do not have running water. Some homes do not have easy access to potable water. Most guardians must walk to either a borehole or a stream to fetch water, carry it back. The women then use firewood – also gathered by hand – boil the water, then finally use this clean water to prepare formula. Because the clean water costs so much in labor and is also absolutely necessary to ensure the baby’s health, we want them to have a place to store the water (thermos). We also discourage the use of bottles and sippy cups because they are difficult to clean. Rims on bottles and small holes in sippy cups easily accumulate bacteria which leads to diarrheal illness. Thus, we supply each family with a graduated beaker that they can use to safely and accurately use to prepare formula.
If you would like to send a thermos or beaker to a baby in Malawi, please visit our Amazon wish list here and ship it to: African Mothers Health Initiative 2421 Golfside Dr. Lebanon, IN 46052-8176.
(If you regularly make purchases from Amazon and would like Amazon to donate to us, please use https://smile.amazon.com and select African Mothers Health Initiative as your supported charity.)
Survivors of Traumatic Births
When Rhoda showed up with a small bump of a belly for prenatal care at a rural clinic, 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 23rd, 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, where he would receive oxygen and share a warmer with one or two other babies. On the 25th 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 additional treatment. On the 26th, clinicians reopened the wound and her abdomen was irrigated. She did not improve. Nor did her son. On November 4th she had a total hysterectomy – uterus, ovaries, hope of future children gone. On the same day, her baby died. She was discharged home on November 11th.
Statistically, Rhoda is a success. She is not counted among the many African women who die in childbirth. Rhoda is a survivor. But, when we focus in on her story and the struggles she will endure from this point forward, 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
Innocent
Angela was a healthy 23-year-old, pregnant with her second baby. The midwife notes and lab results in her prenatal booklet foretold an uneventful labor and delivery. When her contractions started, Angela arrived at the health clinic with the trepidation that is universal among laboring women, but she reassured herself. This was not her first. This time her confidence tempered the fear. A few hours past midnight on May 10th, her son was born. She named him Innocent. Innocent and his mother headed home on the 12th. Over the following days, Angela began to feel sick. A new cough developed then worsened until the fits caused her to vomit. Her family took her back to the clinic. A sputum sample was taken and sent to check for tuberculosis. She had a chest x-ray. She died. There is no record of the results of the tests, there was no further investigation. Her devastated family was left with a newborn and many questions that will never be answered.
Angela’s family was referred to Joyful Motherhood by neighbors and our nurses have been providing support over the past three months. The picture above is of Innocent at three months on his grandmother’s lap. He is doing well and we will continue to provide support until he turns two. His grandmother, though still grieving the loss of her daughter, is relieved that she now has support to ensure that her grandson will survive his infancy.
This work is only possible when you partner with us. Please consider a recurring monthly donation. HERE
In Elizabeth’s Words
Elizabeth is one of the nurses who works for Joyful Motherhood. I asked her to tell us about her work and this is what she said…..
I enjoy my job because of the care we provide. After enrolling babies we follow up with them in their homes. One interesting thing I have noticed is that when we enroll clients at the office, they act as though they understand everything we tell them; maybe they feel uncomfortable or intimidated because it is within the hospital. But, when we go to them in their homes, they feel free. They ask questions. They ask for clarification about what they did not understand. And, over the period that we continue to visit, we see the children growing well. We are happy and the families are happy.
With regard to the mothers, we feel also happy because we know we are doing a lot for them. The picture above is a mother we enrolled last week. The mother had a c-section but was very sick afterwards and was hospitalized for two months. Her milk dried, her husband abandoned her, and she had no one rely on. The other women and families in the hospital were actually contributing money so that she could buy formula for her baby. One of the our nurses found her at the hospital and enrolled her in our program; she was greatly relieved. She was finally discharged last week and taken by ambulance all the way to her village, one hour away. Her neighbor called us when she arrived to let us know that she had been discharged and told us that the child had no formula. We went immediately and were saddened to see that the baby was just crying. They didn’t have anything to feed the baby so they were just mixing sugar and water for feeds. I brought formula, prepared it and fed the baby. I checked on the mother’s wound, which is healing well. They were so happy with the care received.
I love my job. When you work in a clinic as a nurse, you just give the prescribed medicine, you do not follow the patients. You do not know if they understood your instructions, or if they have what they need to care for their family member, you may never see them again. But, here we see our patients in their homes monthly and we know that what we are doing is indeed benefiting many.
Please support our work HERE
Joyful Motherhood & Covid
With limited testing capability, 33 cases of Covid-19 have been identified in Malawi and three deaths have been attributed to the virus. An injunction to stay the original lockdown order by the President has been extended to April 29th. Fear of hunger and related civil unrest continue to eclipse fears of Covid. And, the goal of a lockdown in Malawi is being debated; there is no possibility of flattening “the curve” sufficiently to ensure that the health care system care would be able to cope with cases.
In this world, where everything is changing day by day – and where it seems everything is at stake – Joyful Motherhood staff continue to visit clients in their communities, supporting families with fragile babies as well as women convalescing after difficult deliveries. In the above picture are nurses Verina (left) and Nitta (right) and our driver (Mr. Ritchie).
Corona Virus in Malawi
On March 23rd there were no confirmed Covid-19 cases in Malawi but President Peter Mutharika, declared a national disaster and closed all schools and universities. As of yesterday there were 16 confirmed cases of Covid-19 in Malawi and two deaths. In response, the President issued a three week lockdown order, scheduled to begin Saturday, April 18th at midnight.
Anxiety runs high. People are afraid, not so much of Covid-19, but of the order’s impact. The health care system, in normal times, functions at a skeletal level. There will be no high acuity care for Covid-19 patients, only supplemental oxygen and basic nursing care. Hospitalization for those with Covid-19 is part of a containment strategy, not much more. But, with an extreme shortage of beds, even this function will not be sustainable for long. On a normal day at the regional hospital in the capital city, patients are seen on mattresses outside on the verandas due to limited space. Now, in order to decrease congestion of the wards, patients who are still fragile but deemed stable are being sent home. The concern is that fragile patients will be discharged prematurely and deteriorate at home while others with deadly but treatable conditions, like malaria, will not be able to access care. Recently delivered women are also being sent home as quickly as possible following their deliveries. Many not have any additional care or visits. It is possible that women may experience more severe postpartum infections due to an inability for prompt diagnosis and treatment in the early postpartum period.
Access to transportation may become a life threatening issue. The poor and working class use minibuses as their primary means of transportation. These converted privately owned minivans are ubiquitous in the developing world. Rows of seats are positioned as close as possible, so that the vehicles typically accommodate 21-22people when full. (This means that someone like me at 5’5″ will have my knees pressed into the seat in front of me and my hips pressed against those of the passengers to my right and left.) It remains unclear whether there will be provisions made for minibuses. If they are not allowed to run, hospital staff will have trouble presenting for work and patients with malaria or other acute conditions will struggle to access care. If they are allowed to run, people fear that they will help spread Covid-19.
People fear hunger. Most people survive day by day. The urban poor depend on small trading and the rural poor depend on the sale of their agricultural goods. All of this demands daily movement, daily connections, daily contact. The risk related to Corona virus is high but in a country where the per capita GDP is just over $1/day, in the majority of homes, there is little held in reserve.
Joyful Motherhood nurses are strategizing on how to continue serving our clients in this rapidly changing environment. They are educating about prevention, spacing out visits, and making more phone calls, but for the most vulnerable they must continue to visit and assess and bring food. At this time with the world entering a deep recession (at best), the effects are magnified in countries like Malawi, and exponentiated, in the homes of the extremely impoverished. For many of those we serve, our assistance helps individuals survive.
We know that regardless of where you sit as you read this, it is likely that your home has also been touched, directly or indirectly, by this pandemic. Still, we continue to rely on your generosity. We know that through the experience of our personal hardship we grow compassion, and we appreciate your collaborative support to care for those who need it most. Donate here
