This is Andrew on his grandfather’s back. Andrew was born in April 2018, his mother delivered him by c-section. Following the surgery, Andrew’s mother developed a severe infection which led to the surgical removal of her uterus in a desperate attempt to save her life. Tragically, the infection continued to rage and ultimately claimed her life. Andrew’s grandparents immediately took over his care, but without enough money to purchase formula or adequate knowledge on how to sustain a newborn without breast milk, Andrew began to deteriorate. After several weeks Andrew’s family was directed to Joyful Motherhood. By that time, Andrew was severely wasted and incredibly fragile. In this picture, Andrew is 14months old, he is still small for his age but with the dedication and love of his family and support from JM, he continues to grow and improve.
Shalom (Peace) was born on February 2 this year at home in Mozambique (just across the border from Malawi). She was her mother’s fifth child. Her mother had had four normal births without complication but after Shalom was born the placenta, which usually follows within minutes was retained. (The longer the placenta stays inside after delivery, the higher the risk of hemorrhage. A woman can lose up to 500ml of blood per minute after delivery when the uterus is unable to contact as it should.) Shalom’s mother started bleeding profusely. Shalom’s father quickly started mobilizing everyone to get mother and baby to the hospital but within minutes, Shalom’s mother died. Shalom’s father initially tried to manage with the baby and children in Mozambique but, devastated by the loss of his wife and overwhelmed by the responsibility of caring for four children and a newborn, he soon brought all five children to Malawi to live with their maternal grandmother. She opened her home with sorrow and joy and is doing her best to care for them all. Through word of mouth they found Joyful Motherhood. They are a family living on the edge but taking some small steps forward with the help our. Our nurses have visited Shalom three times. She is four months old and now weighs just over 10lbs.
One of our board members, Dehlia Ramos Gonzalez RN MSN, is currently in Malawi visiting our beneficiaries, assisting nurses with training and helping to pilot a new data collection tool. She is sending stories and pictures, so stay tuned…
Eight months into her pregnancy Miracle’s mother started convulsing – a sign that undetected unchecked pre-eclampsia had advanced. She was taken to the region’s high risk maternity hospital and delivered a 3lb baby that same day. The pre-eclampsia had caused bleeding in her brain and though her life was saved, Miracle’s mother was now hemiplegic. Initially her milk came in but soon after her two week hospitalization ended her milk dried up and Miracle deteriorated quickly. Family members banded together to purchase a single tin of formula and tried to stretch the precious formula over the course of a month. Joyful Motherhood nurses were visiting an orphan in a neighboring community when they were told about Miracle. When they found her, she was severely malnourished and near death. Joyful Motherhood nurses immediately enrolled Miracle and worked to keep her on kangaroo care – wrapping her skin-to-skin on the chest of her mother or grandmother. They also attempted to restart lactation. Miracle is now six months old, she remains underweight at this time but nurses are continuing their visits and working to help Miracle close the growth and development gap between herself and her peers. Time is certainly of the essence as research shows that being underweight at 2 years predicts diminished development, productivity, and intellectual achievements over a lifetime. Joyful Motherhood will keep Miracle enrolled until 2yrs of age.
During her pregnancy with her sixth baby, 35-year-old Tabalire suffered from severe headaches. She attended the recommended prenatal care and repeatedly told the midwives. She was admitted for a few days but discharged without any notable improvement in her condition. While admitted during her delivery, she again complained about the severe headache. Her delivery went well and her baby boy weighed almost 8lbs. At the time of discharge she continued to complain about a headache and backache. Nine days later her family arranged transportation to the hospital realizing that she was quickly deteriorating. Tabalire died on route to the hospital. When they reached the hospital nurses referred the family to Joyful Motherhood for continued support. Tabalire’s children are being raised by her sister.
Memory was born by c-section, she was small but healthy. After the surgery, her mother had severe anemia, she receive a single unit of blood but her body struggled to recover from the stress of the delivery. Her condition deteriorated and within a few weeks she died. Memory is now being raised by her grandmother in the village. She is pictured here in the arms of her older brother.
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.