Stories

October 2018 Activity Report

In October 2018….

  • 8 babies were enrolled, including 4 orphans, 1 set of triplets, and one newborn whose mother was critically ill.
  • 6 recently delivered moms were enrolled (their birth experiences include: eclampsia, pulmonary edema, ruptured uterus, and severe infection)
  • Nurses conducted 149 visits to beneficiaries.

A Woman’s Story.  Lonely Harold was enrolled in October.  She was 20 years old and pregnant with her first baby.  She started labor at home and then made her way to a health center. When it became clear that the labor was not progressing, she was sent to the district’s maternity referral hospital.  At some point her baby girl died inside of her, but it was not until after her c-section that she learned that she would not return home with a baby at her breast.  While still in the operating room, Lonely experienced a heart attack and required resuscitation, her lungs filled with fluid and she was sent to recover in the ICU.  Twenty days later she was discharged home without her baby.

A Baby’s Story.  Tikhale was 23 years old.  Her first baby was a stillbirth.  Her second labor was difficult and finally, on October 10th, resulted in a c-section.  Her newborn daughter was distressed and needed resuscitation but they were both discharged home in stable condition after a few days.  Several days later Tikhale returned complaining of stomach pain, she was hospitalized and given a transfusion.  She stayed in the hospital for two weeks and died there.  The woman who took in her baby, named her Memory and was referred to Joyful Motherhood for support.

 

Enes Foster

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.

Tiyamike

Tiyamike is 15months old.  She was born prematurely on October 19th 2017 weighing just over 4lbs.  Her 22 year old mother hemorrhaged after her delivery and died the same day.  As her mother’s body was loaded into a vehicle to transport her back to her village, her grandmother was handed a couple tins of formula from hospital nurses.  The tins were likely provided as a donation from a kind-hearted individual and stored in the nursey for such events.  There was no additional support to the bereaved grandmother, no promise of future donations or follow-up appointments.

Tiyamike’s family live in rural Malawi, they are subsistence farmers and did not have the means to purchase additional formula.  Her grandmother is illiterate and does not speak English anyway.  She was unable to read the instructions on the formula tin to verify what she understood from the brief instructions provided by the nurse.  The day a squall of grief rattled every cell her being, she needed to absorb and process very specific instructions on how to keep her grandchild alive.  She did her best.

On November 6th, Tiyamike’s grandmother returned to the local hospital.  In the two intervening weeks Tiyamike had lost weight and was now emaciated, significantly below her birth weight. Her grandmother was referred to our program with Joyful Motherhood and our nurses have been visiting them regularly ever since.  Life is hard for Tiyamike’s family, their survival rests on their own physical labor and the capriciousness of weather.  But, they have love, determination, and support from JM.  Now at 15 months, Tiyamike is a normal joyful and busy toddler.

Takindwa Black

Takindwa’s mom started her labor at the District Hospital in Malawi.  She had had a previous cesarean section so it was important that she labor at a hospital with an operating room.  Many women in Malawi labor in rural area which are far from any health facility.  And even when there is a clinic nearby, many times they lack an operating room and staff capable of performing a C-section.  The national C-section rate in Malawi is about 6% this compares with a US C-section rate of about 32% (WHO 2013).  According to the World Health Organization, the percentage of women who will require a C-section in order to birth safely is about 15%.  This means many Malawian women are not receiving necessary C-sections, which as a result jeopardizes their lives and the lives of their babies.

Takindwa’s mom was in the right place to access emergency obstetric care and after many hours it became apparent that she would again require a C-section in order to deliver safely.  Takindwa was born on April 13th by what initially seemed to be an uneventful C-section.  However, within a few hours her mother became short of breath, collapsed suddenly and was pronounced dead.  There is no capacity to perform an autopsy, so the cause of her death will never be know with certainty.  However, considering that her mother was a healthy 19 year-old woman, it is likely that her death was related to a surgical error.  Tragically in Malawi, both poor access to care and poor quality of accessibly care threaten the lives of many women.

Takindwa’s family was immediately referred to Joyful Motherhood and our nurses have been following her ever since.  Today she is a health 7 month-old.

Niya

Niya is only 16 years old, but several weeks after the birth of her first baby she had surgery for a total hysterectomy. Niya took care of herself during her pregnancy and grew a 8lb 9oz baby.  Unfortunately her baby was too big for her to birth naturally and she ended up with a C-section.  C-sections, though common in the US, carry significant risks in Malawi and increase the risk of serious life-threatening infections.  Days after giving birth, Niya became increasing ill, her abdomen swelled and she returned to the hospital.  Clinicians there did a laparoscopic surgery to determine the cause of her swollen abdomen and found that her uterus was necrotic.  The infection was so severe and had continued unchecked for so long that her uterine muscle had completely died as was beginning to decompose inside of her.  She had an emergency hysterectomy.  Soon after the second surgery she experienced severe nausea and vomiting and was diagnosed with a bowel obstruction.  She underwent additional treatment for the bowel obstruction.  It was a traumatic and life changing birth experience.  She would need to learn to care for her new baby, care for her wounds, and strive to accept the loss of her fertility. Joyful Motherhood nurses have been following her, supporting her as a new teen mom, counseling her about her hysterectomy and encouraging her. Her baby is growing well and she is planning to return to school soon.

September 2018 Activity Report

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.

Faith

Faith was born January 28, 2018.  Her birth was uneventful and the next day her 23-year-old mother, Salimba, took her home to meet the rest of the family.  On February 14th Salimba became ill.  Her family says her face and feet were swollen and she started vomiting.  On February 18th they took her to the closest health center.  She died there before she was ever evaluated by a clinician.  Faith’s grandmother was then directed to Joyful Motherhood.  Overwhelmed and grief stricken she told the nurses she didn’t think she would manage.  She had five other children at home to raise.  With support from Joyful Motherhood nurses, Faith’s grandmother has done a wonderful job; today she glows when talking about her granddaughter.

Precious

In the face of this beautiful woman you can see lines of grief, determination, and quiet joy.  She is holding her grandson Precious who was born on the day her daughter died.  Her daughter delivered Precious and then as she lay back to embrace her new son she began to bleed.  The bleeding continued despite efforts of those with her to slow it down.  Her life washed away in a sea of red. Her mother clung to her newborn grandson and gave him a name from her heart.  She worried about her ability to keep him alive and well, without breast milk and without money for formula.  Within the week after telling countless people her story, she was directed to Joyful Motherhood for support.  Precious is now 8 months old.

 

Juliet

Nineteen year-old Juliet was nearing the end of her pregnancy.  She had gone for her prenatal visits at the Mitudu health center, she had taken the antimalarial medications as instructed by the midwife, had the necessary blood work, and regular blood pressure checks.  Everything seemed to be going well until the day she collapsed and started seizing.

Pre-eclampsia is one of the most dangerous diseases of pregnancy.  Even as our knowledge about it continues to grow, our ability to predict who it will effect remains limited.  The onset is often sudden and occurs towards the end of pregnancy.  One of the warning signs is a rising blood pressure.  Pre-eclampsia can affect all the major organ systems, damaging the liver and kidneys, resulting in bleeding in the brain, seizures and death.

Those around her took Juliet immediately to the health center and from there she was transferred to Bwaila, the district maternity hospital.  Without a well organized EMS this process of just getting her to a place where she could be helped took several hours.  When she arrived at Bwaila, Juliet was unconscious and still seizing.  The midwives – familiar with this presentation – quickly administered magnesium sulfate, the only medication shown to help control and prevent eclamptic seizures.  Even with the medication, the only cure for eclampsia is delivery.  Once a woman reaches the point of seizing her life is in grave danger and if she is not delivered within a relatively short period, both she and her baby will die.  Unfortunately even delivery does not guarantee that the mother’s life will be saved.  The clinician at Bwaila delivered her 5lb baby by C-section and Juliet was sent to the ICU, where she remained unconscious for 4 days.

This is where our nurses found Juliet. After talking with her family, she was enrolled in our Mother Care program.  Juliet regained consciousness and after a short period she was discharged from the hospital. The nurses planned to visit her six times in her village.  During their first visit, nurses found Juliet still swollen and convalescing, still struggling to care for her baby.  This picture is from their second visit.  As part of her home based care, nurses will counsel her on the disease and help her community members create an emergency plan for such events in the future.  They will also provide some education on the care of her baby and help set up an income generating project.

August 2018 Activity Update

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 21st 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.