African Mothers Health Initiative

Providing care for critically ill mothers and vulnerable infants in Malawi.

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One Story.

This story was recorded as part of a focus group, transcribed, and translated in 2021

I had a difficult delivery with my fourth born and needed a c-section. After I returned home my stomach began to swell. One day I returned to the doctor and told him that I was experiencing chest pain. He said not to worry, he would prescribe some medication and that I would feel better. But, I knew I was very sick, so I refused. I said, “Doctor, I live very far away. Please help me while I am here. It will be difficult for me to find money to come again.” He said ok and ordered an x-ray.  He told me they saw something in my uterus and that I should pay K15,000 ($20) to get my uterus cleaned. I said I did not have that kind of money. If it meant dying, I should just die. He said, “You will not die, we will call for an ambulance to take you to the Regional Hospital.”  I arrived at the Hospital and was there three days before they took me for surgery. My stomach was so swollen. They did not suture the wound and I did not eat for a whole month. I stayed in the hospital for two months. They would just clean the wound. My baby was also in the hospital on a different ward, he was receiving formula but was malnourished. At one point while I was there, a nurse from Joyful Motherhood [AMHI’s sister org] gave me a card and told me to call once I was discharged. Finally, after the two months, I returned to the smaller hospital near my home where they partially sutured the wound and then discharged me. 

When I returned home to my elderly grandma, I told her, “I am not producing milk, I am eating but there is no milk.” We did not know what to do. I said, “If you have K100 ($0.12) please, let’s call the one on this card and maybe they can help.” My grandma did not have K100. I had no money and my husband had sold all the maize [the staple food in Malawi] we had in the home to cover the costs of our hospitalization. In those days, my baby cried a lot, I had no breast milk and so I was just giving him porridge. He was three months old and very malnourished.  One day my neighbor heard the baby crying and came by and asked me what we should do, I told her about the card and she told me to call the number using her phone.  I talked to them and they said, “We have heard you.  Please do not give water or porridge to the child, your child will live.”  I wondered if the child would really live, the way he was crying, but they assured me that they would come. They came the next morning. At that time, both my baby and I were sickly and malnourished. People in my area thought we had been discharged home to die. The Joyful Motherhood nurses gave us a thermos, 7 tins of formula, they also gave me a pack of soy flour to use to make porridge. I started eating that porridge the same day. After that, people started saying that I was looking like myself again. Life was returning to me. The next month when they came and weighed the baby, they noted that the weight had improved. I kept giving the baby the milk and the health improved, I also received soy flour and I was better.   

Joyful Motherhood has helped me a lot in my household. When they discharged me from their program, they gave me K10,000 ($12) and said I should start a business. My neighbor kept the money for me initially and I found odd jobs – like washing laundry – to earn a little more. Then I rented a small a garden and cultivated it. I harvested ten 50kg bags of maize. There is no hunger in my home now. Joyful Motherhood nurses helped to improve my home, they taught me how to care for my children, they encouraged me, they taught me many things. I thought we would die; there was no food in my home, Joyful Motherhood restored hope in my home. My home is no longer the same. I am thankful to Joyful Motherhood. Please continue this work.

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.

December 2021

11 babies were enrolled (6 orphans (including a set of twins), 2 infants whose mothers are undergoing chemotherapy, 1 baby whose mother is experiencing postpartum psychosis, 1 baby with cerebral palsy, and 1 baby whose mother is not producing any breast milk). 166 visits to babies were conducted. 4 babies were discharged. 247 babies are currently enrolled. Nurses distributed 616 tins of formula to infants requiring this food source for survival.

3 women were enrolled (all three received a total hysterectomy following a severe postpartum uterine infection), 2 women were discharged. 20 mothers were visited. 33 women are currently enrolled.

Baby Story.  According to her family, they notice L’s behavior shift before they realized she was pregnant.  Within a short period, her personality changed completely.  Day to day was a struggle but somehow they managed to get her to her prenatal appointments, and eventually she had a normal birth.  Initially after the delivery, it seemed she started to improve – she breastfed her baby and he was eager to feed.  But, after two days, L. no longer wanted to nurse her baby, much less hold or touch him.  She was admitted to the psychiatric hospital for treatment and her family brought her son to us for care. 

Mother Story.  This year Eliza was pregnant for the third time.  Her first child did not survive the birth and so she carried a great deal of stress throughout both subsequent pregnancies. The days passed without event until November 9th when she presented to the labor ward with contractions.  Upon assessment it was discovered that her baby was already deceased.  Since she had had a prior c-section, this baby was also delivered by c-section.  Within two days of the surgery, her abdomen started swelling and she began experiencing severe abdominal pain. She was referred to the Regional Hospital where her abdomen was reopened, and a total hysterectomy was done.  Eliza’s health remained poor following the second surgery and more than two weeks passed before she walked independently again.  Even though clinicians determined that she was ready for discharge Eliza will need additional support for some time at home.  Life for poor women in Malawi is always physical (fetching firewood, drawing water, tending fields).  When a woman is not able to complete these tasks, there are financial repercussions for the household, food instability worsens, and her surviving children face an increased risk of mortality.  This is why we do what we do.  Joyful Motherhood nurses will visit Eliza in her home to watch over her physical recovery and offer support. Donate to keep this work going.

November 2021

  • 8 babies were enrolled (6 orphans and 2 babies with mothers hospitalized in critical care).  Nurses visited 162 babies and discharged 12.  We are currently following 248 babies (newborns – 24mo).
  • 3 women were enrolled. Two of the three had stillborns and two of the three had total hysterectomies.

Baby Care Story.  Dalitso’s mom attended prenatal care throughout her pregnancy.  She wasn’t exactly certain how far along she was, and on 24th October Dalitso was born, weighing less than 5lbs.  His mom lost a lot of blood during the delivery and was transferred to the District Hospital for a blood transfusion.  Within the relatively short period of three hours after the birth, she arrived at the referral hospital and received the first unit of blood.  It took another seven hours for her to receive a second unit and by that time her condition had deteriorated significantly.  She died during the transfusion.

Postpartum hemorrhage is one of the most common causes of maternal death in Malawi.  The contributing factors include: pre-existing severe chronic anemia (malnutrition), poor management of obstetric hemorrhage, a poor emergency transportation system, poor access to emergency obstetric care, inadequate supply of blood products, and difficulty in accessing available blood products.  It is unlikely that midwives attending her at the referral hospital had an accurate estimate of the blood she lost during the birth.  The midwives were most likely assessing her need for blood by her vital signs and unfortunately a woman can lose 25% of her blood volume before she becomes symptomatic.  Even if she had received the two pints immediately following the hemorrhage, it is unlikely that this intervention alone would have saved her life.  She was 21 years old.   After the funeral, Dalitso’s grandmother brought him to Joyful Motherhood to enroll him in our program.  Our nurses will visit Dalitso and his grandmother monthly to provide formula and ensure that he remains healthy over his first two years of life.   DONATE

October 2021

17 babies were enrolled (12 orphans including a set of twins, 4 babies with mothers not producing milk (including another set of twins and one baby unable to latch due to hydrocephalus), and 1 baby of a mom with postpartum psychosis. Nurses visited a total 165 babies and discharged 13. 253 babies are currently being followed

4 mothers enrolled nurses visited 15 visited and are following 24.

Baby Care Story. Grace was born in June.  She weighed only 5lbs but she was healthy and left the hospital in her mother’s arms after 24hrs.  Breastfeeding went well and Grace filled out quickly and beautifully.  In early September Grace’s mother fell ill suddenly and lost her ability swallow.  She sought treatment at her local hospital and was then referred to the Regional Hospital for imaging.  There she was diagnosed with metastatic cervical cancer.  She died on September 24th. She was 39 with four children. Cervical cancer screenings (pap smears) are not routinely done in Malawi, there is not sufficient laboratory or pathology capacity to provide this service that is considered routine in the US.

Mother Care Story.  After several days of a tortuous labor, 18year-old Justina was transferred from a health center to a hospital capable of conducting a c-section. After the surgeon opened her uterus he lifted her recently deceased baby from her wound.  That loss was already more than her heart felt capable of bearing. After several days her surgical wound started to leak and gape, her abdomen became distended and painful.  She returned to the District Hospital, where the c-section was conducted and from there was referred to the Regional Hospital. When the surgeons opened her, her uterus, which should have been a vibrant pink/purple muscle was black and foul smelling. He removed her uterus and her ovaries, he did not speak to her or her family member. The following day the nurse on-duty at the hospital, informed the patient and her accompanying family member the significance of the surgery.

Our nurses will follow Justina over the next several months, monitoring and supporting her physical and emotional health. They will follow Grace until her second birthday.

September 2021

10 babies were enrolled (7 orphans and 3 whose mother critically ill in hospital). 147 babies were visited and 6 discharged. 243 babies are being followed

2 mothers were enrolled and one discharged. 23 women are being followed

Mother Care Story. 19-year-oldRhoda was healthy and had a normal pregnancy.  When her labor started she went to the nearest health center.  Labor was long and painful and did not progress.  After 24hours she was referred to the District hospital for a c-section.  At the time of the c-section her baby was already deceased.  She stayed in the hospital, with her cramping empty wound and empty arms listening to the crys of newborns around her for two days and then was discharged.  After spending just two days at home she noticed her abdomen beginning to swell and returned to the District hospital.  From there she was sent to the Regional hospital.  She began vomiting blood and seizing.  She was taken back to the operating room and a total hysterectomy was done – uterus, ovaries, baby gone.  On the medical ward her condition failed to improve and she was diagnosed with covid and then placed on isolation.  Rhoda is young and after several weeks her health was stable enough to discharge her but the emotional scars are deep.  Nurses will follow her not only to check on the visible wounds but also to counsel and encourage her as she begins to address the other invisible wounds that remain.

Baby Care Story. 19-year-old Dorothy went to her regular prenatal appointment toward the end of her pregnancy and diagnosed with pre-eclampsia.  Her legs were swollen and her blood pressure was quite high.  Within a few days her labor started on it’s own and she delivered a healthy baby boy.  Dorothy began to hemorrhage and was referred to Salima District Hospital.  There she received a transfusion of two units, but her blood loss had been significant and she died soon after.  Dorothy’s husband heard about our work through someone in his community and his mother arrived with the baby in arms.

August 2021

In August 19 babies were enrolled in the Baby Care Program. Of the 19, 13 of these babies were orphans, 2 babies with cerebral palsy and unable to breastfeed, 2 babies with mothers were unable to lactate, and one set of twins whose mother was not producing enough milk to sustain them both. Nurses visited 155 infants and 21 women.

Two women were enrolled in the Mother Care program.  One experienced sepsis and a difficult recovery, and the other mother had a severe postpartum infection which led to a complete hysterectomy. Both of their babies survived birth.

240 babies are currently being followed, 23 women are being followed.

Baby Admission Story. Chisomo’s mother became sick during her last trimester.  She developed a cough and a terrible headache that was unrelenting.  When she arrived at the hospital, nurses diagnosed her with high blood pressure and admitted her.  In an effort of self-preservation four days later, her body delivered Chisomo one month early.  She remained hospitalized for observation for an additional six days and then was discharged home.  Within two weeks, her condition deteriorated.  She died on her way back to the hospital.  No one knows the true cause of her death.  Covid? Pre-eclampsia? Severe anemia? Sepsis?  All these are possibilities.  What is known is that a previously healthy 39-year-old woman died on July 31st.  And with her death, her daughter Chisomo’s survival was also imperiled.   Thankfully Chisomo’s family was guided to Joyful Motherhood by someone who came to pay her respect at the funeral. Our nurses will continue to follow and support Chisomo over the next two years.

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