African Mothers Health Initiative

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

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maternal death

August 2022

In August Joyful Motherhood nurses enrolled 20 babies (including 9 orphans, 7 babies whose mothers are critically ill and hospitalized, 1 baby with spinal bifida, and 3 babies whose mothers are not producing milk) into our programs. Two women were enrolled, both with severe postpartum anemia. Nurses conducted 190 visits to women and babies this month.

Baby Admission Story. Edina was 21 when she delivered Moses on June 16th. He was born on a grass mat laid over the packed dirt floor in her village home. Rather than slide out after him with one final push, the placenta clung to her uterus and she started to bleed. The blood flowed over and between the weave of the matt and into the floor. Edina died beside her newborn.

Edina’s family pooled their resources and bought a tin of formula; they stretched it as far as possible. Moses ate the white then grayish water. When it finished, they bought another and another. Each time worrying about his thinning cheeks and about how they would afford one more tin. In desperation they brought Moses to a health center and he was referred to our program. Moses is emaciated, still hovering around his birth weight but now he will receive the support he needs from our nurses while living with his grandmother.

Meet Merelina

Ida was only 22 when she delivered her fourth child, Merelina.  At that time, she was living in Mozambique and Merelina was assisted into the world by a traditional midwife in their village.  Immediately following the birth, Ida bled heavily, but the bleeding slowed and she appeared stable.  So, rather than seek medical help, Ida stayed in the village breastfeeding and caring for her newborn.  Two weeks later Ida developed shortness of breath and it suddenly became clear that her health demanded urgent attention.  Initially the family took her to a traditional healer who nursed her with herbs, but she did not improve.  From there, her husband’s family took her across the border to Mchinji District Hospital in Malawi.  Ida died at the hospital before receiving any treatment.  Desperation and grief mixed.  The family lived in deep poverty and could not afford formula for Merelina.  After losing Ida they feared losing Merelina.  The midwives at the hospital referred Merelina and her family to Joyful Motherhood for assistance.  Joyful Motherhood only serves babies within Malawi, so Ida’s mother-in-law who lived in Malawi agreed support her father in caring for the newborn.  And Merelina’s father moved to his mother’s village with his three other children.

Nurses immediately began visiting Merelina in her maternal grandmother’s home.  They taught the family how best to care for Mereina, how to prevent infectious diseases, the importance of sleeping under bed nets, when they should seek care at a hospital, and how to prepare and nourish her with formula.  During those early months Merelina grew well.  At six months, nurses began providing porridge to supplement the food she started eating.  At eight months nurses noticed that her growth deviate from the normal expected trajectory.  This is common in households suffering food insecurity. Once a child’s diet transitions from milk to solids, they begin to suffer the hunger experienced by the rest of the family.  Nurses educated Merelina’s family on the types of local foods they could add to her diet to improve her nutrition and the frequency of meals.  Once again Merelina began to grow and develop normally.  Over the monthly visits nurses watched Merelina learn to sit, then crawl, stand and walk.  Merelina was finally discharged from the program just before her second birthday. 

Most people in Merelina’s village where she lives with her grandmother and her father never expected her to survive.  The experience of people in the rural areas is that babies inevitably die without a mother’s milk, regardless of the care and love provided.  Merelina’s survival was a victory not just for her family, but for the entire community.  Today Merelina’s grandmother continues to support her son in caring for Merelina and siblings (ages 10, 8 and 4) while he takes whatever job he can find to support them all financially. 

If you would like to make more success stories possible, please DONATE.

June 2022

In June nurses enrolled six babies (including 5 orphans and 1 baby without access to breast milk) and two women. Nurses conducted 169 visits to infants and critically ill postpartum women.

Baby Admission Story. Edess was living in a rural part of Mozambique close to the border of Malawi. She was pregnant with her fifth child and the labor started hard and strong. There was no time to make the trip to a hospital, so a traditional midwife in the village was with her during the birth. The delivery happened smoothly and quickly but the placenta did not follow and so Edess was forced to travel to the hospital.

At the end of a pregnancy the placenta receives approximately 500ml of blood every minute. Normally within minutes after a baby is born, the body will release the placenta and blood vessels feeding the placenta will shut down by a combination of the contracting uterus and clotting factors. When the placenta does not deliver within 30mins of a birth, the risk of hemorrhage increases exponentially.

Traveling from a rural community to a hospital in an emergent situation never happens quickly in Malawi or Mozambique. There is no functioning EMS system. In the majority of communities like Edess’ the only transportation vehicles are bicycles or ox carts. Roads are unpaved and rough. And, once a woman reaches the main road, she will need to wait for a passing bus or car to pick her up and take her to the hospital. Edess finally reached a rural hospital in Malawi, but tragically, she died on the same day. After her death, clinicians at the hospital referred her mother and baby to our local partner, Joyful Motherhood. If you would like to ensure that nurses visit Edess’ baby on a monthly basis in her village and provide formula and later porridge, please DONATE. Thank you.

April 2022

This month we enrolled 18 babies and one critically ill postpartum mom. The babies included 4 orphaned singletons, 4 orphaned sets of twins, 2 babies of very sick mothers, and 4 babies without access to breast milk. Nurses conducted 210 visits to mothers and babies this month.

Baby Admission Story. Jaqueline delivered her twin boys normally, but she hemorrhaged afterwards and because of that, her return home from the health center was delayed for several days. During that time, she did not receive a transfusion or additional treatment, she was simply kept under observation. Within a week, Jaqueline was discharged and returned home to introduce the babies to their three older siblings. Unfortunately, Just a couple days after arriving home, she began complaining of dizziness, shortness of breath, and chest pain. This time Jaqueline ended up at Kamuzu Central Hospital (the regional referral hospital) where she was diagnosed with severe anemia and a necrotic uterus. They removed her uterus and transfused her with 5 pints of blood, but 25-year-old Jaqueline died. Unfortunately, the nurses at KCH had not realized that Jaqueline was a mother of newborn twins and so the family did not receive a referral to Joyful Motherhood. It was only when the nurses were visiting another orphan enrolled in our program in a rural area that they learned of the nearby hungry twins and enrolled them. Jaqueline’s babies boys are living with her mother now. We will provide monthly home visits from nurses and formula now, then porridge after six months. Our nurses will continue to visit them in their community for up to two years. Without that fortuitous visit, it is likely that Jaqueline’s babies would have quickly followed her in death. The family had the desire to care for the babies, but they are too impoverished to purchase formula and they had no idea where to seek help.

If you would like to support Jaqueline’s twins, please donate HERE.

March 2022

Twenty-one babies were enrolled this month (10 orphans, 5 babies whose mothers are admitted in the ICU, 1 baby whose mother is not producing milk, 1 set of orphaned twins, 2 babies of mothers with severe mental health illness, 1 one baby whose mother left her with the grandmother). Two women were enrolled, both of whom lost their uterus due to birth complications – they are 19 and 20. Nurses conducted 190 visits to mom and babies this month.

Baby Care Story. Hannah’s mother was diagnosed with breast cancer and started chemotherapy but when she unexpectedly became pregnant at 40, she stopped her treatment. She delivered Hannah prematurely. Hannah weighed just over three pounds at birth, but she quickly put on weight with her mother’s breast milk. After two months her mother’s health began to deteriorate at a precipitous rate, and she returned to the cancer treatment center to resume her chemo. Hannah’s grandmother brought Hannah to us, requesting assistance with formula and nursing support.

Mother Care Story. Loveness was just 20 and pregnant with her first baby. Her labor was long and hard. She headed to health center when her labor started and was watched by the clinicians there. But,health centers do not have the facilities to conduct c-sections. By the time she was transferred to the District Hospital, it was too late. Her uterus had ruptured, her baby had died, she was bleeding internally. Loveness lost her baby and her uterus and almost lost her life. At the time of discharge, Loveness was weak and depressed. Joyful Motherhood nurses will visit her at home over the next couple of months, but she is just starting a long road to recovery.

Many times when policy makers, academics, aid organizations, etc. consider maternal mortality and strategize ways to improve statistics the emphasis is placed on receiving prenatal care and delivering within facilities. However, the vast majority of the women we care for, or whose orphan babies are enrolled in our programs, have followed the “rules.” They attended prenatal visits. They made their way to health facilities for delivery. But in the end, they were not protected from excessive suffering or loss. As an organization we stand with the victims, who are often invisible to the larger system. Our support is focused directly on them.

If you would like to support our work, please DONATE.

February 2022

This month 11 infants were enrolled in our program, including 6 orphans, 1 set of twin orphans, 2 babies of women admitted to the ICU, and 1 baby whose mother is not producing any breast milk.

Baby Admission Story. Thirty-five-year-old Rachel had two children and was pregnant for the third time.  She attended her prenatal visits and when contractions started, she went to Bwaila District Hospital.  Only after Joshua was born, did Rachel learn that she had been carrying twins.  As the second twin settled into her pelvis he had his arm over his head, unfortunately no one noticed until it was too late. The birth became complicated.  Due to a prolonged period of hypoxia during the birth, Joshua’s twin was distressed at birth and he died several hours later.  Rachel took Joshua home on November 14th. She breastfed Joshua for two weeks but then she developed a significant cardiac arrhythmia and returned to Bwaila.  There she was diagnosed with pre-eclampsia and cardiomyopathy.  Her milk supply diminished as her condition worsened. Rachel needed heart surgery, but there is no place where this is done in Malawi. With nothing more to offer her, clinicians discharged Rachel. She died on January 27th. 

Rachel’s mother works at Bwaila District Hospital where Rachel delivered and where she learned her daughter had a terminal condition.  The office of our local partner, Joyful Motherhood, is located at the same hospital.  Rachel’s mother had escorted other grandmothers carrying their orphan grandchildren to our door.  Her knowledge of the Hospital did not spare her the trauma of losing her own child, but she knew where to seek help for her grandson.

Mother Care. The mother who was enrolled this month, is only 19. Her labor with her first child was hard and long. It ended with a cesarean section and a stillborn. Days later she developed an infection in the wound, which led to a total hysterectomy. Our nurses will visit her at home as she recovers physically and emotionally over the next couple months.

Please consider a monthly donation HERE to support our work.

What does your heroine look like?

Every month we hear tragic stories of young women who die shortly after childbirth and of women who lose their babies and/or their uteruses in the course of their labor and delivery experiences.  But, we also hear stories of incredible sacrifice, strength and resilience.  The women who are enrolled in programs sponsored by AMHI are heroines.  They take on the care of fragile newborn orphans and believe in the possibility of their survival even when those around them do not. Before they find us, many of them keep fragile babies alive by selling their own meagre food stores to buy a few tins of formula. Others overcome incredible personal losses – their health, their child, their relationship – and bravely move forward rediscovering hope and purpose. They are our heroines and here are some of their faces…

Who is your heroine? Have you told her? Consider making a donation in her honor to support these women HERE.

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.

Even a small donation can help us save lives.

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