Stories from a maternity hospital in Malawi

I have two good friends who work at the maternity hospital here in
Lilongwe: Deb Lewis and Joanne Jorissen. Both of them are selfless,
dedicated people with some amazing stories. They work at Bottom
Hospital, which is a great name for a maternity hospital. That is, until
you learn that it was named in relation to top hospital, which was the
hospital for white people. Bottom hospital was where the black people
went. Top hospital no longer exists (white people mostly go to South
Africa when they need serious care), but Bottom hospital continues to
churn out 12,000 babies a year with just four doctors. Malawi's maternal
mortality rate is rising, according to the latest WHO report Malawi
is the third highest in the world, and could be number one if it continues to increase.

From Deb:

i've been working in the labor and delivery suite, which consists of 15
or so beds, separated by flimsy plastic curtains, and a slew of nursing
and clinical officer students supervised by too few midwives, a couple
of clinical officers and NO doctors. one may pop in and out occasionally but is usually tied up with the real emergencies. the women bring their
own black plastic garbage bag to deliver on, as well as their own bucket
if they're rich enough and rags to clean up with and wrap themselves and
their baby. the first day i was there i was helping clean up a woman and
threw out the garbage bag filled with poop, blood, membranes, amniotic
fluid and one of her rags. big no-no, since she'll wash the bags and
rags out and use them again...for a tablecloth, the next delivery, but
likely not her trash.
today was crazy. i delivered a little baby boy this morning and was
feeling quite excited about it. then i went to check on an 18yo
[first time mother] who seemed to be in quite distress. of course i
can't understand anything she's saying or communicate back, but she
hugged my neck and i tried my best to give some moral support while i
found a translator. it's weird because it's not like there aren't people
around, it's just that it seems hard to find someone when you need them.
there are a number of students and nurses hanging about, but there just
seems to be no real system for monitoring patients. it seems you pick
up a chart (we only recently got actual charts), maybe check for a
couple contractions, and then move on. so anyways, i found out my lady
needed to pee, and since she was quite far dilated someone told me to
put in a foley catheter, which is a very scary thing here since the
environment is just NOT sterile so who knows how many bugs are given a
free ride to the bladder. so while i was bemoaning the sterility
factor and helping marijn (the dutch student) insert the catheter, a baby pops out on the bed across from us. yes, number two baby in less than a week that i've seen delivered with NO HELP! poor shelia with her full bladder had to wait, while we ran over to see about the baby, cut the cord and deliver the placenta. marijn took the baby to the resuscitation station which consists of a bag and mask ventilator with a bad seal, suction (but no proper tubes to suction with), and oxygen, with again no good tubes. there are no nasal cannulas and basically you have to stand there and hold the end of the tube in the baby's nostril. the little guy was okay, and just as i was inspecting the mom for any tears, a girl starts pushing, which wouldn't be such a strange thing in a labor ward, except that she's by herself and she's ON THE FLOOR! that's right, no beds. she delivered about 30 minutes later, still on the floor, a healthy little boy.

shelia eventually got her bladder emptied and she later delivered by
vacuum, which i didn't do. i called the clinical officers over about
another patient, who they took for c-section due to fetal distress.
again, this is by listening with not much more than a plastic cup and a
sporadic doppler.

later i washed all the suction and oxygen tubes with soap and water, no
chlorine or disinfectant to be found, so you can imagine how clean they
actually got...

From Joanne:

Last week I spent one afternoon with Sakina, a very sweet and absolutely
terrified 19-year-old who was pregnant with her first baby. She was
having a difficult labor but refused all vaginal exams. After much time
spent trying to calm her, she allowed me to check her cervix... Before I
left around 6, I told the nurses and clinical officers ... to be gentle
with her.

When I returned two days later I found out that she had refused a
section early in the night, a vacuum had been performed at 3am, and then
finally she consented to a section the following morning. Her baby boy
was born around 6am but his journey into the world was too difficult for
him to bear and he died just a few hours later. I was so upset. Yes, it
is possible that she stubbornly refused the section after the best of
counseling, and yes, the clinical officer who attempted the vacuum is a
kind person. But, it was incredibly difficult for me to imagine that she
allowed someone to do a vacuum (which in this setting involves inserting
a metal cap that is 4-5cm in diameter into her vagina), considering it
took several minutes just for her to allow me to touch her with two
fingers. It was also difficult to imagine that she would refuse a
section if she truly understood what was at stake, and believed that it
was a necessity not a threat. Possible, yes, but difficult to imagine. I
have seen women held down and threatened, and the vivid horrible
memories flooded my mind. After visiting her in postnatal, seeing her
silent tears, empty arms, and recent cut, I had a tearful conversation
with Tarek about the situation. He listened, tried to help me see this
one woman in the greater context of the Hospital and health care here,
reminding me that things are improving but also saying that at present,
the whole of Bottom Hospital is a human rights' violation.
A couple weeks ago the charge nurse (the only clinically practicing
registered nurse in the entire hospital) told me, "Joanne, I hope that
when you go back to your country you will tell them how hard we work.
People are always coming here and then saying horrible things about
Malawi and our work here." I'm sure she would count my blog among those
horrible things. So let me say now, that the nurses and midwives here
work HARD. That is the truth. There is no one who sits and chats the day
away. These women do work.

2 Response to Stories from a maternity hospital in Malawi

  1. Mike says: had an article yesterday that talks about another Malawian hospital. Have a look: link.Thanks Molly and Mikah who simultaneously sent this in!

  2. [...] you an incredible view in the world that Karen is trying to help written by nurses there: Life in a Maternity Ward. Just a quick excerpt from his postin [...]

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