HELPLESS BUT NOT HOPELESS

As I walked out of the nursery today I wondered how many more tiny lifeless babies would pass through my hands ? How many more mothers I would have to call to tell them that their child had died? Despite the limited care we had given, the time they had spent squeezing their empty breasts for the last drop of milk, their little one just hadn't been strong enough, just didn't have what was necessary. Today it was a young 20 year old mother. Her second pregnancy, her second baby, but nothing to show for it. The first had not survived either. Very tiny, very prem, he didn't really have a chance. The impression is that life is cheap, expectations are low or non existent and another little mound of earth in the village cemetry was was all she had left.



I am amazed each day as I learn more of Malawi, of their ways and of their customs but especially of what they don't have and would never expect. Most of the births will not be registered officially. This means that when they die nor will it be necessary to register the death. Procedure is that the baby's body is wrapped, labelled and put in the hospital fridge. (on labour ward and its generally full) The family will arrange their own funeral with very specific rituals that the older women will pass down to the younger ones. I believe it is for women only, that the men are not present. The child will be collected and a procession will make its way to the cementry, the women carry branches of leafy trees to signify the loss and respectfully all will make way to let them pass. The cementries are easy to recognize as there will be a large number of trees growing there. Each village will have its own area. The baby will be laid to rest with no official recognition that it ever existed.



So this past week has been dominated by the loss of little lives. A baby born with kidney problems lasted just 24 hours. One with a congenital heart defect whom we found impossible to wean off oxygen after more than 10 days just needed a pediatric heart specialist .. in Malawi there are none. (and they certainly dont have the money to be treated elsewhere) Premature babies sometimes weighing less than 1kg. or 1- 1.5kg would survive and thrive in UK, in Spain, in many other countries, but here in Bwaila nursery they have little chance.





40 babies in the nursery. One of the nurses I know has worked more than three 24 hours shifts this week, at night on her own, plus a day shift. The nurses are paid (relatively) well for working extra shifts.Who can blame them for wanting to supplement their meagre earnings. I joke with her that Bwaila nursery is her home that she really doesn't have a home to go to ! I tell her that I don't know how she stays awake to care for the babies. I know she doesn't stay awake. I know their care is minimum and I want her to realize that I know that too. But what will that change? The nurses have to rest but if the babies are not cared for they will die. The matron came to see how they could cover for a nurse who is sick. She must know the situation. Is it really only important to cover the shift without taking into consideration the level of care? I have no answer and the problem is throughout the hospital, throughout health care in Malawi. Today is my day off and I cannot get them out of my head. I know I will have to pass by to see them sometime during today. Who will check if they are feeding ? Who will support the mums and ensure they have enough milk? Who will take the c/section babies to their mothers breast then bring them back? Who will make sure they start antibiotics when necessary or feed the tiny ones regularly through the tube?





As I write I am wondering whether the last remaining triplet born on Monday is still alive. They were born in a health clinic...supposedly a twin pregnancy . Mother and babies were transferred to us several hours later when the placenta had not been expelled. The ambulance took 5 hours to arrive..this is normal, but she arrived in good condition and delivered the placenta without hemorraging. The babies each weighing 1.250g were in good condition, just cold. I warmed them up and gave a litle glucose. The next day...what had happened during the night? It was so sad to see the first one go and then the 2nd one the following day. The mother cried when I placed the 2nd one in her arms. I gave her a hug and told I was sorry, that now she must work hard to express her milk to save her remaining child. I put her on the breast pump twice that day and was pleased to see that by day 3 she had plenty of milk. I hope I made her understand that she must feed her baby every 2-3 hours that she must give it warmth and love. Yesterday as I left she was doing well and the little girl looked strong. The nursery is ripe for cross infection. So many babies in such a small area. The nursery room is like a large incubator with temperatures unbearably high for working in but it is the only way to ensure the babies are kept warm. Sometimes the nurses find it too much and turn off the heaters. Sometimes they forget to turn the heaters back on. I arrive in the morning to find several hypothermic babies. This is definitely not good for these tiny things.



I walked to my car yesterday afternoon to go home, my heart was so heavy, I felt a heaviness throughout my whole body that I did not no how to shift. I felt so helpless, so useless, so hopeless. I could do so much in those 8 hours in nursery, never stopping, never tiring, doing all I could and now what? I saw the grieving mother, I went to her and gave her another hug. There was a cry from the distance and one of my mums came running up to me " see you tomorrow nursey " and gave me a big hug . How could I tell her it is a bank holiday weekend, I need to spend some time with Lucas, with friends, enjoy a trip out ? How can I tell I'm not coming tomorrow?

" Yes nursey see you tomorrow"

Yes I will go by. Yes she will see me today.

My spirits were lifted, I felt some of the heaviness leave me. So that's what Malawi is all about.. those tiny little things that mean so much. It doesn't have to be big, it doesn't have to be clever, it may not move mountains, I can't move mountains but I can feel love, and love will get me by once again. Love of my children, my family, my friends and love of those mothers that come into my care that have so little but give me their love.