BANK HOLIDAY ADVENTURE

Monday was bank holiday, Lucas had a day off school so we decided it would be a good day to go looking for Pirilana and her twins. At 7am I was in the hospital nursery starting the days work. I knew they would be short staffed that day so I was able to help out with the daily cleaning of cots and weighing of babies. The mothers wait anxiously to see if their baby has gained weight, if today will be the day she can return home? Some of these mothers live a distance from the hospital which means that they may have arrived well before giving birth and been camping out away from home for some time. Their stay is then extended whilst the baby is in nursery making them impatient to get home. Most of them will be accompanied by a "guardian" and often other siblings. The guardian will look after them during this time preparing their food in the basic hospital kitchen and washing their clothes. They will have very little money to buy food so if they then have to stay a week or more after birth it becomes very difficult for them. Basic meals are provided by the hospital courtsey of an NGO. but are not always sufficient. Breast feeding one or two infants whilst recovering from giving birth often with underlying chronic conditions like anaemia, TB. HIV. Hepatitis , malnutrition etc. demands a good diet and care, this is not present. I was able to give my sandwich and fruit juice to one of my mums the other day who had not eaten for 24 hours. It felt good to sit at her side and share in this way reminding me once again how much I have and how little they expect.
But back to my story of Pilrani and her twins!
I collected a portable weighing basket, met up with Evelyn (a Dutch medical student who is here for 2 months) who had asked to acompany me and went home to pick up Lucas. I had decided to take our " nanny " Doreen, with us to translate. Pilirani does not speak English and I doubted if I would find English speakers in her village. I met Doreen last time I was in Malawi so was pleased to employ her to look after Lucas whilist I am working. Though outdated, the word "nanny" is widely used to describe these ladies, as are many of the words used here dating back to the British colonial days. So we set off with our instuctions of how to arrive. Doreen insisted she knew where we were going and I believed her...first mistake! She was eager to please but her experience of travelling everwhere in an overpacked minibus had not made it easy for her to understand exact directions. So we missed the turnoff! By the time we had nearly arrived at the airport I guessed we had gone wrong so we stopped and asked! I was glad to have Doreen with us. We set off again with new directions and decided to take the "short cut" Turning onto a mud road I began to doubt we would arrive. Doreen assured me it was a good road! We are still in rainy season so although a dry sunny day the ridges, bumps and holes caused by the rain were evident! I am still driving a hire car..just a normal saloon..definitely not the best car for this sort of adventure. My farming background and four wheel drive experience came in handy and slowly, very slowly we manouvered our way through and around the difficult bits and arrived at the house with a white flag. I must admit I was expecting a large white banner, we found a small piece of rag, the size of a handkerchief, tied to a stick! Once again.. lucky Doreen was there !
There were a few mud huts alongside the track so we enquired as to the whereabouts of Pilirani.
From out of nowhere men and children appeared and offered to take us to her hut. Leaving the car to be watched over by one young man, we set off behind a " gaggle" of children all laughing and talking and running at our side. Through the plantations of maize ( this is used for everything and upon which their whole diet is based) winding round the outskirts of the village past the small mud huts with thatched roofs...yes just like the postcards or images on the tele..we turned the corner and there she was sitting on the step of her hut, home, breast feeding one of the twins. What a suprise! she didn't think I would come! She cried out and covered her face but we could sense how pleased she was to see us. It was a very special moment. The other ladies ( we later found out were her sister, sister-in-law and other family members) jumped up and fetched a cane mat.This they spread out on the ground for us to sit on. We took off our shoes and sat down. Again it was good to have Doreen who translated for me. She showed me the twin boys..Edward and Alex.. I could see that Edward, the largest, first born was doing well but Alex looked thin and ill. I guess I was glad to see them alive but became worried by Alex' condition. We weighed the babies and sure enough Edward had gained 400g in the 2 weeks since discharge but Alex remained the same. Doreen helped me to ask the questions and understand as Pilirani explain how they were feeding and her own worries about Alex. I took his temperature and was relieved to find that it was normal. His breathing was good. I listened to his lungs and they seemed clear. He showed no signs of infection but was clearly severely underfed. Edward was obviously taking the best, leaving little for his brother. I advised her to express breast milk and give it in a cup, thus supplementing the poor feeds as he was becoming slowly weaker and less able to take directly from the breast. I also left her some packets of milk formula with strict instructions, once again, on how to make and use them should she find that she does not have sufficient milk. I hope I did the right thing?
I had bought gifts of knitted blankets and hats for the boys and left them with one of my home baked chocolate and banana cakes. There would not be sufficient to feed the growing crowd that had by now gathered around to inspect the " msungu" ..white lady, but maybe enough for Pilirani and her family. We met her 2 older children and her husband, were introduced to the great grandmother and head lady of the village who came to meet us and shook hands with everyone. Lucas was rather overwhelmed by so many staring faces. His blonde hair is particularly interesting to the local children who laugh and giggle in a way that can be disconcerting to a 7 year old boy. After promising to return next week we followed the children back to the car where the young man was still on guard. The 100kw note (50 cent.) for his services was received as if it were gold and the car was intact. We waved goodbye. Finding the correct way home was far simpler but not nearly as exciting. I am negotiating the purchase of a small jeep which until bought I think I will return the easy way!
I think of Pilirani and her boys everyday. I hope I will find them alive and healthy when we return though I cannot be sure . They still have along way to go before I can feel they are out of danger. Edward weighs 2.250kg and Alex 1.450kg. In most countries they would still be incubators!
It was hard to leave nursery but I felt I should go back to labour ward. I have made friends there so will return often and have told them to call me if they are particularly short staffed or overworked. I hope they will. I will keep up contact with the mums who are caring for their babies in the "kangaroo" nursery I have some very special mums there. Look out for news of Grace and her little one. She has a heart murmur which seems to be the cause of her slow weight gain and "failure to thrive" Grace is a dedicated mum and we have a special relationship. I shall not loose contact with her.

My return to Labour ward was dramatic with breech twins. Helping to save this mother from an almost inevitable c/section was good. There were a few " adrenalin" moments but all turned out well. 2 boys ...1.900kg first then 2.200kg came quickly behind. Wow! am I learning a lot ! Mother nature is wonderful and so knowing and babies and mothers are stong even under the worst conditions. Thankyou!