CHIMWEMWE MU'BEREKI

Chimwemwe mu’bereki means ‘joyful motherhood’ It is the name that Joanne my American midwife friend gave to the small charity she set up whilst working here at Bwaila. Its purpose is to provide support for the needy families whose babies have been cared for in Bwaila nursery/neonatal unit. Some will be premature or HIV positive babies others orphan babies whose mothers have died in childbirth at our hospital. We try to support and encourage other family members to take on their care. This may be a grandmother or an aunt who may already have other dependants. Breast feeding is recommended for all babies irrespective of the mothers HIV status. It is the best protection against gastro intestinal infections which kill many neonates and children under five. But these orphans have no mother and therefore no breast milk. The cost of a tin of formula milk powder is around 800 MK (about 4euros) The small baby will need at least one tin a week to start with. This cost is totally outside the possibility of many of our families. As the child grows the cost of artificial feeding increases and the babies begin to starve. I have become involved in Joanne’s work and am seeing ‘first hand’ some of these problems. The families will either return to Bwaila on a monthly basis to collect milk powder or will be visited by a nurse/midwife who works for the project. The baby’s weight and progress will be documented and the family will be educated in health and hygiene issues. It is difficult to insure that the feeding cups are kept clean and the milk prepared in the correct way. I was concerned that these babies were not getting the possibility to suck, neither at the breast nor the bottle. We know this an important part of a child’s development. I had to learn that the risk of becoming infected by dirty bottles and teats outweighs the lack of sucking stimulation. Our most recent orphans are... a set of twins. These are the youngest siblings of a family of 3 sets of twins! The mother died on our unit after a problem with her blood transfusion. ...Triplets all weighing under 1.600kgs. The grandmother is staying in the hospital and learning to care for them. We hope that with our financial help and support the little ones will be able to stay with her so as not to be separated into the care of the already overcrowded orphanages. On Friday I was called to nursery see Flora and her grandmother. Born in November of last year, prematurely, her young mother died of Eclampsia during her birth. She weighed 1.400kgs. at birth and now 12 weeks later she weighs 2.500kgs. Last month we had supplied 8 tins of milk which should have been more than sufficient for this month, but she had travelled for more than 2 hours to receive more. When I saw Flora her face was pinched and thin. Her eyes seemed to stick out of her head, a round bloated belly and no surplus covering of fat. Anxious and crying she was desperately searching for food. I prepared some milk which she gulped down furiously. Afterwards she lay contented in her grandmother’s arms. Where had all that powdered milk gone? I presume that while the little one went hungry the other children of the family were being given her food. Or maybe they were sold to buy maize so other mouths could be fed? And how can I blame that grandmother? These are some of the dilemmas we confront daily. I said to just give her 4 tins this month and meanwhile we would visit her home to assess the conditions and the number of dependants that were being cared for . My role in this project was just to be supportive of the Malawian nurse and in an advisory capacity but I see myself getting daily more involved. Is there no end to the desperate needs of these people

Friday was the usual busy day on labour ward. My feeling of dread as I arrived early in the morning was justified. Prolonged labours, distressed babies and a queue for operating theatre. Who needed their emergency c/section first? The pre-eclamptic who could convulse any moment with a blood pressure of 210/140? The woman with 2 previous c/sections who had been in labour for many hours and was in danger of rupturing her uterus? Or the baby with fetal distress ?
All got their c/sections and all mothers and babies are alive!
Later that day I attended a surprise twin birth. I noticed that the mother had fever and the baby showed signs of infection. Its heartbeat normally at 120-140 per minute was consistently 200. I treated her infection with intra venous antibiotics and began to prepare her for a c/section. It became obvious by her behaviour that she was a victim of aggressive sexual practices and probably her pregnancy a result of rape. Although she tested negative for HIV at her last test she certainly had a severe STD. ( sexually transmitted disease) I was not keen to send her for surgery due to her physical condition but I feared for the life of her baby. I re-examined her just before taking her to theatre and found that she was almost fully dilated. I judged the situation and opted for an assisted vaginal delivery. It wasn’t easy as she found it very difficult to co-operate. It wasn’t easy as a vacuum extraction requires maximum co-operation from the mother. The baby was born and was taken to be resuscitated by another midwife. As I turned to assist the delivery of the placenta I noticed that the uterus was still rather large. “There must be another baby! “ I exclaimed. And sure enough there was. I quickly ruptured her membranes as I felt the 2nd head engage in the pelvis. The mother was reluctant to push. I called for someone to explain to her that she had another child to push out. I don’t think she was very pleased to hear this! I applied the vacuum cap once more and quickly extracted the 2nd little girl. This one cried loudly as if complaining about having been forgotten! 1.500kgs. and 1.650kgs. were reasonable weights for these twins. I sent them to nursery to be treated with antibiotics to prevent neonatal sepsis. I will check on them on Monday morning.
I will end by sharing two quotes from this week.......
As I wandered round the Ministry of Finance building trying to find my way out, after an unsuccessful visit to procure an extension to my visa. I enquired from an employee as to how to find the exit and commented that I was lost. “ No! ” he told me. “You can never be lost where there are people”
Each morning we listen to BBC Africa whilst having breakfast. There is always a moment called ...wise words. “ Great success comes from great belief “ we heard. “That’s you mummy” remarked Lucas. I didn’t quite understand what he meant so enquired as to his understanding of the quote? “ Great success comes from great BELLY!” he exclaimed.
Now that one needs thinking about!