BACK TO BWAILA

Its 6.30am. Saturday 12th February. I am sitting in my lounge in the lovely house we have made home here in Lilongwe with the warm African sun blazing in through the window. The only noises I hear are the chirping of the birds in the garden, which due to the heavy rains at this time of year, is lush and green. Fiona is still asleep in Lucas’ room and I feel content. Fiona will stay with us in Malawi for 2 months whilst she carries out her experiential learning with the year 1 children at Lucas’ school. Lucas is thrilled to have her here. And me? Well I just feel so grateful for the opportunity she has given me to be her Mum ‘close up’ for a while.
Europe, Christmas and Katy and Nicks wedding seems lost in a different world, in the distant past, but of course it was only just over one month ago. Time spent away from Malawi and away from Bwaila was therapeutic and healing, just as imagined it would be. Flying back into my other world into my other reality caused me the same conflicts and confusion as it has always done. It always takes me time to adapt back to that huge sense of wealth and excess that oozes from the pores of European living. But I did and I enjoyed every minute. I was able to spend nearly 3 weeks in England in the loving and safe arms of my friends and family. It was good to see how my Mum was recovering from her recent stroke and on her way to resuming her independent life once more. Time spent in Yorkshire with Katy and Nick in the final weeks before their wedding was full of excitement and joy. I felt privileged to be able to share this time with them. Christmas was spent in Spain surrounded by the usual hectic rush and tumble of pre Christmas plans then the beautiful giving and receiving of presents. All my four children have acquired the ability to find the perfect gift chosen with such thought and given with great excitement and love.
Katy and Nick’s wedding on 30th December was a fairy tale. Everything was just wonderful and beautiful especially my daughter, the bride. My role as mother of the bride was just so special, I enjoyed each and every single moment. What a wonderful feeling, as a mother, to witness my own child moving forward into a loving relationship with the man of her choice with an unknown but exciting future ahead. As I read in the wedding ceremony from the words of Kahlil Gibram …..
Your children are not your children They are the sons and daughters of life’s longing for itself. They come through you but not from you. And though they are with you they belong not to you……. child You are the bows from which your children as living arrows are sent forth…


Ending my time in Europe I was able to enjoy 6 days in Norway with my eldest son Alasdair before he took up his first job in England since recently qualifying as a vet. I was grateful for this time with him as his possibilities for long holidays and ‘time with Mum’ are so much less now that he has left student life behind and embarks on his chosen career. I never cease to give thanks for my children each one so special in their own way.
And so I returned to Malawi. I must admit having felt rather apprehensive during the last few days in UK. I was ready to return, I felt strong and enthusiastic but leaving the comfort and security of family to return to the huge challenges of living and working in one of the poorest countries in the world left me feeling somewhat fearful.
Needless to say the sight of our dear friends and neighbors who were at the airport to meet us, soon chased away any feeling of doubt I had regarding continuing with my work and our life here in Lilongwe.
So I returned to Bwaila. Having played such a huge role in the setting up of the new Bwaila Maternity Unit it felt like going home as I walked through the doors of labour ward, that first day after nearly 6 weeks away, to be greeted with screams of welcome by my midwife colleagues.
It had been a difficult December as the unit had been without regular medical cover leaving the midwives and clinical officers to take full responsibility for the everyday running of what is probably the busiest maternity in the whole of Southern Africa. Despite predictions that the work load at Bwaila would decrease substantially after the opening of the new tertiary care wing at the Lilongwe central hospital ( Ethel Mutharika Maternity Wing) this has not proved to be the case and we continue to attend more than 1,000 births a month. The high risk mothers are now being transferred and the health centers are sending their difficult cases directly to EMMW. We still have many extremely sick women and emergencies to attend. I can honestly say that the past 6 weeks have been some of the busiest I have experienced since I arrived 3 years ago.
January sees the start of the clinical placements for our midwifery students. This year with an increase in students being trained it also means an increase in the number of students needing close supervision and clinical teaching in the ward situation. We have also had a new set of interns and clinical officer students on the unit all of whom need constant teaching. I quickly decided on my return that I should make my priority during this time the teaching and supervision of students of all cadres. It has been a pleasure to work with the interns, most of whom are highly motivated and enthusiastic learners. They are quick to learn and quickly become essential to the safe medical coverage of the unit. The student midwives are of varying levels of enthusiasm and competence. They have little input from the college staff due to shortage of tutors which means that their practical skills need to be taught by our own permanent midwifery staff. There is still some reluctance on the part of some of these to undertake this role. Others truly do not have the necessary skills to pass on their knowledge to students. I have spent most of my time this past month dedicated to this. I actually enjoy this part of my work tremendously and find that my own enthusiasm plays a key part in effectively creating greater interest and understanding thus leading to better and more adequate care.
As well as teaching I often find that I am the most experienced obstetric professional on the unit. This means that my expertise is being constantly sought to aid in difficult and emergency situations. I was very pleased to welcome a new Nigerian registrar onto the unit. We have already worked together in the past and are personal friends. We refer to each other constantly which gives vital strength to the medical and midwifery cover. I truly feel that together the possibilities to effectuate change are more than ever present.
This doesn’t mean that labour ward is without its distressing incidents.
I had decide to finish a little earlier last Friday afternoon to allow myself time to catch up on some of the more formal teaching preparation and administrative work that forms an important part of my work. It was 3.30pm and the ward was quieter and under control. There were 3 women still waiting for their emergency c/sections, one of whom had been waiting for more than 3 hours. The interns were operating which inevitably leads to delays as their inexperience means that the procedure takes much longer. I had already requested that a more experienced person took over for the 2nd patient as I feared that the outcomes of the waiting women and their babies would be adversely affected if they delayed further. The 2nd c/section was performed by one of our clinical officers but 2 were still waiting. A young 16 year old was just not progressing to delivery. She had been referred by a district health centre and despite all our efforts it became clear that the baby needed to be delivered abdominally. The other was a very small, very short young mother who had not been able to deliver her first child vaginally due to a disproportion between the pelvis and the fetus. There are many women in Malawi whose growth has been arrested during childhood and adolescence due to malnutrition or illness resulting in inadequate development of the bony pelvis which does not allow for normal delivery. Although a c/section is a life saving procedure for both mother and baby we are very reluctant to put a woman through surgery unless it is absolutely necessary. Once she has a scarred uterus she carries the added risk of rupture in any subsequent pregnancy. This is a real danger to our Malawian women living in the more rural areas with no adequate transport to a health facility and with the frequent use of local roots and herbs to induce or speed up labour in a very aggressive manner. I had collected my belongings and was walking out of the ward when greeted by a new referred patient with ‘a retained 2nd twin with fetal distress’, of course I could not leave. Calling for one of our clinical officers who just happened to be around I quickly took her into a delivery room to assess the situation. We performed a quick ultra sound scan on the baby and found a very slow irregular heart beat. This baby needed to be born fast! A c/section was not an option for at least 2 hours so I decided to attempt a vaginal delivery to save the baby. I called another midwife to help set up an IV line, empty the bladder and bring a vacuum extractor. It was not an easy procedure. The fetal head was high and the vaginal tissue, cervix and first umbilical cord were all in the way as I tried to place the vacuum cup on the baby’s head. It took almost 15 minutes to successfully extract the baby and I feared for its life. I have done this procedure before and it requires a great deal of cooperation from the mother and the medical team. At last the cup was placed and the baby extracted with ease. I was amazed and exhilarated when it came out alive! With a little resuscitation the baby was soon crying though still with breathing difficulties so I sent him to nursery for further management. Today he is doing well.
It was now past 4.30pm Before I left I went to theatre to make sure that the clinician on the night shift was aware of the 2 women still waiting for their operations. I could do no more and there was no time to consider administrative tasks. I arrived home after 5pm exhausted. It was Friday afternoon and the thought of the weekend, the rest and free time with Fiona and Lucas filled me with joy and hope.
Despite everything…..I love Bwaila!


When love beckons to you, follow him, Though his ways be hard and steep. . And when his wings enfold you yield to him, Though the sword hidden among his pinions may wound you…… For even as love crowns you so shall he crucify you. Even as he is for your growth so is he for your pruning…… All these things shall love do unto you that you may know the secrets of your heart… And think not that you can direct the course of love, for love, if it finds you worthy, directs your course.