THEN WHAT?

Dec 18th 2011.
It’s cold, it’s icy, but it’s England! Here I am, once again, surrounded by the love of my children and my family. It’s also a very special day for Lucas. Today is his 11th birthday which he is spending in Spain with his papa. I am with Katy and Nick in the north of England and we are all full of excitement as we await not only Christmas but more importantly the birth of their first child! She very cleverly decided to be born around this time so as to assure that her ‘yaya’ from Malawi would be present to help both her and mummy welcome her onto the world. Katy decided very early on in the pregnancy that she would like their daughter to be born in the coziness and comfort of their home. I am excited, calm and confident that it will be a truly beautiful and memorable experience for us all.
It’s been a long time since I last wrote to you all. The past few months have been by far the most difficult that I have experienced since I arrived in Malawi 4 years ago. I will need to explain to you why it’s been so challenging for me.
The shortage of FOREX due to many political reasons, of which I am not going to pass comment, has been the root cause of the problems we are facing in Malawi during this past year which have over time become more and more acute with little hope of improvement. This of course affects all walks of life but I will just focus on how we have been affected at Bwaila and how this has personally reflected in my life.
We started to feel the effects of the fuel crisis early this year. Fuel is the basis of so many areas of our daily life without which it is difficult to function correctly and efficiently. Little wonder so much of the war and power struggles in the world are somehow connected to fuel. Fuel is transport. Fuel is electricity. Fuel is water. Fuel is supplies. Fuel is work. Fuel is leisure. Fuel is food. Fuel is production. Fuel is health. Fuel is not resourced in Malawi. Fuel needs to be imported. Foreign purchases need foreign exchange. Malawi has a Forex crisis.
During the first half of the year we began to notice the shortages of materials and drugs at Bwaila. It became impossible to restock the cupboards in each and every delivery room as our main stock room was half empty as was the central medical stores. It became normal to hear staff shouting out around the ward “ has anyone got any sutures in their room?” or IV fluids, or catheters, or gloves or medication. But we carried on improvising as best we could. The situation became steadily worse and by September was clearly reflecting on the standard of care that we were able to give our mothers and babies. So when situations began to arise whereby the absence of essential medication resulted in loss of lives of our mothers or babies it often became too difficult to handle.
When the mothers blood pressure is dangerously high with the risk of convulsion and subsequent brain damage or death it is essential to administer the appropriate drugs. So if they are just not available…then what? When the mothers are recovering from major surgery and crying out in pain and the most you can offer is a Paracetamol…then what? When the mother is hemorrhaging after the birth of her baby and the life saving injection to contact the uterus and stop the bleeding is not to be found…then what? When a difficult labour needs essential interventions and the materials are scarce…then what? When a woman needs to be brought in from an outlying village or health center due to complications or needs emergency care or when she needs to be transferred to the main hospital unit for intensive care and the ambulance has no fuel…then what? When the patients condition or progress of labour needs to be documented and there is no paper for photocopying …. Then what? When the photocopying machine runs out of ink and there is no money to replace it…then what? When the power is cut and the generator has no fuel so the oxygen concentrators cannot function, the theatre is in darkness…then what?
During the latter part of last year we faced these and other challenges on a daily basis. It wasn’t about lack of obstetric skills, it wasn’t about tired overworked or demotivated staff, it wasn’t about negligent care, it was about an ever increasing lack of support by the government to ensure essential health care.
I remember Alinafe. She was 23 years old and pregnant with her 3rd child. At some stage during her labour in one of our more distant Community Hospitals it all started to go wrong. They decided quickly that she needed a C/section. There was no power and the generator had no diesel so they could not perform the life saving operation so she was referred to Bwaila. The ambulance was called. There was no fuel. By this time the ambulances they has ceased to be given priority in the fuel queues so Alinafe had to wait until morning when fuel could be found to bring her to us. By the time she arrived she had been pushing for hours. The baby had become impacted in her pelvis due to a mal position and try as it might her body could not expel it. We rushed her to theatre but were unable to save either her baby or her uterus. Alinafe lived….but only just.
Continued on 10th Feb 2012.
With each day that passed I found myself becoming less able to cope with the situation and longing for some ‘time out’ some time away from these frustrations and seemingly impossible challenges.
And so I spent 5 weeks in the UK during the Christmas period. Mostly in the north of England being around my 3 elder children but also visiting my mother and my siblings in the South.
My daughter gave birth to her first child, a girl, on 21st December in the comfort of her own home. I ‘Mummed’ and I ‘midwifed’ and was truly astounded and priviledged to be able to share in this wonderful moment that really belonged to Katy and Nick but that I will always form a part of. ( I will publish my reflections on the experience of being a midwife to my own daughter in a later blog.)
Christmas was spent at Katy and Nick’s house with Fiona and Lucas. Alasdair and Laura were in Spain. We then all got together for New Years’ celebrations which were comfortable and cozy. I always appreciate the times when all my 4 children in the one room!
Lucas and I returned to Lilongwe excited and enthusiastic to begin a new year.
Within days we were back into the routine of school and Bwaila, friends and social life.
All is well…………………………….