LOOK AFTER YOURSELF

Stress and exhaustion caught up with me this week making what should have been a simple cold and cough develop into a full blown chest infection. So here I am taking a ‘forced’ rest at home swallowing huge antibiotic tablets, cough mixture and copious amounts of fluids. The drugs make both me and my digestive system feel rotten but after battling away for over a week with a cold then cough then laryngitis then bronchitis I began to realize that things were looking serious and started the dreaded antibiotics. I am pleased to say that now 4 days into the course I am starting to feel the positive effects and although rather weak and tired I am on my way to recovery. I am surrounded by caring friends many of whom are also in the medical profession so have not lacked good advice and treatment. Unfortunately, in the end, it is me that has to TAKE the advice and that is where the problem starts!
I truly find it incredibly difficult to be away from the hospital and even more difficult to REST.
I have had time these past days to reflect on the above statement and to be honest I have even been avoiding doing that. How easy it is to give the right and correct advice to friends and colleagues.....’Take time off, look after yourself, make a full recovery before going back, you’re not getting any younger, take care of your body, you’re no good to anyone if you are sick, your health is important, just stay home and rest, they can manage without you...........etc.etc. We say them so easily and so lightly but how many of us really manage to take our own advice?
As I write I am thinking of all the things I could be doing at Bwaila. The women and babies to attend to, the midwives to mentor, the matron to support, the student midwives to supervise, the new Spanish midwives to orientate and more and more and more. As I sit here at my laptop biting my nails and writing of my dilemma I ask myself once more, ‘Why Rachel, why?...why can’t you switch off and rest ? Why can’t you switch off and recover?’ Where is the peace when I’m not doing enough, today, I’m not doing anything today? I’m resting...I’m recovering!
How arrogant of me to think myself so needed, so irreplaceable! Do I really lack so much in humility? The reality is there is SO much to be done and so few to do it. But I can’t do everything, I can’t be everywhere? What a conflict in my head, in my heart! My world is so small, just Bwaila, just Lilongwe, just Malawi. And what about the rest? Such a tiny part of the whole! Oh how I wish I could change it all make it better for everyone. Where is the justice in this world that means these poor people in Malawi are not and cannot expect to be cared for and attended to in the same way and to the same level as you do back there? How naive, how immature..... just my thoughts.
What if we all really loved enough, cared enough to make things better? Ok, so it doesn’t mean we all have to dedicate ourselves to the poor and the under developed countries but with each and every person we come in to contact with today. Our family members, our work colleagues, the person in the shop or restaurant anywhere, everywhere.....How many times this has been said by how many people? Is it really achievable? Is it really sustainable? So let’s go back to me, in my little world here in Malawi and think small then it becomes achievable for me, it becomes sustainable for me and that is enough.

If I am sick I cannot do this, if I am weak it is not possible. So I must be healthy and I must be strong. I will search for the peace that is not in the physical not in the ‘being there’ but in the spiritual, being here in this moment.
‘We are not a physical body with a spirit but spirit with a physical body.’
I will rest and I will recover so better I can serve others once more.
I am now fully recovered and back on labour ward. The past week has been exceptionally busy as I continue to make the supervision of students a priority. They are only with us for 4 weeks and during that time they have so much to learn and must become competent in all areas of normal physiological birth. Finding sufficient ‘normal’ births so that they all may reach their quota has proved to be extremely difficult. We are attending so many complicated births and seeing so many pathological situations that would never be seen in the first world. Foetal abnormalities that would have been picked up on scan but are not diagnosed until labour, premature births, dangerously high blood pressure are just some of the many situations we encounter daily. So I try my best to teach, to repeat, to show and to encourage the students so that they too in the future will teach others.
My days start at 6am. After dropping Lucas at school I am at Bwaila by 7.15am. This is always a difficult time as the night staff are very tired after their 15 hour shift and keen to get home often leaving many problems to be sorted out by the first day staff to arrive. And that is usually me! After a quick handover when I try to take stock of the situation I start to prioritize. On many occasions I find that there are a least 3 or 4 women who need immediate attention. The day staff have still not arrived and I find myself alone. A grand multipara (8th baby) in room 6 has been pushing for 3 hours, A primipara (1st baby) in room 2 has been fully dilated with foetal distress since 5.30am. In room 3 another primipara has not progressed in 6 hours and Room 4 has been waiting to go to theatre for 2 hours for a c/section but the theatre is busy. I am not exaggerating....this is the reality of Bwaila almost every day. The next time I look at the clock it is nearly 11am. Deciding which to attend myself, which to delegate and which to teach can be difficult. I try to look at the bigger picture and share my knowledge and expertise but very often it just seems so much quicker, easier and more effective to do it myself. The hours and days fly past and the weekend comes round again. How I love to spend time with Lucas, my friends and in my home for those 2 short days before going back to the never ending succession of needy women and babies at Bwaila. This still remains the hardest part of working at Bwaila. Never finishing, never doing enough, always with the feeling that there is so much more to do, so many more women and babies to attend.
Although the new unit has 2 operating theatres we have not been able to open the smaller one due to lack of staff. It would need a totally separate team of nurses, doctors and anaesthetist and this we do not have. As a result we are daily having to make choices as to which mother or baby should go first. The choice is often extremely hard as taking one may lead to the death of another. We have found ourselves in this situation many times this past 2 weeks and women have been waiting for up to 4 hours or more for their ‘emergency’ c/section.
As the main referral unit for the whole of the Lilongwe area, which can stretch up to 80kms away from the hospital, we are daily attending the mothers and babies sent from these outlying areas. The road access to these centres is almost inaccessible especially now in the rainy season. The journey to the main road may be as much as 20 to 30 kms. thus delaying the arrival of these women to our unit. I was horrified to receive 2 women both in the last stages of labour after a delay of 6 hours. The referral was made at 8.15am.... they arrived at 2pm. I always treat these referrals as a priority. On examining the first women I found her to be fully dilated and ready to push. She had been referred as her labour was not progressing. ( at 8.15am!) I could not hear the foetal heart, I quickly scanned here to confirm my findings. Just 10 minutes later she pushed out a dead baby.The second woman had been pushing for many hours.The theatre was busy so I decided to try and assist with vacuum extraction. I tried and I failed. Already prepared for theatre she was taken at 3pm. The baby was extracted alive but died minutes after birth. Two transfers two dead babies. I needed to know why? Why had it taken so long to bring these babies to us?
The ambulance had to negotiate more than 20kms. of dirt road full of pot holes and mud. It had crossed two rivers. The ambulance broke down on the way. The women were waiting for 4 hours on the side of the road for another ambulance to arrive. This is the care that the poor women of Malawi are receiving. They have no voice to complain and their cries of sorrow are not heard.
The problems with my funding are still not totally solved but I have been promised that it will be sorted this week. Things are getting a little tight as I wait for the money to be made available but I remain positive and confident that I am still in the right place, I am still where I am most needed and will therefore continue to love and care for these women and babies as best I can
Thanks to the amazing generosity of our good friends and neighbours Zaida and Vincenzo we were able to spend a beautiful weekend in their cottage on the shores of Lake Malawi. This is just what I needed to reflect, rest and prepare myself for the following week. A trip out in their boat to a small island where we could swim and snorkel in the clear fresh water of the lake, appreciate the beauty of nature and remind myself once more how much we have and how rich our lives are... for that I am grateful.

ONE PERSON CAN MAKE A DIFFERENCE AND EVERYONE SHOULD TRY

I know it’s been a long time since I last wrote to you all. Gone are the days of writing every week. What has happened? Why is it I can’t find the time to sit down and write to you of my joys and my concerns, my smiles and my frustrations, all that goes along with living and working with the people of Malawi? Things have changed for us over these past two years as we have settled down to making friends, getting a home together, attending school, weekends away at the lake and all that makes up a busy life here in Lilongwe. Sometimes I yearn for the simple way I viewed things and approached situations when we first arrived. Without the inside knowledge, that I have now, the deeper understanding of the situation here in Malawi, the role of the aid organizations and government bodies, the immense poverty and oppression of these lovely people, it was all so much easier. But the very nature of learning and understanding brings with it the realization of one’s smallness, the stark reality that however much I do, however much I give, it will never be enough. It brings feelings of deception, of use and abuse, of sadness and sometimes of hopelessness. These people deserve more, they deserve what I expect for myself but it is not possible and finding my way to live with that is sometimes so difficult. Mostly they have few expectations and demand little. My expectations for them are much more, are much greater than theirs, which means that I am daily coping with conflict and confusion within myself that leads me to sometimes setting unreachable goals and unattainable targets. Maybe that is why I don’t find time to write? Does that all sound rather negative? Maybe sometimes I do feel like that but certainly not always. I have always felt that I was clearly led to Malawi, to Bwaila, to the work I am doing and as my role and responsibilities have developed I have been challenged and excited to continue. I was prepared and happy to give at least another 2 years to help develop the potential and possibilities given by the new maternity unit. However, since I returned from Christmas in Europe I have not only had to face the continued daily challenges, frustrations, traumas, sadness and sheer hard work of Bwaila but have been having a difficult time sorting out my contract and funding. I had thought that I was assured a further 2 years funding but it seems I was mistaken. So as I write nothing is sure, nothing is certain except my inner conviction that I should be here, that I still have much to offer and I will not give up.
‘Ever tried. Ever failed. No matter. Try again. Fail again. Fail better’
As has happened in the past I had left instructions and had been given promises that outstanding works and deliveries would be completed whilst I was away. I don’t know why I was surprised to find on my return that very little progress had been made. There are still some items that havn’t been delivered and poor workmanship in the building and installations that needs to be followed up. Unfortunately the DHO who are now responsible for the new unit have very little government funding for administration and maintenance. The new unit is at least 4 times bigger than the old needing 4 times the maintenance. There is much more equipment meaning many more machines that can breakdown or go wrong. The fact is that they were unable to cover these areas in the old unit (much smaller and much less) so it is not surprising to find that the new unit is proving to be a huge challenge.
I will continue to hunt for funding to assist with the maintenance issues. Since returning I have worked on completing a list of outstanding repairs and damages and poor installations. I was horrified, but not surprised, on inspection to find many areas in need of important repair work only 3 months after moving in. The constructors will cover most, but not all, of these things during the first year but after that....what?
We had been waiting, since the opening, for the delivery of 7 new neonatal resuscitaires for the labour ward, theatre and nursery. The delivery had been finally promised for 18th December. They had not arrived when I returned in January. One of my first tasks was to check up on these. Can you imagine my joy when I finally unpacked and installed these last week? I felt as if someone was bringing me a personal Christmas present! The brand new photocopier was still sitting in the office, not yet unpacked. After 2 e-mails and 2 phone calls the Minolta agents for Malawi arrived informed me of the missing items and the cost of installation and left to await my call. The DHO are now responsible for this but as usual funds are not available. Fortunately I still have some money that I have been given by kind donors and will get it set up and working next week. The new anaesthetic machines are causing problems. Having been supplied from Germany it is not altogether straight forward when needing to find replacement parts. The old machine is still in use, it has half the possibilities but it’s familiar and comfortable to use! 2 of the 6 suction machines were not working. The Autoclaves for sterilizing instruments, installed just before I left, are functioning sporadically. Fortunately the representative for the suppliers ( a Brit.) once informed, does his very best to solve the problems. Unfortunately the general habit is to leave the non functioning items in a corner collecting dust and continue either with the old or make do without.
The on-going in-service training that I have been leading for the past 2 years was stopped just before I left to be taken up immediately on my return. This forms an extremely important part of life at Bwaila. It has become, over time, not only an important time for building practical and theoretical knowledge and training in life saving skills, but also for team building, motivation and moral boosting and generally keeping the staff together. Helping to maintain a team spirit is a huge challenge, hence the importance of these regular meetings, discussions and teaching sessions. Unfortunately there has been some mix up with the funding from UNICEF due to a duplication of projects. This has meant that the sessions have not yet been commenced. The staff enquire daily as to when we will start again. They too realize its importance. As I have commented before it is difficult to get people to attend any sort of training or meeting without receiving an allowance. This has become an integral part of Malawi life in all sectors. Invented by some NGO at some time to ensure good attendance it has become the nightmare of any person who is trying to encourage personal and professional growth without the need of economic reward. Last Thursday I was absolutely thrilled to lead a meeting of our Team Leaders/charge nurses without any allowances. I could not have done this without the help of the matrons who encouraged the midwives to attend. I did but them all a Fanta or Cocacola though which was greatly appreciated. This was a huge step forward and made me feel very good. These are the small things that continue to occur daily which give me the courage and strength to carry on.
I am trying to get back onto Labour Ward full time or as much as possible without completely dropping the other areas of higher management, administration and other responsibilities that have become part of my work and to which I am looked for to support the management team. I do just love being with the women and babies and being there this week reminded me of that. I hope you will be getting a few more stories from there in my next blog.
Until such time I will end by telling you that Lucas has settled back happily into school and social life. He is now in the junior squad swimming team and the junior football team. Time flies by, the rainy season is well underway and the maize is growing in the fields. Some areas of Malawi are not so fortunate and already having problems with their crops. This time of year is always a difficult time for the most poor as last year’s maize is running short and the harvest will not be for several weeks. The prices rise and many people in the villages become hungry. I am still supporting 2 lots of twins and the triplets who come to visit me regularly at the hospital. Pilirani’s twins will be 2 years old on 14th February I will drive out to the village to visit them and take some gifts.
I cannot end without telling you that on Friday we were presented with details of the Bwaila maternal deaths for the month of November 2009. I knew already that the numbers had been high. When auditing the case histories it became clear that the majority were young, had chronic anaemia, arrived very late at the hospital for assistance, had suffered severe haemorrhage, blood was not available and if so not enough to save their lives. These women had died in childbirth due to POVERTY. In 2010 this is a harrowing thought, with all the money and aid that is being poured into the developing countries this is still a reality.
I hope this blog has not been too negative. I find it thoroughly therapeutic to write down my thoughts and feelings. Those of you who know me well also know I am strong and determined. When I compare myself to my Malawian Mums I am very fortunate. Think of me often......for me I ask no more......but for them?
PS. Christmas with our family and friends was just wonderful. Just thinking of them and their love and support makes me feel good. My children are just such a joy to me. From Alasdair’s exams in his final year of Veterinary Studies, Fiona’s rollercoaster life and love and trying on wedding dresses and planning weddings with Katy who will be married next winter, I am kept busy and entertained with much to think and worry about as a mum. My Mum who shows no sign of her age or giving up on her hectic life (guess I must get it from somewhere!) continues to worry about me as if I was a teenager. I am looking forward to seeing her plans in the Spring if her plans work out. It will be a big challenge for her but I know that being able to see for herself the life and needs of the people she has been supporting for most of her life will be a real thrill for her. Not to mention visiting me and Bwaila.

CHALLENGES AND ACHIEVEMENTS

I am writing from the executive lounge, Nairobi airport. We very soon learnt that by paying 20usd we could make use of the lounge. Comfortable sofas to lie out on, drinks and snacks, internet access and a rather more peaceful atmosphere than the busy 'corridor' of duty free shops that makes up Nariobi airport. Any of you who have travelled through Kenya from Malawi will understand the how well spent are those dollars to achieve a rather less stressful 6 hour wait!
The past few weeks have flown by as I bravely struggled to achieve my three main aims before leaving for Christmas holidays. 1. The newly installed autoclaves would be up and functioning.
2. The oxygen supply would be piped to the resuscitation areas. 3.The 7 resuscitaires ordered several months ago would have finally be delivered. Well I didnt actually fully achieve any despite all my incredible attempts, phone calls, e mails, personal visits. I think 'frustrated' will be the word that describes how I have felt recently! Nothing went according to plan, delays due to shortage of FOREX or fuel were constantly cited as valid reasons for not delivering anything. True or false? I don't know but 'This is Africa' and therefore to be expected. Once more I am leaving having tried to 'organize' everything and leave all 'under control' How it will be when I return ? I dont know. No expectations, no disappointments! everything is promised and everything is nearly there!
Inevitably we are experiencing some minor problems with the constructionsince we opened. The contractors are not on site which makes it much more difficult to solve the daily difficultied which arise. The electric installation in Labour Ward seems to have some more serious underlying problem which I am hoping will be solved whilst I am away. The e;ectricians have been called on numerous occasions including nihts and weekends but don't seem to have actually found the root cause of the blackouts that we are experiencing all too often. I was amazed at the ability of the midwives to cope on the occasions that the electrics have failed in the middle of the night and they have failed to contact the electrician. During one of those occasions they were also without water as the tap had fallen off in the shower and the plumber had helpfully turned the water off to prevent the flooding thus leaving the whole Labour Ward dry. That night three midwives and one clinician delivered 28 babies, 4 c/sections, 2 breech births and twins all without electric or water. Unfortunately the night did not pass without incident and as often happens, whether to lack of staff or services all outcomes were not good.
Our in-service training program continues. We are loooking once more at very practical everyday situations that occur on our wards to keep the midwives updated and familiar with emergency procedures. I also set up a full day training on Neonatal Resuscitation which was attened by around 50 members of staff. We repeated the sessions 5 times during the day spending the greater part of the time on practicing on our special resuscitation dolls. This was well received, hopefully leading to better techniques on the ward.
Our results have not been good during the past two months. Birth asphyxia is an all too common occurance. Our nursery is overloaded with babies, up to 60 babies in a unit intended for 20. We delivered a record of over 50 babies in 24 hours last week with just 4 to 6 nurses on each shift. Lack or midwives continues to be a huge concern. The Malawian government are reducing funding in 2010 for midwifery training so we are wondering how we will cope and what the future will hold. Trying to get the Malawian midwives to openly admit that they CANNOT do their job well with so few staff is very difficult. When considering our staffing needds for the new unit we decided that we needed a minimum of 8 midwives on Labour Ward , day and night to be able to attend the women and babies SAFELY. This is not being taken seriously. Most health workers of all levels find it almost impossible to be seen to be criticising the government. I have been involved in negotiating for the funding of midwifery training for next year and so far we can sponsor 31 candidates. If anyone is interested in supporting this please contact me. It costs 2.000 euros to sponsor one candidate for the one year midwifery speciality.
On a personal note we moved into our new house on 1st November and have settled in well. What a difference it has made to us both to have a house and garden of our own. Lucas spends all his time collecting all manner of insects and reptiles and putting them in boxes. He has space to play football and run freely. The terrace looks out over the Lilongwe river and open fields so most of the day we feel a welcome breeze. I have had to take on the responsibilty of 'staff' which is a new challenge for me. Lucas' nanny is still with us but has taken over as nanny/housekeeper. I dont know what I would do without her. Alex and his wife live in the 'staff quarters' and serve as day guard and gardener. Actually he hasnt got a clue how to garden,nor much else either but he is friendly honest and always happy! We took over 'Mr.Phiri' as night guard from the previous tenant. Rather older, supporting 9 children (he apprently had14 but the rest died) he works 7 nights a week all the year round and apprently has done for many years ( who says babies are made at night!). He has taken quite a 'shine ' to me, washes my car daily, tells me when the curtains arent completely drawn, controls the outdoor security lights, and reminds me to set the alarm when I go out. I have increased his wages supplied him with tea and sugar and biscuits every night so in return he has taken to truly 'looking after me!'
We hosted our first party in two years for all our friends. I spalshed out on hiring a live band who really made the party a great success. I even stood up and sang some Simon and Garfunkel so it must have been good!
It has been an intense, tiring, challenging, frustrating but happy few months. Despite the huge challenges I have faced I believe much has been achieved. I am ready for a time of recovery and reflection before starting again in the new year. I am looking forward to our family Christmas of fun, laughter and lots of love.
Wishing you all the same....................

5 WEEKS LATER

It is now just over one month since the new unit became fully operative. Time flies by so fast and though I had hopes of being able to slow down a little once the unit was opened this has not been the case.
On Monday 19th October we started the big move from the old to the new unit. Although only 200m distance it was a huge job making sure that patients and equipment were transferred in the right order. We had planned for it to be done over three days but in the end we were able to complete in two. The last to move was the operating theatre and the sick babies on nursery. There was a period of 12 hours when we were operating two labour wards, two theatres and two nurseries! With an already depleted staff this was no mean feat. Most of the equipment and furniture had been supplied new or good quality second hand from a large container from Norway. This meant that only a few essential items that had not arrived or others that could be put to good use from our old wards, would need to be transferred. In practice that was not the case as we found that although basic needs were covered it was good to ‘double up’ on many items from the old and the new. Our 146 bedded unit soon became a 180 bedded unit as we pushed extra beds and cots into all areas. We are hoping that with the imminent opening of the new high risk unit on the Kamuzu Central Hospital site our numbers will reduce and we can use the buildings as intended. It is true to say that even with the extra beds we still have infinitely more space than we ever had at the ‘Old Bwaila.’
The ‘move’ didn’t all go exactly to plan but then it wouldn’t be Malawi if it had! By the end of day one almost everything was prepared but the resuscitaires for the babies had not arrived ( and still havn’t ...another long story...I believe they are somewhere between Brazil and Malawi on a container ship...if they havn’t been hijacked by pirates!) By 4pm. most of the staff were finishing their shift. There was no transport to be found. Refusing to allow the nursery and labour ward to be working without the necessary equipment Dr . Kind ( our new German obstetrician) and myself were to be seen pushing these machines over the bumpy ground all t5he way into the new unit tobe installed. The following day the same thing happened but this time with theatre equipment. Once again he and I manually transferred the anesthetic machine and huge oxygen cylinders into the new theatre. What a sight to see two ‘msungus’ (white people) pushing a huge oxygen cylinder on a patient trolley!
And so it was that at 8.50am.the first baby was born in our new delivery rooms. I just missed that one, arriving as the head popped out. But I was not to miss number two at 9.50am. I proudly assisted the birth of a boy to Ndaona Jonathan, weighing in at 3.600kgs.
Since then things have been totally hectic. All the usual problems heightened by the new environment which although completely superior, is, to most of the staff, totally unknown. Of course many building, electrical, plumbing faults became obvious when starting to actually use the buildings. Mostly these have been solved by the constructors whilst under guarantee, but others have been due to poor use of the services. We have continually found the drains blocked by bits of cloth and other debris. Many of our women are not used to mains drainage and flushing toilets, thus dispose of their rags, as they would at home, into the hole! We have had a couple of emergency runs for oxygen cylinders when the electrics failed in nursery and labour ward. We have an automatic generator which cuts in when the power supply fails. Unfortunately if it just ‘trips out’ in one area this does not happen. If I did not know before, I am now fully aware where the electric box is situated on every ward. I have assured that the ward staff know where to find the switches in an emergency and how NOT to lock the door to the room where it is situated and then not have the key available! Is has been good to see some enthusiastic and motivated midwives who are taking care and pride in their new work area.
Having spent the past months sorting out the buildings, equipment, training, etc. interacting on all levels with just about everyone involved it should not have been surprising to find that after the opening of the unit I continued to be called upon to sort out and solve everything! It soon became clear that many of these responsibilities could and should be taken on by others. In any case all I wanted to do was get back on labour ward where it became very obvious that the organization of the new environment was something of a challenge for the senior staff. With the new possibility of each woman birthing her baby in an individual room with intimacy and privacy came the probability of her birthing alone behind closed doors. The presence of a guardian/partner to accompany her HAD to be encouraged. But this too was a new concept.
Just at the right time appeared Brenda! She is British ICU nurse who had come to ‘help out’ She had no idea what she had come do but without her we would not have achieved the half of what we have during the past month. She became my personal assistant as well as using her ICU skills to train up some of the staff in the use of the new equipment. I shall be forever grateful to her. Realizing that I should off load man y of my more administrative tasks I set about meeting with the District health Authority senior managers and we were able to put together a new Organigram for the unit. This I presented to the staff on 12th November. Although this does not mean everything gets done, it does mean that there is some structure as to who is responsible for what and who is ‘in charge of what.
I still have many administrative things to clear up and supplies to chase as some furniture and equipment has still not arrived. Getting the telephone system working has been one of my biggest achievements and although now in working order some thought (and money) needs to go into supplying extensions to other areas. The oxygen instalment has been a constant head ache for me. The company that supplies this has a complete monopoly in Southern Africa which I guess allows them to do what they like, when they like and how they like! This is still not over but we are VERY near to completion!
On the Staff training side, it has been great to work with our partners CESTAS (an Italian NGO.) They have accommodated ALL the on- going in service training, that has been necessary, with very generous funding. This has allowed me to set up training for all different cadres. Midwives, ward clerks, cleaning staff and clinicians are all being covered. We are also continuing our weekly Team Leaders sessions where we are able to discuss the challenges that are occurring daily in the ward situation as well as recognizing the positive aspects and rejoice in them!
Finally on 16th November I donned my ‘scrubs’ and went back on labour ward. Just for the record, my name has been incorporated in the Organigram as one of the charge nurses on labour ward. This is hugely significant for me as I am formally accepted as one of the management team. Having worked my way into this role alongside my Malawian colleagues gaining their respect and trust I have now been rewarded with a formal recognition. The first week I seemed to be more off than on the ward but I guess that was to be expected. It would have been impossible to drop all my previous responsibilities so I am gradually handing over. Today I have spent nearly all day there and have been very encouraged to see the midwives respond to the new challenges. As time passes it has become evident where the short falls are and I have tried to introduce simple ways of dealing with them. These have been well accepted and mostly implemented.
Overall things are going well. We still have many challenges not the least to reduce our cases of birth asphyxia. We are approaching this in our training sessions and in the clinical areas. We will keep trying.
I have never been so in need of ‘timeout’
I believe our planned trip to Europe over Christmas will be beneficial both for me and for the unit. I will rest and recharge surrounded by the love of my children and family and Bwaila will learn how to be without Rachel!
As a footnote......I popped in to see my triplets last week and they are doing just fine. Strong and healthy a credit to their Mum and extended family.

OPEN AT LAST......WELL NEARLY!

Today is Mothers Day here in Malawi. It is a national holiday. It is good that we celebrate the mothers of this country, their strength, their commitment and their love, even under the most difficult of circumstances. And circumstances are very difficult here for women. Being a mother in Malawi is dangerous. Over 800 in every 100,000 Malawian women will die in pregnancy or childbirth. Many women are already suffering from underlying medical conditions (chronic anaemia, mal nutrition, Hepatitis, AIDS, etc.) when the strains of pregnancy and childbirth are added to this, becoming a mother moves from the physiological into the pathological, from ‘normal’ to ‘dangerous.’ Lack of health care facilities, equipment and medication, huge difficulties in accessing the hospitals also adds to the problem. But of course the biggest challenge is the staffing. Never sufficient doctors and nurses to attend these women, overstretched, tired and demoralised the care is often far less than it should be and women die unnecessarily.
As I write I am looking out onto the waters of Lake Malawi. It’s a warm but windy morning. The sun is shining over the lake in front of me and I can see Lucas throwing his line and patiently awaiting his catch. Fishing is his passion. As soon as we arrive he sets up his lines and there he stays for hours. Yesterday evening was a great success, having caught more than 16 ‘little’ fish he is inspired and encouraged this morning! However, like any true fisherman, it doesn’t seem to matter that much if he doesn’t catch any!
I decided at the beginning of the week to spend these two days with Lucas at the Lake. This week is half-term holiday from school. The past weeks, since returning from Europe in August, have been totally hectic. I have been working 7 days a week and often 12 hours a day preparing for the opening of the new maternity unit at Bwaila. I have felt increasingly physically and mentally exhausted and so overwhelmed with the enormity of the task I have undertaken I sometimes become lost. Where is the way forward? Where do I start this morning? Which of the multitude of tasks is the priority? It is so easy to become frustrated, annoyed or angry. Things just take so long, are poorly done or not done at all. Promises are made and not fulfilled. Responsibility and accountability is hard to find therefore even more precious when shown. Recently I was asked by a Norwegian visitor if I was still positive, encouraged, enthusiastic, and energetic? The answer despite everything is quite firmly, ‘Yes!’
‘Let the fire in my heart, let the wind in my sails, let my reason to live......be love’ and if you want my definition of love you just have to look at the bible....1 Corinthians 13. Love is patient and kind. Not jealous, boastful, arrogant or rude. Love does not insist on its own way. It is not irritable or resentful. Does not rejoice in wrong but rejoices in right. Love bears all things, hopes all things, endures all things. Love never ends.
I’m not saying it’s easy, nor that I manage it all the time, in fact sometimes it’s very difficult and I have to keep reminding myself, but there it is and the closer I try to keep to this the easier it is and the happier I am. It’s about self becoming less important, about looking at the bigger picture. It’s about lots of individuals becoming truly more loving to make up a better world.
At 8am. 1st October, (Fiona’s birthday) after many setbacks in all areas, the Family Health Unit (Out Patient Department) finally opened its doors to the first mothers for their antenatal, family planning, postnatal, immunisation etc. care. It was a truly emotional moment for me. Up until 4pm. the previous day it was still not clear if we would open as some official checks were still not completed but we went ahead. The benches for the waiting area, promised the previous evening, had still not arrived at 7.55am.despite several frantic phone calls on my part. The matrons were eager to let the women in. ‘The lorry is coming through the main gate! ‘I shouted. Benches and women arrived together! Having arranged for the touch screen electronic registration equipment to be transferred the previous evening (I was still on the unit at 8pm.) I was horrified to find that it wasn’t working the next morning. A frantic phone call to the experts assured me they would arrive within the next hour. In the mean time the women were crowding in through the doors but with no way to register them! I decided to take a look. Now my knowledge of computers, as my children will tell you, is not extensive, nor of car engines, but I do know what a car battery looks like and I found two of them somehow linked to the system. Following the cables, as if I was jump starting a dead car battery, I noticed that one of them had become unattached. Red to red, negative to negative.....hey presto and it worked! The curtains came off their hooks, (more DHO workmanship!) the keys to the male and female toilets were identical, causing some embarrassment, the baby weighing scales got hung over the first available door frame, the painter was still precariously balanced on some stacked benches finishing off the health advice and pictures he was beautifully painting on the walls but still the women crowded in and still they sang and danced. More than 400 women and babies passed through our doors that day. It may have seemed like chaos, more or less organized, but all went well. (Malawi style!)
The next challenge was to get the unit ready for the official opening on 7th October. We had already decided that the inpatient side (Labour Ward, theatres and wards ) should not become functional until 19th October when Tarek returns from the FIGO conference in S. Africa. However the two were completely inseparable as the unit should be fully furnished and equipped for the ceremony just leaving a few final details and practicalities to be tidied up for 19th. It was a huge task involving many people, ministry and health departments, suppliers of equipment and services, on site workman, far too many to mention. Some were helpful, some unhelpful, some amazing. Some cared, some didn’t bother, some put themselves out, some did not respond. I pushed and shoved, nagged and pleaded, praised and hugged, laughed and cried as I desperately tried to pull it all together.(Officially known as the coordinator!)
I have never seen so much movement and so much achieved as in the final 3 days before the grand opening! Saturday 3rd saw more than 70 cleaning staff of the unit. Meetings with the MOH and the Vice Presidents Office resulted in numerous visits and checks during the next two days. Official protocols had to be applied to strictly for a full presidential event. Dr. Mary Robinson (ex president of Ireland and current UN Commissioner for Human Rights) was the honoured guest and together with the Vice President of Malawi (Hon. Joyce Banda) would open the unit. The flag pole was erected and the Malawi flag flew proudly at the entrance to our new Maternity unit. The dignitaries arrived early so that they would be in place to greet the Vice President. A grand tour was made of the whole unit led by our DHO Dr. Ndovie. It was an exciting morning, all comments were extremely positive both as to the quality of the unit and the success of the event. The plaque was unveiled and speeches made. Both the speech made by the director of TRP and that of Dr. Robinson were stimulating and challenging. The VP, in her words, showed her surprise at the scale and the quality of the project and its possibilities and potential for improving maternal and child health and addressing the high maternal and neonatal mortality rates. More importantly she pledged her personal and on-going support not only for Bwaila and maternal health but for the women of Malawi. It was a great occasion supported by singing, dancing and ‘Gule Wankulu’ in true Malawian style. You can read more about the occasion on the Rose Project web site. www.
It was a great honour for me to be personally greeted by the Vice President. It was also a huge privilege to be invited to spend some time with Dr. Mary Robinson not only during the ceremony but on other occasions over dinner. Listening to her speak of her international work on Human Rights and especially those of the mothers and babies in the poorest countries of the world I felt encouraged to continue to play my small role in Lilongwe.
The following day there seemed to be a general feeling of lethargy. I spent most of the day sorting out more than hundred and fifty keys that I had in my possession for ALL the locks in the whole unit. I was keen to get at least some of them handed over to the matrons so that I would not have to be solely responsible for opening and securing the buildings every night and morning. As you can imagine this has been very tiring and time-consuming. At last I handed over the keys to the matrons on the FHU on Thursday afternoon just keeping a main door lock and my office. On Friday Lucas started his half term holiday so I decided to stay a little longer in bed, arriving at Bwaila at 7.40am. Rather later than usual. To my surprise I found a vast number of people waiting outside the unit cleaners, nurses and many, many, women and babies. The keys had somehow got left inside the unit and they were all waiting for me to arrive. No one had phoned me, no worry, no rush......this is Malawi!
It was still difficult to get things moving again on Friday and I began to be concerned as to how I would find the necessary to motivate and build up enthusiasm, once more. Just one week before the women would be admitted, just one week before the babies would start to be born in our new labour ward and the place was empty of personnel. There was still much to be done, pharmacy supplies to be ordered and delivered, instruments to be sorted, packed and sterilised, oxygen cylinders to be filled, the wards had to be kept clean and the linen supplied and beds made among many other things. We had organized a ‘simulation’ to take place on the Monday afternoon. This is to ensure that we can respond to an emergency situation that everything is in place for the safety of the patient. How was I to get it all done? Here I must mention Audny. As the Norwegian hospital technician and procurement person she has been heavily involved throughout, though mostly from a distance. The times she has spent in Lilongwe have been a ‘godsend’ for me as she takes over responsibilities for the equipment and it’s functioning plus a many other things. I must admit to doing a bit of shouting and harassing that day which is not the best way and definitely wasn’t very loving or understanding! I decided to take the whole day off on Sunday. It was clear that nothing more was going to get done before Monday.
So here we are in the final days before the REAL opening. It’s exciting, it’s scary, it’s worrying, and it’s incredible! As I sit here and write to you from the peace and beauty of the lake I am thinking of how much more I need to sort out before Monday. I can’t believe we will ever be 100% ready but we WILL be safe. The transfer of patients will take place over three days. That will mean that the first baby will be born in the new Bwaila maternity unit on Tuesday 20th October (Alasdair’s birthday)I can't wait

100% CHALLENGED

Lucas left Lilongwe at the beginning of June travelling to Valencia with his cousin Abigail to spend five weeks with his 'Papa' I was able to make full use of the following two weeks to concentrate fully on the coordination of the furnishing and equipping of the new Bwaila maternity unit. The procuring, ordering, confirming and delivering of each and every item necessary for the setting up of a unit of this size is a huge task. It has been and still is a challenging and often very frustrating process but I feel confident that it is now all 'coming together' and we will be ready for its opening during the month of September. I left Malawi on 18th July for my planned holiday break in Europe. After spending five wonderful days with my eldest daughter, Katy, in Leeds, UK, one of which was spent relaxing and being pampered in a health 'spa,' I flew to Valencia, Spain, to meet up with Lucas and my other two children, Alasdair and Fiona. Needless to say I have enjoyed every minute in the company of my children and friends. The love and support of these people, who are so important to me, reaffirms my conviction that my decision to stay in Lilongwe to continue the work I’m doing with the women babies and midwives at Bwaila is correct. Being in a first world country during these past weeks has not always been easy. It is difficult to completely forget the poverty and conditions from which I have come. It is especially difficult for me when I am in one of the many large, busy, shopping centres. My mind strays back to the villages, the hospital, the people of Malawi and it just all seems too much. How can some have so much and others, just a few hours flight away, have so little, have nothing? How can some people be so preoccupied by material trivialities when others are struggling to feed, clothe and educate their children. How lucky you are that you were born into a rich world that your worries are mostly about the extras and not about the basics, about luxuries and not about survival. I wrote the above soon after arriving back in Lilongwe at the beginning of August. Since then I have often thought about you all and needed to communicate with you but have quite seriously not had the time nor the energy to do so. These past four weeks have probably been some of the most challenging of my life. On my return to Bwaila I was hugely disappointed to find that, despite the huge efforts I made before leaving to assure that outstanding work would be finished or at least well underway for my return, practically nothing had been done in my absence. The jobs that needed to be done ‘on site’ and that I expected to be finished had not been touched and the suppliers of various pieces of equipment and furniture had achieved very little. It was then I decided to dedicate myself full time to pushing and shoving, nagging and pestering, phoning and visiting with a determination that all those who know me will understand. The official opening date of the unit has already been set. October 7th.The unit has to be up and running before that date and I for one was prepared to move heaven and earth to achieve it. And that’s what I have and I am still doing. Moving heaven and earth! Or at least it feels like that. If you’ve never lived in Malawi, though they tell me other African countries are the same and to be honest I guess pulling together this sort of project anywhere in the world would not be easy, maybe you wouldn’t understand, but the Spanish ‘manana, manana’ takes on a whole new meaning here in Lilongwe. I remember back more than 15 years ago when I was involved in setting up a new business venture with my (ex) husband, Andrew. New to Spain and with very little of the language and less knowledge of how the Spanish system worked, the job of sourcing and procuring every little piece of equipment, nut, bolt and curtain hook, for the farm, was my main job. I still remember the huge frustrations of never finding anyone when they were needed, of waiting days and weeks for things that were promised for the following day and finding that many items were just not available. I think that experience has helped me infinitely for the challenges I am facing now. My knowledge of building work, bricklaying, guttering, plumbing, electrics, drains, sockets, taps etc. increases daily. Not to mention the more specialized areas of autoclaves, theatre lights, piped oxygen and anaesthetic machines. Then there’s the procuring of furniture and equipment. I mean, just how many chairs are needed for a 146 bedded maternity unit? And stainless steel trolleys? And why does all the locally made equipment, beds, swab racks, bed pan racks have to be ‘epoxy coated’? and anyway what the heck is ‘epoxy coating’? Just ask me any of this now and I have the answers!I was very happy when the District Health Authority agreed to take on some tasks such as the building of concrete wash tubs for the women to wash their ‘chitenges’ The making of ‘curtain boxes’ for all of the windows and the building of a new road. The unit has been totally funded from outside of Malawi. Mainly from Ireland through The Rose Project but also with Norwegian partners. It will be given to the Malawi government to be run as a public, non paying District Hospital. It was therefore encouraging to see them show their interest in this way. My enthusiasm was somewhat dulled after the new entrance way collapsed and had to be remade. During that time we could not let any vehicles on site for 7 days. I started to panic thinking that I would have to cancel the delivery of materials and equipment which could delay everything. Silly me! The delivery trucks continued to arrive. They parked at the entrance and as if from nowhere there appeared more than ten very fit looking guys who carried the boxes, bags etc. sometimes on their heads, into the unit making several trips with often very heavy loads. But this is Malawi and I shouldn’t have worried. Then when finally they could drive in the lorry carrying the bricks and materials veered off the road onto the pavement smashing the recently laid paving slabs. Not once but twice! I had always been a little Sceptical of the driving skills or lack of but this was just amazing! However I think the best example of the hospital maintenance standards was when I passed by to see how they were getting on with the construction of the wash tubs. Now I am really not an expert but I do know that the water and drains are normally laid before and not after the concrete base. I respectfully enquired but was assured that they knew what they were doing. It was only once the tubs were built that it became clear that the plumbing would now have to be with external piping! It doesn’t look so good but I am assured it works! But that wasn’t the end of the story.... The following day I ’caught’ them on the point of connecting the permanent water pipes to the contractor’s temporary water supply. (An over ground piping that will be removed once the builders leave.) At least I got to that one in time and the proper connections were made. These are just a few stories of the many I could tell you which have caused me to laugh and despair. There are also many more that have been so very encouraging. We have a wonderful site foreman (George) who has always been at my side, listening, understanding, organizing, laughing, despairing, building up and knocking down, putting in and taking out, but always good humoured and willing to help. I have built up a lovely relationship too with many of the workers on site. The only female brick layer, who does a beautiful job, greets me every morning by name and with a huge smile. The gardeners who brought roses to plant just because I wanted them. Not to mention Fyson,the guy who holds the keys. There are more than two hundred keys, two for every door and cupboard on the unit but somehow he knows them all. Actually he’s the second guy to hold the keys and only since July. The story of Andrew, who I have known for over a year since I first started became involved in the new unit, is a long one which is definitely worth telling. This is part of a mail that I wrote to Tarek, soon after the incident, that I thought I’d share with you.... ‘’It’s a huge job I’ve taken on for The Rose Project and I often just wish I was back on labour ward. So much just doesn’t depend on me so I have to cope with the frustration of not getting things right because of someone else. As you said, I can’t change anyone else I can only change me. So I’m having to learn how to cope with so many things that are totally out of my control. I know that’s what you have to do and I am appreciating how hard that is. I have so much more to learn. But that’s not why I sat down to write at this hour. Maybe I’m putting off the moment as I’m not sure if I did the right thing. When I went on site this morning I couldn’t find the guy with the keys. He’s a young lad, always very friendly helpful and we have struck up a relaxed and fun relationship over the past year. I don’t know much about him but I have always had a good feeling about him. I eventually found out that he had been taken to the police station yesterday having been accused by the security guards of stealing a bag of second hand clothing whilst the Norwegians were sorting it all out. ( A huge amount of sheets, material and clothing came over in the Norwegian container.) I was surprised and horrified that he should be locked up in jail without any official charge against him. They also told me he had been beaten up. The charge had to be made by the DHO or myself. I couldn’t do it. I couldn’t bear to think of this young lad in the cell now for nearly 24hours and I couldn’t bring a charge for ‘possibly’ taking a bag of second hand clothes. I think I did the right thing? My instincts told me that I couldn’t leave the country knowing he was still locked up. So I went and got him out. I tried to do it the right way. I went to the security firm, I phoned the DHO to get his support and the guy from the security firm came with me. So I got him released. It wasn’t too difficult. I was so naive that I didn’t realize until I was told afterwards that the police officers were probably waiting for me to give them money, so they didn’t get any! Well, Andrew is out of jail. I spoke to him briefly. He is just so young and was very quiet with me. He thanked me but he could hardly look me in the eye. I felt very sad as I have no idea if he is guilty or innocent. Of course he shouldn’t steal, but it was a bag of second hand clothes! He probably has nothing and the temptation was too great. God knows what I would do if I had so little. Would I steal too? Would you? The foreman says they have always trusted him and will probably put him on another site to work. I hope so. I said he shouldn’t come back to Bwaila. So why do I need to write this down? Why do I feel so unsure? It felt so right at the time.’’
Andrew has been to visit me twice since my return. Both his parents are dead, he lives with his only living brother here in Lilongwe. He is now unemployed as the contractor fired him due to the allegations made against him. He calls me ‘mama’ and seems to be waiting for me to sort things out for him. At present I am not sure what I should do. He thanks God daily for the love I have shown him. How will I continue to show him that love?
You can tell that I haven’t written for two months..... I have so much to tell.
An important part of my work is with the nurses/ midwives and now especially with the matrons. Recognizing the huge differences that will be encountered by all the staff when we finally transfer to the new unit I consider that some training and especially team building is vital. Along with the matrons, who are now taking a very active role in facilitating the groups, I am dedicating our weekly ‘in service’ training sessions to this end. On returning from Europe and taking up the sessions again (which by the way continued extremely successfully during my absence) I became overwhelmed by the task of successfully ensuring team leadership. This is going to be vital in the new unit as we start off with an almost totally new team. Before leaving for Europe I had already discussed the situation with a Malawian led NGO who specialize in Quality Improvement and leadership training. The head of this initiative is a very inspiring Malawian guy whom I felt really understood the unique situation at Bwaila. I contacted him soon after returning and was thrilled and extremely relieved to hear that he had already found funding for us and was prepared to become wholly involved in our leadership training. These sessions have now started and the staff are making weekly visits to the unit with their leaders, sorting out work plans, equipment needs, patient flow, as well as practical details of ordering and storage of materials etc. We will be visiting the public hospital in Blantyre next week to discuss and learn from them. As you can see it all sounds very busy......well it is! It is still a race against time to get the unit up and running before the end of the month but I am determined to do all I can to achieve this. The DHO, who has been away for the past five weeks, is now back and becoming involved. He is/will be ultimately responsible for the new unit. We have a good relationship and I am convinced that he will do all he can to make a success of it. (Taking into account the very limited resources and budget he has to work with.)
On a different note I experienced a rather violent attack on my person a few weeks ago. Being in the wrong place at the wrong time my car window was smashed with a machete knife and my hand bag stolen. Fortunately I only received scratches from broken glass and bruising to my arm. It has not had a lasting effect on me. I don’t feel as if I am in any more danger than I did before and continue to ask myself whether this type of violence is due to extreme poverty or greed? On a more positive note we have some great friends over here who can be relied on for love and support as well as practical help. Lucas is back at school and after a difficult first week as he adapted back to the constraints of being in school is also finding his way and happy to be here. The contact I have with my older children, though never enough, makes me very happy. They are all doing fine, finding their way in life with all its ups and downs, growing and learning, continuing to develop into wonderful young people and I am so proud of them. Both for you and for them I encourage you to find your dream and have the courage to follow where it leads.

100% CHALLENGED

Lucas left Lilongwe at the beginning of June travelling to Valencia with his cousin Abigail to spend five weeks with his 'Papa' I was able to make full use of the following two weeks to concentrate fully on the coordination of the furnishing and equipping of the new Bwaila maternity unit. The procuring, ordering, confirming and delivering of each and every item necessary for the setting up of a unit of this size is a huge task. It has been and still is a challenging and often very frustrating process but I feel confident that it is now all 'coming together' and we will be ready for its opening during the month of September. I left Malawi on 18th July for my planned holiday break in Europe. After spending five wonderful days with my eldest daughter, Katy, in Leeds, UK, one of which was spent relaxing and being pampered in a health 'spa,' I flew to Valencia, Spain, to meet up with Lucas and my other two children, Alasdair and Fiona. Needless to say I have enjoyed every minute in the company of my children and friends. The love and support of these people, who are so important to me, reaffirms my conviction that my decision to stay in Lilongwe to continue the work I’m doing with the women babies and midwives at Bwaila is correct. Being in a first world country during these past weeks has not always been easy. It is difficult to completely forget the poverty and conditions from which I have come. It is especially difficult for me when I am in one of the many large, busy, shopping centres. My mind strays back to the villages, the hospital, the people of Malawi and it just all seems too much. How can some have so much and others, just a few hours flight away, have so little, have nothing? How can some people be so preoccupied by material trivialities when others are struggling to feed, clothe and educate their children. How lucky you are that you were born into a rich world that your worries are mostly about the extras and not about the basics, about luxuries and not about survival.

I wrote the above soon after arriving back in Lilongwe at the beginning of August. Since then I have often thought about you all and needed to communicate with you but have quite seriously not had the time nor the energy to do so.

These past four weeks have probably been some of the most challenging of my life.

On my return to Bwaila I was hugely disappointed to find that, despite the huge efforts I made before leaving to assure that outstanding work would be finished or at least well underway for my return, practically nothing had been done in my absence.The jobs that needed to be done ‘on site’ and that I expected to be finished had not been touched and the suppliers of various pieces of equipment and furniture had achieved very little. It was then I decided to dedicate myself full time to pushing and shoving, nagging and pestering, phoning and visiting with a determination that all those who know me will understand.
The official opening date of the unit had already been set. October 7th.The unit had to be up and running before that date and I for one was prepared to move heaven and earth to achieve it. And that’s what I have and I am still doing. Moving heaven and earth! Or at least it feels like that. If you’ve never lived in Malawi, though they tell me other African countries are the same and to be honest I guess pulling together this sort of project anywhere in the world would not be easy, maybe you wouldn’t understand, but the Spanish ‘manana, manana’ takes on a whole new meaning here in Lilongwe. I remember back more than 15 years ago when I was involved in setting up a new business venture with my (ex) then husband, Andrew. New to Spain and with very little of the language and less knowledge of how the Spanish system worked, the job of sourcing and procuring every little piece of equipment, nut, bolt and curtain hook, for the farm, was my main job. I still remember the huge frustrations of never finding anyone when they were needed, of waiting days and weeks for things that were promised for the following day and many items were just not available. I think that experience has helped me infinitely for the challenges I am facing now. My knowledge of building work, bricklaying, guttering, plumbing, electrics, drains, sockets, taps etc. increases daily. Not to mention the more specialized areas of autoclaves, theatre lights, piped oxygen and anaesthetic machines. Then there’s the procuring of furniture and equipment. I mean, just how many chairs are needed for a 146 bedded maternity unit? And stainless steel trolleys? And why does all the locally made equipment, beds, swab racks, bed pan racks have to be ‘epoxy coated’? and actually what the heck is ‘epoxy coating’? Just ask me any of this now and I will let you know!
I was very happy when the District Health Authority agreed to take on some tasks such as the building of concrete wash tubs for the women to wash their ‘chitenges’ Making of ‘curtain boxes’ for all windows, building of a new road. The unit has been totally funded from outside of Malawi. Mainly from Ireland through The Rose Project but also with Norwegian partners. It will be given to the Malawi government to be run as a public, non paying District Hospital. It was therefore encouraging to see them show their interest in this way. My enthusiasm was somewhat dulled after the new entrance way collapsed and had to be remade. During that time we could not let any vehicles on site for 7 days. I started to panic thinking that I would have to cancel the delivery of equipment which would delay everything. Silly me! The delivery trucks continued to arrive. They parked at the entrance and from nowhere appeared more than ten very fit looking guys who carried the boxes etc. sometimes on their heads, into the unit making several trips with often very heavy loads. But this is Malawi and I shouldn’t have worried. Then when they could drive in lorry carrying the bricks and materials veered off the road onto the pavement smashing the recently laid paving slabs. Not once but twice! But I think the best example of the hospital maintenance standards was when I passed by to see how they were getting on with the wash tubs. Now I am really not an expert but I do know that the water and drains are normally laid before and not after the concrete base. I respectfully enquired but was assured that they knew what they were doing. It was only once the tubs were built they realized that the plumbing would now have to be with external piping! It doesn’t look so good but I am assured it works! But that wasn’t the end of the story.... The following day I ’caught’ them on the point of connecting the water pipes to the contractor’s temporary water supply. An over ground piping that will be removed once the builders leave. At least I got to that one in time and the proper connections were made. These are just a few stories of the many I could tell you which have caused me to laugh and despair. There are also many more that have been so encouraging. A wonderful site foreman (George) who had always been at my side, listening, understanding, organizing, laughing, despairing, building up and knocking down, putting in and taking out, but always good humoured and willing to help. I have built up a lovely relationship too with many of the workers on site. The only female brick layer, who does a beautiful job, greets me every morning by name and with a huge smile. The gardeners who brought roses to plant just because I wanted them. Not to mention Fyson,the guy who holds the keys. There are more than one hundred keys to every door and cupboard on the unit and he knows them all. Actually he’s the second guy to hold the keys and only since July. The story of Andrew, who I have known for over a year since I first started became involved in the new unit, is a long one which is definitely worth telling.
This is part of a mail that I wrote to Tarek soon after the incident that I thought I’d share with you....
I
It’s a huge job I’ve taken on for The Rose Project and I often just wish I was back on labour ward. So much just doesn’t depend on me so I have to cope with the frustration of not getting things right because of someone else. As you said, I can’t change anyone else I can only change me. So I’m having to learn how to cope with so many things that are totally out of my control. I know that’s what you have to do and I am appreciating how hard that is. I have so much more to learn.
But that’s not why I sat down to write at this hour. Maybe I’m putting off the moment as I’m not sure if I did the right thing.
When I went on site this morning I couldn’t find the guy with the keys. He’s a young lad, always very friendly helpful and we have struck up a relaxed and fun relationship over the past year. I don’t know much about him but I have always had a good feeling about him. I eventually found out that he had been taken to the police station yesterday having been accused by the security guards of stealing a bag of 2nd hand clothing whilst the Norwegians were sorting it all out. ( A huge amount of sheets, material and clothing came over in the container.) I was surprised and horrified that he should be locked up in jail without even any charge against him. They also told me he had been beaten up. The charge had to be made by the DHO or myself. I couldn’t do it. I couldn’t bear to think of this young lad in the cell now for nearly 24hours and I couldn’t bring a charge for ‘possibly’ taking a bag of 2nd hand clothes. I think I did the right thing. My instincts told me that I couldn’t leave the country knowing he was still locked up. So I went and got him out. I tried to do it the right way. I went to the security firm, I phoned the DHO to get his support and the guy from the security firm came with me. So I got him released. It wasn’t too difficult. I was so naive that I didn’t realize until I was told afterwards that the police officers were waiting for me to give them money, so they didn’t get any! Well, Andrew is out of jail. I spoke to him briefly, he is just so young and was very quiet with me. He thanked me but he could hardly look me in the eye. I felt very sad as I have no idea if he is guilty or innocent. Of course he shouldn’t steal, but it was a bag of 2nd hand clothes! He probably has nothing and the temptation was too great. God knows what I would do if I had so little. Would I steal too? Would you? The foreman says they have always trusted him and will probably put him on another site to work. I hope so. I said he shouldn’t come back to Bwaila. So why do I need to write this down? Why do I feel so unsure? It felt so right at the time.
You can tell that I havn’t written for two months...I have so much to tell.
An important part of my work is with the nurses/ midwives and now especially with the matrons. Recognizing the huge differences that will be encountered by all the staff when we finally transfer to the new unit I have considered that some training and especially team building is vital. Along with the matrons, who are now taking a very active role in facilitating the groups, I have dedicated our weekly in service training sessions to this end. On returning from Europe and taking up the sessions again (which by the way continued extremely successfully during my absence) I became overwhelmed by the task of successfully ensuring team leader ship. This is going to be vital in the new unit as we start off with an almost totally new team. Before leaving for Europe I had already discussed the situation with a Malawian led NGO who specialize in Quality Improvement and leadership training. The head of this initiative is a very inspiring Malawian guy whom I felt really understood the unique situation at Bwaila. I contacted him soon after returning and was thrilled and extremely relieved to hear that he had already found funding for us and was prepared to become wholly involved in our leadership training. These sessions have now started and the staff are making weekly visits to the unit with their leaders, sorting out work plans, equipment needs, patient flow as well practical details of ordering and storage of materials etc. We will be visiting the public hospital in Blantyre next week to discuss and learn from them.
As you can see it all sounds very busy......well it is! It is still a race against time to get the unit up and running before the end of the month but I am determined to do all I can to achieve this. The DHO, who has been away for the past five weeks, is now back and becoming involved. He is/will be ultimately responsible for the new unit. We have a good relationship and I am convinced that he will do all he can to make a success of it. (Taking into account the very limited resources and budget he has to work with.)
On a different note I experienced a rather violent attack on my person a few weeks ago. Being in the wrong place at the wrong time my car window was smashed with a machete knife and my hand bag stolen. Fortunately I only received scratches from broken glass and bruising to my arm. It has not had a lasting effect on me. I don’t feel as if I am in any more danger than I did before and continue to ask myself whether this type of violence is due to extreme poverty or greed?
On a more positive note we have some great friends over here who can be relied on for love and support as well as practical help. Lucas is back at school and after a difficult first week as he adapted back to the constraints of being in school is also finding his way and happy to be there. The contact I have with my older children, though never often enough, makes me very happy. They are all doing fine, finding their way in life with all its ups and downs, growing and learning, continuing to develop into wonderful young people and I am so proud of them.
Both for you and for them I encourage you to find your dream and have the courage to follow where it leads.


ilongwe