Malawi has one of highest maternal mortality rates in the world, but Susan Dalgety visits a clinic that is doing extraordinary work despite scant resources.
Charity stopped. She bent down and firmly pulled out the young woman’s breast from under her chitenje.
Speaking softly, but firmly, she explained to her how the tiny baby in her arms needed to latch on to her engorged nipple. “Like this,” smiled Charity, pushing the mother’s breast closer.
And just like that, mother and baby bonded.
The young woman visibly relaxed as her first born began to feed, and Charity stepped back, satisfied.
“She gave birth in the hospital, not here in my clinic,” explained Charity. “They don’t have time to properly explain how breastfeeding works, so often women will come to me when their baby is crying, because they are not feeding well. Now, let me show you the labour ward, another baby girl has just been born, only 30 minutes ago.”
And she took me to meet Evelyn, a healthy, calm infant, weighing 3.4kg and already the apple of her grandmother’s eye, who was sitting proudly with the baby swaddled on her lap.
Evelyn’s mother, Marvellous, who had given birth less than an hour ago, said a faint hello from under a warm blanket, apparently not the least fazed that a stranger had interrupted this most private of moments. “It’s okay,” laughed Charity. “You’re a woman. You are welcome here.”
Mama Salima, as she is known in the community, is a force of nature. Ten years ago, she gave up a secure job as a senior research nurse to open her own community clinic in Area 23, one of Lilongwe’s most crowded townships.
“My family were confused,” she laughed, remembering their reaction. “How will you eat?” they asked. “I told them, ‘The Lord is my Shepherd’ and look, he has provided.”
Charity and her team of staff and volunteers have delivered 8,000 babies in a decade. All survived, a remarkable record in a country with one of the highest maternal mortality rates in the world. The latest figures from USAID show that one in 174 mothers die giving birth, and one in 34 babies die at birth, usually from asphyxiation, low birth weight or infection.
What is Charity’s secret? “Experience,” she says. “I know how long a labour should last. And if there are any signs of distress, in the mother or the baby, then we send her to Bwaila, the maternity unit at the central hospital.”
She might also have added expertise. Walking round the small but perfectly appointed clinic with Charity, it is clear she is at the top of her profession, despite very limited resources.
There is none of the high-tech, eye-wateringly expensive equipment we take for granted in our labour wards. No birthing pools, no baby boxes, and no anxious fathers. “We encourage men to come,” says Charity. “In our culture, childbirth is only for women, but it is changing. And I expect the man to come when we have family planning sessions. A woman does not get pregnant alone ...” she guffaws.
Charity has won many accolades. She is dubbed Malawi’s Florence Nightingale, her work has been featured on CNN, and only last week, she was presented with a Commonwealth Point of Light Award for her work by Britain’s acting High Commissioner, Gary Leslie, another Scot in Malawi.
Handing over the Queen’s award, he acknowledged that maternal and newborn health is still a big challenge across many Commonwealth countries, and pointed to Charity as a role model.
“I hope Charity’s life of service and this award will inspire others to contribute towards tackling some of the greatest social challenges of our time,” he said.
But even the indomitable Charity cannot work miracles on her own. “We need support all the time, Sue,” she told me, as I was getting ready to leave. “We are very grateful for our partnership with Freedom from Fistula (founded by Scot Ann Gloag). We get support from George Watson’s College, in Edinburgh. And you know Linda McDonald, she is a Scottish midwife. She helped us tremendously, but there is always a worry. We always need new equipment.”
Top of Charity’s wish list is a £1,000 machine that will help deliver oxygen to new born babies in distress. Even a few minutes of oxygen deprivation at birth can cause life-changing conditions such as cerebral palsy, or even death.
The health of all the nation’s children has been the focus of the government’s work this week. While politicians and civil society continue to argue over the election results, the Ministry of Health has been holding a week-long campaign, known as Child Health Days.
Health workers across the country have set up temporary clinics in rural areas – where over 80 per cent of the population live – to offer basic, preventative healthcare to under-fives and new mothers.
Children have received doses of Albendazole to get rid of intestinal worms, vitamin A to promote their immune system and protect their eye-sight, and micronutrient powders to tackle malnutrition. And mothers are being encouraged to breastfeed for the first two years of their baby’s life.
Health experts say about 1.4 million children in Malawi suffer from stunted growth because of lack of proper nutrition, and it is not just their height and weight that suffers. Poor nutrition can also affect a child’s cognitive development, making schooling even more difficult. It is easy to become despondent about Malawi’s future. The scale of the challenges, in maternal health and for under-fives alone, is daunting. Throw in a million people living with HIV/Aids, the impact of climate change, inflation running at nine per cent, and a national government that has the same resources for 18 million people that Glasgow City Council has for 600,000, and the future looks bleak.
Some Malawi friends shrug and say, “it is hopeless.” Others, like Charity, point to God and smile confidently, “He will provide”.
After three months in this beautiful, welcoming, at times infuriating, but always fascinating country, I am more optimistic than I was when I landed at Kamuzu International Airport.
In recent years, Malawi has cut the number of children deficient in vitamin A from 51 per cent to three per cent, a feat described by Unicef as “remarkable”, and better than any other country.
It has made significant strides in tacking HIV/Aids, with the annual death toll dropping from 64,000 in 2005 to 12,000 last year.
And there are countless Malawians like Charity, doing what they can to build their country. All they need is a little help from their friends across the globe.