Last years maize crop is finished and many people are hungry. Children have swollen bellies a sure sign of malnutrition. The night security man often gets our left over supper. People have no money to buy maize or porridge. The poverty in Malawi is obvious, not hidden as in many countries. The poverty is with the majority, they have nothing, but life goes on.

I was working in the high risk post natal/ante natal ward this week. There were about 50 women, separated into a post caesarean section recovery room of which there were 11 women. The Blood Pressure room with 3 beds and the infection room with 3 beds. The remaining women were in two bigger rooms with beds and mattresses on the floor.

The guardians come in and out at certain times of the day to assist the women and at 4pm they are allowed in to stay until the morning. There are usually one or two midwives on a shift to do dressings, daily checks, give out tablets and do vital signs. As you can imagine they don’t all get done and the charts are a disaster.

When the women are day 3 or four after a caesarean they are discharged and would take a mini bus to the area they live in and walk the many kilometres to the village with the baby. The women are strong, and make no demands and have no expectations.

The triplets are ready to be discharged. On Wednesday I took the grandmother with Beatrix to the village so we could make an assessment of the environment and discuss support in the community.

We set out at 10am and after 30mins on a tarmac road we spent the next two hours on dreadful red dirt track, pothole roads. Fortunately I had Rachel’s four wheel drive otherwise the roads would not have been passable. We had a puncture after an hour and the wheel collapsed immediately. I discovered later it was about a four inch hard piece of wood that had caused the damaged. We were lucky, a mini van was also having problems and the driver was able to change our wheel. Granny stayed in the car out of the sun and many children gathered around the car to watch. Soon we were on our way again after big thanks and 500 kwacha was given to a very happy man. (About £2)

We arrived firstly at the clinic where the mother had been referred to Bwaila. The clinic was run by two nurses, there was no doctor. We heard first hand what had happened to the mother from the nurse who had referred her. A Traditional Birth Attendant had delivered the first baby and the following day the next baby arrived quickly followed by the third girl. The mother had fever and after a day or so arrived at the clinic by ox and cart, fitting. The nurse gave quinine thinking malaria and phenobarbitone for the fitting and then took her blood pressure which was very high. She arranged an ambulance to come and transfer the patient to Bwaila, this would have taken hours. The mother died in Bwaila.

Villages and clinics are miles away from medical care and distance is one of the biggest reasons for maternal deaths, I can see this so clearly now.

We told the nurses about the triplets and how the grandmother would need lots of help and the babies would need weekly weights done. One of the nurses came with us in the back of the car to the village which was only about another 30 minutes drive along worse roads than before. I kept praying we would not get stuck in the ditches. On the way we met an uncle of the grandmother but he was younger than her I think really a cousin. We also met a volunteer who said he would support the grandmother too. We arrived through the maize fields to a small clearing of about 8 huts. The women and children rushed to the car and the grandmother was obviously delighted to be home.
It had been two months since her daughter in law had died. There has never been any sign of the husband.
We saw her hut which had become the home to a few goats and chickens in that time. There was nothing there but a few pots and it was, as you can imagine filthy. The babies could not live here. A meeting was held with the ‘uncle’ who was the second chief in the village, one of his two wives, the nurse and Beatrix. It was decided that a new hut would be cleaned and a window put in for ventilation and prepared for the babies. They were very positive and said there would be support with the feeding and looking after the babies. Beatrix interpreted all this back to me and I said that we had planned to bring the babies home on Monday. This was all accepted and preparations would be made.

The rains came down while we sat and then it was time to go. The ground was wet and again I prayed hard we would get back on to the dirt track road. The grandmother produced a chicken which went into the plastic bag I had the three rolls we had eaten in and it sat behind my seat with its head poking out the top. This was a noisier chicken than the last. Beatrix and the grandmother had a laugh at my reaction to the chicken in the car as I kept forgetting it was there and putting my bag behind the seat.

We dropped the nurse at the clinic and said we would be back on Monday and then we headed back to Bwaila to drop off granny. We were back by 5.45pm safe and sound, what a long day! and Beatrix took the chicken!

Yesterday Beatrix and I went shopping for the triplets. I bought 15 nappies, a plastic bucket and basin, feeding cups, a measuring cup, a mat, some soap and we tried to buy something like a large dog basket for the triplets to sleep in, without luck. I am trying again on Monday. We still need pins and Milton which I will get on Monday morning and the clinic said they had a mosquito net. I have lots of pink baby clothes I bought over from Scotland and blankets so we should be all set for Monday at 8.30. Oh yes I also bought some maize for granny. Beatrix is getting all the milk from the feeding programme and will give a talk to the village on how to make up the milk for the babies and how to cup feed them.

I will be so glad when Monday is over and the babies and safe and the support is in place.

The two midwives spent their last day visiting a feeding station with Beatrix and myself. It was set up in a district in Lilongwe where 93 children mostly under 7 were on the role. Many of these children were born in Bwaila and were either orphans or had been malnourished. It was amazing and an uplifting experience.
There were about 50 children all sitting under a tree with a lovely lady called Toco who was a teacher. They sang to us and a few of the children stood and said a few words about themselves. One said a prayer. We then joined in the singing and dancing, it was such fun. There was a fire with the porridge or pala cooking and 3 volunteer grandmothers stirring the mixture. We helped dish up and distribute the pala into green plastic bowls with spoons. The older children helped the younger ones it was lovely to watch. We then sat down on a mat under the tree with Toco and the volunteers. She told us she was HIV Positive but the children helped her so much. Her diet was good and she was well, what a truly wonderful lady.