I spent the beginning of the week at the Anti natal clinic as part of my orientation programme of two weeks!

The anti natal block also comprises of a Family Planning Clinic, an Under Fives Clinic and a UNC Clinic (University of Northern California) who do HIV testing on pregnant mothers.
This has got to be seen to be believed. At 7.30 in the morning there must be at least 250 women with babies and children waiting on concrete benches, in an open covered enclosure. They all get a health talk which includes HIV testing for about 20 minutes; they then sing a little and clap their hands.

The doors opened behind the Sister who does the teaching and in the women file. On Monday I and one other sister midwife saw 114 pregnant women on their second or subsequent visit in four and a half hours. There are no tape measures to measure the uterus, as we are used to, just an experienced eye and fingers to guess the gestation of the baby. The room was small and hot, with only a very tiny and high window. The women queue for every thing, including blood pressure and weight. Unfortunately there were very few nurses around as some had been sent to work in the cholera tent up beside KCH (the Central Hospital) and therefore the blood pressures were not being taken.

When I noticed this was missed in their shabby, yellow booklet I found a cuff and stethoscope and did my own ladies BP. However when I laid the cuff down to share with the other midwife she did not take her ladies BP. You see that was not meant to be done away from the routine of outside in the corridor.

Women were swarming the corridors either standing, or sitting on the concrete ledges waiting for their turn to be seen.

Today Tuesday I learnt about The Prevention of Mother to Child Transmission Programme. This is done when the women books for the first time, she could be 12 weeks pregnant or 34weeks pregnant. There were 47 women this morning and the screening, education, counselling, urine testing and BP was all done as the women queued or sat on the floor in tiny rooms. There were 10 blood tests that showed HIV positive so these women had further bloods taken and counselling.

They were given the drug Niverapen to take at the onset of labour and they are also given the same drug in liquid form to give the baby after delivery. Emphasis is put on the importance of this drug along with healthy diet and looking after herself in pregnancy and also to exclusively breast feed the baby for 6 months. This will all lessen the chance of transmission.

Knowing what the women are told in the process to the labour room is extremely beneficial to avoid anyone being missed with treatment. Some women don’t take their tablets and don’t have the drug for the baby so the labour ward keeps a supply.


I spent the last two days in the nursery exclusively looking after six orphans, I was being their Mum. An orphan is when one or more parent has died. There were a set of twins, triplets and a singleton. The twins (girls) mother had died last weekend from a massive blood loss and a blood transfusion reaction.

The triplets (girls) had been born prematurely in a village by a Traditional Birth Attendant and had consequently bleed and died when transferred to hospital. This was in November and no one had seen or heard from the father or guardian.

The last wee boy’s mother had died due to being very ill with HIV and TB. Fortunately the wee soul is HIV negative which can happen despite the mother and father both being HIV positive.

I spent the time cup feeding then regularly and giving them my undivided attention. All orphans are cup fed because when they go back to the village there is less chance of them becoming ill. If bottles are not cleaned and the same one used for all feeds gastric problems can be fatal, they are more likely to wash a cup. It is generally the better of two evils- unfortunately the babies miss out on sucking which is a great comfort to them and needed also for development.

The midwife in the nursery was delighted I was there because these babies don’t get regularly looked after and feeds are missed. The triplets are still very small under 2 kilos and need 3hry feeds. Remembering there are no nappies just sheets, makes life a bit messy to say the least, only cold water and no basins to wash little bottoms. I chart everything as I go along which of course is not continued and was not being done. At one point at the start the charts were all mixed and I did not know which twin was which as they were not named ‘one’ or’ two’.

Yesterday afternoon the twin’s grandmother and father appeared to take them home, which was great. They were very sad and wept when they saw the babies. The midwife talked for a long time about the care and feeding they will need. There is a feeding programme and follow up for orphans in place, started by an American midwife Joanne whom I met when I first came to Bottom. The guardians are given powered milk, clothes, soap and support visits.

Beatrice, a Malawian midwife runs this, on her bicycle and Joanne had asked Rachel to give Beatrice the support needed. Rachel is very busy implementing all sorts of other positives initiatives in the hospital and asked me to help out with follow ups. I have the time and a car so we can take scales, milk and go the distance to check on the twins next Thursday.

I met the grandmother and father and gave my sympathy on their sad loss. I explained I would be out next week to weigh the babies and bring more milk. The husband was most gracious and said’ you are most welcome’ So Beatrice and I will leave early next Thursday to go the 180kilometers to the village and home before dark.

The triplets will stay in the nursery until Beatrice tries to trace the family or if we need to go out to the clinic where the mother was first referred.
The wee boy will stay until we hope the family has had time to bury and grieve the mother and come back to pick him up.
I will keep you posted on developments.