Saturday and off to the airport to collect our first visitors. Two of my work colleagues from Edinburgh have arrived for a two week Malawi experience. After the girls freshened up we went to visit the orphans in the nursery and for the girls to have their first taste of Bwaila.

While looking at the babies I noticed one of the new arrivals looked very unwell. My friend said the baby looked dead and it was. Despite trying all we could at that moment we could not bring this little baby back to life. It felt warm as it was under a heater but we had no idea how long he had been dead. There was only one midwife for 23 babies and for a while there was no midwife to be seen. ‘Welcome to Malawi’ I said to the girls.

Labour ward was busy on Monday morning and to add to the busyness and few staff there was undiagnosed twins and a footling breech which became a traumatic, frantic and in some ways quite a barbaric experience for mother and staff. Fortunately mother and baby were fine.

At this point I would like to mention a very relevant and frightening fact. There are only 23 midwives in Bwaila and 4 matrons with 5 midwives leaving soon which will leave 18. These midwives work day and night and frequently do double shifts for more pay, to cover shifts and to help their colleagues. This hospital as I keep reminding myself delivers approximately 1000 babies a month, twice as many as the Royal Infirmary in Edinburgh who have hundreds of staff. These figures are unbelievable and what is more concerning is where are the midwives going to come from for the two new hospitals?

We spent a wonderful morning at the Crisis Nursery in the centre where very young babies are brought from the village when the mother dies in childbirth. The nursery is financed by the church and the 19 babies are very well looked after by the staff. It was wonderful to see the babies clean, well fed and being stimulated. They loved human contact and reacted to voice, play and cuddles. They were obviously used to white faces and we were able to help feed them their porridge or milk.
It was lovely to be in a ‘normal’ environment with nappies, toys, baby talc and nice smells.

That same afternoon we were shown around an American funded HIV clinic for HIV positive children. 50% of HIV- infected children will die before their second birthdays without treatment. It was an inspiring and uplifting visit but also very sad to see all these very poor mothers and children waiting in the very posh waiting area.

We went back to the village to check up on baby David and his infected eyes. I am delighted to report that his eyes were much better and I told the grandmother she had done a great job. However his weight was the same and this did give me cause for concern. Because he has no mother and therefore is not breast feeding I don’t think the grandmother is feeding him frequently enough. Most babies at a year old are eating and still breast feeding. This was all explained to the grandmother and his diet discussed again- I hope- as all I can do is hope Beatrix is saying what I hope she is saying.

The women were pleased to see us again and to meet the new visitors. I am going to start an antenatal class with these women as we can combine it with weighing and keeping an eye on David. I will have to gain approval from the village chief first but Beatrix thinks I should not have a problem.

We had a very uplifting visit to a Traditional Birthing Attendant called Mrs Msumba. It was difficult to put an age to her but as a child she helped her mother who was also a TBA. Her skills as a midwife I am sure were second to none and her record keeping was extraordinary. She looked after the women in a special mud hut with a main room where a bicycle ambulance was kept; two post natal rooms each with a single bed and then one room with a cot in the corner. In this room was a small solar panel and light.
Mrs Msumba delivered 24 babies on average a month and referred around 30 women to Bwaila.Her reputation went before her and after having the privilege of meeting her we could see from her warmth and sincerity that the ‘with women’ experience was for her high on her priority list.

In short this week there was no petrol in Malawi for 24 hours.

There have been power cuts day and night all week. This meant that the main supermarket Shoprite was closed three days in a row as it does not have a generator, so I won’t be buying my chicken there!

The triplets and baby Oscar have much improved over the week and their future is much talked about. They should leave the nursery soon as the longer they stay the greater the chance of getting infection. The aim is to get them back to the village to be in their own environment and also the chances of an orphanage having three spaces for three babies are unlikely. This week will determine where they will go.