Interim Report from Malawi: The Visit to Gaga Maternal Center
In early July, a team of 12 students from all six professional schools of the University of Maryland in Baltimore arrived in the African nation of Malawi for a six-week study of maternal/child health services.
The students are administering the World Health Organization's Safe Motherhood Survey in the rural district of Chikhwawa, in the southern region of Malawi. Chikhwawa, the same district visited by last year's University interdisciplinary project team, is one of the sites participating in the seven-year surveillance study of malaria in Malawi by Miriam Laufer, MD, an associate professor at the School of Medicine and one of the faculty members on the trip.
Laufer's faculty colleagues include Emilie Calvello, MD, MPH, medicine; Jody Olsen, PhD, MSW, social work; Peter Danchin, JSD, LLM, LLB, and Virginia Rowthorn, JD, law; and Mary Regan, PhD, RN, MS, and Barbara Smith, PhD, RN, FAAN, nursing.
The group filed the following report on July 31, 2012:
Friday afternoon, 11 of the 12 maternal health centers in Chikhwawa District had now been surveyed. We were told that the 12th center, eight kilometers from the Mozambique border, was unreachable; the bridge was out, the road was gone, the distance too far.
"It is so difficult to go to Gaga. You shouldn't go." Our particular team, six students, one faculty and three translators, debated about going as District health officials were so discouraging. Why do it?
But we had committed to interviewing all 12 maternity centers in the district, and one of us remarked "We need to go and show our respect. What would they think if even the Americans would not come?"
So, Monday at 4 a.m. we began our journey to Gaga. The road was washboard dust and dirt, the bridge was out, and the time it took was 3 1/2 hours.
The bridgeless river almost defeated us, but women washing clothes as the sun rose encouraged us onward through water that was broader than the Potomac but nowhere more than six inches deep.
We found the center, largely written off by the District, very well organized, very clean, clearly listed protocols, and staffed by midwives who showed respect and caring to the 15 women there for antenatal exams and education.
They had well-organized policies for observations and venue for first child deliveries and timely education programs for pregnant women. Those that came to and worked in the clinic also knew that they had been largely forgotten. Despite numerous calls, no equipment had ever come for building latrines or showers for the women.
The nurses had built a tin lean-to to help women wash in private. No refrigerator was available for medicines so they bicycle taxied 11 kilometers to a neighboring district clinic for medicines which they brought back in ice packs.
Lack of running water in the clinic sent the staff and women to a nearby river to gather the water. As is true in many clinics, the health clinic had no supplies. Every woman ready to deliver was asked to bring two clean 1-by-2-meter pieces of cloth for herself and the baby, a blanket, a razor to cut the umbilical cord, and water.
Because of distances, women began carrying their bag with these items from seven months onward to be ready for any journey once labor began. We saw many bags at the antenatal visits.
The ambulance took over a day to arrive from Chikhwawa, and when called, the usual response was "we don't have fuel or our ambulance is down."
Staff thought that the real reason was a fear of distance from Chikhwawa to Gaga. Women, even in labor, were asked to go to the Chikhwawa hospital by whatever means possible, usually bicycle taxi, over the same roads that took us 3 1/2 hours by car. The neighboring district hospital, Mwanza, half the distance was used instead.
During our individual time with the women, no one complained.
Each seemed grateful for a chance to see a midwife at the center. The two midwives, a husband and wife team, came from the north of Malawi, built their own house across from the center, and committed themselves to these women. They dressed in clean uniforms, had good rapport with the women and children, and took whatever time was required.
Unlike any other health center we visited, nearby children were reticent to join us, staying hidden behind walls and trees. Women themselves were mildly hesitant to meet with us until guided by the midwives, whom they trusted.
Over the four hours we spent with the women, they came closer, asked more about us, and sat with us. Slowly, later as balloons, forehead stickers, and bubbles came out of our own bags, first one, then two, five, 15 and 30 children quickly became part of our gathering.
Amazing jump rope feats quickly followed while more balloons became animals, hats, and airplanes. We were reluctant to leave and so glad we went.
Gaga was the most engaging of all the maternal centers we had visited.