There is no maternal care that four-month-old Cassim Joseph does not receive from Lakumizinga Theni.
She breastfeeds him, sings him sweet lullabies, washes his napkins and wraps him at her back every day as she arranges firewood to prepare him hot milk.
But Theni is not little Cassim’s biological mother. She is only an elder sister to her mother. The mother, Janet, died in October last year while giving life to little Cassim.
And Theni does not forget.
“This is her fourth son. Of course, she managed her third through caesarean section, but for all the time she was with Cassim’s pregnancy, she never complained about anything,” says Theni while attending to the crying Cassim.
In fact, in the six month of the pregnancy, Janet started attending her antenatal clinic at Mchoka Health Centre, situated almost six kilometres from Mpunga Village in group village head (GVH) Mpunga’s area, Traditional Authority (T/A) Ndindi in Salima. She could walk on her own.
But when the ninth month approached, adds Theni, nurses at Mchoka advised Janet—who delivered at home during her first and second pregnancy—to deliver at the district hospital.
“I don’t know if they noticed something wrong; if they did, then they did not tell us. But what I saw in her was nothing different from what I had being seeing in her during her last pregnancy,” she says.
And they left for Salima District Hospital.
“After staying for a week at the district, doctors recommended that she be operated on. We were not told the reason.
“After the operation, the doctors told us that they failed to save her because she lost a lot of blood in the process and again, her uterus had wounds. But they managed to save the baby,” she says.
Without authentic medical data, is not easy to establish the cause of Janet’s death. In fact, it is not easy, again, to establish the amount of blood Janet needed to survive.
Like Janet, each year an estimated 287 000 women die worldwide from complications related to pregnancy and childbirth. More than half of these maternal deaths occur in sub-Saharan Africa with haemorrhage, severe bleeding, as the leading cause.
Efforts, on the other hand, have been made to reduce maternal deaths from haemorrhage through skilled birth attendance and ensuring the availability of emergency obstetric care.
Despite the fact that caesarean sections and blood transfusions are key components of comprehensive emergency obstetric care, improving the effectiveness of blood transfusion services has not received enough attention. It is estimated that 26 percent of maternal deaths in sub-Saharan Africa are directly related to lack of blood.
According to the World Health Organisation (WHO), a major reason why so many women die from haemorrhage is because once bleeding starts death can occur in around two hours, compared with 10 hours for eclampsia (a rare but severe condition that causes seizure during pregnancy) and 72 hours for obstructed labour.
Therefore, among other strategies to prevent maternal deaths from haemorrhage, it is crucial to make available rapid access to adequate, safe and affordable blood for transfusion.
Yet blood supply in the country’s hospitals is still a challenge.
National coordinator of Parent and Child Health Initiative (Pachi) Charles Makwemba told The Nation months ago that blood shortages in hospitals remain one of the major contributing factors to prevailing deaths among pregnant women.
Currently, according to the Malawi Blood Transfusion Service (MBTS), the total blood collections, as of 2011, stood at 49 700 units. Sixty-six of the collected blood goes to mothers and women.
However, according to MBTS chief executive officer Natasha Nsamala, Malawi needs 80 000 units of blood per year, but only collects 50 000 units through voluntary and unpaid blood donation.
“We are in huge deficit, but we are doing everything possible to ensure we collect as much blood as possible,” she said.
The question of blood donation—which is complicated by various myths among Malawians—continues to be a challenge in the country. But it is almost without expression that if maternal health is to improve, the question of boosting the country’s blood bank is without question.
According to MBTS, most blood donors in the country are aged between 16 and 25. It is against this background, as part of helping MBTS in blood collection, Pachi launched a Mamaye Clubs which aims at sensitising communities on the importance of donating blood to save mothers.
“Mamaye clubs are meant to help address issues of blood shortage which contributes towards the death of women in hospitals by encouraging communities to donate blood.
“Nurses and midwives attending to pregnant women in our hospitals need the support of communities to support pregnant women,” he said.
Mamaye clubs are in various districts and, in Kasungu for instance, they have been formed at Chilanga Community Day Secondary School (CDSS) and Kapiri Primary School to encourage dissemination of information on topics such as disadvantages of teen pregnancies, participation in blood donation and the need for pregnant mothers to go to hospital in time.
Through Mamaye, Pachi, in partnership with MBTS, collects blood in communities through action development committees (ADC) with the help of traditional leaders and influential people at district level like the district commissioner (DC) and district health officer (DHO).
Makwenda argued that Mamaye campaign is about making life saving changes for the country’s mothers and babies at community level, adding the campaign is also meant to encourage accountability on all deaths of pregnant women.
The Millennium Development Goals (MDGs), which Malawi is a signatory to, expects signatories to reduce by three quarters the maternal mortality ratio between 1990 and 2015.
Unfortnately Malawi is yet to impress on both fronts as the country still has one of the highest maternal mortality rates in Africa.
The tragedy of such news, however, does not just end at giving Malawi poor health indicators. In Africa, a woman holds up half the sky of their families and communities.
As such, their sudden death, if you take it from the story of Theni’s sister, becomes the birth of their families’ myriad challenges.
“She was married and, with Cassim, had four children. Her husband is a fisherman and she was a farmer—she grew maize. There different undertakings complemented each other and they lacked nothing,” says Thena of her sister.
But her death has now become a destruction of her home. Being a matrilineal society, the husband, after minor disagreements with her wife relations, packed his belonging and left.
“He rarely comes—if he does, then he only brings biscuits and meets his children on the road,” complains the deceased wife’s mother.
Little Cassim and his other three relatives now live in Theni’s one-bed roomed house. Theni is married and has two kids.
“The good thing is that my husband understands. He agreed to take care of all the children,” says Theni.
Unarguably, raising somebody’s baby from the moment of birth is not an easy task, more so for a couple whose livelihood is dependent on farming.
Often, newborn babies like Cassim, with the country’s neonatal mortality estimated at 31 deaths per 1 000 live births, rarely live to see their first birthday.
According to 2011 data from the National Statistics Office (NSO), the main direct causes of neonatal death are estimated to be pre-term birth (28 percent), severe infections (26 percent) and asphyxia (23 percent).
“We are doing all we can to give little Cassim his best childhood. We want him to grow into a health adult, just like any other, but we cannot manage on our own,” says Theni