Carrie Longton, founder of hit parenting website Mumsnet, is on a factfinding trip with Oxfam in Malawi. This is her latest blog.
Day 3: We travelled to Lilongwe yesterday via a visit with one of Oxfam’s partners to a family in the most remote rural area we’d visited so far. They lived in a hut, with no other huts in sight, surrounded by maize crops failing due to late rains.
The mother, father and smallest child (of five) were HIV positive. The good news story in this otherwise bleak landscape was that they were receiving free Anti Retroviral Drugs (ARV), and since Oxfam had last visited they had all made a – literally – miraculous recovery.
The bad news was that they had to pay to travel monthly to the hospital to collect drugs, which often meant there was no money for food. The answer to our question of what would help them most was two goats. The lovely volunteer – who helped to look after them and the many other HIV-affected families in the five local villages – desperately wanted a bike to save her walking tens of miles a day.
So an unashamed plug here for Oxfam Unwrapped – where you can buy these things.
Day 4: Today was the big meetings day. We’d had our whistle-stop tour of Malawi’s maternal health situation and this was our chance to take our observations to the people in power.
After a few lessons in etiquette from the Oxfam local office, our first stop was the Minister for Health, Khumbo Kachali. An ex doctor and academic, he was welcoming and enthusiastic, grateful for the support Malawi had received from the UK and he was keen for us to take back the message that it was vital that this support continues.
He listened patiently to our concerns on midwife training and retention and better health care for the villages, but had no real reponse to why the training programme had stopped. He did say that it was a project that had come to an end and needed evaluating. This didn’t quite tie up with the story we’d heard earlier in the week, of students turning up to find their course unexpectedly unfunded but he had nothing else to offer and batted the ball into Department for International Development’s (DFID) court. We said we’d certainly be asking them.
Slightly disheartened we met the fabulous Joyce Banda, vice president of Malawi, African Union’s Goodwill Ambassador for Safe Motherhood and passionate advocate on all things women/health related. Raised in a village in her early life, her immediate response to tackling maternal mortality was to start with an education programme for village chiefs. Get the chief on board and you can start to affect what happens to a woman when she gives birth.
In the first area where she had piloted this scheme, there hadn’t been a maternal death since 2005. She now had chiefs from the initial pilot areas running workshops for other chiefs, a low-cost success story that made complete sense given the things we had seen and heard.
The things she wanted help with was – guess what – training for midwives. She was personally supporting some midwives who couldn’t afford to continue their studies, but looked as bewildered as we were when asked why the government had stopped the funding so abruptly. She wanted to start a scheme whereby donors could sponsor students through training. We said we’d take this thought back to the UK.
The other desperate need she outlined, and this rather stopped us in our tracks, was for the construction of “holding shelters”. Literally four walls where women could come for the month – yes, month – before their due date, to ensure they got to the hospital on time.
There was hard evidence that getting women to get themselves to the hospital a month ahead of time had significantly reduced maternal deaths in rural areas. But at the moment there was very little provision when they got there and they could end up sleeping in the open – she sometimes went round distributing blankets.
Until Malawi can train enough health care professionals to run rural health centres, this, apparently and almost unbelievably, is the best and only solution.
We handed over a sample of the blanket mumsnetters had helped to make for Oxfam, and just wished we’d brought more to fill the gaps until the shelters could be built.
Our last official meeting was with DFID. And our never ending quest to find out why the midwife training programme had stopped was destined not to be fulfilled. According to DFID – the Malawian government’s biggest donors for health – they supply the Malawian government with a sum of money to spend on health (and a list of priorities) but ultimately it’s up to the Malawian government to choose how they spend that money.
Despite being second to bottom in the hideous league table of maternal mortality, Malawi has made huge strides in the last six years thanks, to a large degree, to British aid. As decisions are made both in the UK and in Malawi in the next few months about the aid budget, I can only hope that the decision makers keep in mind the people whose lives they have the power not just to change but to save.
Read: Carrie’s previous post