Author: Carrie Longton

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.

Carrie in Lilongwe, malawi, visiting Oxfam projects. Credit: Oxfam

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

Following earlier collaboration with us to highlight the massive problem of maternal mortality in the developing world, Carrie Longton, founder of hit parenting website Mumsnet, is on a factfinding trip with Oxfam in Malawi.

A bike ambulance used to carry people to hospital. Credit: Oxfam

We’ve now had two full, very full, days in Malawi visiting pregnant women, mission hospitals, community projects, meeting all sorts of people in our quest for information on maternal health. On Thursday we’re meeting with Malawian government officials, please leave questions for us to ask them in the comments section at the bottom.

Day one was meeting local women (both pregnant and those who’d given birth recently) in a rural village about an hour outside Blantyre town. It felt strangely normal to be sitting with a breastfeeding, pregnant woman on a straw mat outside a very basic mud hut talking about the difficulties of making it to hospital when pregnant.

The sort of conversation that regularly takes place on Mumsnet, with any mum to be (especially one with 3 children already). The harsh and very real difference being that in Malawi there was a 1 in 100 chance that the mother wouldn’t make it through childbirth.

Sitting in the sunshine in this peaceful, friendly village full of beautiful children with this didn’t seem to be a concern. They were happy with the monthly antenatal check ups they get in the village and pleased with the free healthcare they received at hospital. Getting to hospital was an issue (and the only main cost), but they seemed confident that when the time came, they would make it in a local public taxi, though we couldn’t quite get out of anyone how on earth you got a public taxi if you went into labour in the middle of the night.

The village was a good 2 km away from the main road down a dirt track with no lights. It certainly put all my moaning about being driven through London in labour into perspective. Or so I thought.

Day two’s visit to an even more remote rural community, added yet another layer of perspective. Meeting with community project volunteers we heard how difficult it is to access an ambulance in an emergency.

Mobile phone coverage was unreliable and families would sometimes cycle to the nearest hospital with a letter requesting an ambulance – the cycle ride was uphill on a road that made yesterday’s dirt track look like the M1. The alternative, when it didn’t have a puncture, was the bicycle ambulance – a stretcher on two wheels pulled behind a very basic bike, with no seat belt. Although it took us about 20 minutes by jeep, the journey to hospital was a three hour bike ride. The last person to use the contraption had died on their way to the hospital.

After all the good news stories of yesterday, this was a horrific and sobering thought.

Chatting to the students and staff at our next stop – a hospital with a nursing/midwife training college attached – was both inspiring and depressing. One trainee had witnessed two maternal deaths, one of them in the hospital closest to the last village we’d visited, both caused by getting to the hospital too late.

Another student had been a beneficiary of the education for girls project, which offered free secondary school to girls, but which has now been abandoned. All had benefited from a scheme to offer free places at nurse/midwifery school, in exchange for a minimum of 5 years service in state health care. Enthusiastic and committed to helping rural communities, these soon to be midwives are, from my brief experience here, exactly what Malawi needs.

Sadly this scheme ended last year, and this year’s intake will have to pay their own way – around 130 UK pounds – a fortune in Malawian terms. None of the original candidates for the course had managed to raise the funds. Those that had finally taken their places were, in the words of both staff and students, never going to practice in rural areas :‘any Malawian could tell you that just by looking at them’.

We drove back to the hotel through driving rain, having promised to add their cause to the lengthening list of questions we have prepared for our meetings with DFID and vice president Joyce Banda later in the week. We, and the women of Malawi, can only hope that they have some answers.

Oxfam’s Health and Education For All campaign