Thanks to the Scotts

This past week included my first days back at Bottom. Two months away from birth is long enough. I was eager to witness the covert strength of women surge forth and push their babies into the world. I was eager to see glimmering soft brown eyes as they opened to light and color for the first time. It was wonderful to be back; greeted warmly by the nurses, clinicians, maids, and security guards. The usual chaos reigned: many women, many students, few nurses precepting and overseeing care. Even so, my first three days back at Bottom passed without catastrophe. Wendesday, at some point I encouraged students to get the women up off their backs. Thursday morning I walked in to find two students with their patients in neighboring beds squatting and pushing - pink wriggling babies emerged almost simultaneously within minutes. Friday I assisted students deliver two sets of twins including one breech. I conducted a vacuum for fetal distress - the mother visibly exhausted and the baby’s heartbeat disturbingly slow - but the little girl, once on her mother’s belly, blinked and greeted her mom with a loud cry. The mother asked me for a name, I suggested Mwaye (fortune).

The good days are both gratifying and exhausting. The constant movement and noise in the labor ward at times reminds me of a force of nature, the environment is neither safe nor malevolent. It is the uncommitted energy and space affecting beginnings and endings; expectant mothers face an unpredictable course upon entering the grounds. A hospital should not mimic a force of nature. A hospital should protect dignity and uphold life. It should contain a safe space for women to give birth. It should facilitate necessary interventions (not obstruct them), and offer consistent care in all senses of the word.

There are many reasons why Bottom lingers in a place far from these simple descriptions but happily there will be major changes soon. Last December, Sir Tom Hunter - of the Clinton and Hunter Development Institute - spearheaded a Christmas fundraising drive in Scotland and raised two million pounds to put towards a new maternity hospital. Clinton and Hunter have on-going projects in Malawi but during one of his earliest visits to Malawi, Hunter was whisked off course and directed towards Bottom by an inspired woman who believed that if someone with the means and a conscious saw the conditions, he would feel compelled to help. She was right.

The first quick tour of Bottom led to meetings with the obstetricians, Dr. Chiudzu and Dr. Tarek Meguid, meetings with the representatives from the Ministry of Health, visits from a Scottish media crew to document the progress, and finally approved plans and a full bank account. Saturday a groundbreaking ceremony for a new maternity hospital was held with short speeches from Sir Tom Hunter, The Minister of Health, and The President. Hunter spoke about the construction as a step towards protecting the human rights of Malawian women and mentioned that the money was given with the fundamental understanding that Malawians know best how to care for Malawi.

I have never been as acutely aware of the impacts of a physical structure on human life as I have at Bottom. In the new plans self contained examination rooms will increase possibility the probability of privacy and support. Self contained labor rooms, with enough space for a mother, sister, husband, or friend mean laboring women will have the option of bringing love into space where they give birth. Multiple operating rooms will mean that one life will never have to be weighed against another; a distressed woman over another woman’s distressed baby. The location of the hospital on the grounds of Kamuzu Central Hospital will mean that women who have hemorrhaged will not need to wait hours to receive blood or to be transported to the ICU. The physical structure will make humane care possible. The new hospital will be named after the President’s late wife Ethel waMutharika, a great advocate for Malawian women and mothers.