Surgical supplies go awry

 She has sworn that she will never again go to a government hospital for labour. She says she now understands why most women prefer delivering at home or at private clinics rather than government hospitals. She says that one of her friends also went through the same ordeal four months ago at the same hospital.

Adamson says many expectant mothers die at hospitals because of the negligence of staff. She said she wondered why the midwives almost sacrificed her life because of a plastic sheet.

'No wonder this country has high maternal mortality," she said.

Icele Medi is a matron at Bwaila hospital. She says that 25 expectant mothers died last year after delivery.

The 2004 MDHS says factors that contribute to the high maternal mortality include heavy bleeding, stroke or convulsions, infection or fever, long distances to health facilities, post partum depression and poorly equipped hospital staff.

Deputy director of Nutrition HIV and AIDS Catherine Mkangama said expectant mothers in Malawi are in big trouble because of inadequate facilities at health centres. Mkangama said that, even where a health facility is available, maternal problems require the services of a qualified doctor.

And most of the clinics, she says, do not have doctors.

“Malawi is one of the worst countries in the Southern Africa Development Community with regard to maternal mortality,” Mkangama said. She said many expectant mothers in rural areas have little or no access to health facilities.

“Some important tests are not done where they have such access because they require a doctor,” she said. She said that, although attendance at antenatal clinics is high, most mothers get low comprehensive care because they start going for antenatal care late.

Long distance to health facilities is another problem killing Malawian mothers at child birth. Blantyre is one city in Malawi where officials decided to establish antenatal clinics to solve the problem of long distance for mothers going to the hospital to deliver.

Despite the establishment of more antenatal clinics, mothers are still dying at childbirth due to infection after delivery. Hospital officials tell mothers to bring their own plastic sheets to be spread on the delivery bed. The trend has grown wide in the past years.

Medi said that officials tell women to bring their own plastic sheets or face the risk of getting infections - and even dying.

"The Hospital no longer provides the plastics, known as mackintoshes, to mothers at delivery,” she said. “Hence, they tell them to bring their own."

The trend appears to be similar in many health facilities, Malawi Observer discovered.

Medi said midwives use one mackintosh more than once.

"For instance at Bwaila there are a lot of mothers delivering babies against little availability of mackintosh," she said.

Malawi Observer reporters talked to experts and officials at all levels to find out who is responsible for providing the basic supplies clinics and hospitals need to ensure quality healthcare. There was no definitive answer, however.

Lennie Kamwendo is the president of the Association of Midwives in Malawi. She says that patients at government hospitals should not have to provide their own surgical and sanitary supplies.

"That is not a ministry of health policy,” she said. “Hospitals need to provide that to the mothers."

However, Central Medical Stores senior manager Charles Abondo said his office has enough stock of the plastics ready for supply to hospitals. He says that, every Monday, his institution sends a bulletin to all hospitals that advises them on the available medical supplies in stock. He blames district hospital administrators for not ordering for the equipment.

"Hospital administration have their own reasons for not ordering the supplies,” he said. “We have them in stock.”

Kamuzu Central Hospital Director Haji Juma said he is surprised to learn that some hospitals ask women to bring plastics when they are going for delivery at government hospitals.

However, Director of Reproductive Health Unit Dr. Chisale Mhango conceded hospitals are, indeed, asking expectant mothers to bring plastics.

"Hospitals do ask expectant mothers to bring plastics when going to deliver in some government hospitals,” he said, “but this is just an infection prevention measure.”

Mhango said it is the responsibility of District Assemblies to ensure that health facilities within their districts have adequate supplies, this since the government decentralised the procurement system.

District Health Officer for Blantyre Amos Nyaka also said it's true that hospitals ask women to bring plastics.

"We ask them to bring plastics because the health centres cannot sterilise the mackintosh,” he said.

District Health Officer for Lilongwe Dr. Maida said she has no responsibility on what hospitals under her jurisdiction order from the Central Medical Stores.

"I cannot comment on whether we ask women to bring plastics to hospitals or not. That is not my responsibility," Maida said.

Expectant mothers must provide surgical supplies before delivery at government hospitals, clinics
By Pilirani Tambala, Deogratias Mmana, Dorothy Kachitsa and Doreen Sonani
Hana Adamson was born at Bwaila Hospital. She was born in the hallway of Bwaila Hospital. She was born on the floor

The story that Hana's mother, Charity Adamson, tells is more common than most people would imagine. Malawi Observer has learned that, despite their nightmare at the hospital, Adamson and her daughter are among the lucky. In reality, women in Malawi are dying shortly after giving birth due to factors such as poverty, post-birth, loss of blood during delivery and poorly equipped medical staff in hospitals. At least one clinic, Malawi Observer learned, is requiring expectant mothers to provide their own surgical tools and protective plastic sheets at the time of delivery. If they don't, clinic officials tell them, they could die.

Many maternity patients told Malawi Observer reporters that staff members at various government clinics and hospitals told them that they must provide scissors or razor blades to cut the umbilical cords after deliver as well as black thread the attendants would use to tie the cord. In most cases, the patients told of having to provide their own plastic sheets.

That was the case with Charity Adamson. This is the story that she told to Malawi Observer reporters:

It is a bright sunny morning and Adamson, 33, of Falls township in Lilongwe is about to give her second birth. She goes to Bwaila hospital in Lilongwe to deliver.

She is shocked when midwives tell her that they will not help her during delivery because she has not brought a plastic sheet. They gave her an option to buy one from a ward attendant at K30.00 but she did not buy either. They ignored her outside the maternity ward where, in no time, she gave birth.

On the floor. In the hallway.

"I almost died. Nobody helped me. I gave birth on my own,” Adamson said.