Life and death in Malawi

Here in Malawi they call it the “suicide month”, describing the unbelievable heat as we step off the fight into the country’s thick air. 

Traveling through the countryside we are greeted by a stark, blighted landscape, punctuated by occasional baobabs. 

Landlocked Malawi ranks among the world’s most densely populated and least developed countries, with Malawian families still averaging six children. 

As a medical doctor and filmmaker, husband-and-wife team, we are here making a documentary for Al Jazeera’s series Lifelines: The Quest for Global Health on breakthrough health interventions around the world. 

This film looks into how the death rate of mothers and their newborns, which had Malawi at the bottom of the global list 10 years ago, is starting to improve.  

Until now, pregnancy in Malawi has been such a high-risk undertaking that all three words for pregnancy in the local Chichewe language mean “ill” and “between life and death”. Babies were traditionally not named until after their first week of life, by which time they have a better chance of survival.

Today women are now encouraged to deliver at health facilities with trained assistance and traditional birth attendants have been banned. 

In Malawi, most people live in rural villages far from emergency medical help so they are urged to wait out the last four weeks of their pregnancy in maternity waiting homes in the hospital grounds – the only way to ensure skilled help is at hand when their labour starts.

Delivering in the facility also saves pregnant women and their families a goat.  

The country-wide structure of traditional authorities, or chiefs, is right behind the change in traditional values when it comes to safe motherhood, and chiefs these days can fine anyone delivering at home one goat.

The chiefs’ involvement is driven by senior Chief Kwataine, a former English school teacher appointed by President Joyce Banda to head her Presidential Initiative for on Safe Motherhood.  

He travels Malawi and has a radio show, to constantly urge other chiefs to get their men involved in helping bring down the maternal and newborn mortality rate.

But many health facilities are poorly resourced. We visit what is said to be the biggest maternity hospital in Africa to see how staff there is coping with the additional number of deliveries.  

Bwaila Hospital in Lilongwe deals with an average of 50 deliveries a day with only one full-time obstetrician and a severe shortage of trained midwives, equipment and drugs. Despite this, Dr Kaliti and his team, have managed to halve neonatal and maternal mortality at the hospital in just three years using a systems-improvement approach. 

Dr Kaliti remembers the chaos in the hospital when he first arrived: “We found a state of desperation and the message I received was, ‘You cannot change it, it’s been like that for years.’ I said ‘If we continue like this, we’ll just end up converting this [hospital] into a graveyard.” 

Every death is now understood to be the result of a “system failure”, and so each one is carefully audited.

Dr Kaliti’s advice to the team, “Move out from your comfort zone. Ask yourself  ‘What can I do different. What can I do to make things a little bit better in whatever I’m doing’.”