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Malawi Maternity Clinics

Summary & Objectives

We have become interested in the catastrophic maternal mortality levels in Africa. In a recent article entitled "Epidemiology of Maternal Mortality in Malawi" by Dr. Eveline Geubbels, current issues related to these problems have been described. Furthermore, through our own experiences, we find that rural village midwives generally do not admit to maternal deaths in relation to their services even though Malawi has one of the highest rates in the World. Based on Dr. Geubbels’epidemiologic studies, roughly 60 to 70 percent of maternal mortality is due to maternal hemorrhage, sepsis or hypertensive disorders, and our project is aimed at the treatment of these problems. While we realize there is some disagreement as to how, and where, to place resources in order to affect change in Global Health, we agree with those who feel that the resources, supplies and training are best placed with the "front line," or first level providers, as opposed to the building of more medical schools to produce more physicians.

In response to this serious concern, we have initiated a project designed to provide rural Malawian women with more effective, and greater quality, maternal care even as we maintain certain aspects of the traditional midwife practices. Essentially, we plan to promote development of maternal facilities made from modified, no-longer-in-use, 8 by 8 by 40-foot steel shipping containers. These decommissioned containers, available in the Ports of Dar es Salaam, Tanzania, and Durban, South Africa, can be retro fitted so they have doors and windows. Each would include modules for four delivery "pods", a central nursing area and a recovery pod. Lighting in the facility would be provided by a small solar and wind generated electrical system. A composting toilet would be contained within the module, and water would come from a shallow well. These self-sustaining clinics would provide safe and antiseptic settings for delivery and a calm supportive area for recovery where the mothers could be observed for hemorrhage or other complications. They would be placed in areas of Malawi that are too distant for mothers to obtain care at a hospital. While the capacity of a single module seems modest, in fact most mothers without complications will deliver, recover and be ready for discharge within 5 to 6 hours. Thus each module could be capable of caring for 10 to 12 deliveries per day, or 440 per year. Ten clinics could provide care for 44,000 mothers per year. Ultimately, we hope to establish enough of these maternity clinics so that all rural Malawian women have access within a reasonable distance from their village.

Prototypes of these clinics are being designed and produced by students in the Arizona State University Schools of Engineering (please see their website:https://sites.google.com/a/asu.edu/malawi-empowerment-village/), but our plan is to eventually have them produced in Malawi. The mission of this project is that it will be eventually be sustainable without continued infusion of charitable or grant funding sources.

Furthermore, we propose that “Traditional Birth Attendants” provide the staffing of these clinics. These individuals currently offer what would be considered lay midwife services and, as such, are not recognized by the medical professionals in Malawi as being trained medical personnel. We propose that these attendants could, in fact, be trained to follow specific protocols for the treatment of the common complications of the antenatal and post partum period. Protocols, along with kits of medications, intravenous fluids, and antibiotics would be provided for the most common complications. Training would be provided to the attendants, and of course one of our challenges will be to convince them to accept the training and to recognize the value of these clinics. Here we believe that the network of contacts in the villages and their leaders will be particularly important.