March 23, 2002

Dear Friends,

The Story of a Maternal Death

I think most of us mission co-workers with the Presbyterian Church (U.S.A.) try to write letters of information and perhaps encouragement back home. I have waited for several months to write such a letter. It seems this letter will not be very encouraging, but it is a true picture of our situation in Malawi, a small, land-locked country in southern Africa.

A maternal death is the death of a mother during pregnancy or within the first six weeks after delivery. A direct maternal death occurs when the demise is caused by a complication of pregnancy. Since I work as an obstetrician/gynecologist at a mission hospital, I am very concerned about preventing maternal deaths. Here is an account of what I found out yesterday.

I went to the hospital as usual very early in the morning yesterday. There was a new baby weighing 1.6 kilograms (about 3½ pounds) admitted to our nursery whose mother had died at the government district hospital in our town two days before. I asked to speak with the person who accompanied the baby to our hospital. The person who came was the mother of the woman who died. This is what she told me.

Her daughter was living with her husband and six children in a small town about twenty miles from our hospital. Six days previously the daughter had started bleeding and went to the mission hospital in their town. She stayed there three days, but was not attended to because the workers at the hospital were on strike. Three days ago they hired a vehicle in their hometown to take them to the government hospital. She was still bleeding. A cesarean section was done at the government hospital two days ago. The mother died at the hospital early in the morning after the operation.

As an obstetrician, I can tell you that this death did not have to happen. With adequate and timely intervention, complications of pregnancy like this can be attended to. When the pregnancy is very early the baby may not survive, but the mother can almost always be saved.

A maternal death in a developing country is usually a combination of unfortunate events and conditions. This time the fact that the mission hospital in the home town was on strike was very unfortunate. This small mission hospital has served that community for decades. Now the hospital is unable to pay the workers the same amount of salary as the government hospital workers. There is no government hospital in their town or anywhere nearby. That is why they made the 20-mile trip to Mulanje, our town.

Our Mulanje government hospital has only one doctor. We were told that this hospital has no glass slides for the laboratory. Our Mulanje Mission Hospital has been sterilizing their operating room supplies for six months with our autoclave because theirs is broken. I do not know what happened to this woman who died at the government hospital. I only know of the fact of her death.

As I finished talking to the mother of the deceased, I asked if I could see the baby. The nurse told me that the baby had died. So this grandmother was going to prepare to leave with the small corpse in a bundle to make the trip back to her hometown.

This is a sad, but true account from our small African country. Stories like this are happening every day. On the positive side, we are making small but sure steps in the right direction to prevent maternal deaths. Doctors and clinical officers are being trained right now who will join the battle when they have finished their training. We have 34 nursing students right now in residence at our nursing school who will join the battle. We have a new autoclave supplied to us by the Medical Benevolence Foundation of our PC(USA), which is capable of sterilizing all the supplies for our district of 500,000 people.

If I did not believe that God is calling me to work here in Malawi, I could not continue to work here. Folks like you at home are continuing to support the mission outreach of the church. I thank you for that and ask you to continue and increase your support.

Sincerely yours,

Dr. Sue Makin

The 2002 Mission Yearbook for Prayer & Study, p. 39