Area 25 Health Clinic - Maternity Waiting Home

This project and vision started six years ago as part of a safe motherhood initiative, under Joyce Banda´s presidential leadership.  Area 25 Health Clinic happened to be one of the chosen sites because it was one of the fastest growing peri-urban areas in Malawi – and still is. The idea was to introduce maternity waiting homes at health facilities around the country which would reduce maternal and neonatal mortality which often happened because of 1)  the late decision to access care 2)  getting to the facility that provides care late and 3) difficulty finding expert care once at the facility.   Historically women were deciding not to use maternity waiting homes because the maternity homes did not have water, power, food or anywhere for guardians to stay.  The maternity home now addresses all of these areas, and more, because while they wait , women not only have those basic needs met but also have a space to learn, be inspired, have access to healthy food AND encouraged to take care of the environment.  The vision is no longer just to reduce maternal and neo natal mortality but to take a holistic, integrated approach to human health and environmental health and to to connect them.  It is not just about survival and food and nutrition, it is about a way of living and inspiring women, with they hope they can then integrate knowledge and experiences gained at the clinic, into their families and communities once they leave.  

 

The woman at the clinic receive nutritious meals from the onsite permaculture garden 3 days a week, and can access the gardens on the other days, to prepare their own meals.  The expectant mothers are able to keep themselves busy and find purpose in the therapeutic space of the garden (as opposed to just sitting around and waiting) by also helping to tend to the plants and assist with watering. They can attend workshops on site while waiting for the birth, and learn about health and how to keep their babies healthy once born - all through the lens of agriculture, nutrition permaculture and regenerative garden design.  They learn about People Care, Earth Care and Fair Share and how these are inter-related, and relate to the mothers.  They learn about intercropping, compost, building soil health, and connecting environmental health to human health.  They learn about nutritional and medicinal benefits of multiple foods within the garden, look into topics like food waste, water management and mimicking nature within a human setting.  They dive into other health topics like family planning, contraception, dangers related to pregnancy and what are the signs to look out for.  They learn about healthy deliveries, healthy babies and how to breastfeed.  Women learn what pregnancy can look like if they have malaria or are HIV positive.  Expectant mothers learn how to avoid issues like fistula too, which is a huge problem in Malawi.  Training and workshops and the experience at the waiting home hope to also remove the myth that healthy food is expensive and that healthy food can be delicious, nutritious, and affordable.

 

Every woman that leaves the clinic with her child gets three seedlings: ONE BAMBOO (it's great for soil stabilization, a great fuel wood alternative that regenerates,  it increases biodiversity,  brings shades and helps cleaning grey water), ONE FRUIT TREE (that they can watch growing while their child is growing and eventually harvest its fruits to eat and sell) and ONE INDIGENOUS TREE.

Through giving these seedlings the hope is also that there is a renewed relationship between the mothers and child´s relationship with nature too.

 

To paint more of a picture: on average 25 women leave the clinic each day with these trees.  These women are leaving from the maternity waiting homes or from the ward. Women can arrive on one day, give birth the same day and leave the next, or there are women who are at the clinic and waiting home for 2 to 3 weeks or some stay longer if in post operative care.

 

Meals are made for the women every Tuesday, Thursday and Saturday and on average for each of those days they feed between 75-150 women (this includes women from the waiting home, labour ward, maternity wing, guardians and staff).  They would like to move towards feeding everyday. Currently, the permagarden is able to provide ALL leafy greens for the meals and they can also include starches like sweet potato and cassava from from the garden but there are still additional things that need to be purchased: tomatoes (too intensive for garden), onions (the garden has some but not enough), oil, salt, rice, maize, sorghum, millet, occasional meat and bread.  
 

There is also an outpatient adolescent mother programme where they identify mothers between the ages of 12 and 19 at the antenatal clinic who have some challenges (financial or physical).  These young mothers go to the clinic every 2 weeks and go from when they are about 18-20 weeks pregnant till the babies are born and 6 months old.  The idea is to influence their mindset - to learn about nutrition but also to encourage them to go back to school, learn about financial literacy, beading, sewing, painting, tree planting etc, and helping them stay healthy.  On these days there are an added 100 youth to feed, in addition to the mother mentioned above.
 

The project is a public private partnership between Baylor College of Medicine and Ministry of Health in Malawi where they are both pooling their resources together.  Baylor supports the Maternal Child Health initiative at the Health Centre, and supplements, supports and empowers the Ministry of Health in the shared vision to reduce maternal and neonatal mortality by providing respectful quality maternity care.  USAID has supplied some interventions such as drip kits for gardens.  

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