Mwai

Sometimes the hospital seems an uncomfortable place to be in. A five hour and a half ward round seeing all the patients in a packed medical ward can be pretty uncomfortable as can arriving in OPD to see a queue out the door. SCBU is always uncomfortable when you have to go there on call. First of all it is full of tiny babies who I have little experience in looking after. Then it is hot, very hot and getting worse as the temperature outside rises and then there is the omnipresent smell of milk which I find somewhat nauseating.

Mwai is 3 days old and weighs just 1800g. He lies in his incubator in the Special Care Baby Unit in St Francis. Incubators here are not like what we know at home. Mwai’s incubator is basically a box with glass panels. There is a light bulb in the box under which there is a tray of water to disperse heat and moisture through the incubator. Mwai shares the incubator with a few cockroaches. Mwai’s mother Clemintina kindly agrees to talk to me so I can get an insight into the life of one of the mothers here in SCBU. Exildah a qualified nurse who is now training to be a midwife helps me translate, we move from the incessant heat to a cool office.

Clemintina explains that Mwai was born in the hospital as she had a twin pregnancy. She delivered at 36 weeks but unfortunately Mwai’s twin was still born. Tragically for Clemintina her two previous pregnancies did not carry to term and she lost both in the second trimester. ‘Despite all the other losses I am happy to have Mwai’ she explains before going on to say that so far things are going well, Mwai is bright and alert and feeding ok. However she finds it difficult hat her baby is here in SCBU. ‘It is difficult for me having been here for some few days, but my mother has come to be here to support me.’

The mothers of the SCBU babies stay in a room nearby and come regularly for feeding. Many of the babies are too premature to suck effectively so are fed with expressed breast milk via a tube. Clemintina finds that the environment makes it hard for her to bond with Mwai ‘I am not feeling ok because I would like to be with my baby, but here I can only spend some hours so there is distance between me and my baby. I didn’t really expect to have to stay here, but for the sake of the baby I know I must stay wherever there are good things.’

Clemintina does though understand why her baby needs to be in the incubator ‘I was told that my baby wasn’t strong enough so it had to be kept warm’. Even Clemintina finds the heat difficult to cope with and she has noted the cockroaches attracted here by that same heat ‘If there would be any poison for them, that would be good.’

Clemintina is 23, married, Catholic and has a lot of aspirations for the future. Exilidah translates that she wishes for the baby to grow up well, go to school and lend a helping hand in the future. ‘This is our African way of life’ Exildah explains, ‘people who have gone to school and been educated will plough back, if one is to be educated it benefits all members of the family, (that person) becomes a source of income, a bread winner.’


Currently Clemintina and her husband survive as subsistence farmers, they grow maze and ground nuts which they then sell at the market. Clemintina says she would like just four children. I ask will she consider using birth control to limit her family size to four. I am surprised by her response that she wishes use the ‘Jadel’. Exildah explains that this is a subdermal progesterone implant. Implanon a similar product is available in Ireland and I have previously had some patients opt for it as a contraceptive method but until now wasn’t aware of its availability here. Exildah explains that it can be got for free from the Ministry of Health but unfortunately not enough staff are trained in its insertion.

I tell Clemintina that I feel that is wise and responsible plan to have and ask her what she thinks of the Catholic Church’s view on birth control. ‘I understand the Catholic Church and family planning issue, but looking at my history it is difficult for me to say I am not going to use family planning because at the end of the day I might be the one who to die.’

I also want to ask Clemintina does she know why her three other babies did not survive. ‘I have been told it is about hard work (on the farm), that is the reason the babies die, there can be other reasons such as witchcraft.’ The topic of witchcraft presents itself to me almost everyday but I am surprised to hear it from Clemintina who comes across as a well informed and independent thinking young woman. I ask who may be responsible for the witchcraft ‘it could be from my own family’ but do not challenge what seems to be a deep seated belief in much of the population here.

Exildah outlines her thoughts on the reasons for Zambia’s high peri-natal and maternal mortality rates. ‘We are a developing country, most of our women come from far areas as to where they can find a clinic. The other thing is our literacy levels, most of the women in rural areas are uneducated, they get married at an early age.’

I thank Clemintina for her time and openness in talking about her and Mwai. ‘I called the baby Mwai because of my history, it means Lucky.’