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Improving Maternal Health in Malawi Wilma Brown is NHS Fife’s Employee Director and represents the many trade unions as a member of NHS Fife’s Board. A long-term UNISON member, Wilma was invited to join the union's delegation visiting Malawi in their efforts to improve maternal health in the country.

The Manchinjiri Health Centre lies in a tiny village at the foot of the Zomba plateau in Malawi. The Centre provides a general outpatient clinic treating all kinds of illnesses, including Malaria and TB and hosts a testing and advice clinic for viruses like HIV.

The Centre is also the home of the local labour ward. It is not what we would immediately think of as a fully functioning labour ward – there is sometimes no electricity, let alone birthing balls or ‘gas and air’. In this small annexe staff must deliver babies, carry out pre and post-natal checks and take measures to prevent the onward transmission of HIV.

Despite the modest surroundings, women from the surrounding villages walk for many days to birth in the labour ward.

“Because they walk for a long, long time to get to the clinic, you can't give these mothers a definitive date that they need to come”, Wilma explained.

“Obviously they have a due date so they just they start walking to come to the clinic, days before the due date. What you end up with is a lot of women there who are not yet ready to give birth, and then women who will go over their time but they can't go back because the walk is so long. So what they were finding was that they had more women waiting to have their babies and then they ran out of room.”

The delivery room itself is similarly short of basic amenities. There are only two beds and the conditions are particularly cramped, as is the four-bedded room next door where women go to recover after birthing.

“It was fundamental things, for example, there is no shower for the ladies after they've given birth, or a bath. They have very few facilities for the babies as well and they're a long way away from the main hospital. They still have quite a number of maternal deaths and also neonates dying, so we need to help them with their facilities - it's pretty basic stuff.

“Obviously it's not for us to go in there and tell them what they need to do - we’re asking them what they want us to help with that will improve their daily lives in terms of delivering services.

While the facilities are yet to be brought into the 21st century, the partnership formed between this small village and the UK’s largest trade union very much is.

Issa Jafali was, until he was very recently unseated, the equivalent of a local councillor in Manchinjiri, and it was Issa’s use of social media to tell the world about the plight of his local community that drew the attention of UNISON Lay President, Gordon McKay. Through Facebook and WhatsApp, a partnership was formed that would see UNISON branches across the UK raise almost £40,000 to improve facilities in the region.

“We met with the villagers and the elders of that community to discuss with them what their priorities were and they gave us a kind of wishlist - they wanted pretty much what we thought they would need.

“We also spoke to the District Health Officer, who I think in our terms is probably a kind of hybrid between a medical director and a public health director. We spoke to him to ensure that what we were talking about met the strategic aims of the health authority, and he was very pleased with what we wanted to do.

Wilma was invited in her role as a UNISON activist, and Chair of the Fundraising Committee, to be part of a delegation which visited Manchinjiri as they sought to improve maternal health in the country.

As Wilma explains, she wasn’t prepared for how little resource local nursing staff had to provide such vital care, and indeed how well they are able to cope despite the shortages of basic facilities.

“I wasn't surprised that the clinic was out in the sticks, so to speak. What I was surprised at was how rundown it was and how they managed so very, very well with so very, very little resource.

“They don't have a doctor at all at this clinic - it’s purely run by midwives and nurses and they have healthcare support workers who take on vital tasks without any supervision at all.”

And it’s not just healthcare in Malawi where resources are scarce – Global Finance Magazine recently ranked the country as the fourth poorest in the world – and areas like education are every bit as badly affected.

As part of their visit, the delegation visited a school and were taken aback by the conditions they found.

“They have shelter from the blazing sun and from the rains, but it’s very basic conditions that the teachers taught in”, Wilma explained.

“The day that we visited was a holiday but the children come in to school because they still want to be taught, and the teachers were there although it was in the middle of the school holidays.”

When the delegation met with the school’s headmaster, he was very clear about the reasons why children were so keen to attend – firstly, they want to be educated to help them better their lot but perhaps more importantly, they would be fed.

“The government had put a scheme in to feed the children at school, where children get one meal per day. It was Nsima that they were given – it’s made from maize and they make it like a thick porridge, and the children have that every day. The parents actually come and cook the Nsima - they make it for the children and it's given out to them.

The delegation were told that budget cuts had recently resulted in the abolition of the feeding program, and the Headmaster was concerned that attendance would suffer as a result – the knock-on effect being that the schools future could be threatened.

Around 700 hundred children of all ages attend the local school, often walking many miles each day to do so. When asked how much it would cost to continue the programme for the school, the headmaster explained that each child could be fed daily for around £150 per year.

“We couldn’t believe it! We quickly did our sums and we said ‘we will pay for your school to be fed for the next year’. But then we asked how many schools were in the community served by the health centre, and he said about ten.”

UNISON has agreed to fundraise to provide meals at those schools also, feeding several thousand children a meal every day while they attend school.

Wilma explained that meeting the schools pupils was perhaps the most rewarding part of the trip.

“They were so enthusiastic and happy - the happiest, warmest people I have ever met - and they have nothing, absolutely nothing.

“We had collected a lot of things here, just because people heard that I was going, pens, paper, things for children to use in a school, football tops. They have a real fascination with our football teams and they all wear football tops.

“We handed out some sweets just some small packs of sweets as a treat for them. They don't get things like that and they were absolutely delighted - the pleasure on their faces was just amazing.

And Wilma was keen to stress that the learning between our two countries, eight-thousand miles apart, is far from being one-sided.

“They've got so much to share with us and we've got so much to share with them.

“I was surprised at the innovative ways that they deal with things, and I was heartened to see the way their community pulls together, and again I think we can learn from that.

“So I think that we need that learning, and in our case learn to use the resources we have in the best ways we can.”

When asked why it was important that we supported communities like those in Manchinjiri, Wilma’s answer was simple - “Because we can, that's why it's important, just because we can.”

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