Catching Babies in Malawi

by Andrew Schwartz

"I've seen so much here. I'm not sure I'd ever see this much in a lifetime of practice in the US," says Joanne Jorissen of her extraordinary first six months as a volunteer midwife at Bottom Hospital in Lilongwe, Malawi.

In interviews and in her blog, the graduate of both the Master's Entry Program in Nursing (MEPN) and the midwifery master's specialty at UCSF School of Nursing sorts through a flood of images:

The 14 beds in Bottom's labor and delivery room. They're separated by thin curtains and typically filled with women at various stages of childbirth as Jorissen and, perhaps, a nurse and another midwife rush from one to the next. "You learn the practical skills," she says. "A lot of times there's nobody else; you just have to do it." She's already caught "over 60 babies with my own hands."

The dedication and humanity of a staff wrestling with painfully thin resources. "Sometimes it's hard just to find a scissor sharp enough to cut the umbilical cord," says Jorissen. The four wooden shelves, which on one of her first days Jorissen found filled with "small bundles, colorful chitingis [the cloth that women wrap around their skirts] with women's names written on tape and stuck on the outside." The bundles were babies that had died that day. The Malawian women singing outside the hospital; repairing black plastic shoes - bought for just a few pennies - with plain white thread; and an hour after childbirth taking a cold shower, and then quite often washing their bloodied clothes themselves, cooking and caring for other small children they had to bring along. Getting to Malawi
After graduating from Brown University in the late '90s, Jorissen spent two years working on USAID projects. She felt the work was too far removed from those she wanted to learn from and serve, but it did bring her into contact with nurse-midwives, inspiring her to apply to UCSF. At her graduation last spring, Jorissen met Sally Rankin, a School of Nursing professor who for the last five years has been deeply involved with HIV/AIDS work in Malawi. Jorissen explained her lifelong desire to work in the developing world, and Rankin contacted Chrissie Kaponda at the Kamuzu College of Nursing at the University of Malawi. Kaponda, a US-trained nurse-midwife who received her PhD degree from the University of Illinois in Chicago, opened her home to Jorissen. "They (the Kaponda family) have been incredible to me," Jorissen says. When she arrived in March 2005, Jorissen began training to become a licensed midwife in Malawi and learned enough Chichewa to at least get by. She began working at Bottom Hospital in April. Bottom Hospital
"The hospital itself is surprisingly small, considering it is the principal hospital for the entire central region," Jorissen wrote in her blog, an eloquent series of entries on her time in Malawi (www.babycatching.blogspot.com). Bottom "actually consists of a cluster of buildings in various states of disrepair." But, says Jorissen, the hospital's administration is trying to transform it into a cutting-edge center for teaching and care. As part of that process, Rankin and Kaponda hope to establish an ongoing relationship between their two institutions. "For Kamuzu College and Bottom Hospital, this will provide increased access to, and support the utilization of, evidence-based care, and give direct support to the struggling profession of nursing in Malawi," says Jorissen. "For UCSF, it will provide incredible international work experience and an opportunity to learn firsthand about the issues affecting health care and the profession of nursing in the developing world. It may also lead to collaboration on research benefiting the populations served by Bottom Hospital." Where She Belongs
Visibly exhausted as she eats peanuts and tangerines she's bought from a street vendor during a shift break, alternately disturbed by the harsh conditions and inspired by the strength and beauty she sees around her, Jorissen says she has no doubts Malawi is where she belongs for the present. She talks of emerging from the hospital when a Malawian woman grabbed her hand. "I didn't remember standing by her bedside [when she gave birth earlier in the day]," says Jorissen, "but she kept saying 'thank you' over and over. It was, just, I don't know, it was worth it then."