Sunday Morning ~ Keeping Water…building a reservoir?

Sunday Morning ~ Keeping Water…building a reservoir?

Mtsinje wopanda miyala sasunga madzi. ~ A stream without stones does not keep water.

~ Chewa proverb

May 26, 2024

HI Everyone,

An architect is coming this week and I’ve been trying to set up a time for her to give a presentation about birthing unit designs. My hope is to get the ball rolling for our new ward. When I sent out an email asking for availability, the head of the obstetrics department pointed out we have a new hospital administration since we got approval for this project in 2018 so we should  approach the new director before going any further. This frightened me a bit, so we urgently scheduled a meeting with the hospital director for Thursday morning. Three of us went to make our case to him. The Malawi president was in Blantyre that day, so traffic around town was horrendous. My fifteen minute ride to campus took over forty and I was worried about being late for this critical meeting. I managed to arrive on time, as did my colleagues, but the director didn’t. He called to say he’d be an hour late. We decided to wait. If we rescheduled who knew when we’d get our next chance. So we sat in his waiting room making the secretary uncomfortable. She kept asking if she could call us when he got there? We all preferred to wait, knowing something else could come up and our chance would be lost. He arrived, polite and all apologies, and shepherded us into his office.

I try to be ready for disappointment, almost expecting to be told “No”, so I had data ready to show how this project would improve care, reduce maternal mortality, and improve student performance. I was forming a backup plan for when he refused us. After all, it took us ten years in Bar Harbor to get approval for a new Women’s Health Center even though everyone agreed we needed more space. Ten years! Then, after getting a yes, it was another three years to raise the money and get the place built. So, I wasn’t expecting this to be easy. 

The hospital director is a physician and quite young. Once we were seated in his office, Christina, the head of midwifery at the hospital, explained our original project and goals and how it nearly came to fruition when the pandemic struck and our designated ward got taken for covid patients. She continued, “Now Linda is back and she wants us to re-introduced the project.” Ok, this is not what I wanted her to say. I’ve made very clear this is not my project. I believe in it and am willing to work hard for it, but it is not my project. With sinking heart I smiled and stayed silent.  Ursula, former dean for midwifery at the university, went next and I prayed she did not mention me. She provided a more academic angle, emphasizing the educational component and adding we have the support of the head of obstetrics. The director then looked at me, asking if I had anything to add. I hadn’t intended to speak, but it seemed I should say something, otherwise why was I there? I explained about my history in Malawi as a Peace Corps volunteer forty-five years ago. He looked up and said, “Forty-five years?!” Everyone laughed. I’m sure it was well before he was born. I said I became a midwife because of the role models I had in Malawi. I was fortunate to come back as faculty in the midwifery program and really believe this can be a model for the rest of the world, including the United States. Then we outlined what we hoped for: an addition built onto the postnatal unit where we could have a delivery suite to care for uncomplicated maternity cases and a clinical site for students. He paused for moment and I braced myself for the no. He described his experience in medical school and what he learned from midwives. He said he believes we should think bigger. “Why have just a small unit that would not allow growth? I think we should build a Center for Excellence for Midwifery. We should plan a bigger building where there could be a library, a conference room, room for teaching, as well as a comfortable place for women to receive care.” The following thoughts went through my mind simultaneously: 1) Am I dreaming? 2) Wow, this man’s mother did a fantastic job. 3) Sit still. Do not jump up and scream for joy. 4) Why are Ursula and Christina not hugging each other? 5) It is culturally unacceptable for women to touch men. Do not go hug him while jumping up and down. 6) Breathe. This is good. 

Those were just my initial thoughts. My heart was thumping out of my body. This can be so amazing! Ok, so it will take some money. It will take some time. But what took us ten years to accomplish at home took a matter of minutes! (plus the hour wait). Hospital administration saying yes to this means we can get plans drawn and get some quotes. We’ll need all that to apply for grants. The hospital director actually asked how he could help. (I pinched myself) He said he would speak to the Department of Health. He asked to be included in the architect’s presentation this week. I mean, if I wrote the perfect script for how I wanted that meeting to go this would have been it in fantasy land. 

“Can you believe this?” I whispered excitedly as we were walking out. They both turned to me and smiled. They don’t hyper-react like I do so I tried to tone it down. It was a struggle. 

This is so much more than we thought possible and we have to re-imagine a plan. Late Friday afternoon the midwives got together to brainstorm. I was still bubbling over and gushing about the meeting to the ones who weren’t there. They don’t understand my excitement about that Thursday meeting. I had to explain that, getting approval and this kind of support from administration is harder than finding funding in my experience. No one is going to give us money unless the hospital administration agrees this is a good project. Finding funding will be a job for sure, but it’s all a job. They looked at me, amused. I said, “You can’t grasp how hard this would be in the U.S.. Midwifery isn’t valued like it is here. I cannot fathom a hospital administrator saying yeah, let’s build a Center for Excellence for Midwifery on campus. That would be science fiction at home. In Malawi midwives are the largest workforce in the health system. It’s not like this where I live.” We started making a wish list, a real plan for what would work for women, students, and staff. In a way, it’s absurd to feel like a facility that meets all these needs should be such a gift, but that’s where we are. Let’s see where this goes.

Love to all,


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