Womb loss in malawi – an unfolding tragedy — the bureau of investigative journalism

In a dark room in a hospital in Thyolo, a town in the south of Malawi nestled among tea plantations, Ngellina Chikopa was lying on a bed. The 18-year-old unwrapped her chitenje, the sarong worn by Malawian women, to reveal a long wound oozing with pus. The cut stretched from her lower abdomen through her belly button and up past her stomach.

Ngellina gave birth by Caesarean section in April 2018, but the baby died of asphyxia, where the infant becomes stuck and suffers brain damage from lack of oxygen. She should then have had time to grieve; instead, her wound became infected. She was given intravenous antibiotics but the infection raged on and the wound started to release foul-smelling pus. It spread to her uterus. Doctors gave antibiotics but they didn’t work.

Doctors at Thyolo hospital were forced to perform a hysterectomy, an operation to remove her womb. This meant she could never bear children in the future.

Later, she suffered another infection and was transferred to Queen Elizabeth Central hospital, a major referral hospital in the city of Blantyre, where she had another two operations to clear the pus and close the wound. She was discharged, but then returned to Thyolo hospital because her stomach was not healing properly. The Bureau visited the hospital during our recent investigation into antibiotic resistance in Malawi. Ngellina was sharing a room with a young woman called Margaret, who had also lost her baby to asphyxia.

Ngellina told us that she feared being ostracised, now that she is no longer able to have children. In Malawi, there is a stigma attached to both being unmarried and childless. “I know that I will never ever have children in my lifetime, I have accepted it with a lot of pain as there is nothing I can do about my situation,” she said. “Some relations are aware of my situation and I know the social discrimination that I will be facing out there.” She hopes to go back to school when she recovers or seek employment.

Dr Makwero, the acting head of the maternity department, believes resistance is hampering treatment of women with infections. There are many women for which the antibiotic, ceftriaxone, is not working, Dr Makwero said. “The bugs that we are seeing are resistant to ceftriaxone,” she said. “It really affects our management. We tend to clear the infection through surgery but it is not always working,” she said. She fears for the future as resistance rises. “It would be catastrophic if we could not use ceftriaxone any more,” she said.

For these patients, she has to seek permission to use meropenem, an expensive antibiotic which the hospital doesn’t always have in stock. The head of the department has to sign forms and the pharmacist has to be convinced it is needed. There are concerns using it more frequently would lead to resistance emerging. Rising resistance to meropenem would be disastrous, medics told the Bureau, as it would leave doctors with even fewer options for treatment.

Dr O’Brien accepts that hysterectomies are carried out to save women’s lives. Yet he believes this is a false economy as the operations are far more expensive than a blood culture would be, and much more traumatic. “If it’s truly the case that doing a hysterectomy is the only way to save someone’s life then clearly that’s a better option regardless of all of this. But clearly getting the right antibiotics and blood cultures would be a better way of dealing with this,” he said.