Why Give a Buck?

Mercy Kafotokoza on preventing maternal and child deaths in Malawi with nurses on motorbikes

• Johanna de Burca and Christey West • Episode 1

Share episode

Johanna and Christey speak with Mercy Kafotokoza, the midwife and nurse tackling Malawi's alarming maternal and infant mortality rate head-on! Mercy discusses how she trains nurses to ride off-road motorbikes so they can ride over rugged terrain to treat the furthest away patients. She also provides an overview of the complex cultural context she works in where consulting witch doctors is the norm, and how lack of education around maternal health leads many women to hide their pregnancies in fear. Mercy also describes how her powerful nurses use culturally appropriate techniques (like song and dance!) to educate, treat and ultimately save thousands of women and children in rural Malawi. You'll love her!

Get Involved!
Learn more about Mercy's work and how you can support her to reach more mums and their babies here: justpeoples.org/leaders/mercy

Why Give a Buck?
Because with $2,160 USD Mercy can buy a motorbike, train a nurse to ride it, obtain her license, and cover fuel and maintenance costs for a year.

And with $15,672 USD one hundred women can receive comprehensive pre- and post-natal care, and emergency support from Mercy's nurses whenever they need it for themselves and their babies. These mothers and children will be given the best chance to survive and thrive!

Johanna:

Why Give a Buck? is proudly brought to you by Just Peoples, an international nonprofit that directly connects givers and doers to address global poverty. Hello, and welcome to Why Give a Buck? I'm Johanna de Burca,

Christey:

and I'm Christey West.

Johanna:

Each month on Why Give a Buck?, we highlight innovative individuals tackling poverty in their local communities across Africa and Asia, and explore why we should give a buck.

Christey:

For our first episode, we're super excited to introduce you to one of the main reasons we decided we need to launch a podcast in the first place. The incredible Mercy Kafotokoza.

Johanna:

When Christey and I first heard Mercy describing growing up in rural Malawi, a place where the only medical care available came from the local witch doctor, and how her uncle's tragic and preventable deaths from a tooth infection eventually led her to do the literally life saving work that she does today. We were like, this has to be heard.

Christey:

Absolutely, Mercy's story has to be heard. So today we're speaking with Mercy about the remarkable experiences she had growing up that led her to now train registered nurses to ride serious off road motorbikes out to the remotest parts of Malawi, so that pregnant women, new mothers and their babies can receive quality medical care. We're so happy to have you here with us today. Mercy. Welcome.

Mercy:

Thank you so much for having me Christey and Jo.

Johanna:

Welcome, Mercy. You're the first leader whose work we've supported in Malawi. So we're curious to understand a little bit more about your home, tell us something special about Malawi.

Mercy:

We live as a community, in my house, if do not have food, I can easily go to a neighbor, and they'll give me food. In the village, it's different households will cook. And then they'll bring it at the same time, then all the children will be on one side or the women on one side, or the men on one side. So no one shouldn't be hungry. My first time to go outside of Africa. It was the US. So to me, it was wow, this is a different world. This is a completely completely a different world. But one thing that I saw in the US when I went there, it was people live alone, like individuality. That's what I saw in the US. So that's the difference here. We live as a community, outside, people leave as individuals. And that's one of the things that I missed. Then I went to I went to Germany, that country is just too too clean for me. It was just

Christey:

don't come to Japan.

Mercy:

It was extremely too clean for me, and I think my hosts, I was there for three weeks. And my host said Mercy, what are you missing in Africa? Because you have been here for three weeks?.What are you missing? I said I'm missing dust I'm missing dust. This place is just extremely too clean for me.

Johanna:

Wow, you can come and stay at my house Mercy you'll feel you'll feel right at home!

Mercy:

Things are done in order. Everything is orderly. And the places I just like you can see even in the roads walking you could not even see a leaf. Anyway, it was extremely too clean. Yes and no, I can't stand this.

Johanna:

I don't think you should go and visit Christey in Japan,

Christey:

Japan, it's pretty similar to Germany in that way. That's so interesting. I used to live in Vietnam. And I love it. When I go back there. I feel really free. It's just more relaxed, you know, and there's more dust around and there's less rules and people will live in a community like you're talking about not so individualized and it feels like it's more living from the heart rather than from the head somehow. I feel you.

Johanna:

Well, Mercy, the freedom, the dust, the beautiful sense of community. It sounds wonderful. But at the same time, Malawi is facing some really huge challenges.

Mercy:

We do face some tough challenges and poverty is the big one, we are among the top 10 poorest countries in the world. With 85% of Malawians living below the poverty line.

Christey:

Malawi has one of the highest rates of infant and maternal mortality. Do you mind explaining a little bit about why that is? Why the mortality rate is so high amongst women and infants?

Mercy:

Yeah, I think one of the reasons, is 80% of people live in rural areas. So the majority of Malawians live far from a health facility, because in rural areas, the geographical location of the remote areas, so the distance to the next health facility, and also the economic challenges, and the social beliefs or cultural beliefs. So, for example, if this woman is in a rural area, when she becomes pregnant, she has to fight the cultural norms. So she will hide the pregnancy up until maybe the second trimester, because the she has to hide it, she's afraid if I tell someone that I'm pregnant, they are some beliefs that okay, because of witchcraft, they will take away my baby from my belly, so they hide, so she fights the cultural beliefs, after fighting the cultural beliefs, then she has to fight the geographical isolation or the terrain, it's a very long distance. So all these and also the financial barriers because of poverty, this woman may not have enough money to hire public transport to go there. So all these challenges combined, they lead to delays. Now we are going through food insecurities. It means this woman will be thinking okay, if I go 50 kilometers away from where I am, what will happen to the other children at home? What will happen to them, who is going to help me with food 50 kilometers away from my home? So all these things people weigh up, should I go to the health facility? Or should I go to the witch doctor, the witch doctor is close. And also some witch doctors they provide food they will provide porridge to make sure their clients eat. But if they go to a far facility to a public facility, most of the times there is no food so l'd prefer to go to a witch doctor where i can find porridge then walking 50 kilometres and then I'll be starving.

Johanna:

Oh wow, I completely understand with all those barriers to accessing health facilities. The witch doctors are just so much more accessible. Do you mind sharing with us what the experience of going to a witch doctor is like and what they actually do?

Mercy:

A witch doctor? It's like a general doctor. So they attend to any kind of disease that happens in the community. You have diarrhea, you go to a witch doctor, you fall. You break your arm, you go to a witch doctor.

Johanna:

Do they give medicine - traditional medicines or anything like that?

Mercy:

Yeah they give traditional medicines, herbs. And yeah, like what happens, you go to a clinic, you do consultation? You have medicines. So there you go to a witch doctor, you do consultations they give you herbs.

Christey:

Are they generally effective for minor ailments?

Mercy:

You know, sometimes health it's about the belief. Sometimes people get well, because they believe if I take this, I will be well, but there are some cases like for example, TB, there is no way they can get well, just by going to a witch doctor. There is no way someone can get well, if it's malaria, it means they will delay the time until they'll be thinking of going to a health facility.

Johanna:

And what about the children are the children taken to see the witch doctor as well?

Mercy:

When a child is sick, the very first thing they think of it's a witch doctor, because witch doctors, they're closer to them because of the knowledge deficit. When a child is sick, for example, malnutrition, if a child is malnourished, that woman will be in trouble. They'll be thinking she has an extramarital affair. That's why this child has malnutrition. So the first thing is pressing on this woman tell us what are you doing? Why are you messing around? Because this child is malnourished they will not call it malnourished. They'll call there's these signs that we're seeing in this baby. It shows you have an extramarital affair.

Christey:

Oh, wow. So these are the sorts of traditional and cultural beliefs in rural Malawi. And that forms the context within which you provide maternity health care. That must certainly add another layer of complexity to things. So as a child growing up within this cultural context, what was it that inspired you to become a nurse?

Mercy:

So my parents got divorced when I was about six or seven years old, and I grew up with my maternal grandmother. And when we were in the village, it was me, my grandmother and my uncle. So one day my uncle said he didn't sleep and he was complaining of pain. He said, I've got a very bad toothache and my grandmother started giving him some herbs to put on the tooth. And after three or four days, it was so bad that he said, No, I can't, I can't handle this. And he was taken to a local witch doctor whereby they extracted the tooth. Back home, it didn't heal and it got infected. So after it got infected, my grandmother was kind of No, I think we need now to go to the hospital. The hospital was about 50 kilometres from our village, and there was no public transport. So we had to use an oxcart, walk, oxcart walk until we reach to the hospital at around 3pm. And my uncle was really like, down, down, down. And after they examined him two days later, he died. So the infection was so bad that it spread to the brain. And that's the way we lost him. And my grandmother cried and she really cried my son, my son. Only if I had known that this will take your life. I could have come with you to the hospital, earlier, maybe if only I had come here earlier. And now me being a young child and then I look up to my grandmother then I said no, no, don't worry. When I grew up, I will be a nurse so that no one in our community should die, or in our family should die because of something that can be treated, because at the hospital, they said, If only you had come here earlier, we could have treated this, we could have done the extraction here. So fast forward, I grew up, I became a nurse. The good thing is my grandmother is still alive. So she has seen all this.

Christey:

Oh, I'm so sorry that you and your grandmother went through that Mercy. And I can imagine it must have just added salt to the wound when the hospital staff told you that they could have saved your Uncle if he had been able to get to the hospital on time. But it's so impressive that as a child, you decided to do something about this problem and resolved to become a nurse off the back of it. I'm sure your uncle would have been so proud of that decision. So you did become a nurse and worked for several years at a regional hospital before starting your own organization, Wandikweza, focusing on maternal health care for rural Malawians. What was it that prompted you to leave such a secure job and launch your own organization.

Mercy:

I was in the labour ward one day. So a woman, she was I think seven months pregnant, she was pushed into the labor ward, she became unconscious. So we prepared her to go to theater. Unfortunately, we lost her on the theater table. So two boys were expected, like twins. But after two, three days, the twins also died. So I went back to the guardians. And I said what happened? And the guardian said she has been complaining of headaches, she had swollen feet, but the husband was not around to give us permission to take her here. So we were waiting for the husband and there was no transport and we had no money. And then this clicked at the back of my mind reminded me about my uncle, how it all happened. And I said, Whoa, if only maybe they could have come here earlier. We could have saved this life. We could have saved the life of the mother, we could have saved the life of the babies. So I said no, I think I need to do something. I'm here in the ward waiting for patients to come, waiting for complications to come. What if we go into the community and prevent complications from happening, and empower women, and empower the community so that they should be able to identify complications and danger, warning signs before they happen so that we go to the hospital on time. So I resigned and started Wandikweza. So that's how Wandikweza was born,

Christey:

oh my goodness, that dear woman and her twin babies. Oh, another extremely powerful moment where you took an absolute tragedy and turned it into a catalyst to create the change that was needed. I loved it when you said why wait for complications to come into the hospital ward, we need to be out in the communities preventing complications from arising in the first place. Yes. But it's a very brave move to quit a stable job and start something completely new, even changing the way people receive health care. So what actions did you take? How did you get Wandikweza off the ground?

Mercy:

So in 2014 to 2016 I was learning more about the community complexities, building relationships with the community, learning how things are done learning the culture. So by the way, where Wandikweza we are it's not my own village, but it's still in Malawi and the problems are the same. So that's why it took me time to Learn about the cultural context of the community where I was, how people conduct things like, as simple as attending wedding ceremonies, as simple as attending our funerals and sitting with the women. So in 2016, that's when we started with community health worker program training women. So we started with 15 women, so the first program, our training was how they can identify danger signs in pregnancy, and make referrals.

Christey:

Wow, sounds like you really did your research. I love how you took the time to engage with the local culture of each new village and build those key relationships. They're so important. Okay, so you started out by training 15 health care workers, where are you at now?

Mercy:

We have now 130 community health workers that proactively search for patients through door to door home visits, and they make referrals. We also run mobile clinics. So the mobile clinics, we go into eight different places, eight times a month. With the mobile clinics, we have a team of medical personnel, we go into areas like we can travel in 25 kilometers. So that provide the services closer to the people. That's our motto of care closer to the people. So we go where the people are, treat in make referrals or check patients, if we cannot provide all the treatment that is needed at the community level. We also have nurses on bikes. So the nurses on bikes, we started them in 2020. After seeing the gap that is between going to the facility into the community health worker, there's things that they're going to walk away cannot do. For example, if a child is convulsing, 20 kilometers away from a health facility. There's no public transport, even if the public transport might be there. They could have no money to go there. The nurses on bikes provide the necessary care at the doorstep. So what happens is, if a child for example, is convulsing, they make a call to an nurse on a bike, in village B, my child is convulsing. So the nurse on a bike ride on a motorbike and then they go there within 30 minutes. So they are stationed in places whereby they should go to get to their furthest point, within 30 minutes, they should be there. But it depends on the distance, sometimes it's five minutes, 10 minutes, but the furthest, it's 30 minutes. So these go in this household, stabilize the patient, and make referrals if there's a need for referrals. If someone is bleeding, if someone fell, for example, something that needs emergency care, the nurses on bikes will take care of that. But on top of that, they also have 10 scheduled visits antenatally. So they take a woman from pregnancy, making sure they attend all the antenatal visits until the child is born. When the child is born, they have 10 scheduled visits until the child is five years old.

Christey:

My husband runs a motor bike company and I showed him pictures of your nurses on bikes and he was like they are serious off road bikes. I think that's very impressive. He thought it was such a cool project using these kind of off road bikes to get nurses out to remote areas. It just makes so much sense when you think about it. Because of course, there are not going to be ambulances that can drive on that terrain. It has to be an off road bike. So incredible that you're training nurses to do that job. I would love to be a nurse on bike too. This sounds so cool. They've got so much purpose and then they solve these problems. Powerful

Mercy:

Powerful women, super women.

Johanna:

So earlier we heard that Malawi has one of the highest maternal mortality rates in the world. Have you seen a reduction in these deaths within the villages you work in since your nurses started traveling out there?

Mercy:

We have never in the past three years, we have never had any maternal death.

Christey:

That is so wonderful mercy. Congratulations. How many mothers and babies are you reaching each month with the nurses on bikes program?

Mercy:

So we have 14 nurses on bikes and we are reaching 1000 to 1500 per month of women and children.

Christey:

Oh, that's incredible. And so is that all prenatal antenatal visits or what sort of services do the nurses provide?

Mercy:

So before pregnancy they make sure the women of childbearing age have access to family planning services. And during pregnancy, they have access to antenatal services make sure they identify complications and make referrals or treat on time, making sure this woman has attended four or eight antenatal visits during pregnancy and also during childbirth, making sure this woman gives birth at a health facility with a skilled birth attendant and after pregnancy, the postnatal care, and they have 10 scheduled visits and to the child is five years old.

Christey:

Fantastic. Wow. So they're really seeing through the whole journey from pregnancy birth and to make sure kids are healthy.

Johanna:

Wonderful. And what's next? What's your vision for the work that you're doing with the nurses on bikes?

Mercy:

So currently, we are in two districts we are in Doha and Mangochi and Malawi has 28 districts. So our vision is to have these nurses on bikes providing the quality Maternal and Child Health Services at the doorstep across Malawi or the 28 districts. That's where we are going.

Johanna:

That's brilliant, missy. So you proved the model is really effective and that it works and now it's time to scale it up. Do the nurses enjoy riding the motorbikes?

Mercy:

Yes, they do like riding the motorbikes and in the community they are perceived as you know, angels on two wheels. That's right. Yes, they're armed with the medical equipment. And also they are big smiles. So they are angels on two wheels in the communities and they also motivate the girl child you know, it's not easy to see a woman riding a motorbike in the in the rural areas. So they also act as role models to a girl child.

Christey:

That's awesome. It's such a powerful vision of a woman, isn't it? The motorbike, the profession, the nurses coming in saving the day doing incredible work. What a vision. I love it.

Johanna:

Christey used to ride a motorbike when she lived in Vietnam, when I would go and visit it was pretty terrifying riding around the streets of Hanoi on the back with Christey. I'm not sure I'd describe Christey as a as an angel on two wheels in those days.

Christey:

I'm not sure I could do it now.

Johanna:

She's the brave one of the two of us.

Christey:

I'm not as reckless as I used to be there. So I'm not sure

Johanna:

that's true. Yeah. Since you became a mother, you've definitely become a little bit more serious and responsible Christey.

Christey:

Yeah, safety first these days.

Johanna:

So Mercy, you're having some brilliant success in the two districts that you're working in currently, in terms of reducing the mortality rates. What sort of success are you seeing in terms of changing behaviors around seeking medical care throughout pregnancy and for children under five?

Mercy:

In our catchment areas, 75% of women start antenatal care in the first trimester. So this is an increase from 40% when we started the nurses on bikes program, so you can see 40% to 75% now women starting antenatal care in the first trimester. That's why we want to spread our program across Malawi, so that we deal with these traditional beliefs. And this is one of the major challenges that nurses on bikes had to fight with. When we initiated the nurses on bikes program. Still women could not trust the nurses on bikes, they're hiding their pregnancy. Especially in the first year, they were hiding their pregnancies. They didn't trust the nurses. So it also took time for the nurses to develop relationships with the women and the communities and the community leaders. So it doesn't happen overnight. It takes time to develop relationships.

Christey:

Absolutely. Wow, they're doing very, very deep work out there changing traditional beliefs to bring pregnancies out in the open and to help women and babies access quality care.

Mercy:

And because since 2021, in the areas that we have the nurses on bikes program, we have never seen any maternal death. So people see the importance of starting antenatal care in the first trimester going through all the services or the immunizations, or the vitamins that are supposed to be taking or the screening and the results is you don't die with your pregnancy, you're going to give birth to a bouncing baby boy or girl, so it's not all these myths are just beliefs. But if you do A,B,C,D and E, you have all the care, you're going to have your baby and you're not going to die. And you know tracing the babies up until the baby is five years old. It also adds value to the nurses on bikes program. And also during this time, they are in the community having chats with the community learning more about their cultural beliefs in seeing how best they can deal with harmful cultural beliefs. Because not all beliefs are bad or harmful. There are some that are good cultural beliefs.

Christey:

Yeah. Absolutely. Wow, how interesting. And how deeply transformative.

Mercy:

Thank you.

Christey:

Thank you so much Mercy for explaining the intricacies of your work. And for going deeper into the complexities of the problem that you are solving. And, you know, it's it's very cool. The nurses on bike and providing health care, people understand it. But when you go into the deep layers, you know, and the longer term work that you're doing short term, woman by woman, you're saving lives, but also long term, you'll be saving entire communities as these belief systems gradually change. And getting care from the first trimester becomes the way to do it. And I just loved how you explained. If you do A,B,C,D, and E, you will have a bouncing baby and you will not die. It's fantastic. Who wouldn't sign up for that?! Once they understand.

Johanna:

And Mercy. It's incredible that you're having these fabulous results, and that the women and community members are beginning to see that those results are speaking for themselves and changing behaviors. But how do the nurses even approach actually suggesting that women change their approach to something as personal as healthcare when it's at such odds with their cultural beliefs?

Mercy:

Malawians, we like dancing a lot. And even when I'm working at home, I'm doing household chores. I'm always listening to traditional music, then I'm dancing. And most of our health education is through music and dancing. The nurses on bikes, they'll be providing family planning education, through music and dancing. So we do it like this. **Mercy sings and dances**

Johanna:

Christey, I wish we decided to do a video podcast, it was so wonderful to see your dancing Mercy. I feel sad that our listeners weren't able to see that, too. That was beautiful. Thank you.

Christey:

That's so cool. What's the meaning.

Mercy:

So they're saying, If you don't practice family planning, you'll be so busy, you'll be so busy, you don't have time to take care of yourself. Because you're always taking care of children, you are pregnant. And at the same time, you have another baby that is only maybe a year who in some months at your back. And then you have a baby. So all these babies cannot walk. They are all over you. The other one at your back, the other one here. And you also have a load on your head, and you're pregnant. So all of this around you, please, woman take care of yourself.

Christey:

Wow. So the nurses on bikes know these songs and they go out and they perform the songs and they teach through the dance.

Johanna:

it's beautiful to see that you have so much joy in terms of your work as well. It's beautiful to watch that fun and watch that joy throughout your work.

Mercy:

My pleasure. And thank you so much for having me. And we don't take this for granted. And thank you for being our voice.

Johanna:

We want to bring your beautiful voice to the world because your story really needs to be here. It's wonderful.

Mercy:

Awesome.

Christey:

I love that point. You just said about the joy Jo, because actually Mercy, Jo and I often say that Just Peoples has to be fun. You know, if we get stressed, we always try and recenter on enjoying the wonderful work that we get to be a part of. And so this conversation was so joyful. It's why Jo and I do our work because we get to speak to people like you that just do incredible work in this passionate and joyful way.

Johanna:

In my head. I'm booking a trip to Malawi.

Christey:

Yeah for sure. We're coming, we're clapping, we're dancing. we're riding those bikes. I'm going to take the herbs.

Mercy:

We need people like you to walk alongside us. We know the we are close to the community. Our proximity makes us good to do what we are doing, but we also need you to walk alongside us. Thank you so much for this time. It was like my time to charge my time to vent what is inside me. This also like kind of a therapy - I've talked, I've danced, I've sang. Thank you so much.

Johanna:

For anyone listening who is interested in learning more, or supporting Mercy's vision to roll out her nurses on bikes offering across rural Malawi, you can visit justpeoples.org/leaders/mercy. You can find these details in the show notes. To give you some context of how much your support can help Mercy achieve, with a little over 2000 US dollars, Mercy can purchase a new motorbike and driver training to get another nurse on bike on the road and backing Mercy with 15,000 US dollars will enable her team to provide one year's worth of comprehensive health care to 100 rural Malawian mums and their babies.

Christey:

And a final question, you mentioned that your grandmother is still alive. Is she proud of you?

Mercy:

She is she's now 97 years old. And sometimes when I'm happy I call her. Or when she feels like she calls me. How many lives have you saved? I still talk to her and she says she's always thankful that she has lived to see this today.

Johanna:

Why Give a Buck? is proudly brought to you by Just Peoples, an international nonprofit that connects givers directly with local leaders at the forefront of tackling poverty in the local communities across Africa and Asia. You can learn more and directly support the work of mercy and other inspiring leaders by visiting justpeoples.org