The patient was a familiar face – staff members had seen her through her first two pregnancies – but this time was different.
“She wasn’t feeling any fetal movements,” recalled Dr. Maggie Maseko, lead medical director and an obsetrician/gynecologist at the community organization Pothawira, in Malawi’s Salima District. Still, the ultrasound detected cardiac activity, and the doctors determined that an emergency C-section was the best course of action for the mother and child.
At the time, however, Pothawira did not have the surgical capacity to perform this woman’s delivery. Physicians had no choice but to send their patient to another hospital.
There, the doctors hesitated to operate. The pregnancy wasn’t at full term, and they monitored her all day before sending her back to Pothawira.
The follow-up ultrasound that night showed no cardiac activity. By the time she returned to Pothawira, she had lost her baby.
“It’s hurtful for us,” Dr. Maseko said. “It’s hurtful for them.”
It was the woman’s third and final cesarean section, and with it, her last hope of having a son.
This felt deeply personal: Over the years, the Pothawira team had grown close to this patient, conducting all her prenatal checkups. They hadn’t wanted to refer her elsewhere, but her history of cesarean sections put her at risk for a ruptured uterus.
“You build bonds with these people, including the unborn baby,” Dr. Maseko noted.
Determined to prevent similar tragedies, Pothawira set its sights on constructing a new surgical center equipped with four operating rooms, a blood bank, and hematology and pathology labs. These installments will expand the surgical capacity of the Salima District of Malawi by 400% and allow emergency complications to be handled on-site.
According to Dr. Maseko, the surgical center will open later this year, bringing life-saving operations to Pothawira that previously required referrals to other hospitals. The construction will also alleviate the pressure placed on the local district hospital.
Since 2023, Direct Relief has contributed more than $5.9 million in medical aid to Pothawira, consisting of oncology medication, cold-chain refrigeration, funding for the new surgical center, and midwife kits. Ten full midwife kits and two replenishments have been shipped to Pothawira thus far, with six more outgoing, enough in total to support 900 safe births.
Direct Relief has provided support for more than 24,000 safe births to Malawian maternal health partners thus far, including Pothawira.
Founded in 2009 by Dr. Anne Alaniz and her parents, Peter and Emma Maseko, the name Pothawira translates to, “Safe Haven.” The community village occupies fifty acres in Salima District, Malawi. Through collaboration with nonprofit partners, Pothawira operates an orphanage, a health clinic, a primary school, a birthing center with a women’s shelter, water towers, and a maize and rice mill.
Employing Direct Relief midwife kits, Pothawira conducted 281 successful deliveries in 2025, handling a range of complications. While some patients were referred to the Salima District Hospital, the high-risk cases were first stabilized before transfer. Impressively, Pothawira had no maternal or neonatal deaths at all last year.
In a nation with one of the highest maternal mortality rates in the world, these outcomes set Pothawira apart. With the surgical center nearly complete, the sanctuary will continue expanding access to quality maternal healthcare.
Justin Makondo, head of the medical department, attributed Pothawira’s infection prevention and sterile delivery environment to the maternity kits. The umbilical cord clamps, medical devices that close the baby’s navel before the umbilical cord is cut, are particularly vital, they note.
“When cord clamps run out, people end up using threads. Women are even advised to buy wool from the streets, and we end up dipping them in surgical spirit to disinfect them,” he explained. The makeshift clamps are nowhere near as effective as those provided in the midwife kits.
Multiplying impact
In the capital city of Lilongwe, another Direct Relief partner concurred. “All of the umbilical cord clamps we’re able to get in country are defective,” said Dr. Chikondi Chiweza, director of the Maternal and Child Health Program at Area 25 Community Hospital, “They will slip off when used on babies.”
Area 25 began as a primary health center, established through a partnership between Malawi’s Ministry of Health and Texas Children’s Hospital and Baylor College of Medicine. With the addition of a four-room operating center and continued support from Direct Relief, it has since been upgraded. Area 25 now takes referrals from 14 primary health centers in the area.
“We used to deliver less than 1,000 [babies] in 2017, and now we’re projected to deliver close to 9,500,” Dr. Chiweza reported.
Direct Relief has provided Area 25 and Baylor College of Medicine with more than $8.4 million in medical aid since 2018. To accommodate the increasing patient numbers and deliveries, Direct Relief funded a storage building to safely house pharmaceuticals and equipment. The building opened in April 2025.
As part of Direct Relief’s ongoing support to Area 25 Community Hospital, 225 full midwife kits have been dispatched or are outgoing, along with 250 resupply kits, enough to support more than 23,000 safe births. In addition, 90 perinatal health kits have been provided or are outgoing, enough to treat 18,000 cases of pregnancy and delivery-related complications.
This access to medicine and the infrastructure to store it have been crucial to advancing Area 25’s medical services, upgrading its status, and attracting more specialized staff.
As patient visits and deliveries have increased, so has the need for additional staff. The public-private partnership between the Ministry of Health and the Baylor Foundation-Malawi led to a unique team of doctors and midwives. According to Dr. Chikondi, the partnership is so successful that, from an outside perspective, it is impossible to distinguish between the Baylor employees and the Ministry of Health employees.
Reducing the Risks
Nearing the end of a rainy season, both Area 25 and Pothawira, equipped with pharmaceuticals and capable doctors and midwives, identified transportation as a major challenge to maternal healthcare.
Local health centers rely on a single ambulance, creating a delay in emergency care. When the surgical center is completed and begins taking referrals from local primary centers, Pothawira anticipates a larger volume of patients needing transportation.
The ob/gyn Dr. Chisomo Zinyemba said having one ambulance available causes dangerous delays: “We could get a message saying, ‘Hey, we’re referring a woman. She’s obstructed, she needs a cesarean section,’ and she’ll come in 10 hours later.”
Emergencies cannot always be predicted. To keep the ambulance available and reduce risk factors, Area 25 designed a waiting home for women to stay in as their delivery date approaches. The waiting home eliminates any travel issues and ensures patients are stable before their due date.
But health center’s rapid growth has had an important positive impact: Area 25 staff now choose to deliver their own children on-site.
Traditionally, those with greater access to healthcare chose to deliver at private hospitals. But the recent developments inspired more staff to stay at Area 25 for their deliveries, strengthening patient trust at the facility.
Dr. Chikondi reflected on this change as a heartwarming sight: “These are people who can afford private services but are choosing to come and deliver [at Area 25]. That’s a testament to the quality of care.”
Direct Relief has also supported more than 2,900 fistula repair surgeries in Malawi for postpartum women through 48 surgical modules. Eight more modules, supporting 400 fistula repair surgeries, are outgoing.
