S02E04: Lorraine Muluka on Revolutionizing Maternal Care in East Africa through Technology

INTRO

Welcome to What Do You Understand? Brought to you by Global Partners for Development. I’m your host, Ria Pullin, and together we’ll explore the world of philanthropy and development, confronting global disparities and the impacts of our collective efforts.

Joining me is my co-host Daniel Casanova, the Executive Director of Global Partners for Development. So, are you ready to question what you understand? Let’s dive right in.

Today, we’re joined by Lorraine Muluka, CEO and co-founder of Malaica. In this episode, we explore the intersection of technology and maternal health. Lorraine shares her insights on the challenges pregnant women face in East Africa and the innovative solutions Malaica is implementing to transform their experiences. We will discuss real-world impacts and a vision for a healthier future for mothers and children in Kenya.

00:00:58:19 – DANIEL

So like, do you have children? 

00:01:02:24 – LORRAINE

Yes, I’m a mom of two boys. Yeah. So the first one, just turned six and the second one, I need to get this right. The second one just turned four. Yes, I’ve been through the pregnancy

journey twice. Yeah.

00:01:18:12 – RIA 

Same here, same here. I have two. I have a six and a ten year old.

00:01:20:25 – DANIEL

Great joys and great pains.

00:01:23:16 – RIA

Oh, it’s a lot. 

00:01:25:12 – LORRAINE

Yes. That no one prepares you for, you know.

00:01:27:28 – RIA

And being a full time working mom, you know, that’s a whole other side of it. And I’m sure, like, is that part of like what’s driven you to do your work? ‘Cause you’re a medical doctor. 

00:01:37:20 – LORRAINE

You know, having been a medical doctor and always really, from the time that I was in med school, I knew I wanted to work with women and pregnant women for these many reasons. I mean, I’m very passionate, obviously, about maternal mortality, but I also just love good outcomes, you know?

So in terms of like the whole spectrum, I mean, you rotate through several spaces and you really get to see that pregnant women are mostly happy and, you know, happier when you give them a baby who’s also healthy.

So this the, I mean, yeah, part of my driving force, and so having been in that space and then getting pregnant you think you know. And then you start experiencing things and you know, it’s, it just really took me a moment to, like, think through, you know, all the times that a mom said, “I am experiencing this,” and it’s not in the science books.

00:02:35:20 – RIA

Yeah, it’s not in the textbook. It’s not there.

00:02:37:18 – LORRAINE

And I, you really get to, to be at a space of humility understanding and yeah, for myself personally also, I did get some complications in my pregnancies. I got high blood pressure. I, you know, unfortunately also bled quite a bit after. So you know, it’s such things that you

then realize that, yeah I mean, having the right support during this time is quite critical. Yeah.

So that’s partly why I embarked on this journey to really make the pregnancy journey safer. But I also had very close people to me unfortunately, not survive. So it was for me something that I said there’s more that I could possibly do. And having the passion for digital health, as I mentioned previously, having worked in this space, being able to reach people who I would ordinarily never see, I mean, I just knew that there should be something that can be worked out here.

00:03:41:14 – DANIEL

Unfortunately, in Sub Saharan Africa, it’s too common of a story, right? Women losing their lives.

00:03:46:28 – RIA

Because they’re too far from the health facilities that they need or they don’t have the type of facilities they need out there.

00:03:54:11 – LORRAINE

Yeah. So I mean, it’s really a combination of several things. The story is very unfortunately, as you said, common. And having been in this space for a while, you get to see that at the time that you see the mom at the hospital, for example, I walked in like the National Hospital, which is the referral center.

And so you find that by the time she gets there and we actually are having maternal mortality,

it’s really late. So there’s a lot more that can be done prior to this. And it’s in that, there’s the fact that one, is the distance to the facilities, there’s also just an education piece. Mothers do not know what is normal. I mean, your whole body changes, right?

Like, so you’re like, okay, fine. This must be some of the pregnancy stuff that I expect. But then there needs to be a line or there needs to be a marker that shows you that at this point this is not normal. And so you probably need to seek care. So filling these gaps, it could really help us.

00:04:57:15 – RIA

Right. And so when did you start your organization?

00:05:00:19 – LORRAINE

So it actually started one and a half years ago and yeah I mean the concept came in during COVID, as I mentioned. So basically just thinking what can we be able to do that could change this? And so, yeah, one and a half years ago we then got in, I mean, I was lucky enough to meet co-founders in this space who are also really passionate about maternal health. And so we just began and had a pilot with moms really getting to understand what are their needs. 

What is it that makes mothers not even adhere to the WHO guidelines? Like going for the eight antenatal visits, having the three postnatal visits. So really understanding from their perspective, and then now bringing in also the medical piece to see that we could be able to make this journey better.

00:05:50:27 – DANIEL

Yeah, okay. Very, very cool. So tell us about your co-founder. There’s a co-founder, so tell us about your co-founder. 

00:05:57:06 – LORRAINE

Yes. so they’re actually three co-founders. The first one, he’s Swiss. And he’s actually been in the health space for a while. He’s built three different health startups. The last one was actually in fertility and Ava, based here in the U.S. And so he was, yeah, he founded that. And really got to see that even after the mothers get pregnant, there is something missing, right?

The maternal health journey is quite broken. So he’s very interested in doing something in digital health and has a best friend in Nairobi, Kenya. His best friend told him, “Hey, you know, this journey is also broken here.” And, you know, there’s people who are in this space. Working digital health, maternal health. And we actually got connected. Yeah. By a mutual connection and started having this conversation.

And then the other one is Kenyan,a Kenyan lady, Isis. So he’s Pascal, and so she’s founded one of the largest, actually it’s the largest pregnancy and parenting community in Kenya, MumsVillage. So very, very passionate about, you know, good outcomes for pregnant moms and also that you know, because this goes on like, you know, the support was there all the way until the babies are, you know, more than five years old. So she’s one of my co-founders as well.

And then the fourth one is Victor, who is our CTO. Now has also been building tech, health, tech startups and now has got to be also very passionate about the maternal journey from a personal experience. And so we were really happy to meet, come together and build this.

00:07:51:11 – DANIEL

You must be on a rollercoaster. It’s interesting when things take off like that because you must just like, yeah. And I’m sure it’s overwhelming as well.

00:08:03:14 – LORRAINE

Yeah. I mean it is, yeah, you know, you start and there’s lots of learnings as I said, of course is what you know, what you conceptualized and then is what you learned. But it has been, yeah, it has been a very interesting one and a half years up till now. And still, I mean, every day there’s something new.

00:08:27:16 – DANIEL

Yeah. My mom’s a midwife.

00:08:29:15 – LORRAINE

Oh, really?

00:08:30:13 – DANIEL

She’s a nurse practitioner midwife. But I grew up with, I had a  grandmother was a midwife too. And then so, like, I’ve seen lots and lots of births, like from a young age. And both my sister and I were born in our homes.

00:08:43:20 – LORRAINE

Nice. Yeah.

00:08:44:25 – DANIEL

My mother delivered my middle son at our house, which is cool. So do you all do work with midwives at all?

00:08:54:26 – LORRAINE

Yes.So midwives are actually at the core of what we are offering and this was actually, this is actually based on evidence, right? So we do know that pregnancy supported by nurse midwives are, you know, have been shown to have better outcomes. So it’s in getting this sort of care, there’s like a no-do gap, right? So we know it, but implementation is not where it should be.

00:09:21:19 – DANIEL

Right. How did you say that again? A no-do gap?

00:09:25:15 – RIA

I like that, I really like that. A no-do gap.

00:09:28:23 – LORRAINE

Yeah, like we know this, but somehow it’s just really not happening as it should, right? So it’s about really getting these nurse midwives the kind of support that they need and then ensuring that there’s a linkage with the moms. Yeah. And that’s what is at the core of Malaica, so what we do is actually connect pregnant moms to a personal nurse midwife.

00:09:56:00 – RIA

Oh great.

00:09:56:14 – LORRAINE

And this is done digitally. Our front end is WhatsApp. So you are able to directly message a nurse midwife, have calls with your nurse midwife. We built this longitudinal trusted relationship whereby whenever you have any questions you get a reliable medical answer. But it’s not only that, there’s more to it. It’s a personal touch.

00:10:19:14 – RIA

Exactly.

00:10:20:08 – LORRAINE

You actually get to know this person, trust this person, and we are seeing more than just the clinical piece. You know, a normal consultation in a hospital would take like 10, 15 minutes.

00:10:34:20 – RIA

Exactly. And then you’re out. 

00:10:36:04 – LORRAINE

Most of the time within the government’s sector is 3 minutes. Yeah. And so you never get to talk about, really, what are the factors that affect the pregnancy. We know there’s mental health issues, we know there’s intimate partner violence. So these are some of the things that we’ve seen. And through our model, we now can offer all this other support. So the nurse midwife is at the first point. In case of any risks she escalates this to the appropriate channel.

This could be the gynecologist, this could be the psychologist, this could be the nutritionist. And just building this sort of support from the mom online, I mean, has really shown to be beneficial.

00:11:14:27 – RIA

Completely, yeah. And they’ll be more in tune with their bodies. I also had two deliveries by nurse midwives and I had them in my text phone. I’m like, you know, this is not feeling right. And she knew. She’s like, yeah, I will take you to the ER and I’ll sit with you to get the test done. So I went into early labor and so she sat with me the whole time in the hospital my nurse midwife. And it just does make such a difference when you have someone you know who’s going to be with you through your whole journey and at the birth.

00:11:41:16 – LORRAINE

Yeah.

00:11:42:03 – RIA

Just being able to have that is so different than most traditional ways that pregnant moms are taken care of. So how are people finding and accessing, like,  how is your outreach to get people on this app? Yeah, so very interesting because I mean, this is a digital platform and so we go out online, we realize that most pregnant women where are they, so they are online, they’re really looking for resources, so there’s Facebook, this has been one of the biggest channels that we’ve been able to reach out to moms from.

There’s also Instagram and then as I mentioned, our co-founder Isis, who built MumsVillage, this big community. When we came together, we’re also able to now have moms from this community joining Malaica.

00:12:31:08 – DANIEL

Where are they located? I’m curious, the MumsVillage, where are the places? You must have demographic information.

00:12:37:27 – LORRAINE

So I mean when we started off first we were just really doing the recruitment in Nairobi, so Nairobi is the largest in terms of where moms are coming from, but we have that 48% of them are from Nairobi and now we have mothers from the rest of Kenya. So we now currently have moms from 40 counties in the Malaica program.

So a lot of them are, I mean Nairobi’s still leading, but we are seeing growth and really from very rural areas. That’s what I was going to ask. Some parts of Kenya, which I also have never been to, but they are now here in the program having this support.

00:13:15:27 – DANIEL

Yeah, yeah. We do work in Turkana. 

00:13:18:11 – LORRAINE

You do? Amazing, yeah.

00:13:24:22 – RIA

Yeah, our Program Director, she’s based in Kisumu, but she was in Nairobi and she traveled to Turkana and she’s like, I’ve never been here before. And it’s just like, this is my country,and it’s so different. It’s so different than, like, the Kenya she knows, but she loves it. She just has fallen in love with the women in Turkana.

00:13:44:10 – LORRAINE

Yeah. Yeah. I mean, we sometimes, as Kenyans rarely get to travel. You’ve just been in the space where you work. So it’s really nice to, I mean, and even for us, whenever we see, we’re like, wow, we got someone from Turkana. You know, it’s really a place on a map and it’s not, right?

00:14:03:08 – DANIEL

Yeah, Yeah. Very, very cool.

All right, I’m going to  ask you some questions and then we’ll lead up to the What Do You Understand things. So can you tell me about people that are heroes for you? And maybe you can tell me two like, one maybe there would be someone we might know or could look up online that’s famous, that’s like someone that inspired you and like, why that is.

But then maybe there’s someone else that we don’t know that’s not. Like personal and maybe you can tell us about them too. And why that is, you know, meaningful for you. But you can take your time.

00:14:36:24 – LORRAINE

Yeah. I mean, I just want to think through I mean, there’s several, you know, when you talk of heroes, I mean, obviously several people come to mind, I think of people who have defied circumstances and actually done things. This is from when I was a child, because when I was a child, I was really, I knew I was going to become a journalist. Yeah.

And I knew I was going to have a talk show so you can start guessing what I wanted. I mean, my dad is a journalist and that’s his background. So I really wanted to be something  on TV at some point. Yeah, no surprise I said yes to you. So yeah, obviously I’d say it was Oprah. She’s amazing, like, just over the years. I mean, it’s like fine wine, right, getting better with age and, yeah, I mean, I think I was really inspired by what she was doing.

The connections she’s having, the reach that, you know, she has. And I mean to date, of course, I still listen to her podcasts and, yeah, there’s a lot of wisdom. So I just think like, what she has been able to do is really inspiring.

00:15:58:18 – RIA

Yeah.

00:15:59:03 – LORRAINE

And I’d say it’s been, yeah, for me it was just like, see how I do that? And you know, how all these audience and how amazing she was at it it was sometimes like, okay, I could probably do something. Yeah, great at some point in my life. So that would be one of the people that I would say, like from a young age, from that perspective of what, yeah, what do I think of a hero? And I mean, she stood the test of time.

00:16:27:03 – RIA

Yeah. 

00:16:29:19 – DANIEL

Yeah, but then you grew up so then you were like, then, then you’re like, okay, then you’re not that little girl that’s going to be a journalist. I know you switched to be a doctor. Somehow you like, became a doctor. You’d have to talk to my  daughter. I tell her, I’m like, you’re going to be a surgeon and a cellist. She’s like, no, dad, I’m going to dance like, I’m going to be a singer. I’m like, what do I need to do to get her to be a surgeon.

00:16:53:19 – LORRAINE

Let her keep dreaming, to be a dancer and a singer. That’s adorable. So I’m trying to think of, yeah, maybe just growing up and now really, in my career path. I would say, this is a difficult one.

00:17:16:15 – DANIEL

What about your father? Your father’s a  journalist. He must have been inspiring for you. Yeah. Do you like him?

00:17:19:27 – LORRAINE

Love him! Yeah, and he’s, I mean he’s built many things over the years. So, I mean, his basically background. He was a journalist and then did a lot of it in the publishing world. And I mean, he was at some point at the helm of a company and used to take me to work with him. And like, I’d sit in the-

00:17:46:13 – RIA

The boardroom.

00:17:48:27 – LORRAINE

Yeah, in the boardroom or the corner office then I would like, I’d be like, okay, this is interesting. So, I mean, he also used to tell me I’ll be a surgeon. He’d look at my fingers, and tell me you have a surgeon’s fingers. And I was like, dad, I’m not doing this. This was way before I even thought of doing medicine, right?

And so, I mean, for me, I mean, he’s always been, yeah, I think a voice in my head because, you know, growing up in a setting in Africa as a lady. Yeah. You’re not always, you’re not always at the forefront, right? So there’s that voice that he always used to say, you know, you are, you are good, you know, he’d always like there was like a thing that he used to say and you need to walk with your head held up and you need to speak loudly.

And I think it’s the voice that really, yeah, it stays in you and pushes you through the difficult times. And like, I could do this. Yes, so for sure my dad played a big role in me getting here together with my mom. I mean, I think they’ve always believed in me supported me. Yeah.

00:18:58:01 – DANIEL

Do you guys have same politics? Do you like, have similar politics? Like, do you  support the same parties?

00:19:04:06 – RIA

I see her face. She’s all, no comment, but I see the comment. No comment on that.

00:19:12:10 – DANIEL

We don’t want to get you in trouble.

00:19:17:24 – LORRAINE

Actually very active politically, you know.

00:19:20:22 – DANIEL

I’m sure.

00:19:23:15 – LORRAINE

Yeah. Yeah. There have been times that we’ve had interesting conversations.

00:19:27:24 – RIA

That’s amazing.

00:19:28:27 – DANIEL

It’s amazing how generations when things happen like that.But then when they’re your family, you know them. So you can see how they build those opinions and what it was like.

00:19:39:22 – RIA

And why you build your opinions based on your life experience.

00:19:42:21 – LORRAINE

Exactly.

00:19:43:07 – RIA

Which was very, probably very different than their life experience growing up.

00:19:47:14 – DANIEL

So what’s the thing that you understand particularly well in the world? Is there something that you feel certain about that drives, that we should like, as a people or as Kenyans or like, not us as Kenyans, you know. What are you putting your money behind? Like what’s driving you to move forward? What do you need to tell people? Like, is there something you can be certain about?

00:20:15:19 – LORRAINE

Yeah, I mean, I’d say the future of medicine is changing. You know, I think that’s something, it’s not, it’s no secret. It’s no surprise. And technology is really, really going to revolutionize a lot. So this is something that I’m certain about and we need to embrace it. We need to actually make it work for us and utilize it to do the many amazing things that we can do.

And if we really position ourselves wherever we are. I think, in this space working in the healthcare space, for example, it can really lead to amazing outcomes, you know? So for me, I am sure that in the next ten years, if we are to actually leverage what technology can do, I mean, it will be a different world, like literally. So it’s not just about the maternal mortality, it’s really in the health space in terms of diagnostics, in terms of basically, yeah, treatments as well. This is really something that I’m really sure of.

And I would, you know, I would actually actively, what’s the word, actively promote. Yeah, like we encourage everyone to embrace it and to actually believe in it because I think there’s been so much doubt in this space like, how would you be able to, you know, have an impact even in the lowest of the, you know, when you think of the most rural areas, technology is advancing, accessibility is day by day changing. And so just embracing this right now, I think it’s what I would advocate for.

00:22:24:28 – RIA

Yeah, especially with satellite Internet being making it available for people in rural areas where there was no cell signal remember? When we go to Tanzania, he’s like, there was never signal here. Now there’s signal here! Ten years ago he said, no, there was no signal here. I was like, it’s great now. And so like, and you said, when we go see the indigenous Massai, they all have cell phones. 

00:22:47:09 – LORRAINE

Everyone is on their cell phone like, it’s, it’s amazing. So penetration is increasing.

00:22:53:13 – DANIEL

Yeah. Okay, good. That’s a good thing. That’s good, I think. And so what do you  think the pitfalls are there? What are the challenges for that? Like how, what are the, and in particular where the obstacles were in Kenya that you see  with technology reaching people?

00:23:11:27 – LORRAINE

Yeah, I think the first biggest challenge is acceptability, right? So I would say in terms of people just being open to utilizing this technology for health care, that’s the first thing. And then in terms of now reaching people, you have to think of the different challenges that are in this space. So for you to have a phone, you need to have access to electricity. You need to have, or you know, somehow that you charge this phone, right? You need to also have access to the internet. So, I mean, I think  as I mentioned those are challenges that are there but are getting better. Right.

So I think definitely in the coming years, even right now, the current Kenyan government, they’re really focused on actually improving accessibility to internet and digital solutions. So things are looking up, but penetrating also markets. And for them to actually have that trust to accept these digital solutions, I think that that would be the other challenge that I see.

00:24:25:01 – DANIEL

Yeah, well, you did really well for having us, you know, so impromptu. You were like, you were ready. And we have a new Kenyan friend.

00:24:33:13 – LORRAINE

I should have been a TV presenter.

00:24:35:20 – RIA

Right? You still can.

00:24:37:07 – DANIEL

It’s not too late. 

00:24:42:17 – RIA

But there is like these doctors who are like TV presences now, who are like the experts that, you know, discuss whatever they talk about on the segments of Oprah. Maybe you’ll be

that, you’ll be that person.

00:24:55:04 – LORRAINE 

Yeah.

OUTRO

At Global Partners for Development our mission is to advance community-led initiatives that improve education and public health in East Africa. We envision a world in which every East African community has the capacity to implement dynamic, sustainable solutions to the challenges they face.

To learn more, visit gpfd.org.

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