Death in Birth By DENISE GRADY Fragile Tanzanian Orphans Get Help After Mothers Die By DENISE GRADY BEREGA, Tanzania The Berega Orphanage, a cluster of neat stucco cottages in this village of red dirt roads and maize plots, is a far cry from what the name suggests. The 20 infants and toddlers here are not put up for adoption, nor kept on indefinitely without hope of ever living with a family. Most of their mothers died giving birth or soon after something that, in poor countries, leaves newborns at great risk of dying, too. The children are here just temporarily, to get a start in life so they can return to their villages and their extended families when they are 2 or 3 years old, well past the fragile days of infancy and big enough to digest cows milk and eat regular food. And, in an innovative program designed to meet the infants emotional as well as physical needs, many have teenage girls from their extended families living with them at the orphanage. Africa is full of at least 50 million orphans, the legacy of AIDS and other diseases, war and high rates of death in pregnancy and childbirth. With the numbers increasing every day, Africans are struggling to care for them, often in ways that differ strikingly from the traditional concept of an orphanage in the developed world. Programs like the one in Berega are the way to go in Africa, said Dr. Peter Ngatia, the director of capacity building for Amref, the African Medical and Research Foundation, a nonprofit group based in Nairobi, Kenya. He said similar programs for AIDS orphans had worked well in Uganda, looking after the children until age 5 and then sending them back to their families or volunteers in their communities. In less wealthy nations, people are being very creative, said Kathryn Whetten, an expert on orphan care from Duke University. She had not seen the orphanage in Berega or encountered others like it. But that did not surprise her. Little is known about orphan care in Africa, she said, because little research has been done. On a recent trip to Moshi, a Tanzanian city of about 150,000, she said, local officials knew of three orphanages. She and her colleagues found 25 there, most with 10 to 25 children each. The Berega Orphanage is of that size, one small, apparently successful attempt to cope with the aftermath of more than a quarter-million deaths of women each year in pregnancy or childbirth in Africa. They die from bleeding, infection, high blood pressure, prolonged labor and botched abortions problems that can be treated or prevented with basic obstetrical care. But in Tanzania, which has neither the worst nor best medical care in Africa, but is similar to many poor countries, everything is in short supply: doctors, nurses, drugs, equipment, ambulances and paved roads. By the time many women get to the 120-bed hospital here, it is too late to save them. Their babies may be saved, but their survival hangs in the balance. Often, the father or other remaining relatives cannot take care of newborns. Without breast milk, infants here are in real trouble. Formula and baby food are not widely available, and cows milk is a poor substitute. Malnutrition and infection are constant threats. An orphanage can provide basic needs, but to thrive, babies need dedicated caregivers, and their extended families may live in distant villages.