One year after opening a hospital in Malawi, the pop icon, 59, returned to the African nation to visit with all six of her children: 21-year-old Lourdes Leon(with ex Carlos Leon), 17-year-old Rocco Ritchie (with ex Guy Ritchie), Mercy James and David Banda, both 12, and 5½-year-old twins Estere and Stella.
On Monday, Madonna posted an Instagram photo with her kids in front of a mural in the lobby of the Mercy James Centre for Pediatric Surgery and Intensive Care in Blantyre, Malawi.
“Tree of Life…..🌴 Mercy James Pediatric Hospital! 🏥 One Year Later! 👏🏻👏🏻👏🏻 #everythingislove #malawi,” the “Living for Love” singer captioned the family photo, alongside emoji characters of a tree, hospital, handclaps, heart and Malawian flag.
On July 11, 2017, Madonna’s charity — Raising Malawi — opened the Mercy James Centre, the first children’s hospital in the country.
At the time, the star invited PEOPLE to Africa for the launch of the hospital, where all of her kids (except Lourdes, who had a school commitment) participated in the festivities: Rocco painted a mural in the recovery ward; David danced with a performing troupe from the nearby Jacaranda Foundation, a school for orphans; and Mercy, the building’s namesake, recited a speech.
Since her first visit to Malawi 12 years ago, Madonna has had a long history with the country. She adopted David from the capital city of Lilongwe in 2008; a year later, she finalized the adoption of Mercy, whom she met in Blantyre; and in February 2017, she adopted Estere and Stella, who grew up in the same orphanage as David, Home of Hope.
“I love when my kids are in Africa,” Madonna said in a September 2017 PEOPLE cover story. “Their selfless behavior, compared to the normal complaining in the privileged world we live in, is great to see.”
Madonna launched her charity efforts in the country in 2006. Per its mission statement, “Raising Malawi supports orphans and vulnerable children in Malawi through health, education and community support.”
In addition to opening Malawi’s first children’s hospital, the organization has helped build 10 schools; and earlier this year, Madonna announced plans to build four new schools.
This article originally appeared on PEOPLE.