After traveling an hour through rough terrain our destination finally emerges from the brush and I can’t help but feel unimpressed. The aged two story building seems to be clinging to life. Its fractured brick and mortar construction is solid enough but exposed in areas and uneven in others. The paint, once bright yellow and blue has been equally weathered and cracked. Surrounding grass and shrubbery is maintained naturally by grazing livestock but the cattle don’t seem to be very hungry. Laundry hangs on a wire, haphazardly suspended from protruding rusty rebar, drying in the midmorning sun. A thick coat of algae has grown on the concrete overhang welcoming us inside. Dirt, dust and grime adhere to each wall showcasing the constant traffic ushering in and out of its open doors. Rooms are sparsely furnished with aging essential equipment but lack any creature comforts of a modern hospital. The government has erected a new building for this area and when we arrived a completed yet unpainted concrete shell was pointed out. Construction has been ongoing for the past three years and it is explained that because of political delays it will be at least another two years before opening.
These health posts, primitive as they might be, are a life line to the surrounding community. Health care providers that staff these remote sites supply vaccinations, antibiotics and perform regular check-ups. This particular location also operates a twenty four hour birthing center. In addition to other maternal and neonatal health goals the SAMMAN project supplies needed equipment to the many birthing centers scattered around this country. We are here to gather feedback from staff and various officials that volunteer and work in this community. During my travels I have viewed many examples of health posts but this is the first one that has been actively seeing patients during our visit. People, predominately the young and elderly, have traveled long distances (sometimes walking for hours) to see the nurse and they linger in the humid midday heat for their turn. As a pharmaceutical sales representative I am somewhat familiar with this situation. I smile while watching kids play with whatever they can find as adults make small talk to pass the time, typical waiting room behavior. To quote a really annoying song, it really is “A small world after all”.
By this point in my travels I should have known things were about to get much more interesting. While waiting for the designated health post officials to arrive and assemble, a faint cry is heard from inside. Upon investigation it is discovered that a baby has just been delivered and we are invited to observe. Against better judgment I follow my escort into a dark, dank room and am immediately confronted with a scene for which I am wholly unprepared. Windows and doors stand ajar to let in light and air because there is no electricity or proper ventilation. A woman squirms uncomfortably on a cold, rusty hospital bed. Between her legs lies a pool of freshly clotting blood atop old newspapers that double as makeshift bed sheets. The culmination of a long effort is revealed by the sweat covering her body and brow. Lingering pain is evident from a hard grimace worn by her face. On the bedside table cries a bloodstained new born baby boy. A lone midwife is busy cleaning and clothing the precious life she not two minutes prior delivered. As I stand there, wide eyed, astonished at the scene unfurling before me, I come to a realization. There are no doctors out here, no nurses to assist, no emergency number to call. A heroic midwife, operating with improvised tools and minimal training, is the first last and only line of defense for the life of countless innocent children and, loving mothers. This is exactly who the SAMMAN project is trying to help. Here they are gathered together almost purposely to highlight the importance of this assignment: A nurse doing her best with the tools provided, a mother trying to obtain the finest care for her child, and a helpless infant born into a world of possibilities. They are why I’m here and I will never forget that.