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A Mother's Final Look at Life

Sierra Leone has the highest rate of maternal mortality in the world. Hospitals lack basic equipment and medication, and factors such as poverty and lack of transportation make every pregnancy a gamble.
[Map: Sierra Leone]

They sent for Saidu, who ran frantically around the neighborhood, trying to wake up someone with a car. He found a driver, and Fatmata walked herself out of the room, across the muddy courtyard in the rain and into the car.

They sped off on the 20-minute dash to the Princess Christian hospital. Fatmata was talking in the taxi, complaining that she felt dizzy and weak, and saying over and over, "I think I'm going to die."

They arrived at 6:06 a.m. Nurses wheeled an old iron gurney down to the car and lifted Fatmata onto it. They pushed her quickly up a long ramp to the hospital's main maternity ward on the second floor, where four nurses went to work on her.

Although she had been talking a few minutes earlier, Fatmata was now unconscious and gasping weakly for air. She had no pulse or blood pressure.

The Princess Christian hospital is a sprawling, low structure that sits between one of the city's busiest market streets and a slum astride the Atlantic shorefront. It has no air conditioning, a broken light in the operating room, bathrooms with an overpowering stench and virtually no medical supplies.

It is the country's best maternity hospital, handling emergencies and complicated cases referred to it from all over the country.

"We are the last resort; if we fail, there is nowhere else," said Ibrahim D. Thorlie, one of only two specialists in obstetrics and gynecology and director of the 130-bed hospital. He carries a battery-powered desk lamp with him into surgery, in case of power failures.

S.K. Sidique, the other obstetrician on staff, said he had spent almost $250 out of his own pocket this month for sutures, because the hospital has none.

Before a Caesarean section or other surgeries can start, the patient's family must hurry out and buy medications, intravenous fluids and bags, catheters, blood for transfusions and surgical gloves for the doctors and nurses.

"Everything you see here, the patient has to buy," said Sidique, who had to delay a C-section for 15 minutes one recent day while the patient's husband ran out to buy the gloves.

Because the hospital handles the most difficult cases, its mortality rate is dismal. Last year, there were about 1,230 births at the hospital, and the mother died in 141 of those cases.

During one recent 48-hour period at the hospital, six women died and five babies were stillborn. Two of the women bled to death, and the others died from high blood pressure, infection, complications from HIV and a botched illegal abortion. All the women whose infants were stillborn had first gone to local nurses or semiskilled "traditional birth attendants" for care, then came to the hospital when they developed complications.

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