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In Sierra Leone, Every Pregnancy Is a 'Chance of Dying'

Adama Sannoh, unable to find transportation to a medical facility, spent a sleepless night suffering from symptoms of eclampsia. She and her baby later died at the hospital before she could deliver.

She put the body on a scale: 6.5 pounds.

A good size, otherwise apparently healthy and well developed.

"If she had come to the hospital earlier, this baby could have survived," Kamara said.

Kamara wrapped the baby in the colorful cloth that Marah had worn wrapped around herself as a dress. Then she placed the tiny body on a small rolling table and pushed it into the room where Marah had waited for her surgery. She left the baby there alone, under the harsh neon light, with the wind and rain still blowing in the window.

As Konteh stitched up Marah's belly, he said he had found the baby's head badly stuck in Marah's pelvis, with the umbilical cord wrapped around its neck.

His staff had been working since early morning, he noted, and had needed to go home to eat and rest. They came back as quickly as they could.

Konteh said the hospital doesn't have the money or the staff to have 24-hour coverage. Konteh lives in a house on the hospital grounds, and the surgical team works all day and is on 24-hour call for emergencies. Doing surgery without the full team could risk the patient's life.

Konteh stepped down from the table, pulled off his gown and tugged at his scrubs, which were soaked with sweat and sticking to him.

Two hours later Marah woke up in the hospital's post-surgical ward, where eight other women who had recently had C-sections were lying under anti-malarial mosquito nets with their babies.

The ward was dimly lit by a kerosene lamp.

Konteh was at her bedside, rubbing his patient's cheek to rouse her.

Still groggy and not quite lucid, she looked at Konteh.

"Thank you," she said.

"I didn't do this for you, God did it for you," he said.

Marah closed her eyes and opened them again.

"Where is my baby?" she said.

"Tomorrow I will tell you everything about your baby," he said.

"God Bless you," Marah said, and drifted back off to sleep.

Shortly after 6 the next morning, with a heavy mist hanging like a wooly blanket over hills so thick and lush they looked like heads of broccoli, Marah's dead baby girl still lay in the same empty room.

Marah lay in her bed, awake.

Her husband was at her side, with a bundle of clothes for her. All over the ward, babies were crying and mothers were nursing or changing diapers.

"I am not going to cry," Marah said, her eyes filling with tears.

"Thank God I came to the hospital," she said. "If I had stayed at home I would have died."

Relatives and friends stopped in to offer their condolences about the baby, but mainly they seemed happy that Marah was well.

She had still not seen her baby, and she said she didn't want to.

"There is no need," she said.

Her husband stood outside the ward with two nurses, discussing the bill. The total for the anesthesia and other medicines and supplies was about $50, and the operation fee was another $70.

He peeled off notes and paid about a third of what he owed; the rest he would pay in installments.

At around 10 a.m., several of Marah's female relatives picked up the baby girl's body, with its perfect little hands and feet and tufts of black hair, and brought it into a hospital bathroom. There, in a shallow basin, they washed it and wrapped it in a white cloth for burial.

They handed the baby to its father, who said a quick silent prayer with the baby in his arms. Then he handed the baby to the hospital's night watchman.

In this part of the world, the bodies of stillborn babies are often disposed of by the hospital. Stillbirth is such a common occurrence that the hospital has a small, unmarked graveyard set aside for them.

Sierra Leone has the highest rate of infant mortality in the world, with 16 percent of babies dying before their first birthday. Kargbo, the hospital director, said 26 babies were stillborn at this hospital last year.

The watchman carried the baby out the hospital's front door. He climbed up a hill into the long grass, behind a utility shed, where he had already dug a shallow grave.

It was set amid several small mounds overgrown with thick grass, the unmarked graves of other stillborns.

He placed the baby in the hole, and said a little prayer.

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