Sierra Leone has one of the highest levels of maternal mortality in the world. Among the myriad problems mothers there face is a lack of skilled, motivated and well-equipped health workers. One of just 220 trained midwives in the country, Rugiatu Kanu, who works at the Princess Christian Maternal Health hospital in Freetown, told IRIN about the challenges of treating her impoverished clients.

“The first problem we face is getting families to take the decision that a woman should get medical assistance. Maybe they are too poor to pay or just ignorant about the need.

“Sometimes the roads are so bad there’s a delay in getting them to a doctor even when they’ve made the decision. The rural areas health facilities are far apart so when there is a problem woman have a lot of work to do to get there.

“Mostly we get late referrals here, women who are much too far gone. That’s why on the wards there are a surprisingly small number of babies. Most of these women lose them and it’s the most we can do to keep the women alive.

“We lack everything from drugs, supplies, and surgical equipment to basics like gauze and gloves.

“The main causes of death are haemorrhaging, prolonged labour, and unsafe abortions. Blood services are poor because there is no real blood bank. We have to ask family members of patients to donate blood for them but because of superstition people are often unwilling to do that even for their own relatives.

“They usually shy away until we tell them that the patient can die from blood loss in just two or three hours.

“Electricity is more stable these days since the election - it isn’t off all the time like it used to be. Water works about 80 percent of the time since the African Development Bank funded a refurbishment of the hospital, although because of problems in the way the work was done there are whole floors of the hospital which still don’t have water. We have to carry it up the stairs in buckets or the patients do it themselves.

“There is a shortage of skilled attendants at all levels. Doctors, gynaecologists and midwives. This is the main teaching and referral hospital in the country and it has just one doctor. All the previous doctors left and took up government jobs.

“Can you imagine coming to work and meeting the demands of these kinds of problems on 260,000 leones (US$88) per month? And the tools we know we need to make an effective diagnosis and treatment are not there.

“Low salaries and poor availability of tools are the main problems we face.”