Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
International Federation of Red Cross and Red Cresent Societies - 18 July 2003
Rosemarie North in Freetown
When people had wounds, the only solution was to wipe away the blood. Women gave birth in the bush without clean water or equipment.
As a result, survival was a matter of luck. Sierra Leone, one of the poorest country in the world, has the highest maternal mortality rate in the world (1.8 per 100) and some of the highest death rates for under-five year olds (28.6 in 100) and infant mortality (17 in 100).
In Kenema, a district in the country's south-east, midwife Agnes Musa proudly guides visitors around a new birthing house on the edge of the village of Burma, built with the help of the Sierra Leone Red Cross Society and the Canadian Red Cross.
There are three rooms, all with concrete floors and big plastic tubs for water. In the delivery room a plastic sheet covers the bed. Above it, rubber gloves are pegged to a line to dry.
Another room holds three beds where new mothers are kept for up to a day after giving birth. A third room is used for training and health care, such as weighing babies and giving vaccinations.
The rooms have woven grass ceilings, which do not muffle any noise. Outside, down some steps, are three charred rocks where the midwives light fires to sterilise their equipment. A few metres away is a toilet.
Four trained birth attendants and three untrained assistants use the house to deliver about 10 babies a month, or three-quarters of all babies born in Burma, which has population of 2,000.
Agnes Musa, who was trained by the Red Cross six years ago, works hard doing her bit to reduce those shockingly high mortality figures.
"What I have learned well, what is new to me and to most of my colleagues, is to take my time," she says. "In the villages our old women would force these (pregnant) women to deliver very fast. If I have learned one thing, it is time and how to deliver a child safely without too much pain."
Other changes include preventing infection for mothers and babies. The women have new techniques for tying and cutting the umbilical cord, with a clean razor blade. Before they would massage the cord, a process they called "milking the umbilical cord," and which could result in a hernia for the baby.
"There have been remarkable improvements in the health status of children and even the mothers," says Agnes, who is known as "Granny Pickin" (midwife).
The Sierra Leone Red Cross Society has trained 620 traditional midwives in basic health care, including first aid, sexually transmitted diseases and HIV/AIDS, managing potentially fatal diarrhoea, the importance of immunisation, food hygiene and how to protect clean water sources to prevent the spread of infectious diseases.
The society's health programme is supported by the British, Canadian and Swedish Red Cross. Every month the midwives report how many children they have delivered and how many of their babies and mothers have died. Look in the branch exercise books and you will see the statistics improving.
The midwives still lack basic drugs. They depend on water drawn from wells, which can be contaminated. And they would also like to protect women and babies with mosquito nets.
But Agnes says most of the mothers and babies who die these days have not benefited from the ante-natal help the midwives offer, which includes how to eat well and to get help if they have a fever.
Traditional birth attendants have a special place in Sierra Leonean society. Often the women are also the heads of secret societies which perform ceremonies such as initiation rites for pubescent girls and "circumcisions". Influencing them, the Red Cross believes, can make a big difference to people's health.
Fatu Kamara has been delivering babies for 20 years. She knows when a mother is ready, and when it's all right to leave her for a few minutes.
She learned from her mother and grandmother, who were also midwives, secrets such as which herbs to grind up into a paste and feed the women.
"Before I was trained I used to give herbs to pregnant women when they came to deliver. According to tradition, they would assist the pregnant women. With the training I don't do that anymore," Fatu says.
When she returns to her village, she plans to revive the tradition. But she still intends to use many of the new techniques she's learned too.
"Praise to God, things have changed over the years. The child and maternal death rates have dropped," she says.
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