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A very avoidable death

On a trip to Katine this month, Sarah Boseley witnessed an everyday African tragedy: a young woman dying after childbirth
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Tiriri health centre
Outside the maternity ward of the Tiriri health centre. Photograph: Dan Chung/Dan Chung

The other day I watched a woman die. A small crowd of nursing staff, orderlies and onlookers clustered round the bed in the treatment room where she had been taken after collapsing on the grass outside. It seemed like an intrusion to join them but, in truth, one more spectator made no difference.

She was motionless, legs bent below her red dress and head to one side. With the horror of a westerner used to ambulance sirens, I counted the seconds ticking away while nothing was done. No drip, no oxygen mask, no injections, no resuscitation. There was nothing they could do, and they knew it.

This happens in Uganda all the time. The previous day there had been nothing wrong with Florence Ayupo. She was fit and healthy, cooking for her husband and four children, sweeping the yard. Then, in the early hours, she went into labour.

"She woke me about 3am," said her husband, Joseph Etoku, outside the health centre. He seemed to want to talk. I didn't realise he hadn't yet been told his wife was dead. "I had to hurry on a bicycle to get the TBA [traditional birth attendant]. She delivered a baby girl about 6am. We realised there was a problem."

Exactly what that problem was, nobody will ever know. They don't do autopsies on women who die in childbirth here. The nearest obstetrician was in Soroti town, 20 miles away. The nearest doctor of any sort, in fact. That's why Florence Ayupo died. Certainly she haemorrhaged - but she could still have been saved had she got to a hospital in time. It was like one of those nightmares where you try to run, but your feet are stuck to the ground.

Florence's husband hired a motorbike from a neighbour and took her to a local health centre - but it had only low-grade nursing staff. She was bleeding heavily, and they told Joseph she had to go to the district hospital in Soroti. They set off again - and promptly ran out of fuel. Nobody can afford a full tank here. So Joseph had to flag down a car. They got a bit further - then that broke down, too.

Eventually a Land Rover stopped, but the driver took one look and said Florence needed urgent medical help. It would take half an hour to get to Soroti - but he could only drive them the short distance to Tiriri health centre, a facility that's supposed to have a doctor but doesn't, because the doctor left for better pay elsewhere. It has an operating theatre but nobody qualified to do surgery, and hardly any drugs, let alone a blood bank.

Florence was carried inside and laid on a sloping bed in the treatment room. People gathered around. Everybody knew she was going to die. And she did.

Outside, a girl sat silently on the grass in the shade of an out-building, a tiny bundle wrapped in a blue-and-white checked blanket across her knees. The life of Florence's last baby is now at risk too, with no mother to feed her. Unsterilised baby bottles and formula made with dodgy water could kill her. The life prospects of the family's other four children have also been severely compromised. It is mothers in Africa who care for children, feed, protect and get them educated.

More than half a million women die every year across the world in, or as a result of, pregnancy and childbirth. Their children's chances of dying before the age of 10 increase as a direct result - two million of the children who die every year have no mothers. This month has seen a flurry of activity in the UK to coincide with the International Day of the Midwife, yet reducing the death toll from childbirth is the Millennium Development Goal on which we have made least progress.

One day, Florence was a healthy, pregnant mother, the next day she was dead, leaving five motherless children to an uncertain world. If she could have called an ambulance, she would be alive today. If she had swiftly reached trained medical staff with the right drugs, she would not have died. Those are things we take for granted in the NHS. In Africa, whole health systems need to be upgraded. Childbirth is not an illness, but in Katine, it kills as abruptly and shockingly as a car crash.

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