A young women has been in labour for 28 hours - she is not in hospital but lies instead in a scanty shack in a village far from any form of civilisation. By her side is no doctor or midwife, merely her grandmother, the oldest woman in the village.

This is no special case in Madagascar. The shockingly basic conditions of this birth are a normality. Insufficient medical facilities and staff coupled with extreme poverty makes medical care in rural areas of southern Madagascar particularly difficult. Most women have never set eyes on a doctor during their pregnancy, let alone received a check-up.

Such was the case for this young woman, waiting over 24 hours for her delivery. Suddenly the baby’s tiny legs become visible. Both women realise with horror that the child is in breech position. A C-section is urgently required for mother and child to survive. But the next clinic is over 50km away. The family hurries to find an oxcart which they rent with the last of their savings. The exhausted woman is loaded into the back. A seemingly endless journey along mud roads and dusty paths begins. After almost 22 hours the clinic is in sight, but what will the doctors say when they see this penniless woman, unable to pay her medical bills? The family reaches the hospital wracked with worry - the woman is no longer conscious. However, in this hospital no one asks about their financial situation. Doctors and nurses are on the scene immediately. A C-section is carried out, and it becomes clear that both mother and baby will survive.

With this project, Doctors for Madagascar seeks to improve medical care for pregnant women and newborns in the South of the island. We aim to provide women with more access to check-ups, and to ensure that pregnant women are better treated, particularly when complications arise. Of course this care is free and entirely independent of a family’s income.

In practice, this means that pregnant women are transported for free from a Centre de Santé de Base (CSB) in an ambulance stationed in either Fotadrevo or Manambaro. These ambulances can be alerted via a free hotline from the CSBs.

Additionally, we provide special courses in which pregnant women learn to recognise early warning signs, watch their nutrition, and how they can prepare for the arrival of their child. Our Community Health Workers travel by motorcycle to cover the long distances more quickly.

Mobile clinics are another important service. They consist of a car with a midwife and/or doctor and an ultrasound monitor. Every day they visit different villages where they monitor and consult high-risk pregnancies, and take urgent cases directly to hospital. International and local specialists also carry out upgrade training courses for midwives, nurses and doctors. This project is being run in 10 health centres (CSBs) and the hospitals in Fotadrevo and Manambaro. Doctors for Madagascar works with clinics, government institutions and traditional care providers to reach as many pregnant women in the region as possible.

The monthly salary of a midwife who travels to distant villages via motorcycle and provides prenatal care there, amounts to about 200€. The cost of a life-saving C-section, including hospital stay and medication, is approximately 130€ per case.