The sun burns hot on 7th December 2012. One of Médecins Sans Frontières’ white 4x4s pulls into the gate of the hospital in Fotadrevo, carrying three women from the town of Bekily, 60 km away. One of them is groaning – the diagnosis: obstructed labour. Surgery is inevitable. 36-year old Maria has to wait a few more minutes until the operating theatre is ready. Her sister and sister-in-law try to make her comfortable. Nurse anesthetist Angeline applies spinal anesthesia, and Dr. Elson and Dr. Pierre begin their work. A few minutes later Dr Elson lifts up the baby. It’s a girl, and bawling healthily. Midwife Eduardine cleans the baby with practised hands, wraps her up and carries her out to her aunts. After Maria’s wound has been stitched, she is transferred to the hospital tent that serves as the women’s ward.

She shares it with 14 other women and children. It is hot and stuffy, with flies whirring about, and a chicken peeks out from under a bed. Maria will have to stay for a week to recover. Her daughters, aged five and ten, are being cared for by her family at home. The two neatly-dressed women who came with her sleep in the courtyard outside, with the other patients’ relatives. They bring food for the mother-of-three and cool her feverish forehead with a wet towel. The baby sleeps most of the time on a mattress or in the arm of one of her aunts, only being brought to her mother for breastfeeding. When I ask for the child’s name five days later, the aunts don’t remember at first. They dig out a crumpled note: Rafaravary Rahelimalala Omega, or Malala for short. This much Malagasy I have learned already: “Malala“ means “my darling“.

(MSF ran a hospital without surgical facilities in Bekily until 2014. All surgical emergencies were brought into the Hopitaly Zoara – almost daily. The costs for the transfer and the surgeries were covered by MSF. But since MSF withdrew from Bekily, the hospital has diminished greatly)