The youngest of Chantalle Bukuru's six children does not have a name yet but the 17-day-old girl has attitude – her fists swat the air, her eyes are wide and alert. Bukuru (27) gave birth by Caesarean section in the CMCK clinic in Bujumbura, the steamy, hill-ringed, bicycle-filled capital of Burundi.
She was referred to the clinic as part of an emergency obstetric care programme run by Médecins sans Frontières (MSF) in the poor, landlocked country, which has one of the world's highest maternal mortality rates. Bukuru's labour was not progressing, which is why she was admitted, and she is still in hospital because the cut became infected.
"If the MSF had not been involved, things would have gone very badly … they saved me," she said, speaking in Kirundi, a local language. She will name her daughter when she goes home, as is the tradition.
In a report released last week, MSF said the €1.8-million project in Kabezi, just outside Bujumbura, and a similar programme in Sierra Leone, had cut maternal deaths by up to 74% by providing free access to emergency obstetric care 24 hours a day, seven days a week.
In 2011, maternal mortality in Kabezi fell to 208 per 100 000 live births, compared with a national average of 800 per 100 000 live births. In Bo, Sierra Leone, the rate declined to 351 per 100 000 compared with 890 per 100 000 in the rest of the country – a 61% decrease.
This means that, in Kabezi, the millennium development goal of reducing maternal mortality by 75% from national rates in 1990 has already been achieved. The MSF is confident it can replicate that success in Bo.
Threatened by floods
"You do not need state-of-the-art facilities or equipment to save many women's lives," said Vincent Lambert, the MSF's medical adviser for projects in Burundi.
In Kabezi, the MSF provides an ambulance referral service for women who suffer complications during labour or pregnant women at risk. The women used to be brought to the MSF Curgo clinic in Kabezi but since the facility was threatened by floods in November the team has been based in CMCK. They hope to move back to Kabezi in a few weeks.
The cost works out at just more than €3 a person in the Kabezi area, which is home to about 600 000 people. The Curgo clinic registers about 3 000 births a year, with 50% by caesareans.
Bavo Christiaens, head of the MSF's mission in Burundi, said the Kabezi clinic was opened in 2008 after the organisation noticed they were receiving more women than former fighters in a clinic set up to treat the injured from Burundi's 1993-2006 civil war, which left much of the densely populated country's infrastructure in tatters.
Burundi is one of the poorest countries in the world, ranked 185th out of 187 in the UN human development index. Although progress is being made to stamp out corruption and improve the business climate, life is still hard for many of its eight million people, 90% of whom are subsistence farmers. Although medical care for pregnant women and children under five has been free since 2006, there are still barriers to access, not least the cost of transport and poor roads, especially during the rainy season. Public hospitals also lack staff and facilities. The MSF has been training local doctors and other medical staff in Kabezi since last year.
Julie Bana Ngongo, head of nursing at the Kabezi clinic, said the MSF installed radios in nearby districts so that nurses in the health centres there could contact the MSF to refer a patient.
"We refer patients who are at risk and those with direct obstetric complications … such as pre-eclampsia, abortions, prolonged labour, septicaemia and uterine rupture."
Women over the age of 35 or women who already have six children are also considered at risk. When a woman is referred, one of three MSF ambulances is dispatched to bring her to Kabezi, which is equipped for surgery and has neo-natal facilities.
The MSF also hopes the techniques it uses – such as the no-cost kangaroo method of caring for underweight newborns – will be picked up by local doctors and in public hospitals.
Bana Ngongo explained how the kangaroo method works. "She puts the baby here," she said, placing her hands on her chest, "like a toad, and the mum can sit and sleep and walk around. This … prevents asphyxiation and infections … It's as though the child is still in the mother's stomach."
Christiaens said Burundi's government was aware of the clinic's achievements. "They really understand the importance of good obstetrics care. They understand the ambulances and the system of referrals." She added that cost remained an issue in a country where donors still accounted for at least 50% of the government's budget.
Vera Niyokwizera winces as she sits up on her bed, where her fourth child, a girl, is sleeping, swaddled in a bright cloth over a yellow babygro. The epidural Niyokwizera received during labour four days before is still giving her headaches but she praises the nurses at the CMCK clinic who ensure she gets her medicines regularly.
Her baby's life may well have been saved by the MSF but the 22-year-old mother knows there will be further expensive risks, not least malaria, when she returns to her home, where she grows manioc, maize and beans. "It is hard to find the money to take care of your children. My husband can look for work on plantations until we get the money for medicines," she said. – © Guardian News & Media 2012