It’s life,

When a river and several hours of dirt roads stand between you and the nearest hospital, giving birth can be deadly. One nurse is hoping to change that

It’s 8am and already the air hanging over Bonthe Island off Sierra Leone’s southern coast is humid and sticky. Wearing jeans and rubber slippers, nurse Flaviour Nhawu arrives at the pier breathless, in an ambulance that is the only four-wheel-drive vehicle on the island.

A few minutes before, she had received a call from a remote village called Bendu, where a 35-year-old woman named Kadi had just gone into labour. Now, she and another nurse are preparing to board a white motorboat for the choppy 20-minute ride across the Sherbro River. On the other side, they will walk another quarter of an hour along a dirt path, between tall palm trees and villages of sparse huts, to reach Bendu’s small clinic.

There, Kadi, who is frail and malnourished, is writhing in pain.

Nhawu knows this will be a difficult birth, so she calls for a motorcycle to carry Kadi back to the boat. As it speeds across the river, the woman stares at the water, her eyes clouding over.

Once they reach the opposite bank, it’s straight into the waiting ambulance.

A few hours later, in the Bonthe district hospital, Kadi gives birth by C-section to a healthy baby girl. And then, on the maternity ward’s pink sheets, she falls at last into a deep, untroubled sleep.

Sierra Leone is the most dangerous country in the world to become a mother, 2015 World Health Organisation (WHO) data shows. For every 100 000 live births, more than 1 300 mothers lose their lives, 2015 WHO figures reveal. According to the country’s latest Demographic Health Survey conducted in 2013, a third of women between the ages of 15 and 49 who die in the country die before, during or shortly after childbirth,

By the time that Sierra Leone’s decade-long civil war ended in 2002, the conflict had decimated the national health system. Clinics and hospitals lay in ruin and some healthcare workers were either dead or gone — fleeing the country to take refuge abroad.

Almost 10 years later, less than half of the hospitals surveyed were able to provide expecting mothers-in-distress with life-saving care such as caesarean sections or blood transfusions in the case of complicated births. Postpartum haemorrhages (heavy bleeding after birth) are the leading cause of maternal deaths and responsible for one out of three such deaths, a 2016 government report shows.

None of the clinics in nine of the country’s 13 districts, 2011 research published in the journal PLOS found, could provide basic emergency obstetric care or the type of treatment needed to resuscitate newborns or prevent post-birth infections.

When the Ebola virus hit in 2014, the situation went from bad to worse. The world’s largest Ebola outbreak would last three years, sweeping through Guinea, Sierra Leone and Liberia. Safe deliveries and C-sections fell by more than 20% during the peak and even as new cases began to dwindle in 2015, a 2016 study featured in PLOS reveals.

In the year the outbreak started, the C-section rate fell to one-fourth of what would have been needed to prevent excessive maternal deaths.

Even for Sierra Leone, however, Bonthe is badly off.

The intense and melancholic beauty of its