Due to tradition mothers in remote PNG villages often have to give birth outside the home, on the ground. Birth attendant Mary Dare helps make sure mother and baby survive.
The Herald and World Vision want to raise $100,000 for the urgent water and sanitation needs in the Hanuabada village of Port Moresby, and World Vision wants your long-term support for ongoing work in the Pacific. Each day we'll be reporting on a particular problem for the region and showcasing how World Vision has helped. Today, maternity.
The doors of the Daigul Health Clinic are wide open, and there, lying on her back, drifting in and out of consciousness, is a mother with a fresh out-of-the-wrapper newborn lying face up, perfect-looking, in a small blanket next to her.
Following local custom, Annie Malagui, 29, gave birth inthe bushes outside the village on Papua New Guinea's northern coast.
Complications leading to blood loss are behind the loss of consciousness. They forced her sister-in-law, the usual childbirth support person in remote communities like this, to run 1500m to the clinic to fetch help.
Luckily an NGO medical team was visiting, and they went and collected Annie who now lies in a ward with no mattresses, just hard wooden bases for patients to lie on.
The clinic has no power, no running water and no privacy. But World Vision has partially refurbished the birthing room next door to provide a clean place for women in labour.
Annie arrived just an hour ago. Next to her are bandages and a pile of gauze covered in blood. The thick padding placed into her underpants is already soaked through again. I ask if she will be okay. A nurse, through teeth stained red from chewed betel nut, assures me she will be.
Papua New Guinea has some of the worst maternal and child health statistics in the Asia-Pacific region. The maternal mortality rate is 215 deaths for every 100,000 live births. In New Zealand it's 11.
An estimated 63 out of 1000 children born in Papua New Guinea die before their fifth birthday. About half of all children are malnourished.
At the Daigul Health Clinic a mother was now passed out on the wooden hospital bed, a drip in her arm. Photo / Mike Scott
World Vision is at the forefront of efforts to improve those figures. Besides upgrading healthcare facilities, it is training women as Village Birth Attendants (VBAs). Equipped with home birth kits, including gloves, a blanket, scissors, torch and soap, they are trained to perform emergency births and promote positive health practices.
When Linda Kongate went into labour with her first child in 2009, she knew she was not going to be able to travel the many hours to the nearest health clinic.
In the village of Boroi, about four hours' drive west along the coast from Daigul, Linda's local aid post was too rundown to provide a safe place to give birth.
She had no choice but to give birth without medical support. And like many women in rural communities, she was not welcome to give birth inside her home.
Custom dictates that births are a women-only affair, with a cultural belief that if the baby is born in the house and can smell the father, it can lead to health issues like asthma.
So when the time comes women are sent out into the bush, sometimes under a banana tree, sometimes a coconut tree, often just on dirt. "I did not give birth to her in a good place," says Linda. "It was deep in the bushes. Now she is 7 years old."
Seven years later, Linda's second child was the first baby born in Boroi's newly equipped maternity ward, helped by two World Vision-trained VBAs.
"I delivered my little girl here at the aid post, at the right place. And I delivered my baby here safely."
The Boroi aid post was rehabilitated as part of World Vision's maternal health project, funded by the New Zealand Government and the Dove Charitable Trust.
"Since this [aid post] opened in August [2016] we have already delivered six babies," says VBA Josephine, after who one of those first six babies was named.
Josephine is boisterous and proud, and greets us with a megaphone when we arrive in Boroi.
She has become an essential educator on maternal health and a powerful voice for women, visiting the homes of pregnant women and helping them understand the importance of a safe, clean birth.
Dominica George is a Village Birth Attendant received two weeks training from World Vision and has helped more than 20 mothers give birth since 2015. Photo / Mike Scott
She also educates them on antenatal nutrition and about the importance of their place in society.
"We try to change the culture. The culture is one of the barriers. We try to break through these barriers and encourage mothers in different style of taking care of ... your family."
Inside the maternity ward of the aid post, mothers have laid flowers around the room - a symbol that this is a safe, comfortable place to be cared for while pregnant.
World Vision has trained more than 30 VBAs in the region and the work is having a knock-on effect.
In one village I meet an unofficial VBA named Mary Dare, who walks me through the bush pointing out where she has buried placentas from each birth, deep enough so the dogs can't get them.
Mary has no official equipment and wishes for simple things like scissors, fearing the razor blade she has is unsterile. It's rusting.
She typically uses a support team of three women for each birth. One woman's role is just to keep mosquitoes away. If it's dark, banana leaves are lit, if it's raining everyone gets wet.
In all the villages with trained VBAs and birth kits, locals say they've seen survival rates of mothers and babies improve significantly. With access to labour wards and antenatal classes these rates improve further.
Dominica George was inspired to do her bit to help by her own experience.
For the births of her four children, the 32-year-old travelled for three hours by river from her remote village to get to the Bunapas clinic, about two hours' drive inland from Bogia.
We met Dominica in the Bunapas clinic's maternity ward, which is being refurbished and expanded.
There she explained how that arduous journey inspired her to train as a VBA. She and four other women in her village received two weeks' training.
Now she is an essential resource for her community of 720 where almost all expectant women are unable to reach healthcare.
"In my village women have no health facility to visit. I have helped more than 20 mothers give birth. They were all successful with no complications. Mothers are grateful and calmed knowing I am there.
"I am viewed as very important to the community. The training has given me, and the women in our community, a voice."
There's an old saying in Papua New Guinea - have five and live. It's a blunt educational tool to encourage mothers to have smaller families, or risk complications, including death, that increase dramatically after five births.
While there is no law preventing woman from seeking contraception, it is still frequently required to have the husband's consent.
With Annie's husband not present to witness her trauma, it's hard to know if he will ever understand how close he came to losing his wife.
But back in Daigul, her condition has improved. Now partially conscious she has been helped onto her side with her baby placed on a stained squab next to her, able to breastfeed for the first time.
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