Feb 2004

ANGOLA :: AN EMERGENCY IN CUEMBA

Dark clouds have gathered over the village of Cuemba. At any moment, it will start to rain and the pilots of the Médecins Sans Frontières aircraft urge us to leave before the sandy airstrip becomes a muddy pool. The small plane arrived only a short while ago, bringing drugs, medical material and other goods from the capital Luanda to this remote place in Bié province, right in the middle of Angola.

The pilots are ready to go when the emergency call comes in. The Cuemba health centre has received information that there is a pregnant woman out in the bush in need of urgent medical help. It is not easy to get detailed information but it seems that she is having difficulties giving birth. The baby's arm can be seen, but the child is stuck in the pelvis unable to move forward. If the information is correct, the lives of both mother and child are in danger and a caesarean section is vital. But this cannot be done in the small health centre in Cuemba. A medical evacuation to the provincial hospital in Kuito is the only option.

© Ton Koene MSF plane used to transport staff and supplies to different locations in Angola.

Meanwhile, heavy raindrops have started to pour down and the pilots look at each other with concern. There is no time to lose.

Belgium midwife Christine Lebrun jumps into the four-wheel-drive next to the driver. They quickly leave the few houses of Cuemba behind and follow a bumpy sand road into the bush. It is hardly possible to see through the windscreen because of the rain and the enormous potholes on the road quickly fill with water. After a short drive, they reach a small group of people carrying the pregnant woman on a stretcher made of twigs and leaves. They look anxious and forlorn in their old clothes soaked from the rain.

Christine gets out of the jeep but the driver has to drive for one or two more kilometres before he can turn at a road junction. The area is heavily mined and only some roads are cleared and safe. Coming back, he sees the people standing together holding an old plastic sheet, under which the midwife is examining the woman. Christine tries to hear the heartbeat of the baby, but due to the rain splashing on the plastic she can't identify any vital signals.

The woman, Celesta*, is carefully lifted into the jeep. Only one person is allowed to accompany her. The husband? No. It will be Celesta's mother, since giving birth is “women's business”. Pain is written on Celesta's face as the jeep follows the bumpy road back to the village, but not a single sound escapes from her lips. After the first consultation, midwife Christine, who sits next to Celesta and holds her hand, is content. Celesta is in a good physical state and her blood pressure is stable. Luckily her relatives came to the hospital when problems first started and didn't lose precious time.

Celesta is barely 30 years old but has already given birth to seven children. Three of them are alive, four have died. Not a unique fate in the remote areas of Angola, where malaria, respiratory tract infections, poor nutrition and diarrhoea are a deadly threat for children under five. The danger is increased by the fact that access to health care is very limited.

Before the jeep drives to the airstrip it stops at the hospital. Christine fixes a drip onto Celesta's arm through which she is given a painkiller and a drug to suspend labour. As the birth has proceeded so far, the body wants to expulse the baby at all costs, which can cause a rupture of the uterus.

By the time the jeep finally reaches the plane, the rain has stopped. But the airstrip is soaked and looks slippery so the pilots don't dare take off. Christine again examines the woman, who is still lying in the car. This time Christine has a smile on her face: "The little hand is moving, so the baby is alive."

It takes more than an hour before the pilots give the green light to leave. Christine, who will stay in Cuemba, says goodbye to Celesta. "Terás um bebé feliz, Celesta" – "You will have a nice baby. And if it is a girl you can call her Esperanca … Hope,” she says with a reassuring smile, before the doors are closed.

During the flight Celesta lies on a mattress in the back of the small plane, where the cargo was stored previously. It is the first flight that she and her mother have ever taken and it is a bumpy one, as the weather is still bad. Fortunately the plane reaches the provincial capital after only 20 minutes. In Kuito, the Médecins Sans Frontières jeep is waiting on the airstrip to take Celesta to the provincial hospital, where the caesarean section can be done.

When the Médecins Sans Frontières team hear later that mother and child survived and are doing well, they are greatly relieved. Celesta and her baby boy have been very lucky. Without medical assistance, neither would have survived.

In Cuemba (Bie province), Médecins Sans Frontières works in the heath centre and provides quality health care to resident and displaced populations. In November 2003, the team completed the rehabilitation of the maternity centre. Construction work in the hospital is ongoing, so most of the patients currently have to be treated in tents. For major medical problems or surgery an evacuation to the provincial capital Kuito is necessary. Kuito can only be reached by plane from Cuemba, as many of the streets and bridges that were not destroyed during the war have flooded or collapsed. The area is also heavily mined.

*name changed

Anke Stockdreher