Photostory: “We’ll be at port in five minutes. She’s giving birth right now!”

Doctor Alexander Nyman is waiting on a riverbank in South Sudan. An MSF boat is speeding towards his emergency team...

31 May 18

It’s 4:22pm. In a remote South Sudan hospital, a radio call comes in. An MSF boat is speeding towards port. Onboard, a woman is going into labour and bleeding heavily. The emergency team are ready.

WARNING: This story contains distressing information about a complicated childbirth

Swedish doctor Alexander Nyman is waiting on the riverbank at the town of Old Fangak. He remembers the call:

Alex: "ER for Camille..."

Camille: "We’ll be arriving at the port in five minutes. The woman is giving birth right now, we need a stretcher!”

Alex: “The emergency team will come to meet you!”

Camille, an MSF midwife, puts her hand on the belly of 36-year-old Martha to check her labour.

Martha lays at the bottom of the boat and clings to a bench. She is experiencing contractions and is in a lot of pain.

Her sister, Nyajine (left), accompanies her for support.

The boat was urgently called to retrieve Martha from the nearby village of Wanglel.

She had gone into labour the day before and received traditional support from friends and family.

“As long as there are no complications, it often goes well,” says Alexander. “This time the delivery has been going on too long and she is also bleeding.

“The family have been trying to seek our help since yesterday, but the distance to the hospital is both long and difficult.

“When we got information, the midwife and the driver went directly upriver the 30 minute distance to transport the patient to the hospital.”

Camille opens the paper case of a compress as Martha goes into the final stages of labour on the floor of the boat.

An MSF translator leans in to comfort Martha, listening to her despite the noise of the engine.

Her pain and contractions are now more intense.

She already has five children, one girl and four boys. However, she has sadly lost two children.

The boat slows down as it hits the sand. The waiting emergency team rush towards the boat.

“The head is already out. The umbilical cord is wrapped around the baby’s neck,” recalls Alexander, who oversaw the delivery. “The midwife puts two forceps on it, cuts the cord with scissors and releases it."

The baby is born at that exact moment on the riverbank. It is not breathing.

Camille the midwife wraps cloth around the newborn, who is then quickly placed into the arms of a waiting ER nurse.

“Then we’re all running the 30 metres to the emergency room,” says Alexander.

In the emergency ward at Old Fangak, a large tent, Alexander and a nurse try to resuscitate the newborn.

Camille is preparing an injection for the baby – brought into the world only moments before. 

“The infant is neither crying or breathing,” says Alexander. The situation is critical.

A larger MSF team gathers to treat the infant. Nurse Delphine Jacquet (left) and Doctor Mustafa Alajeeli (centre) join the efforts.

Meanwhile, the mother is also in a serious condition. She’s lost a lot of blood and is in shock.

“Here in Old Fangak, there is no blood bank,” says Alexander. “If you need to do a transfusion, it’s usually a family member who will be the donor – if their blood group is the right match, that is.”

Delphine and Alexander continue their attempt to resuscitate the newborn.

Sadly, the child will not survive.

“They reached us too late,” says Alexander. “We couldn’t save the child, but we saved the mother.

“Luckily her sister had the right blood group. We started the transfusion with haste and four hours later her condition was stable.”

Alexander summarises the problems faced by the people living nearby: “Old Fangak is a rural village with 48,000 inhabitants, surrounded by swamp and a river.

"No bikes, cars or road transport exist. The access route is by boat or plane – most often helicopter.

“Electricity is only via a generator. Food is difficult to find, especially during the dry season, and particularly for most of the population who live far from the larger villages.

“(It’s the) same for healthcare. People who live in the smaller rural villages have sometimes travelled for days to reach the hospital, and they’re arriving by foot, sometimes canoe.”

Visit our MSF Blog to read more stories about Alexander's time in South Sudan.