FOR Christiana Boma. the hot Wednesday started typically. In the morning, the pregnant woman In her late thirties had gone to the market square In Gogoima, a village of 100 Mende people, to sell vegetables from her backyard garden.

But by midday. Boma was feeling spasms of pain. Her labour had started. Within two hours, she was In agony.

There was no time to get to the nearest health centre, which could be reached only by a couple of hours walk through the bush to a graded road where, if lucky, a passing vehicle would give a ride. The only solution was to get one of the two traditional birth attendants (TBA) in. the village to help with the delivery.

A short time later. Boma lay beside her newly-born identical twin boys, successfully delivered In the house of senior TBA Keimatu Foudie.

There were shouts of jubilation and the babies were placed in afelay. a mat for fanning rice, held up to the sky and danced around the village in the Mende tradition for the birth of twins.

All agreed Boma had been lucky to have normal deliveries that did not require more exceptional treatment. Most rural women in . Sierra Leone life far from the paved roads that lead to modern mqdlcine. And vehicles, where they available, can extort high prices, especially for emergency runs.

If you have an emergency situation, says a village woman, "you will smell hell because you have no means of getting to a medical centre especially, at night.

Mammy Blackie is an example. Returning from her ■ farm under a toad of cassava, the pregnant woman stumbled

on a rut in the road and fell. The fall caused her to haemorrhage, requiring urgent medical attention to remove the dead baby.

Villagers were able to get her to the health centre in Mano, about 20 kilometres away, where she received the treatment that saved her life. One middle-aged woman said Blackie was lucky to have survived. In a more remote village. the woman said, her relative and baby died in childbirth, leaving eight children motherless.

Because of the costs, fewer poor women are delivering their babies in government hospitals, and more children are born in poor health. Maternal mortality due to complications of pregnancy and labour is also still high.

Rural women agree hospital care is the best for their health if they have serious complications that cannot be handled by traditional village medical people. A woman whose life was saved at the nearby clinic said: I had serious bleeding the day after delivery, but .the TBA under whom I had the baby could not do much. I was rushed to the clinic where the nurse discovered that the placental had not been completely removed. The Job was qufckly done.'

But the women who said they owe much to the formal medical system also spoke frankly about its deficiencies.

"Labour and the complications of childbirth do not know office hours.' said Margaret Musa. The nearest health centre may not be open at night and there Is no transport to the big hospital."

On the cost of care, one woman said: They ask you to buy heaven and earth and we do not have the kind of money." Nurses, she added, "treat you rudely, and you dare not complain, or you will be completely ignored and abandoned to groan in pain and die."

The women also pointed out that TBAs and other healers are from the community, speak the local language, charge ,modest fees or accept payment in kind, and very Importantly. they provide strong emotional support during and following labour.

The United Nations Children's Fund is also trying to provide some healthcare for young children, providing free vaccinations against six major childhood diseases: measles, tetanus, whooping cough, diphtheria, polio and tuberculosis. The country's infant mortality rate has dropped from 175 per 1,000 live births when the programme began, to 144 in 1992. It is still the fifth worst total In the world, according to Unlcef.

At one immunization programme outreach session in a village about 10 kilometres from Gogoima. the community health officer, Brima Kamara, stressed to the women at the clinic that the vaccines were free. As an Incentive to attend the monthly clinic, the women are given plastic cups and spoons and children are offered bangles.

Kamara and nurse Ruglatu Jah also provided treatment for diarrhoeal diseases and told the assembled women — and men — about family planning. showing them various contraceptives. "You can only give your children quality education as well as protection from diseases by living in a clean and healthy environment when you have Just the right number you can care for,”. Kamara said.

Some of the Muslim wojnen complained that their husbands are not In favour of contraceptives, believing they make wives promiscuous. Kamara assured the men that the use of contraceptives had nothing to do with promiscuity and that in fact condoms d4uii£l

protect them from sexually transmitted diseases. Including AIDS.

Later, after the children and pregnant women had been treated. Kamara was told about an 18-year-old woman. Jitta Dugba, who was two months pi'egnant and In danger of aborting. She was in pain, with beads of sweat streaming down her face.

Dugba said she had a history of pregnancy complications. The nearest health centre was kltoihetres away, she could not walk because of the 'pain and no vehicles travelled the route. So Dugba said she had been stuck in the village, taking the age-old traditional medicines.

Kamara examined the woman and found she had a tommon vaginal infection. He gave her some medication.

If the medical crew had not visited the village that day. Dugba could have tost her baby. On that day there was Joy In the village as wives, husbands and children received medical attention. But when help is not al hand, it can be a community in agony.