Midwife Toughest Place to be a...


Midwife

Midwife Suzanne Saunders-Blundell abandons the maternity unit at Good Hope Hospital in Sutton Coldfield to work in Monrovia, the capital of Liberia.


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Transcript


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This programme contains scenes which some viewers may find disturbing.

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Three British workers - a bus driver, a midwife and a paramedic.

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They've all accepted the challenge to do their job under some of the toughest conditions on the planet.

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That was a really, really horrible birth.

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See that, one satisfied customer. He got off and he's alive.

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He's even smiling!

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How you guys do this in these conditions?

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Hello, gorgeous.

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Midwife Suzanne Saunders-Blundell is swapping her hospital in Sutton Coldfield

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for one in Liberia, West Africa.

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This is so different to the hospitals at home.

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In one of the world's poorest countries,

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Suzanne will join midwives stretched to the limit and lacking the most basic resources.

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Can we have some fresh water so we can keep sponging her? She's so hot.

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She'll get to grips with the local culture and cuisine.

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This is dry fish.

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But in a country where babies die every day and mothers risk their lives in childbirth,

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all Suzanne's resilience will be put to the test.

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I don't want to experience that again. That was awful.

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Oh, my gosh. Oh.

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Every day, Suzanne Saunders-Blundell

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holds the hopes and dreams of expectant parents in her hands.

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The best bit for me is to see a woman through labour.

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If it goes the way she wants it to go,

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that is the most fulfilling job in the world,

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and to see a mum and a dad with their newborn baby is just... It's amazing.

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It's the most amazing experience ever.

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Suzanne has been delivering babies for nine years and is now a labour ward coordinator

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at Good Hope Hospital in Sutton Coldfield.

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'It's quite important that we can ensure

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'both mum's and the baby's well-being.'

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This maps out your baby's heart rate.

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The heart monitor is just one of the hi-tech devices that helps Suzanne

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make birth as safe as possible.

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That's it. You're very welcome.

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But alongside all this technology, the midwives here

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are keen on natural childbirth.

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Suzanne helps women to have just the kind of birth they want.

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Take it easy. Put your hand on the side.

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I don't like to do too many examinations, cos it's quite invasive,

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so just take a watch and wait.

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Baby seems absolutely fine.

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Encourage her to go with what her body's telling her.

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Well done, well done!

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Hello!

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Hello, Jessica! Happy birthday!

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Are you OK?

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It was great. It was the best six hours of my life.

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I was in my own little world. I can't believe how fast it went.

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She was great. She was telling me to calm down and when to breathe.

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It was just like having your best friend at your side.

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Now Suzanne is off to West Africa,

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where she is expecting their midwifery to be more in line with her own style of natural childbirth.

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We are such a technology-based culture,

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and childbirth does tend to get quite medicalised,

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despite the fact we really try to make it as low-risk as possible.

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I might learn something that's really fascinating.

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Living and working in Africa is going to be tough.

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But Suzanne reckons she's ready to tackle anything.

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I kind of think if a man can do something, so can a woman.

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Whether that be running, playing rugby,

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there's something a bit different,

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and it appealed to me - I like a challenge.

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She's determined, independent,

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she's very focused on whatever she does,

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whether that be midwifery or her personal training or fitness.

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Suzanne's been with husband Dan since she was 17.

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She's only been abroad once without him.

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26 degrees Celsius... Oh, nice.

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Now she's heading to a country many people have never even heard of.

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"Founded and colonised by freed American slaves." Oh, that's good.

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'It's the idea of her going out there to Africa, of all places.'

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She's going off, but I'm staying at home -

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that's going to be weird, totally weird, actually.

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The first African nation with a female president.

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Well, it would be a better place with women in charge.

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OK.

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I like a challenge.

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I think I'm going to get a whole new perspective on life.

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I'm quite open to whatever opportunity,

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whatever experience is going to come flying at me

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and embrace it with both hands and give it a big hug.

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I'm ready for my world to be shaken up, I think.

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Liberia - population 3.5 million.

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The country was founded in the 19th century by freed American slaves,

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but in recent years, this promised land has been torn apart

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by one of the most brutal civil wars in African history.

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As warlords fought for control,

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a quarter of a million people were killed,

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and nearly 800,000 fled for their lives.

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Women were raped, houses burned,

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and child soldiers as young as ten held the power of life and death in their hands.

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Suzanne's arriving in Monrovia, Liberia's capital.

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The war's been over for seven years, but the country is struggling to rebuild.

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Today, eight out of ten people live on less than a dollar a day.

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And even in the capital, there's little electricity

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and no running water.

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-Hiya!

-Hello! Bye!

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It's fantastic. Everyone's so curious about everything. It's very welcoming.

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This is Redemption Hospital,

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where Suzanne will be working for the next two weeks.

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Hiya, I'm here to see Rosalind, the head midwife.

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All right? Thank you.

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This is...so different to the hospitals at home.

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Hello!

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Like Suzanne, Rosalind Bro is a midwife supervisor.

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She runs the maternity unit.

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So you're going to show me the wonders of midwifery in Liberia?

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First stop is the delivery room.

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The facilities are not quite what Suzanne is used to.

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Wow!

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Right. Gosh!

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Do they all lie on their back?

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Yes, they lie on their back.

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Fascinating, absolutely fascinating. Brilliant.

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Right, OK.

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Right, so women in labour in here...

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-Right. OK.

-Yes.

-Gosh.

-OK....

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How long are they in the labour ward until they come into here?

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You are welcome, you are welcome, you are welcome!

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Thank you very much indeed.

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It's... Wow, I really don't know what to say, it's so different.

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So many things and... Oh, I just...

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It's so, so different from home.

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Almost a trolley with stirrups at the end - that's where they give birth.

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At least they have got some beds to put the women in

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and they have got some equipment.

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Redemption Hospital was shut during the long years of the civil war.

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Charities have got it up and running again.

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Now it's back in government hands, medical director Dr Dada is trying to keep it going,

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despite a severe shortage of medical staff.

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Very busy.

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Situated in one of the poorest areas of the city,

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Redemption Hospital is inundated with patients every day.

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Is this the only free hospital in Monrovia?

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-So far.

-So far.

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Lunch in the hospital canteen gives Suzanne her first taste of Liberian cooking.

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Wow! This looks great.

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Right, then, let's give this a whirl.

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-Really spicy. Like chilli.

-Hmm?

-Spicy.

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So what else have I got in here?

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-Fish.

-Any particular fish?

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Any...any particular fish or just any fish?

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-Any fish.

-OK.

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The midwives here are on government salaries.

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And in such a poor country, they aren't generous.

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60 US dollars?

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Yes, it's very small.

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For a month?

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How do you manage to live, if you don't even know if you'll get paid?

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And it's not just the staff suffering the effects of underfunding.

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Premature babies need specialist equipment to keep them warm,

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but in Redemption,

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tin foil and lamps are the best they can hope for.

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OK, no problem.

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Two brand-new incubators were donated by UNICEF six months ago

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but have been standing idle ever since.

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Your adapter definitely works?

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-Even they didn't know how to put it on?

-Yeah.

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How do you feel about being unable to use it?

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There must be an on-off switch somewhere.

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So, we've got power.

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The air temperature - you need to set it.

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It should automatically, I would have thought, start to heat up.

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That's the idea...in theory. Oh, yeah, it's just gone up.

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Hopefully, we'll have a toasty warm incubator we can put a baby in.

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There you go. There you go, and close it.

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Suzanne, thank you.

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You're very welcome.

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Suzanne's beginning to realise

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that the hospital is struggling with even the most basic equipment.

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But there's no time to dwell on it,

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as there's an emergency in the delivery room.

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Well, it looks like a lady's come in who's bleeding.

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She's about 36 weeks pregnant.

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It's either a placenta praevia or placental abruption.

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Placenta praevia means the placenta is coming out ahead of the baby -

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a life-threatening condition.

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On the scan, it looks like there wasn't a heartbeat, but she's carried on bleeding.

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Her pulse is quite rapid, so they've put her in for an emergency section.

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Beatrice Woods is fortunate to have a doctor treating her.

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There are less than 100 in the country.

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It's OK. It's all right, it's all right.

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The baby isn't breathing, and its pulse is weak.

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We'll do CPR. I'll do three.

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One, two, three, right. One press from you.

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One, two, three from me. One press from you. That's it.

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He's got a very slow heartbeat.

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That's better. Are you going to give us a cry?

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Are you going to give us a cry, you naughty thing?

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Oh, what were you thinking?

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What happened?

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At just under 5lbs, the baby's very small,

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but Suzanne and Rosalind have saved his life.

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Yeah, placenta praevia.

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Yeah, it was, wasn't it? Good work, you.

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But Suzanne has been disturbed by the lack of consideration shown towards Beatrice.

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It's nothing like the mother-centred approach she practises in the UK.

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She was there, and everybody was making decisions around her

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and not really explaining to her what was going on.

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'I felt bad, the fact that nobody was talking to her, which was why I went over to her.

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'At least, if you're so scared, if somebody is at least paying you some attention,

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'it's better than being there on your own.'

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Does she get to cuddle him at all? Would she get to give him a cuddle?

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Not at the moment.

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Tonight, Suzanne's going home with Rosalind.

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She lives on the outskirts of Monrovia.

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So sometimes your journey home from work

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could be over two hours?

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Yeah.

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Gosh. That is a long way to travel to come to work.

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People are starting to leave work.

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This is the only public transport in Monrovia.

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This is completely mental!

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The people's driving, everything.

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It's absolutely mad.

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I think people in England would be a little bit miffed

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if you started just driving on the pavement.

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It's interesting, but I quite like theme park rides,

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so it's a bit like that, really.

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After a rattling bus ride,

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there's still one more leg of the journey.

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I really would rather not.

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I'd rather not.

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Well, he will drive you.

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No, I don't like motorbikes, I'm really sorry.

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I don't like motorbikes.

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Suzanne decides to treat them both to a taxi.

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Hiya. Oh, gosh, you're going to carry my bag!

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I think it's almost bigger than you -

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it might be too heavy.

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Four generations of Rosalind's family live under one roof.

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That is my father.

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Nice to meet you, sir, all right, very nice to meet you.

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The living room.

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Wow. Oh, how lovely. What a beautiful house you've got.

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Your room. Wow, look at this.

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This is beautiful.

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You have, you've worked so hard. But it is just...

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Even a small midwife's salary

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makes Rosalind better off than most Liberians.

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But she has to support ten people,

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so she does two jobs,

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often working 48 hours at a time,

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to put food on the table.

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Yeah, got a bit of fish here as well.

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Oh, lovely.

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If my husband at home could see me picking up a fish head,

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he would die laughing.

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Suzanne's sleeping on the floor in Rosalind's room.

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When Rosalind goes to bed,

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the generator gets switched off.

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So, yeah, that was quite funny,

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having a generator go off mid-wee,

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in the bathroom, with no torch. And no idea where the loo paper is.

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And no idea where the door is.

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So it's good fun.

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It's 25 past 5

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and time for work. And I'm tired.

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SHE LAUGHS

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Cold water.

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Cold water, here we come.

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'Rosalind's very lucky - she's worked so hard to actually...

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'it's really nice.'

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And everything doesn't seem to matter so much.

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You know, yeah, you tip a jug of cold water down yourself in the morning,

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but this is life.

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It's 8am.

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Rosalind and Suzanne are taking over from the night shift.

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-Have you had many deliveries in the night?

-Yes.

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Really? Six, seven, eight?!

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Yeah, a very busy night for you.

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So you need your sleep now.

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It's not long before Suzanne gets her first patient of the day.

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And once again, it's not straightforward.

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I'm opening the...

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No, I gathered that.

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I help you.

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Yeah, yeah. OK, so...

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WOMAN SCREAMS

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Rebecca Cara's baby is dead,

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but she still has to give birth.

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We'll wrap the baby in that once it's born.

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-It's not alive.

-OK.

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WOMAN MOANS

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Yeah, I think that's a foot.

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WOMAN SCREAMS

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There's an added complication -

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it's a breech birth.

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The baby is coming feet first.

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The arms...

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the arms are like that.

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Suzanne's been dropped in the deep end.

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WOMAN SCREAMS

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Hang on.

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It needs... The arms are extended.

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At home, she has never dealt with a situation like this.

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SHE SCREAMS

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Yeah. It's a little boy.

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Where's the baby going now?

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OK.

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Right. OK. OK,

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so it just rests on the side?

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You just pop it on this?

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OK. OK.

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It seems like the baby's actually been dead for quite a while.

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It was quite difficult to deliver the body.

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And what was very strange was

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the woman just thanked everybody.

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She didn't cry,

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or didn't seem particularly upset.

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Very matter of fact here, really.

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I don't know if it's because it happens so often,

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people are more accepting.

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One in 25 babies in Liberia

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is stillborn, or dies within 24 hours.

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At Redemption Hospital,

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this is the third stillbirth this week.

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Almost immediately,

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another woman staggers into the labour ward demanding help.

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There's no time to get her into the delivery room.

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Rebecca, who lost her child less than two hours ago,

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is watching from the next bed.

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Suzanne is shocked by the lack of sensitivity.

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They've got a woman with diarrhoea

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next to a woman who's just had a stillbirth,

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straight next to a woman who's got a live baby,

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next to somebody who's just had an abortion.

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It seems bizarre that all these women are just put together.

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-Full term?

-Yeah.

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As she gets on with the paperwork,

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she let's slip that it's her husband's birthday today.

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It's a chance for the midwives to lighten the mood.

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She had oxytocin?

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Yes.

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# Happy birthday to Suzanne husband

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# Happy birthday to Suzanne husband

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# Happy birthday to him! #

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He would have loved that.

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# Bless him

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# We wish him long life

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# We wish him prosperity

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# Happy birthday to Suzanne husband! #

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35.

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THEY CHEER

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But the laughter is short lived.

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Suzanne's challenging shift is about to take a turn for the worse.

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WOMAN SCREAMS

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As she goes into the delivery room once more,

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there's a young mum who's too shy to be filmed.

0:23:080:23:11

WOMAN SCREAMS

0:23:110:23:12

-Go on.

-N-o-o!

0:23:120:23:14

BABY CRIES

0:23:170:23:19

It's a healthy baby,

0:23:190:23:22

but Suzanne's appalled by what she's seen.

0:23:220:23:25

That is NOT how we do it at home.

0:23:250:23:29

No, I need, er, a minute.

0:23:290:23:30

A very shocking experience, actually.

0:23:330:23:36

Um, I didn't think, um, that...

0:23:360:23:39

I'm really sorry.

0:23:390:23:41

Um. That was a really silly outburst, I don't normally...

0:23:420:23:47

That was a really, really horrible birth.

0:23:470:23:49

Obviously, my personal practice is very hands off.

0:23:490:23:52

It's very personal.

0:23:520:23:54

And birth here is obviously

0:23:540:23:56

not personal in any way, shape or form.

0:23:560:23:58

And then, to physically,

0:23:580:24:00

literally put their hands on her stomach

0:24:000:24:03

and physically push the baby out,

0:24:030:24:06

I just find very, very brutal,

0:24:060:24:08

and not a happy experience. And I think, um,

0:24:080:24:11

I really don't want to experience that again, to be honest,

0:24:110:24:14

that was awful.

0:24:140:24:16

Tonight, Suzanne's staying at a local guest house.

0:24:250:24:29

It's an opportunity to reflect on her hopes of seeing

0:24:290:24:32

a natural approach to childbirth here in Africa.

0:24:320:24:35

Quite an intense day, really.

0:24:370:24:40

There is so much that's been thrown at me.

0:24:400:24:42

So much I've had to take on board.

0:24:420:24:44

So much that I've seen.

0:24:440:24:46

I really thought there'd be a lot more tradition, a lot more

0:24:460:24:50

that these midwives could teach me, signs,

0:24:500:24:52

you know, of how a labour advanced,

0:24:520:24:54

not having to intervene.

0:24:540:24:56

And it's none of that.

0:24:560:24:57

It's a big shock, and it's a big disappointment

0:24:570:25:00

that these are the people who really should be

0:25:000:25:02

getting back to nature,

0:25:020:25:04

to improve the care they give, but not dominate it.

0:25:040:25:07

After a restless night, Suzanne's back on shift.

0:25:160:25:19

-Morning. How are you?

-Yeah, good morning.

0:25:190:25:22

Today, she's meeting Lucy Barr,

0:25:220:25:25

Redemption Hospital's most experienced midwife.

0:25:250:25:28

So how long have you worked here?

0:25:280:25:31

14 years.

0:25:340:25:36

So you can teach me loads of stuff.

0:25:410:25:43

Lucy's head of the Liberian Midwifery Association,

0:25:450:25:49

so she's interested to hear how Suzanne's getting on.

0:25:490:25:52

It's not how I imagined at all.

0:25:520:25:56

I imagined it would be very,

0:25:560:25:58

um, very natural,

0:25:580:26:00

but I find it very difficult,

0:26:000:26:02

because all women lie on their back here.

0:26:020:26:05

Yes, it's quite different.

0:26:050:26:07

Very different.

0:26:070:26:08

Yeah. Is there any particular reason

0:26:110:26:13

why everybody does it that way?

0:26:130:26:15

And the other thing I've found quite shocking for me

0:26:220:26:25

was that you do a lot of fundal pressure to deliver.

0:26:250:26:28

Fundal pressure.

0:26:280:26:29

I did see it, and thought, "Oh, that's really something."

0:26:380:26:41

I don't think the midwives here listen to the heartbeat

0:26:410:26:45

as often as they could do at home,

0:26:450:26:47

that's something I've observed.

0:26:470:26:49

And it's very difficult.

0:26:570:26:59

If it's two of you to a full bay,

0:26:590:27:02

you've got to just do what you can, really.

0:27:020:27:04

Yes.

0:27:040:27:06

It's quite interesting to get Lucy's view on things.

0:27:060:27:10

She's obviously a lot more experienced.

0:27:100:27:13

And she seems very much more open

0:27:130:27:15

to new, different ideas, different way of working.

0:27:150:27:18

I really didn't think that birth would be the way it is here.

0:27:180:27:22

I really didn't think it would be

0:27:220:27:24

so medicalised,

0:27:240:27:25

um, to be honest.

0:27:250:27:27

I thought it would be more how we're trying to encourage women to be,

0:27:270:27:30

very much more natural and observational

0:27:300:27:34

and, you know, the kind of,

0:27:340:27:35

don't worry, you know, this is happening,

0:27:350:27:38

we don't have to intervene just yet.

0:27:380:27:40

-So this is where you live?

-Yes.

0:27:510:27:53

Lucy has invited Suzanne to her home in Logantown,

0:27:530:27:56

one of the oldest and poorest communities in Monrovia.

0:27:560:28:00

-This one, the green one? Oh, wow!

-Yes.

0:28:010:28:04

Suzanne, this is my house, this is your home.

0:28:040:28:07

Oh, wow. Fabulous. Oh.

0:28:120:28:16

This is beautiful.

0:28:160:28:17

Ah.

0:28:170:28:20

Oh, wow.

0:28:200:28:22

That's fantastic.

0:28:220:28:23

This is my daughter.

0:28:230:28:26

Hello. Nice to meet you, I'm Suzanne.

0:28:260:28:28

Lucy lives with a large extended family.

0:28:280:28:30

Who's this little one?

0:28:300:28:32

That's his daughter.

0:28:320:28:34

So your, your granddaughter?

0:28:340:28:36

-Yes.

-Aww!

0:28:360:28:37

I can shake you by my elbow,

0:28:370:28:39

I'm peeling the paw paw.

0:28:390:28:41

Lucy's husband Edward is a nurse anaesthetist at Redemption Hospital.

0:28:410:28:47

What are they?

0:28:470:28:48

-This is a dry fish.

-Ooh.

0:28:510:28:53

What, what kind of fish?

0:28:530:28:55

Do you use that a lot in your cooking or do you just kind of eat it?

0:28:570:29:00

Is that the kind of fish I'm eating?

0:29:020:29:03

-Uh-huh. Yes.

-Yeah, the teeth and everything.

0:29:030:29:07

Yeah, everything in there.

0:29:070:29:10

Oh, yeah, and the eyes. Everything.

0:29:100:29:13

Sweet, it's sweet.

0:29:150:29:16

OK. Wow.

0:29:190:29:22

Amen.

0:29:290:29:31

Fufu.

0:29:310:29:34

OK, so, fish.

0:29:370:29:38

It's huge.

0:29:380:29:40

Some juice.

0:29:400:29:43

Or I can chew it. It's quite chewy.

0:29:460:29:50

A bit like, er...

0:29:500:29:51

I have no idea what it's like, I really can't describe it.

0:29:540:29:58

I think I prefer chewing.

0:30:040:30:06

No, we pretty much chew everything.

0:30:100:30:12

Lucy has lived here all her married life. It's a close-knit community

0:30:140:30:17

and everyone's heard about Suzanne's visit.

0:30:170:30:20

I have no idea what is going on.

0:30:220:30:24

Keep going!

0:30:320:30:34

Well, we're playing game of kick ball, which is like, er, baseball, but you kick the ball.

0:30:400:30:46

Er, and it's quite hard work.

0:30:460:30:49

It's interesting, it's all the women playing, not men.

0:30:490:30:53

Thank you too. Welcome.

0:30:530:30:55

I'm beginning to see sort of how, once you get past the initial shock

0:30:550:30:59

of everything, it's every little neighbourhood, every area taking their own bit of character.

0:30:590:31:04

Really nice, it's been a really nice day in terms of learning about

0:31:070:31:11

the importance of community and family, it really, really has.

0:31:110:31:15

The fact that everybody's so welcoming.

0:31:150:31:17

I don't know if everybody would get this kind of reception at home.

0:31:170:31:20

63% of all births in Liberia happen away from hospital.

0:31:270:31:32

Many women live in remote villages where the roads are bad and they have no transport.

0:31:320:31:37

Their babies are often delivered by traditional birth attendants, local women with few medical skills.

0:31:390:31:45

Lucy has invited Suzanne to meet some of them.

0:31:460:31:50

I'm so excited to meet some traditional birth attendants because, really, when I came

0:31:520:31:56

over to this country, that's how I thought birth would be.

0:31:560:32:00

On behalf of the TTM and the TBS, we say you are welcome,

0:32:000:32:04

you are welcome,

0:32:040:32:07

-and this is your home.

-OK, you are more welcome. Yeah.

0:32:070:32:13

THEY SING

0:32:140:32:17

Hello, and thank you for welcoming me so wonderfully.

0:32:250:32:29

Oh, right, OK.

0:32:360:32:38

It's not long before they let Suzanne in on a few of their trade secrets.

0:32:510:32:56

And bite it.

0:33:040:33:06

Just coal?

0:33:060:33:08

Wow! Yeah!

0:33:080:33:11

It will stop.

0:33:110:33:13

Yes.

0:33:310:33:32

Really?

0:33:350:33:36

Do you know, I might have to try these at home?

0:33:360:33:39

Somebody's going to think I'm absolutely bonkers.

0:33:390:33:41

It is a calling that you really want to do, but you dedicate your life to it as much as you can, really.

0:33:450:33:51

But traditional midwives have no way to treat medical emergencies.

0:33:510:33:55

And Lucy teaches them to recognise their limitations.

0:33:550:33:58

I found it really, really touching, very motivating.

0:34:590:35:03

The birth attendants here are all so passionate, really, really passionate about midwifery,

0:35:030:35:08

really passionate about the health and the wellbeing of the mums they care for and the babies.

0:35:080:35:13

'They are spreading the word of the midwives from the hospitals downwards.

0:35:130:35:17

'They are the, the unsung heroes, really, of the midwifery world here.

0:35:170:35:22

So is that clear?

0:35:220:35:23

ALL: Yes.

0:35:230:35:24

Is that clear?

0:35:240:35:25

ALL: Yes!

0:35:250:35:26

Is that clear?

0:35:260:35:27

ALL: YES!

0:35:270:35:28

I'm coming round to this place, you know? You know, it's such a welcoming nation, everybody is so, so nice.

0:35:410:35:49

It really makes you want to be here, to be honest.

0:35:490:35:52

Back in the hospital, there's an emergency which highlights the problems with home births.

0:35:550:35:59

She delivered.

0:36:000:36:02

A woman has been brought in after giving birth to a stillborn baby.

0:36:020:36:06

She's losing a dangerous amount of blood.

0:36:060:36:09

And there's certainly no tear. There's no membrane there.

0:36:120:36:15

She's got a really, really weak pulse.

0:36:150:36:17

No, as you can see, she's had quite a substantial bleed and she's not really very conversant.

0:36:210:36:26

Yeah, I think she's just completely shut down.

0:36:340:36:37

39 year-old Jeanette's stillborn baby was delivered at home by an unqualified neighbour.

0:36:370:36:43

Jeanette's fighting for her life and Suzanne is getting more and more worried.

0:37:010:37:05

Do you need to get a doctor?

0:37:050:37:07

He needs to see she's still bleeding.

0:37:070:37:09

The doctor thinks he's stemmed the bleeding, but he's furious

0:37:330:37:36

with Jeanette's friend who delivered the baby at home.

0:37:360:37:39

-A bit like...

-Like this.

0:38:010:38:03

But it's...

0:38:030:38:04

Do you find that really frustrating?

0:38:040:38:06

Suzanne is starting to see the realities of being a midwife in Liberia.

0:38:270:38:31

The country has one of the highest maternal mortality rates in the world.

0:38:320:38:37

Here, one in 12 women will die in childbirth.

0:38:370:38:40

Jeanette has survived, but she's had to have a major blood transfusion.

0:38:450:38:50

Now she's recovering in the postnatal ward.

0:38:500:38:53

Hiya! How are you doing, Jeanette?

0:38:530:38:56

You look a lot better.

0:38:560:38:58

You had two more pints of blood?

0:38:580:39:00

Wow, that's so expensive.

0:39:030:39:05

Not everything at Redemption Hospital is free.

0:39:050:39:09

Jeanette's blood transfusion has cost more than most Liberians earn in a month.

0:39:090:39:14

With a large family to support, it's money she can't afford to pay.

0:39:150:39:19

One thing I've learned coming here, everybody works very, very hard for small, small money.

0:39:300:39:37

Out of the blue, Jeanette makes a desperate plea for her children's future.

0:39:370:39:42

She gave me her phone number and actually what she wanted

0:39:510:39:54

was for me to go to her home and take one of her children off her.

0:39:540:39:58

It's heart-breaking to see and, if that's just one person,

0:39:590:40:03

you know, just one woman on the ward, and I'm sure everybody is like it.

0:40:030:40:08

I just can't imagine the life that these people are living to be that desperate.

0:40:080:40:14

And she at one point was then saying that she wished she'd die

0:40:140:40:17

because then she wouldn't have a, have to find a way out of the situation she was in then.

0:40:170:40:22

As soon as Jeanette's released from hospital, Suzanne heads to her home with some supplies.

0:40:250:40:30

-Hello, Jeanette.

-Hello.

0:40:300:40:33

How are you? I've brought you some rice. Cassava.

0:40:330:40:38

-Yeah.

-OK? It's quite heavy, you all right to carry it?

0:40:380:40:40

Jeanette lives in New Georgia on the southern edge of Monrovia.

0:40:400:40:45

Her family of seven live in a small tin shack.

0:40:450:40:49

-We live here, yeah.

-All of you, in this space?

0:40:490:40:52

-Yes.

-That must be, that's quite, quite cramped.

0:40:520:40:55

There's a lot of you to fit in into a small space, and look at all these toys!

0:40:550:41:00

-Gosh, and is that you, Jeanette?

-Yeah, that is.

-Ah!

0:41:000:41:04

That's lovely.

0:41:040:41:06

You've got such lovely children, you know, and I know once you're feeling

0:41:250:41:29

better, you know, and things won't be such a struggle, and feel as bad.

0:41:290:41:34

I know it's difficult, I can see it's very, very difficult for you.

0:41:440:41:48

A gift of money will help Jeanette's immediate problems, but it doesn't feel enough.

0:41:480:41:53

Bye-bye.

0:41:530:41:56

You feel like you want to do more, but you don't quite know how to do more and it's quite awkward, really.

0:41:560:42:03

And then you just feel like you've not done enough.

0:42:030:42:05

And I don't know how she's feeling now.

0:42:050:42:08

I don't know if she's disappointed or angry with me, cos I haven't taken one of her children away or, or what,

0:42:080:42:13

really, but I suppose they've gone through what probably is the worst,

0:42:130:42:17

and it's just keep on going and hopefully things will get better.

0:42:170:42:21

It's the first time Suzanne's seen close-up the hardship of daily life for most Liberians.

0:42:270:42:34

The people here, they literally live hand to mouth, just to eat.

0:42:370:42:41

You want to help everybody because everybody's deserving of something.

0:42:410:42:45

Everybody deserves to have their lives made a bit better,

0:42:450:42:50

but you can't. It's so very difficult.

0:42:500:42:54

It's becoming clear how badly everyone's life has been affected by the long years of civil war.

0:42:560:43:03

It's really sad to see that they've got all the pipes,

0:43:030:43:06

they've got all the taps and everything in the shower,

0:43:060:43:09

for the running water, there just isn't any running water because of the war.

0:43:090:43:13

-Ta-da!

-Hey, how are you?

0:43:140:43:17

-All right, what do you think?

-Oh, it's beautiful.

0:43:170:43:21

Just really curious cos I don't really know much about Liberia and the civil war,

0:43:210:43:26

because obviously you moved here over 20 years ago and have lived through it.

0:43:260:43:31

I suppose that must have been even more scary for you

0:44:280:44:31

because of being pregnant and it...

0:44:310:44:33

What brought about the end of the war?

0:44:380:44:41

I've observed a lot about women in this country

0:45:030:45:06

and you seem to have a very predominant role.

0:45:060:45:09

I really can't imagine being in that kind of situation

0:45:190:45:22

and where you draw your strength from.

0:45:220:45:25

She's a very amazing woman, she has got such strength

0:45:250:45:28

and such faith. And courage, just to get through it.

0:45:280:45:31

It makes you want to aspire to her, she's truly a fantastic woman.

0:45:310:45:35

I think when I go home it's going to be quite difficult

0:46:020:46:04

to readjust to what I've seen here.

0:46:040:46:07

It makes me feel woefully inadequate

0:46:100:46:12

and it makes me really feel

0:46:120:46:14

that I've really not achieved that much, really

0:46:140:46:17

and I've certainly not achieved my full potential as a midwife

0:46:170:46:21

or a woman yet, to be perfectly honest.

0:46:210:46:23

And then you see the midwives in hospital,

0:46:320:46:36

there are a lot of them that you meet have got two or three jobs,

0:46:360:46:39

they're still the major breadwinners, they're all absolutely amazing women

0:46:390:46:43

and it certainly makes you look at it from a completely different angle.

0:46:430:46:47

Thank you. Thank you very much.

0:46:490:46:51

Back on the ward, a 21-year-old woman who's four months pregnant

0:46:540:46:58

has been brought in with stomach pains.

0:46:580:47:00

Hannah has been in the labour ward for three days,

0:47:000:47:03

but is reluctant to be examined.

0:47:030:47:06

She's frightened and confused.

0:47:060:47:08

Dr Cooper has seen cases like this before.

0:47:140:47:18

She thinks she knows what may have happened.

0:47:180:47:21

The reason for Hannah's reluctance is becoming clear.

0:47:580:48:02

Most abortions in Liberia are illegal

0:48:020:48:04

and she has taken desperate measures to end her pregnancy.

0:48:040:48:08

You don't have to be scared.

0:48:080:48:11

The examination shows that Hannah's baby has died

0:48:130:48:16

and is now infecting her body.

0:48:160:48:18

She's not had any pain relief.

0:48:220:48:25

They don't even have the antibiotics they need to treat her.

0:48:250:48:29

Try and help you now. Yeah, we'll help you now.

0:48:400:48:44

Without antibiotics, all the doctor can do

0:48:440:48:46

is try to clean out the infection caused by the traditional treatment.

0:48:460:48:50

I find that quite difficult.

0:48:520:48:53

If we had somebody who was that poorly,

0:48:530:48:55

they'd be in a high-dependency room.

0:48:550:48:57

We'd be aim to give them one to one midwifery care.

0:48:570:49:01

She'd have all sorts of monitoring

0:49:010:49:04

so we could see if she's deteriorating or not.

0:49:040:49:06

But the cost of life here, oh, it just seems worthless in some cases.

0:49:060:49:11

In the next three days, Hannah's condition steadily deteriorates.

0:49:180:49:23

I just keep trying to find out what's happening but I don't really know at the moment.

0:49:270:49:31

I've just been given some gloves. She's so hot.

0:49:310:49:33

Have we got another cloth and I'll sponge her as well?

0:49:330:49:36

She's developed a high fever.

0:49:360:49:38

She still has the dead foetus inside her.

0:49:470:49:50

Two attempts at inducing it have failed.

0:49:500:49:52

But now, at least, they've finally got hold of some antibiotics.

0:49:540:49:57

Can we have some fresh water so we can keep sponging her? She's so hot.

0:50:050:50:09

No more can be done now except pray for Hannah to live long enough

0:50:220:50:26

for the antibiotics to take effect.

0:50:260:50:28

I can't quite put into words how I feel.

0:50:290:50:31

I know I felt like crying at one point.

0:50:310:50:33

I don't know if I come in tomorrow,

0:50:330:50:35

I don't know if Hannah's going to be alive or not.

0:50:350:50:37

I hope she is, but I don't know what they're going to do to make her

0:50:370:50:40

better cos they're giving her pretty much every single antibiotic

0:50:400:50:43

that they've got and every other treatment they've got going.

0:50:430:50:46

But I also have to say,

0:50:460:50:47

if she dies at least she's not suffering any more.

0:50:470:50:51

Not long after, Hannah loses her fight for life.

0:50:560:51:00

The tragedy has brought home

0:51:090:51:11

what a harsh world Lucy and the other midwives work in.

0:51:110:51:15

Where the medicines they need to save lives are hard to come by

0:51:150:51:19

and the traditional remedies people turn to can do more harm than good.

0:51:190:51:24

We don't have all the struggles that you have,

0:51:450:51:47

and it's very hard to see...

0:51:470:51:50

I've never watched anybody die.

0:52:050:52:07

It was like she was almost dying in front of my eyes,

0:52:070:52:10

is the best way I can describe it. You just feel so helpless,

0:52:100:52:13

don't know what to do, don't know what to say,

0:52:130:52:16

but she must have been in an awful lot of pain.

0:52:160:52:19

THUNDER RUMBLES

0:52:190:52:21

It's Suzanne's final day,

0:52:260:52:28

so she's cooking Lucy an English breakfast of scrambled eggs

0:52:280:52:31

as a thank you for her stay.

0:52:310:52:33

They normally fry them, if they're going to do eggs,

0:52:330:52:37

but I did suggest that we do some scrambled egg

0:52:370:52:40

because of the amount of oil that I seem to be consuming.

0:52:400:52:44

You can be honest, you tell me what you think.

0:52:490:52:52

Wonderful. It's wonderful.

0:52:520:52:55

-Hello, good morning.

-Good morning.

0:53:050:53:08

On her final shift in the maternity unit,

0:53:080:53:10

Suzanne's decided to show the other midwives

0:53:100:53:13

how she conducts a birth at home.

0:53:130:53:16

Slow...

0:53:160:53:20

She wants to demonstrate how labour doesn't need to be rushed

0:53:200:53:23

to deliver the baby safely.

0:53:230:53:25

Her name's Corpo, she's 18, it's her first pregnancy,

0:53:250:53:30

she came in in labour overnight.

0:53:300:53:32

I know, I know.

0:53:340:53:35

At this stage, the midwife would normally take Corpo

0:53:350:53:38

into the delivery room to encourage a quick birth.

0:53:380:53:41

OK. So you, OK.

0:53:430:53:45

OK, all right then, well, I would wait and see.

0:53:460:53:50

Things are progressing. And I'd leave her alone for now.

0:53:500:53:54

And that's my way of doing things.

0:53:540:53:56

Yeah, well we would just watch and wait, OK.

0:54:000:54:03

It's all right, it's all right. Slow, Corpo, Corpo.

0:54:030:54:06

All right, all right.

0:54:110:54:13

That's it, it's OK, it's OK...

0:54:140:54:16

All right, darling.

0:54:180:54:19

CORPO MOANS

0:54:290:54:31

It's all right.

0:54:340:54:35

She's going slowly, OK.

0:54:420:54:44

And it's OK of the leave it a couple of minutes,

0:54:450:54:47

she'll feel movement, then she'll get a contraction

0:54:470:54:50

and then we deliver the baby.

0:54:500:54:52

Oh, happy birthday! Hello, baby! Well done.

0:54:530:54:56

And we put our babies next to mums, OK, like that.

0:55:010:55:05

So they get to stay nice and warm.

0:55:060:55:08

Thank you.

0:55:100:55:12

That was nice, nice they actually stood back and let me do,

0:55:180:55:21

conduct a delivery how I wanted,

0:55:210:55:23

so all's good, really.

0:55:230:55:24

Got a nice happy mum and nice safe baby, nice well baby.

0:55:240:55:29

Well, I think if you wanted to change the way of working here

0:55:290:55:32

to something different, you have to compromise,

0:55:320:55:34

that's the only way to do it here, I think,

0:55:340:55:36

is just to do little things and explain why you do little things.

0:55:360:55:40

You can't just go all guns blazing and do a great big change,

0:55:400:55:43

it doesn't work that way because people won't be accepting of it.

0:55:430:55:47

In her two week stay at Redemption Hospital,

0:55:500:55:52

Suzanne's come to realise how much dedication is needed

0:55:520:55:56

just to get through each day.

0:55:560:55:58

Every midwife is passionate about what she does.

0:55:580:56:01

These midwives here, who have nothing, get paid a pittance

0:56:010:56:04

and just do it for the absolute love and the passion of the job.

0:56:040:56:10

And it really restores your faith.

0:56:100:56:12

I'm never going to forget this experience.

0:56:120:56:14

Ta-da!

0:56:170:56:18

Oh, thank you for having me in the hospital,

0:56:410:56:45

and also thank you for having me in your home, it's been lovely.

0:56:450:56:48

-I won't forget you.

-Wish you happy back.

-Yes.

0:56:480:56:51

I've encountered so much and I've seen so much

0:56:520:56:54

and taken on board so much of this country

0:56:540:56:56

and I hope that the reason for me coming here

0:56:560:57:00

is to make me a better person

0:57:000:57:02

and to make me fulfil some sort of potential that I've got

0:57:020:57:04

in every aspect of my life.

0:57:040:57:06

Six weeks later, Suzanne's back at work in Sutton Coldfield.

0:57:150:57:19

But her experience in Liberia is still raw.

0:57:190:57:22

Real mixed feelings when I got back, real mixed feelings.

0:57:240:57:27

All the time you're thinking we're very privileged,

0:57:270:57:29

and then on the other hand you're thinking

0:57:290:57:32

and there's people that don't have access to this.

0:57:320:57:35

So there's a tinge of resentment, you know,

0:57:350:57:38

when you've got a woman who is demanding an epidural, say,

0:57:380:57:42

there's some women that don't even have access to paracetamol, really.

0:57:420:57:46

It made me look, then, at birth in a different light

0:57:460:57:48

and think that we're very incredibly privileged in this country.

0:57:480:57:52

Looking at birth in Liberia,

0:57:520:57:55

it's natural birth in a completely different way.

0:57:550:57:57

It's because there is nothing else, there is no technology.

0:57:570:58:00

I think it's given me a lot more passion for midwifery again

0:58:000:58:04

and to really give women the best experience that they can do,

0:58:040:58:10

knowing that it does make such a difference.

0:58:100:58:13

Women in Liberia are very strong.

0:58:180:58:20

All wanted to achieve,

0:58:210:58:23

all wanted to do the best they could do

0:58:230:58:25

for themselves and for their families.

0:58:250:58:27

They are the backbone, really, to everything, from the President down.

0:58:270:58:32

So it's nice, nice in terms of being a woman that, you know,

0:58:320:58:35

there is a little country somewhere that hasn't got a lot,

0:58:350:58:38

but there's certainly women fighting to get things better.

0:58:380:58:42

Subtitles by Red Bee Media Ltd

0:59:120:59:15

E-mail [email protected]

0:59:150:59:18

In the third programme in the series where British workers accept the challenge to do their jobs in some of the toughest conditions in the world, midwife Suzanne Saunders-Blundell abandons the high tech maternity unit at Good Hope Hospital in Sutton Coldfield to work in Monrovia, the capital of Liberia in West Africa.

This is the third poorest country on earth, where one in twelve women dies in childbirth. Suzanne, a fan of natural child birth back in Britain, soon learns that there is little time for such luxuries at the Redemption Hospital. On her first day she has to deal with a traumatic still birth and during her stay a young woman she has helped to care for dies in front of her. Yet by the end of her stay Suzanne is amazed and inspired by the strength of the Liberian midwives she lives and works with, who in turn are keen to learn from her.


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