Champion of Choice

Midwives on Motorbikes

midwife Ofelia Soares MadeiraTibar, East Timor

On a July evening Ofelia was awakened by a strange man knocking at her door. She threw on some clothes, grabbed her bag, pulled on her white helmet, then hopped on a motorbike to shoot off into the night. She was headed to his house, although the stranger did not go with her. The woman wound up the treacherous hairpin turns of Fahi-Ten Mountain, avoiding the hazards she knew were waiting for her in the dark: the free-roaming goats, dogs and cattle, and of course the other drivers who would hurdle around a blind curve dead in the center of the narrow thoroughfare. On top of this, Mother Nature had voided the plan to introduce civilization here in the wilderness, creating an obstacle course by washing boulders and uprooted trees down the slope. The resulting condition of the roadway proved to be more rutted earthen track than smooth concrete, and in spots the surface suddenly dropped several feet in jagged tiers; in other places the pavement had washed away altogether, leaving potholes several yards wide, yawning like jaws as they waited silently to swallow the unsuspecting rider. And the rainy season had not yet begun.

As I retrace Ofelia’s route in daytime, in an off-road vehicle, I cannot imagine navigating this course in the black of night. On a dirt bike. My driver Carlos sits stoically behind aviator sunglasses as he steers along the edge of a cliff. The valley lies hundreds of feet below, the view slightly hazy as the fresh morning air suspends dust particles from the arid hillside, and the scent of dried grass and minty eucalyptus rushes in the open window. We round the bend and come upon what I initially take to be a pond covering the road, reflecting blue sky. Carlos cuts the wheels sharply, and as we careen around the edge, to my horror I realize that it’s not water we’re avoiding; rather the cliff has eroded and I am staring through a gaping hole larger than our truck, into the void. He has just saved us from dropping through nature’s manhole to freefall through the heavens and flatten one of the unsuspecting thatched huts dotting the basin below.

It’s not an unusual occurrence for Ofelia to have men awaken her in the middle of the night. She’s a midwife in this remote district in East Timor, the world’s newest nation, and she delivers twenty to thirty babies a month. Everyone in the district knows where she lives, and so when this gentleman’s wife went into labor he rushed straight to the midwife’s home to summon her. The dutiful husband had waited hours for a bus to pass by the winding, isolated route down Fahi-Ten Mountain, and there is no phone service in this region where even the health professionals communicate by shortwave radio. When he finally reached Ofelia she dressed quickly and leapt aboard her Honda Supra X Astrea, a bike built for rough terrain, and headed up the treacherous road in the dark to deliver Ermelinda’s baby. Unfortunately, she did not succeed.

Ofelia Soares Madeira is part of a program called Midwives on Motorbikes, an operation begun by UNFPA in 2003, where the maternity professionals of Timor use motorcycles to traverse the mountain passes of this country bordering Indonesia. The agency ordered sixty-five cycles from Honda, and the manufacturer threw in another fifteen for free. Local healthcare workers also ride the dirt bikes to reach their remote clientele for other projects, particularly to deliver immunizations.

Ofelia herself coordinates the midwife program, having practiced since 1989. She’s lost track of the number of babies she’s delivered after sixteen years. Her professional training was thorough—attending nursing school for three years followed by a year of midwifery courses. Her husband taught her how to ride the Honda and he sometimes accompanies her on missions. She thinks the motorbikes are a great asset to healthcare workers’ ability to reach patients, but laments the poor communication options in the district. If she runs into problems with a delivery, she must ride back to the clinic to radio for an ambulance, wasting valuable time that has cost lives.

Today I am traveling to visit the home of the man who summoned the midwife in the middle of the night. As we climb, I take in the breathtaking tropical scenery of mountain vistas, the leafy green of banana and coconut trees , the brilliant magenta bougainvillea, the delicate feathery limbs of acacia trees sheltering the coffee plantations, the gatherings of thatched huts built of bamboo and palm fronds, the baby goats and full grown cows meandering aimlessly, the vans barreling around blind curves as Catholic schoolchildren amble across this same road in their spotless white shirts and dark trousers, heading to morning mass.

On this sunny September morning, we find the new mother, Ermelinda, sitting on a bench outside her hut, a one-room box built of twigs topped by a corrugated tin roof. She is a petite woman, with mahogany-colored skin and large eyes luminous with worry; her ebony hair sweeps back from her face into a bun. She is dressed in a simple black cotton skirt and blouse with tailored lines and fitted, puffed sleeves, an outfit that looks oddly formal for life in the wilderness. Ermelinda holds two-month old Maia, whose face is contorted beneath a shock of wild hair. The infant howls until mama removes one breast to nurse and it’s clear this newest member of the family has a healthy appetite.

As mother and child stare transfixed into one another’s eyes, they form the hub for the melee of life swirling around them: the newborn’s six siblings—some teenagers dressed in t-shirts and baseball caps, some naked toddlers wearing nothing but dust. Other villagers in this outcropping called Aldeia, a name which means “small community,” come out to meet the visitors.   A neighbor walks up balancing a plastic jug of water on her head, while roosters crow, baby chicks peep and peck around our feet, goats endlessly search for something to eat, and puppies look for playmates. A grey monkey studies us solemnly with his tail curved around his feet, and the morning calls of songbirds float down from the palms.

I am accompanied by Cecilia da Silva from UNFPA and the midwife, who tells me the story of what happened on the night Maia was born. While Ermelinda’s husband made his way into the village, his wife lay at home alone in labor. Before Ofelia arrived the mother had pushed her tiny daughter out on her own, but she was frightened because even though at thirty-two she had already given birth to eight babies, only six had survived. Of additional concern was the fact that on this night the mother’s placenta had not come out, a situation that could cause hemorrhaging because the uterus won’t contract, and she could bleed to death.

When Ofelia arrived at the hut on that dark night, she set to work cutting the umbilical cord, then massaging the top of Ermelinda’s uterus while pulling steadily on the cord to deliver the placenta. This procedure allowed the patient’s womb to begin contracting, thus returning to its normal size—a necessary step that ceases the flow of blood.

With her patient stabilized, the midwife packed up her equipment and boarded her Honda Supra X for home. Now the sun was rising, casting a golden light over the coffee plantations as she rode slowly back down the mountain, dodging the obstacle course. Ofelia yawned, hoping she could get some sleep before another baby decided to enter this world.

 

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