Midway across the river the outboard motor on our pirogue, as the dugout canoes in this part of Democratic Republic Congo are called, falters and dies.

These simple craft, each hewn from a single forest tree, have been paddled backwards and forwards on the Congo from time immemorial. But our motorised version, I now notice, doesn't seem to have a paddle.

Returning to Ubundu after visiting a medical centre in the outlying village of Ndjale, we paused before climbing back into our boat to watch four young men paddling swiftly downstream to rescue a solitary boatman who had got too close to the rapids.

Now, as the gathering wind whips up little waves on the murky brown water, the already distant bank seems to be receding fast.

Our boatman tries again and again to bring the engine back to life. We drift steadily downstream.

I am sitting behind Espere Lukosa, a Congolese Ministry of Health doctor responsible for the primary healthcare of some 75,000 people - over 14,000 of them under five - in Ubundu, an area half encircled by the Congo River in Congo's northeastern Orientale province.

Crouched in the bow in front of him is a young mother who's begged a lift with her 10-month-old daughter, whom we gather has malarial convulsions.

While I try not to panic about the rapids, the doctor's concern is clearly elsewhere.

He leans forward and as he lifts the baby from her mother's arms, the blanket drops away revealing a very sick little girl. A quick look and he hands her back, but something in the way he does so makes the mother's face crumple.

The boatman gives yet another pull on the starter, the motor splutters, and this time does not fade.

Safely back on dry land, Dr. Espere disappears up the bank with the mother and baby.

Almost before we have had time to load ourselves into the 4x4 for the journey to town, we see him returning on his motor bike.

His expression tells it all. The baby has already died - bacterial meningitis which, he had realised the moment he had picked her up, was far too advanced to be successfully treated in the best hospital in the world, never mind the one at Ubundu.

TWO

Sobered, we arrive at what must once have been a fine hospital when the Belgians built it in 1954.

Now pigs and goats forage between the crumbling buildings, devoid not only of running water and electricity, but of everything but the most basic supplies, antiquated equipment and a small, dedicated staff who simply refuse to acknowledge the odds against them.

As we begin our tour of the "facilities" the dreadful keening of the bereaved mother echoes round the near empty hallways. "How did it happen?" I ask. "She was so close to help. Why didn't she come earlier?"

Dr. Espere simply shrugs and makes the universal sign for money.

Someone spells it out for me. It costs 50 cents for a course of treatment at the clinic. The mother wasn't an indigent eligible for free care and she had probably taken the chance that the fever would break.

By the time she sought help, it was already too late.

Flying low on the approach to the town of Kisangani the previous day, the thick green carpet of the rainforest had stretched to the horizon, broken only by lone fromager trees, their bleached branches stark against the canopy, and by thin brown ribbons of water feeding the massive Congo River.

The words I had read many times in grant proposals were suddenly a reality - "tropical rain forest, difficult access: bad road and river".

The International Rescue Committee (IRC) is working here with the Congolese Ministry of Health, implementing a Primary Healthcare Programme funded by the British Department for International Development.

Through this and similar programmes the Ministry is trying to roll out basic health provision across the whole of the country. The standard is that no one should have to walk more than 5 km ( 3 miles) to seek medical help but Congo's enormous size is not the only obstacle to this becoming a reality any time soon.

The people of Ubundu, just like so many other remote communities across the country, suffered horrendously during the years of war.

In Orientale province, control of the local gold mines was a particularly tempting prize for the Ugandan, Rwandan and Congolese factions who fought their vicious campaigns backwards and forwards through the long-suffering villages.

Many local people had spent literally years living in the forest, unable to return home for fear of whichever group was in temporary control of their area.

After peace returned, nationwide surveys carried out by the IRC shocked the world, revealing excess mortality rates, particularly among children under five. And these were deaths from what should have been totally preventable causes, if any serious primary healthcare infrastructure had survived the war.

We spend the night in Ubundu before tackling the road back through the jungle to Kisangani.

When we get up, Dr. Espere is already standing in the road, ready to accompany us back to town.

A conference is giving him an excuse to pay a rare visit to his wife and two young children who live in the city.

He looks fresh and alert, no hint at all that, as I discover, he has performed an emergency caesarean section during the night.

The mother has survived but not the baby.

I imagine him in the grim operating theatre we had glimpsed yesterday, dusty 50 year-old lights, bulbless for decades, hanging above the scene, his assistant holding a generator-powered lamp as he works at the antiquated operating table.

THREE

Halfway down the road, a woman comes into view, walking by herself and very distressed.

We slow down but then realise she is not alone. Following is a little group surrounding a young man who is carrying a tiny, tightly wrapped bundle.

Dr. Espere looks at me and wearily raises three fingers.

We are witnessing the aftermath of the third death of a baby in less than 24 hours in one small part of his area.

We travel in silence for what seems an age until the next village appears and I realise just how far that mother must have walked seeking help for her baby now only to be trudging back home to bury it.

The pictures I have taken during my visit show happy smiling faces full of hope, mothers with babies born and later vaccinated at the new health centres gradually being rebuilt and restocked.

They don't, however, show just how much still remains to be done. Dr. Espere's three raised fingers do.

Read more from IRC's Lydia Gomersall in Congo:

How does a Congolese village decide what to do with $30,000?

What do Congo's women really want?

Congo's road to health care is full of potholes

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