In July of 2007, Medair began a reproductive health programme in remote Badakhshan province in order to reduce high rates of maternal and neonatal mortality and to make lasting improvements to the health system. Gul Bibi is a pregnant 31-year-old woman who has been in labour for two days in the small, isolated village of Ghojan. This is her sixth pregnancy. Of her previous pregnancies, three children survived, one was stillborn, and the other succumbed to neonatal death.

This time, she has what is called a malpresentation of the fetus, so her baby is not in the correct position to be delivered normally. Without intervention, her labour will continue for a few more days until her uterus ruptures. When that occurs, the baby will die and she will most likely bleed to death.

Gul Bibi's only chance for survival is an emergency caesarean section, something not readily available in this region of the world.

Medair Battles Maternal Mortality Gul Bibi's situation is an all-too-common reality in Badakhshan. Its remote and difficult-to-access location, along with political unrest and extreme poverty, all contribute to its highest ever recorded maternal mortality rate in the world.

Medair initiated the Comprehensive Reproductive Health Programme (CHRP) to help change this reality. The two-year programme began with numerous goals including the strengthening of emergency obstetric care services, ambulance services for transportation of complicated pregnancy cases, improved communication and referral systems, and increased community awareness about reproductive health and family planning.

By July of 2008, the facility for reproductive health at the health centre in Yawan District was constructed and operational. It included an operating theatre, recovery room, and washing/changing station.

At the same time, specialist health staff were hired-including a much-needed female obstetrician-and 41 staff received refresher training. Most importantly, 9,230 beneficiaries accessed life-saving or life-sustaining reproductive health services in first six months.

Gul Bibi's Story In the early morning of 21 October 2008, Gul Bibi was in the second day of her labour. One of Medair's CHRP initiatives was to improve the communication and emergency referral system between distant villages, an initiative that may have saved Gul Bibi's life. She was examined in her village of Ghojan and the Community Health Worker (CHW) there knew that she needed to be seen at the health centre in Zeriaki, an hour's walk away.

In Zeriaki, the community midwife diagnosed the problem, but they were unable to perform the c-section that Gul Bibi needed. The head of the clinic urgently referred Gul Bibi once again, this time to the new reproductive health facility in Yawan. The doctor called for the Medair ambulance. It was 09:00.

By 12:30, the ambulance had made the round trip from Yawan to Zeriaki and back, arriving with Gul Bibi, her husband, mother-in-law, and a nurse. Upon arrival, Dr. Gulsara determined that the baby was alive, but its condition had worsened. An immediate c-section was the only measure that could save Gul Bibi and her child.

Dr. Gulsara performed the procedure, attended by an anesthetist, an assistant doctor, and two nurses. As none of the relatives had the same blood group as the patient, all available Medair clinic staff and Medair Yawan base staff were asked to volunteer in case they had the same blood group. Ten candidates were tested and two were asked to stay in the clinic in case a blood transfusion was needed.

At 15:20, a healthy boy was delivered by c-section. Gil Bibi's family and all the clinic staff at the health centres in Yawan and Zeriaki were exuberant. Gul Bibi was smiling all day long and so happy. "I know that you saved my life and the life of my little boy," she said. "I feel very well and very happy. Thank you!"

Gul Bibi's mother-in-law kissed Medair's Gabriele Faender every time she entered the recovery room. "We are so thankful for all you've done for us," said the mother-in-law. "We will daily pray to God to bless you and to bless Medair."

All of the staff in Zeriaki who had referred Gul Bibi to Yawan were equally happy. They beamed at photos of the health baby, and were very proud to have been involved in such a successful event.

"I'm very thankful that Medair is working in our areas," said Gul Bibi's husband. "In all health facilities, from the health post to the extended health care centre in Yawan, Medair staff cared for my wife."

Gul Bibi's story is just one of many moving examples of the profound impact that Medair's health programmes are having in this isolated province. With a comprehensive system of clinics, health professionals, and beneficiaries all working together, we will continue to save lives and rejuvenate communities. After far too many desolate years, hope is on the rise for families in Badakhshan. ------------------------------------------------------------------------ Medair brings life-saving relief and rehabilitation in disasters, conflict areas, and other crises by working alongside the most vulnerable. Its internationally recruited staff are motivated by their Christian faith to care for people in need, providing practical and compassionate support, regardless of race, religion, or politics. Founded in 1989, Medair has an unwavering commitment to bring hope to the world's most vulnerable.

Medair's Food Aid and Food Security activities in Afghanistan are supported with the assistance of DG-ECHO ( European Community Humanitarian Aid Department ) and MCC/CFGB. Other activities in Health and construction are supported by USAID/WHO/MOPH, UNFPA, MCC/CFGB , Hirzel Foundation and EO-Metterdaad. However, Medair's life-saving activities are also dependent upon private financial donation. To contribute to this work, please visit www.medair.org

Medair also provides essential health care (four permanent clinics and over 40 health posts) and water & sanitation to the people of Ragh, Yawan, and Kohistan districts in Badakhshan province, and to the people of Wardak province as well.