On the bright morning of November 3, 2014, a 29-year-old mother of three named Adem arrived at the Yambio State Hospital’s maternity ward with advanced labor pains. While taking her medical and obstetric history, the medical team discovered that she had undergone a Caesarean section exactly one year earlier.
Unfortunately, due to her late arrival and delivery complications, she had lost the baby then. This means that she had gotten pregnant again barely three months after the operation. This is not uncommon among women in Yambio. When a mother loses her baby during delivery, or through a miscarriage, she will often try to conceive again immediately. They believe that having another child will replace the sad experience with a happy one. However, this can sometimes be risky.
Making a Hard Choice
Due to her last experience, Adem was reluctant to come to the hospital. She wanted to deliver at home, so she stayed there too long and was once again brought to the hospital late—when her labor pains were very advanced.
Home delivery is common in Yambio; it is the custom, and most women are unfamiliar with the advantages of hospital delivery, or they can't afford the transport needed to reach a medical facility.
Because Adem’s scar from her previous surgery was barely a year old—putting her at imminent risk of a potentially deadly uterine rupture—the doctors at the maternity ward decided to perform another Caesarean section. However, Adem wanted to deliver normally, and it took a long time, and lots of counseling for her and her family, to finally persuade her into the operating room.
During surgery, the doctors’ worst fears were confirmed: Adem’s uterus had ruptured. Despite the dire situation, the doctors performed the surgery successfully, delivering a baby boy weighing 3.01 kilograms [about 6.5 pounds]. They managed to save both the baby and the mother.
Alive and Happy
When Adem regained consciousness, the doctors and the counselor explained to her what had happened during the operation. “I risked losing my baby again!” she exclaimed. “This would have finished me. I was lucky that it wasn’t too late.”
Adem was happy with the counseling she’d received from the team. Any other decision, she now knows, could have led to a tragic end. Four days after the surgery, Adem and her baby were discharged in good health.
Where Outreach Meets Medicine
Adem’s situation is not an unusual one in Yambio. It is one of the reasons why MSF’s information, education, and communication (IEC) teams go out every morning to educate the community and answer questions from the populace regarding maternal and child health.
IEC forms an integral part of MSF’s work at both community and hospital levels. The teams use different types of communication to deliver their messages. Broadcast media is one means of communication with a wide reach and large listenership in Yambio. MSF uses radio to disseminate health information and create awareness around certain problematic issues like delivering in a health facility and the importance of antenatal and postnatal clinics.
It’s also an important opportunity to get feedback from the community. In fact, in the 10 years that MSF has been working in Yambio, IEC has significantly contributed to a notable behavioral change in the way women in general, and expectant mothers in particular, access medical care.
IEC is also used to inform and improve the referral system: people are informed of the services that MSF offers, and where and how to find them, so when they come across a complicated case, the local community organizes to transport the sick to the nearest health center or hospital, or from primary communal health centers to larger hospitals and vice versa.
Yambio is the capital of Western Equatoria State. The state has the highest maternal mortality rate  in South Sudan, which itself has one of the highest rates of maternal deaths in the world. Cultural practices, traditional beliefs, and social and economic constraints continue to hamper access to health care. Like Adem, many women suffer or die simply because they do not have sufficient information on maternal and child health issues.
“It is such a traumatic event to lose a mother when you know that most maternal deaths can be prevented," remarks Lisa Errol, an MSF midwife who just finished a mission in Yambio. "Most of them come in late, in very dire condition, and we do our best to save them. In the end, even though you know you have done your best with the resources you have at hand, it is still painful to lose a life."
By working with—and within—communities, MSF and its IEC teams are striving to provide more women like Adem with the information and health care they need to give birth safely in South Sudan.
 2,327 deaths per 100,000 live births. Ref: South Sudan 2010 household survey and Statistical Year book for RoSS of 2010; Southern Sudan Centre for the MMR for Census, Statistics and Evaluation Report, pg 82.
 2,054 deaths/ 100,000 live births. Ref: South Sudan 2010 household survey and Statistical Year book for RoSS of 2010; Southern Sudan Centre for the MMR for Census, Statistics and Evaluation Report.