Published: September 29, 2010
Midwife Farangis Sultani tells the story of a woman who was in a great deal of pain last winter. The woman was in labor -- and her family had brought her to the Shatak village clinic after a three-hour walk on the back of a donkey.
Farangis delivered the woman's baby, but quickly determined there was a twin baby still inside the womb. "It was horizontal," she says. "If she delivered a baby that was horizontal, she was going to die."
The young midwife did what she could -- and "with God's hand" -- the second baby was born successfully. Mother and twin children were healthy -- defying the statistics in Afghanistan's Badakhshan Province, where pregnant mothers and newborns die too often because villagers live too far from health care.
"These women are like guardian angels for infants and mothers," says Zafaran Natiqi, head of women's affairs in Badakhshan.
It's a career path that has the backing of elders in the province, even though Afghanistan's culture doesn't normally allow young and married women to work outside the home. Village councils actually vote to select the midwife candidates from their own community.
"I come from a very religious family," says Mawlawi Zabihulla Atiq, the leader of the provincial council. "I realize this is a necessity. It's how we can protect our pregnant women and daughters."
Farangis Sultani has recorded each delivery she's performed in a giant log book. She points an entry that describes what happened last winter:
When I helped that woman, I felt proud. It's an honor for me, for the people who trained me, and for my family.
Jim Wildman is a senior producer of Morning Edition, traveling with NPR's Renee Montagne on her reporting trip to Afghanistan. [Copyright 2013 NPR]
ARI SHAPIRO, host:
This is MORNING EDITION from NPR News. Im Ari Shapiro.
STEVE INSKEEP, host:
And Im Steve Inskeep. Our own Renee Montagne is in Afghanistan.
And where exactly in Afghanistan, Renee?
RENEE MONTAGNE, host:
Steve, you're finding me, this morning, in the most remote region along the country's northern border. It's the Province of Badakhshan. And this province is where the ancient Silk Road once passed through China. These days, those days are gone. It's an impoverished place. It has few passable roads and that is one reason Im here, because Im going to talk women - isolated, unable to get care, dying in childbirth in greater numbers than anywhere else in the world.
INSKEEP: Okay, so you're in this province that if you look at a map of Afghanistan, if you think of it as a big pot or a big kettle, this is the province that's kind of the handle sticking out on the right side - very mountainous there. And very high, not just infant mortality, but maternal mortality rates - and how are Afghans trying to change that?
MONTAGNE: In a word, Steve, midwives. In rural areas, generally midwives are the key to bringing down these really high rates of both infant and maternal mortality.
You know, here in Badakhshan Province, more than one out of every five babies born dies at birth. And it's not easy getting help to these tiny villages, a lot of them perched along narrow valleys threading through the mountains that cover this region.
And added to that, unrest has made it more dangerous. It was in Badakhshan, here in this province, where just a few weeks ago, 10 members of a different medical mission - some of whom had been working in Afghanistan for decades -were pulled from their vehicles and murdered.
INSKEEP: Has that stopped the aid workers - the aid efforts that you're focusing on?
MONTAGNE: Not at all. They, of course, take precautions. They call ahead to check on the places that they're going, as to what the security situation is.
But Im following a group here thats been setting up clinics and training midwives in half of Afghanistan's provinces, including war zones like Kandahar and Helmand. So it's a pretty intrepid group. It's called Jhpiego, this organization. It's affiliated with Johns Hopkins University. It's funded by USAID. And we've been visiting some of its more far-flung clinics here in Badakhshan.
Ms. FARANGIS SULTANI (Midwife): (Foreign language spoken)
MONTAGNE: The first thing that strikes one walking into this clinic, perched high up on a mountain in the village of Shahtak, is how fresh it smells, and how its white tiled floors shine.
At a desk just outside the delivery room, a slender young midwife, in a crisp white jacket and cap, leans in to offer advice to a patient in a faded blue burka. Theres a baby hidden beneath that burka, but the top is pulled back just enough to reveal the deeply tanned face of a woman who's worked all her life in the fields.
Midwife Farangis Sultani is showing a series of illustrated lessons on child nutrition, hygiene, and how best to keep her baby healthy.
Mr. SULTANI: (Foreign language spoken)
Unidentified Woman: (Foreign language spoken)
MONTAGNE: Here, the midwife is telling her patient, feed her baby breast milk. Powdered or cows milk, that will lead to diarrhea.
Farangis Sultani has been delivering babies here, for two years now. And when I asked her if she remembered one birth in particular, she quickly reached to the top of a high cabinet and pulls down a large, bound ledger.
(Soundbite of pages turning)
Ms. SULTANI: (Foreign language spoken)
MONTAGNE: Inscribed on these pages are the names of all her patients. She traces her fingers until she finds the one she wants: A woman in labor who made the journey on a donkey.
Ms. SULTANI: (Through Translator) I successfully delivered the baby, but I found out that it was a twin. But the problem was that the second baby was in a horizontal position. If she delivered the baby horizontally, she is going to die.
MONTAGNE: Farangis Sultani says it may have been the hand of God, but the baby turned and came out fine. The joy lasted but a moment, because on that winter's day this new mother began to hemorrhage, and that's something that kills one out of every three women here, who die in child birth.
Ms. SULTANI: (Through Translator) So I put the babies in this room and I turned on the heater, and I went to the other room to take care of the mother. And after injecting some drugs and medicines, I finally managed to stop the bleeding. And at the end of the two days, she was completely healthy and she went home.
(Soundbite of a crying infant)
MONTAGNE: Out in the hall, obstetrician Nasratullah Ansari(ph) looks around the clinic with pride. He's the technical director of the midwife project. And his group figured out a way to help women survive giving birth when they're too far up in the mountains to reach the clinic in time.
It's quite simple. Health workers are supplied with a pill that can stop bleeding - a drug, long used in America for gastric ulcers, called misoprostol.
Dr. NASRATULLAH ANSARI (Director, Jhpiego): We call it a life-saving drug. We can save the lives of thousands and thousands of mothers in the country with this intervention, which is cheap and women can be saved.
MONTAGNE: When this project began six years ago, the men of Afghanistan posed a particular challenge to training midwives. Fathers and husbands here abhor the idea of their women working at a job, or worse, traveling many miles from their village on their own. Which is exactly what these young women must do. Each spends a year and a half at the provincial capital at a school for midwives.
To get buy in, the organization Jhpiego set up village health councils, so that it is the elders themselves who decide which bright young woman should be sent for training. Habanun is one of those women.
HABANUN: (Through translator) I was selected by my people in this village, and since I was living here, everyone knew me.
MONTAGNE: Does it make a difference, is it important that it was the people in this village and the elders who approved and chose her?
HABANUN: (Through translator) It was a very important. They chose me and sent me to school, and now Im back, here to serve my people.
MONTAGNE: Dr. Ansari says hes heard this over and over again.
Mr. ANSARI: They are so proud to be a midwife. You are taking care of the whole village. And the thing is - the other thing is, they are so proud they can receive salary. It's a sort of empowerment of women.
(Soundbite of baby crying)
MONTAGNE: One of the most influential men in Badakhshan is Mawlawi Zabihullah Atiq. As the head of the provincial council, he has visited every one of the hundred clinics in the province. His only criticism: there should be more. Mawlawi Atiq was born within days of the Soviet invasion 30 years ago, in a snowbound village deep in the mountains. For those people, he says, not much has changed.
Mr. MAWLAWI ZABIHULLAH ATIQ: (Through translator) Most of the time, these women, these pregnant women, die on the way. They put them on a stretcher and they walk all the way from - in these remote districts. One of my aunts died during delivery. Another aunt has lost over eight children.
MONTAGNE: When this program started, what was the response, here, to the proposition that girls from villages would be trained as midwives?
Mr. ATIQ: (Through translator) I'm a religious person. I'm a mullah. But I realize that it's a necessity. I even send one of my sisters to go and be part of the training. We realize that's how we can protect our pregnant women and daughters.
Unidentified Woman: (Foreign language spoken)
MONTAGNE: The very last clinic on the list for Dr Ansaris team to visit, is in a village called Karah-koose(ph). And it offered a fine farewell to Badakhshan. A baby was born.
The next morning, I went along with the young midwife who delivered the baby to find see how the mother was doing. She was sitting on a dirt floor, holding her hours-old infant, surrounded by grandmothers and aunts and the father - all beaming.
Aw. He's so tiny.
GRANDMOTHER: (Foreign language spoken)
MONTAGNE: The grandmother is telling me that no woman there had ever gone to a midwife before and many had died. They all agreed this far better, because, look, says the grandmother touching to this perfect baby boy he is, she says, a golden child.
(Soundbite of music)
INSKEEP: Renee's reports from Afghanistan are produced by Jim Wildman. It's NPR News. Transcript provided by NPR, Copyright NPR.