Fig. 5

Multiple referral pattern 1. She was from a village 50 km north of Renk town. Her labour pains started at around 8 pm. Her family called the TBA who assured her that the delivery would be smooth, but the pregnant woman remained in severe pain for hours. By noon next day, she was in severe pain with no progress made. Her husband decided to go to the nearest health facility. They rented a pickup truck at a cost of USD10. They arrived at 1 pm at the house of the trained midwife, who was busy with another delivery. The midwife examined her and tried to deliver her. After a while she called for the doctor. The doctor referred them to Algabaleen hospital in North Sudan for an emergency caesarean section. At 6 pm they rented an ambulance, which cost them USD20 and crossed the border of North Sudan to Algabaleen town. They arrived at 7 pm and found that the theatre was closed for 72 h. They called another ambulance at 8 pm, which cost them another USD20. They arrived at Rabak city hospital at 10 pm. They were asked to pay USD20 for the caesarean section operation. There were many patients ahead of them and she was not operated until 4 am. She was transfused the next day with 4 units of blood and was given medication. She was hospitalised for 22 days. During her stay, her family stayed with her and supported her as much as they could. Her husband sold their cattle to cover the expenses. The expenses exceeded USD350. The woman lost her baby and lives now with a fistula. She goes every 14 days to the nearest health centre to her village to change her urine catheter. (13RMNM)