Five years ago this month, one of the worst outbreaks of Ebola ever recorded began in Sierra Leone, lasting from 2014 to 2016.
The country's health service is still recovering. Ten per cent of health workers were killed and the Government, having taken on huge loans to help cope with the crisis, is still paying for it. This is money that could be spent on improving access to healthcare.
It's the world's most dangerous place to give birth: maternal mortality rates there are the highest by a significant margin. For every 100,000 live births in Sierra Leone, 1,360 mothers die, compared to nine in the UK.
Lack of access to a healthcare facility or health professional is one major factor in the high number of maternal deaths. If there is no clinic in their village, women in labour can wait up to eight hours before an ambulance arrives. Others travel to hospital on the back of a hired motorbike, but the poorest have no choice but to walk for hours on foot. Many women and babies do not survive the journey.
Jebbeh Konneh is heavily pregnant with her fifth child. Pregnancy should be a time of joy but for Jebbeh, it is overshadowed by fear. Her sister, Fatmata, recently went into labour in a nearby village. She had no choice but to walk three hours to the nearest hospital.
"My sister was crying out with hunger. She died on the side of the road. She never gave birth," Jebbeh said.
"I'm afraid to give birth. Whenever I think about my sister dying, it's painful, and I think the same thing will happen to me."
In Pujehun district, southern Sierra Leone where Jebbeh lives, there are three ambulances for a population of 375,000.
Tenneh Bawoh was pregnant with her first child when she felt the agony of labour. With no health centre in the village, she turned to the help of a traditional birth attendant. After two days of labour, Tenneh fell unconscious. When she came to, the baby had been born but Tenneh had lost a lot of blood and was very weak. The newborn struggled to breastfeed and at three months old, he died. "If we'd had a nurse and a hospital at the time, my baby would not have died," she says.
With the help of a nurse and a temporary health centre in her village, Sawula, Tenneh went on to have a healthy baby. She is pictured with her son, Ansumana Bangali.
Mamie Sawyer has given birth to five children but only two girls have survived, now aged 14 and six. She knows well the perils of labour and childbirth and is now pregnant again. In some African countries, it is said that "a pregnant woman has one foot in the grave". This rings true for so many women living in poverty, who do not have access to adequate healthcare.
With the support of Christian Aid and its partner organisations in Sierra Leone, women in Pujehun district are taking action.
A simple saving initiative using a basic padlocked steel box has meant women in rural villages can pay for themselves to get to hospital in an emergency.
Women who join the box scheme, pay a small amount of money each week and when they need to borrow for transport, medicine, school uniforms or other necessary items, they can take a loan and pay it back gradually with interest. Three women are custodians of each box that has three padlocks, needing all three to open it and dispense money.
Massah Brewah is a custodian of a box in Bumbeh Pejeh village. She is a widow and has five children. She tells many stories of people in her community who have been helped by the box – which is called 'Muloma', meaning 'let's love one another'.
"Before [the box], there hadn't been peace and unity between the wives and the husbands but because of the box, we have unity. Poverty was responsible ...Because we didn't have money wives were angry at husbands for not having money. The children are hungry. The women had to face the men with aggression...they fight, they quarrel but with the box it is better."
Fatamata Dugba has given birth to five children. Only two have survived: her son, 13, and daughter, 12, who both live with relatives so they can attend school. Fatamata sees them once a year and only then if she is able to take the relatives gifts such as food or palm oil.
Her story shows the impact the savings box can have.
Six months ago, Fatamata was seven months pregnant when she started to feel pain. An ambulance was called.
"I can't remember how long the ambulance took because my condition was...[she trails off]." By the time she reached the hospital, Fatamata had lost a lot of blood and needed an operation. She borrowed money from the box to pay for it.
"They had to remove the womb. I wanted to keep it, but my husband gave the authority, he said because of the situation, they should get rid of the womb. The men gave the order, so I just decided to accept what he did for me to have lived.
"I would have died if there hadn't been any box."
Sierra Leone has some of the highest rates of teenage pregnancy and child marriage in the world with 13 per cent of girls marrying before the age of 15 and nearly 40 per cent before the age of 18. Some 28 per cent of girls aged 15 to 19 are pregnant or have already given birth at least once.
Not only does this impact their education but teenage pregnancies are also particularly high risk.
Nurse Kannie - this is her name, not her occupation – says she is 17 but looks younger. Her daughter Betty is less than a month old. Nurse's boyfriend left when her parents found out she was pregnant.
Nurse says, "I look at [Betty's father] to be somebody with a curse. He doesn't want to be responsible.
"Now my desire for my child is for my baby to leave Africa for the White Man's Land."
Working alongside its local partners and communities, Christian Aid is building more health clinics in Sierra Leone, so that pregnant women can deliver their babies safely. The charity works in 22 villages out of 867 in Pujehun district so there is clearly much more still to be done.
According to Joanna Tom-Kargbo, Senior Programme Manager at Christian Aid in Sierra Leone, "The communities are yearning for this project. Like yesterday, when we were in Nyandehun [a village that isn't supported by Christian Aid] the nurse was telling me, 'every day I am praying for Christian Aid to come...we've heard a lot of the good things that Christian Aid is doing within those communities'."
Joanna goes on to say, "Communities here see a woman dying in childbearing as the will of God. But we work so they know it is unacceptable."
Christian Aid is also training nurses to provide urgent care in communities and is improving hygiene, so mothers and babies can fight off diseases.
Nurse Judith Lassie has been working in Sawula village since 2017 and when she arrived, she was not happy with the conditions.
"What I saw, depressed me so much. The same place is set aside for every function, every operation, delivery...everything in one room."
With no running water or electricity, Judith works in cramped conditions and with little equipment. But soon a new health centre will be ready which has been built by the community with the help of Christian Aid.
"It gives us hope," says Tenneh.
This week is Christian Aid Week, the charity's biggest annual fundraiser which unites more than 12,000 churches every year to support global neighbours in need.
The charity is asking people to stand in solidarity with mothers and to raise funds for better healthcare services to support some of the world's poorest communities like in Sierra Leone.
It is also inviting supporters to join its campaign to drop Sierra Leone's debt that was incurred during its fight against Ebola. Debt repayments are taking money away from improving healthcare services that are so desperately needed.
Claire Meeghan is Media & Communications Adviser at Christian Aid
