A mother pulls down her blue burqa as we approach the community health clinic at Darra, high in the mountains of Afghanistan. The baby in her arms is grizzling listlessly. "He has a respiratory ailment, but the basic problem is that he is malnourished, like most of the children here," explains Hadisa Aladod, the clinic's midwife, as the woman queues up at the dispensary counter for medicine.
Even by Afghan standards, Darra is remote. The village is up a side valley off the Panjshir, which runs between the peaks of the Hindu Kush mountain range. The tar runs out a few miles short of the turning where the Darra and Panjshir rivers meet, and the clinic is at the end of an hour and a half of bone-jarring dirt track. When there is a medical emergency, its ambulance faces a difficult journey to reach the hospital at Anabar, near the mouth of the Panjshir Valley.
Up here land is scarce, and the clinic is perched on a steep slope. This at least spared it when a flash flood roared down the Darra river last summer, carrying a torrent of boulders, trees and silt that washed out bridges, killed 100 people and cut off the village for weeks. It is a tough climb for pregnant women or those with small babies, but Ms Aladod says that is not the main reason many of them stay away.
"The biggest problem is lack of space," the midwife says in her tiny consulting room, which feels crowded even with the two of us. It is just off a busy hallway, and cultural restraints against mingling with strangers make many women reluctant to come here, let alone give birth in these cramped surroundings. Dr Ayobi Sayed Habibullah, a provincial adviser to the Afghan Ministry of Public Health, also complains there is nowhere to give lessons in basic hygiene or family planning.
Instead Ms Aladod has to attend many births in women's homes, where any complications that might appear can prove fatal. Afghanistan has managed to bring down the number of children who die in their first year to 165 per 1,000, still the second worst in the world, but the midwife reckons it is higher here. "We are up in the mountains, and access is poor," she says.
The solution to many of these problems is taking shape next door to the clinic, where Afghan Mother and Child Rescue (AMCR), the charity The Independent on Sunday is supporting for its Christmas appeal, is building a facility dedicated exclusively to women and their children. It is modelled on its two existing mother-and-child health clinics in the Panjshir, which have already had a dramatic impact on mortality rates.
AMCR, founded by a retired Coldstream Guards officer, Brigadier Peter Stewart-Richardson, is a decidedly hands-on charity. As soon as we arrive in Darra, Roddy Jones, a 73-year-old former major in the Royal Welch Fusiliers who is an AMCR trustee, goes into trouble-shooting mode. The flood has delayed the start of the project, and forced the builders to site the clinic higher up the hill. Roddy tells the contractor to get the roof on with all speed, to prevent the winter's heavy snows from damaging the new walls, and works out where a flight of steps will have to be added. Another difficulty is water: the owner of a spring above the clinic is claiming the supply for himself. Roddy decrees that, rather than wait for a deal which may never come, water should be pumped up from the river.
Despite these obstacles, the mother-and-child clinic will be in operation next year. Experience has shown that when women know there is a clinic specially for them, they come in far greater numbers for pre-natal checks, choose to have their babies in clean and secure surroundings rather than at home, and bring their children back regularly to have their health monitored.
Each clinic costs about 30,000 to build, and the local health authorities have identified the need for at least three more in the Panjshir alone. Zahir Khan, provincial finance director of the Afghan Ministry of Public Health, said many aid agencies made commitments that were never fulfilled, but Afghan Mother and Child Rescue was different: as fast as readers donate to our appeal, the clinics will be constructed. "What Mr Roddy promises, he delivers," said Mr Khan.
The Independent on Sunday Christmas appeal
How you can give hope to the most vulnerable
Donations from Independent on Sunday readers have put Afghan Mother and Child Rescue well on target to build another clinic, helping to save the lives of women and their children in one of the world's poorest countries. But more is still needed.
Donate online www.independent.co.uk/iosappeal
Send cheques, made payable to "Afghan Mother and Child Rescue", to Afghan Mother and Child Rescue, 128 Kensington Church Street, London W8 4BH
A Gift Aid declaration form, which increases every pound you donate by 28p, can be downloaded at: www.amcr.org.uk/ GIFT_AID_DONATION_FORM.pdf
By BACS transfer
Account name: Afghan Mother and Child Rescue
Account number: 00011780
Sort code: 40-52-40
For more information on Afghan Mother and Child Rescue (registered charity no 1097423), visit www.amcr.org.ukReuse content