• Women and their babies in Sierra Leone. (SBS Dateline)
She survived months as a sex slave and escaped to Australia as a refugee. Aminata Conteh-Biger can’t change the past but now she’s ready to help the future of her homeland, which has become the world’s most dangerous place to give birth.
Airdate: 
Tuesday, March 7, 2017 - 21:30
Channel: 
SBS

When rebel soldiers knocked on Aminata Conteh-Biger’s family home 18 years ago, she knew one chapter of her life was ending and a new, horrifying one, was about to begin.

She was 18 years old at the time and Sierra Leone was in the midst of a decade-plus long civil war.

Revolutionary United Front (RUF) rebels, in a war against the government, were pillaging Aminata’s neighbourhood in Freetown, the country’s capital.

“I remember one of the rebels outside – ‘who is in this house?’ and then they said, ‘If nobody comes out we’re going to burn the house’,” she recalls to Dateline reporter Amos Roberts. “So this is when we all feel panic, we have to open the house.”

“One of the rebel leaders, Daramy, looked at me. As soon as he looked at me, I knew that he was coming straight for me.”

Aminata was taken by the rebels as a sex slave. She was released four months later in a trade for food – by that point, a broken and traumatised person. Her father’s guilt over not being able to stop Aminata being taken haunted him for the rest of his life.

“He was almost scared of looking at me,” she says, crying. “He was scared because he knew I had been hurt and he didn’t protect me.”

Memories of growing up in the middle of a country at war left images in Aminata’s mind that will remain there forever; “seeing people’s hands being chopped, that was very common.”

Shortly after her release from the rebel Aminata was resettled in Australia as a refugee, but for years kept her experiences to herself, saying her life after leaving Sierra Leone has often felt surreal, like a dream.

In this Dateline special, we follow Aminata back to her home town, where she confronts what her life may have been like had she not migrated to Australia – particularly, whether she, or her daughter Sarafina, would be alive today had they stayed there.

Sierra Leone has some of the highest maternal and infant mortality rates in the world and Aminata believes had she remained in Freetown, both herself and Sarafina may not be here.

Aminata travelled to the country with co-workers from a foundation she has started, which aims to reduce the rates of maternal and newborn deaths in Sierra Leone – and currently supports several programs in the country for pregnant girls, many who live in slums.

Some of the women Aminata’s foundation supports are staying at Aberdeen Women’s Centre, one of the few safe spaces in the entire country for women to give birth.

“My father died when I was six years old,” says one young girl at the centre, Isha. For a young women, she has survived significant trauma – she dropped out of school at 10 to help her family sell drinks, and was raped by a customer.

Stories like Isha’s are not uncommon for women at the facility, but at least they have a chance at surviving their pregnancy. Across much of Sierra Leone, shortages in the availability of reliable maternal health services condemn many pregnant women and their babies to gambler’s chance of survival.

Kroo Bay is a sprawling slum in Freetown, and according to nurse for the Aberdeen Women's Centre, Aminata Ngegbai, is one of the most dangerous places in the country to give birth.

“For human beings to live together with animals is very, very dangerous,” she says. “They are prone to diseases like cholera, scabies, malaria.” The average life expectancy in Kroo Bay is 36 for women and 32 for men.

While visiting Aminata meets pregnant women, many of them malnourished, who are lacking basic health services. Their pregnancy poses a direct risk to their health, and by extension, their unborn child’s.

“Most of [the girls here] survive on prostitution,” says Ms Ngegbai. “Some as early as twelve [years old].”

Visiting Kroo Bay the stark difference in health provision between her two home countries is made clear to Aminata – here, one woman has birthed two babies who’ve died, one after four days of labour and one in a fire. In Australia, Aminata had 7 doctors help deliver her baby, and in a safe hospital.

The lack of services is even more noticeable in the countryside. At one small health centre, which services 14 surrounding villages and around 4,000 people, keeping mothers and their babies alive is a constant struggle. Only a week before Aminata arrived, a 16-year-old girl died at the centre. Her baby lived through the birth, but whether she survives much longer is not guaranteed.

Penny Gerstle chairs Aminata’s foundation and was with her during her trip to Sierra Leone. She says the dire state of the country’s maternal health services offer an opportunity for outsiders.

“Whether we decide to tackle education, whether we decide to tackle provision of equipment, or train doctors, train midwives and nurses, it’s an open book,” she says.

Aminata wants to make a difference in Sierra Leone – and her own personal experience gives her confidence she can.

“I survived, my life is a miracle every single day,” says Aminata.

“I was living around bombs, so if I’ve come through that, you can’t really tell me I can’t be something.”

Watch the full story at the top of the page.

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Credits

Reporter / Camera: Amos Roberts

Producer: Kylie Grey

Story Editor: Simon Phegan

Transcript

AMINATA CONTEH-BIGER:  I just wanted to come to a country where I feel safe, where I will not be recognised for what has happened to me.

Aminata Conteh-Biger never thought they would have this life in Australia. Being with her family feels unreal after the brutality she endured during Sierra Leone's civil war.

AMINATA CONTEH-BIGER:  Seeing people hands being chopped, that was very very common.

At 18, Aminata was abducted from her home in Freetown and kept as a sex slave by Sierra Leone's brutal rebel forces. When she was released, the UNHCR fast tracked the young refugee to Australia.

AMINATA CONTEH-BIGER:  For five years I didn't really talk to people, I would just go and I would leave quickly and disappear and I would come home and I would stay in my bedroom. Nobody wants to live like that, and that was still holding me in prison, so even though I was in Australia, I was still kidnapped by them.

She enrolled in a suburban Sydney high school and kept her past hidden for years.

AMINATA CONTEH-BIGER:  Sometimes I don't feel like I survived what I survived.  I think everything in my life since after the war, has always been like a dream, like I'm dreaming sometimes. But when Sarafina came, when she was little, I would touch her to feel if it's real.

Aminata's pregnancy was a blessing but her daughter's birth was traumatic.

AMINATA CONTEH-BIGER:  Doctors are saying push, push, push, nothing is happening.  It was really, really bad, we had over seven doctors in the room.

The doctors later told Aminata they didn't expect her daughter to survive.

AMINATA CONTEH-BIGER:  When I came back home with Sarafina, I realise that 110% if I was in Sierra Leone, myself and Sarafina would not have survived. That is a guarantee. I would have been one of those women that would have passed away with their daughter.

SARAFINA:  Thank you god for this lovely day and this lovely story and amen.

Aminata was horrified to learn that women in Sierra Leone are almost 300 times more likely to die in childbirth than Australian women. This was a turning point. Her husband, Antoine, says until then, Aminata had been reluctant to go back.

ANTOINE BIGER, HUSBAND:  I remember one day I was telling her, "Oh, I can't wait to go to Sierra Leone and visit where you grew up". And at this point she told me, "Oh no, no, no I'm not going back until I have something to give to the community".

AMINATA CONTEH-BIGER:  So Sarafina, you going to help Mama pack to go to Africa?

I just want to help. I really just want to help.

REPORTER: So you felt like it was something that you could do something about?

AMINATA CONTEH-BIGER:  So Sarafina, you going to help Mama pack to go to Africa?
Yeah I really believed that even though I had so many challenges.

Aminata wants to find out why Sierra Leone is the most dangerous country in the world for a woman to have a baby and what she can do to help. She's brought along 2 close friends she met while working as a spokesperson for the UNHCR.

PENNY GERSTLE:  It was so sweet what that guy just said to me – thank you for looking after our sister.

Penny Gerstle and Maureen Collins helped set up the Aminata Maternal Foundation. They're being hosted by the Aberdeen Women's Centre, which is one of the only safe places for women to give birth in the whole country. The mothers and children treated at this private clinic get free health care. They're among the poorest and most vulnerable women in Sierra Leone.

NURSE:  Good morning dream team.

Aminata's foundation is already supporting this program for pregnant girls, some as young as 10 years old, who live in Freetown's slums. They're often malnourished and their pelvic bones are sometimes too small to give birth. Many are victims of neglect and abuse.

ISHA (Translation): My father died when I was six years old.

Isha dropped out of school at 10 to support her family by selling drinks, and was raped by one of her customers.

TRANSLATOR:  One day the man told Isha, when he bought the drinks, to take her to his room.  Immediately Isha took the drinks to the room. The man tampered with her.

AMINATA CONTEH-BIGER:  So how old is Isha?

TRANSLATOR: Aisha is fourteen. Isha is fourteen years old.

NURSE: She’s 12 years old?

AMINATA CONTEH-BIGER:  It's almost impossible that this is really happening. My head was spinning just to hear a 12 year old girl got pregnant.

REPORTER:  You've been through something even more traumatic while you were still a teenager.

AMINATA CONTEH-BIGER:  I know. I know.  I think even though like things that have happened to me, being raped during the war and especially for my first time, a few men, I feel like that was a war, that I didn't have control over. But this is not a war. That's the difference for me.

Unlike these girls, Aminata had a privileged upbringing, until Sierra Leone's savage civil war arrived on her doorstep.

AMINATA CONTEH-BIGER:  Yeah, this one.

REPORTER:   Looks different?

AMINATA CONTEH-BIGER:  Looks so different. This is where my father used to live, so this used to be his bedroom.  This is the kitchen where he would make our breakfast.

REPORTER:   Your dad?

AMINATA CONTEH-BIGER:  My dad, my father. And he would have his apron on and we’d have breakfast with him here.

Aminata enjoyed an idyllic childhood here, but it came to a sudden end on the sixth January, 1999.

AMINATA CONTEH-BIGER:  When the rebels came to the city, Freetown, we used to watch from the windows. So we would see everything that’s happening, all the smoke, all the people being burned, all the houses being burned.
I remember one of the rebels outside.. “Who is in this house?” And then they said, “If nobody comes out we are going to burn the house.” So this is when we all panic, we have to open the house. I was holding my Dad’s hand, his hands were shaking he had Parkinson’s, and I would hold it still so it wouldn’t shake, and just at that moment, one of the rebel leaders, Daramy, looked at me. As soon as he looked at me, I knew that he was coming straight for so by the time he walked I already let go of my Dad’s hand. And then he called “Come here.” Then I walked towards him.

Aminata's father was powerless to save his 18-year-old daughter. They both knew what would happen next. Young women who caught the eye of warlords are often taken as sex slaves.

AMINATA CONTEH-BIGER:  I was very innocent when Daramy took me. I’ve never really been with a man before. That night when he finds that I have not slept with a man he became more obsessed with me.  I remember just now waking up and just bleeding but my recollection that he has called some of his friends to rape me at the same time. So yeah, so that is my first experience.

Aminata lived through unspeakable atrocities on the frontline of the civil war. After 4 months, she was released with other prisoners in exchange for food and found her father a broken man.

AMINATA CONTEH-BIGER:  He was almost scared of looking at me. He was scared because he knew I had been hurt. And he didn’t protect me…

Aminata's dad died in 2003 and was buried in Freetown. She has yet to say her final goodbye. With encouragement from friends like Penny and Maureen, she started speaking about her ordeal in public, using her profile and newfound strength to help other women.

AMINATA CONTEH-BIGER:  I survived. My life is a miracle every single day. … I was living around bombs.  So if I've come through that, you can't really tell me I can't be something.

But it's still early days for the Aminata Maternal Foundation. She's using his trip to work out where to direct her help. Today, she's exploring one of Sierra Leone's most notorious slums, with a nurse from the Aberdeen Women's Centre.

NURSE:  Kroo Bay is one of the most dangerous communities to have a baby and for human beings to live together with animals is very, very dangerous.  They are prone to disease like cholera, scabies, malaria.

The average life expectancy for a woman in Kroo Bay is 36 years. For a man, it's 32.

NURSE (Translation):  How long have you been pregnant? 

GIRL (Translation):  Six months. 

NURSE (Translation):  Have you heard of Aberdeen Women’s Centre? 

Everywhere we go, we find more pregnant women. All of them get a slip of paper and the same advice.

NURSE:  You will take this paper and go to the gate, yeah? Early morning.

WOMAN:  Which time?

NURSE:  Wednesday.

Many are malnourished and HIV positive.

PENNY GERSTLE:  How do most of these girls survive here?

NURSE: Most of them survive on prostitution.
 
PENNY GERSTLE: And how old are they when they begin prostitution?

NURSE: Twelve. As early as twelve.

Sierra Leone's health system had slowly started to recover in the years after the civil war but then came the recent Ebola outbreak that killed almost 7% of all health workers and was back to square one.

JAKIA (Translation):  I was wondering where I can go to deliver this baby safely without anything happening to me or the baby”.

The last time this woman was pregnant, her baby died after four days of labour in a community clinic and government hospital. Another baby died in a fire.

AMINATA CONTEH-BIGER:    She has already lost two babies. It’s really sad because I live all the way in Australia and I had seven doctors when I had Sarafina, if I was here, I would have lost her and I would have died but they did everything in their power for me to deliver that baby safe and for her not to be able to have that, I just think that is really unfair. Thank you so much, thank you.
 
It's even more dangerous for women giving birth in the countryside. Where there are no doctors or hospitals. This is where Aminata thinks her foundation can make the biggest difference, perhaps even opening up its own clinic.

PENNY GERSTLE:  We’ve heard there’s been a maternal death in one of the local villages. We know that many women die from um sepsis or infection, many women die from obstructed labour and another large number die from haemorrhaging, but without knowing the specifics of the deaths and how many are dying and where etc, then it’s hard for government to form policy.

BERNADETTE FOFANAH (Translation):  Good morning, Sir. I hope you guys are doing well.

Nobody knows more about what help is needed out here than Bernadette Fofanah, one of the nurses from the Aberdeen Women's Centre. She leads us to the grave of a 16-year-old who died last week after giving birth.

AMINATA CONTEH-BIGER:  So where’s the graveyard?  Oh look.

Kadiatu Fofanah now lies in her family's backyard.

BERNADETTE FOFANAH: I don’t know how to try to express this because for us we are still today fighting so that a woman does not die whilst giving birth. We want the government to improve on this for the pregnant woman.

PENNY GERSTLE: You did your best. You're doing a good job.

AMINATA CONTEH-BIGER:  Such a baby.

PENNY GERSTLE: She’s such a baby. So young.

Kadiatu's little brother wanted to show us these precious photos of his sister. We decide to visit the health centre where Kadiatu died. Bernadette suspects she had anaemia, but there's no way to screen blood here. There's not even a decent phone signal if you need to call for help.

AMINATA CONTEH-BIGER:  This one is for water? Clean water.

This is the delivery room for women from 14 surrounding villages, almost 4,000 people.

AMINATA CONTEH-BIGER:  You’re doing a lot. You should not be struggling.  You should have a lot of equipment.

PENNY GERSTLE: Things are diabolical.  It’s the worst place in the world to give birth. I guess that means that there’s so much we can do. That gives us a lot of opportunities. Whether we decide to tackle education, whether we decide to tackle provision of equipment, or train doctors, train midwives and nurses, it’s an open book.  

So this is the baby whose mother has died?

BERNADETTE FOFANAH:  Yes.

Kadiatu's baby daughter has a big fight ahead to survive, one in 5 children in Sierra Leone die before they're 5 years old.

BERNADETTE FOFANAH:  What’s the baby eating now? What type of food?  Gripe water with glucose? Is that all? Are you breastfeeding the baby? 

WOMAN:  No.

AMINATA CONTEH-BIGER:  So that’s what the baby’s going to eat all the time.

PENNY GERSTLE: Just glucose?

AMINATA and BERNADETTE: Glucose And gripe water.

PENNY GERSTLE: I mean it is tragic there is no access to baby food to baby formula. And this baby, no one’s going to take it on to breast feed it so it will just get sugar and water.

Penny arranges to provide the family with milk formula for the next six months. With any luck, Kadiatu's baby won't share her mother's fate. At our next stop in a remote village an hour's drive away, we're hoping to prevent a death rather than mourn one.

CHIEF: Yes Madam, how are you?

AMINATA CONTEH-BIGER:  Very good.

There's a pregnant teenager here who needs urgent medical care and her family seems resistant.

BERNADETTE FOFANAH:  Zainab how are you doing? So this baby is disturbing you.

We think that Zainab is about 16. No-one here keeps track of birthdays and she is 43 weeks pregnant. Women are considered to be in danger after 42 weeks of pregnancy.

AMINATA CONTEH-BIGER:  I was I think 39 weeks pregnant and I almost lost my baby and that was in Australia. So I’m sitting here with someone who is 43 weeks, and no doctors around. I can’t even imagine what is going to happen if she actually went into labour tonight or now even.

PENNY GERSTLE: There’s a one in 17 chance of dying while giving birth in Sierra Leone, and women tend to have 5 or 6 babies so you’ve got to say that Zainab’s in a pretty high risk category, don’t we?

BERNADETTE FOFANAH:  Of course. Zainab, if we said we can take you to the hospital where I work so that you can deliver the baby safely, and then come back, are you happy to go?

Zainab's silent because it's not her decision to make. It's up to her parents.

AMINATA CONTEH-BIGER (Translation):  Is the mum afraid of someone taking her daughter? Is it?

Bernadette asks the village chief to help the family see reason and we leave them to discuss it amongst themselves. The next day, we take Zainab too to her mum's village so we can ask her in person.

MAN (Translation): Zainab… Zainab – you’ve got a big stomach, like a whale.

BERNADETTE FOFANAH (Translation):  If Zainab's pregnancy continues like this the unborn baby will get sick.

Zainab's mother isn't here, so her aunt explains their concerns.

AUNT (Translation): I am not denying that she has to go with you, however, if her mum was here then it would be okay. She isn’t here. If she came later and someone told her that I let her daughter go with white people…

The villagers are clearly suspicious. It's hard to get across how much danger Zainab's life is in.

AMINATA CONTEH-BIGER:  This is going to go on and on. They’re not going to let us take Zainab.

REPORTER: It's very difficult to get people to trust you.

BERNADETTE FOFANAH: The problem with trust for some people is it’s because of the illiteracy rates. Honestly.  It’s because of the illiteracy rates.  Most of them they are not educated. I’m really, really frustrated.  I’m really… because my efforts have gone in vain.

But then, just as we're about to give up and leave, the village chief finally relents.

BERNADETTE FOFANAH (Translation): Who will give me Zainab?

CHIEF (Translation):  Okay, we will give you this little girl. We will give you this little girl.

It's a last-minute change of heart that may have well saved the lives of Zainab and her baby. It's almost midnight by the time we get back to the Aberdeen Women's Centre in Freetown. The next day, an ultrasound confirms our fears.

DOCTOR TAMIMU MARIATU, OBSTETRICIAN: If you did not go and rescue her then she would have lost this baby.

The doctor recommends an immediate caesarean.

DOCTOR: Relax, relax, relax. 

PENNY GERSTLE:  She must be utterly terrified, she is 16,

BERNADETTE FOFANAH: Don’t tense your body. Zainbab, Zainab. Relax Zainab, don’t do that. Sit still.

DOCTOR:  Time of birth?

PENNY GERSTLE:  Oh, that is amazing!

AMINATA CONTEH-BIGER:  It’s a boy.

PENNY GERSTLE: It’s a boy?

BERNADETTE FOFANAH:  Zainab, Zainab what type of baby is this? I didn’t hear you?

ZAINAB: A boy, yes.

BERNADETTE FOFANAH: Are you happy? Then kiss the baby.

REPORTER:  Do you feel proud Bernadette?

BERNADETTE FOFANAH:  Oh, really!  Very very proud.  Very, very, very ha-ppy!  I don’t even know how to express my feelings right now.  I’m so glad.  So glad. 

PENNY GERSTLE: This is kind of our first success story, right?  This is the first baby, the first Sierra Leonian baby that we’ve at least played a part in saving. That’s beautiful.

The birth of Zainab's baby is just the beginning. Aminata's trip is almost over but before she leaves, she wants to visit her father's grave for the first time.

AMINATA CONTEH-BIGER:  He was a very kind person, very selfless.  And, I feel like I have to continue that legacy of what he’s done for people. They are so happy that one of their own is here to do something, I can feel the love so much.

In 5 years, Aminata wants to build a clinic like this one for women for the countryside. She knows she has an important role to play in making sure that Sierra Leone is no longer the most dangerous place in the world to have a baby.

AMINATA CONTEH-BIGER:  At the end of the day, yeah things happened to me when I was kidnapped, really bad things happened to me. What has happened to me, I can't go and change it, but this is something that I can change. I can be part of that change.

 

reporter and camera
amos roberts

story producer
kylie grey

researcher
pip hutchinson
kylie grey

fixer
ibby kabia
miles ibrahim kamara

story editor
simon phegan

translations
abdul jalloh
sia mansaray

7th March 2017