[This journal from the BBC's series on a medical clinic in the country next to Liberia, is typical of the challenges that African heathcare workers face...]
Medical staff at a clinic in the coastal slum of Kroo Bay, in Sierra Leone's capital, Freetown, are keeping a diary of their working lives.
Here, Bintu Koroma, who is a midwife at the clinic, talks about traditional beliefs and troubled pregnancies.
A woman arrived on the maternity ward last month, who had been in labour for more than one-and-a-half days without delivering
Her waters had broken from a premature rupture and she had gone to a traditional birth attendant, who had tried to deliver the baby but with no joy.
I examined her, however, there was not much I could do at this stage and I advised her to go to the hospital at once.
It is in our regulations that if a delivery goes on for more than 24 hours we must refer them immediately.
Inside I felt it might already be too late for this baby.
I learned later that in fact she had gone back to the traditional birth attendant because her family did not have the money to take her to the hospital.
The issue here is always money.
She eventually delivered but the baby was stillborn.
When I saw her several days later, her belly was still swollen as if she was still pregnant, I told her she must go to the doctor.
Most people in the slum still prefer to go to a traditional birth attendant as this is what they have done for generations.
They use local medicine and herbs, which are part of people's beliefs.
Herbs are often rubbed over a pregnant woman's belly to protect the baby, not only from medical problems but also from any curses.
When something goes wrong, people blame others for putting a jinx on them - and this was also the case with this woman.
She said that she had a competitor for her husband, who, she believed, had placed a curse on the baby so that it would die.
I told her that this was not the case.
"Your baby died because your waters broke too early and you didn't go to the hospital," I said.
Excuses
We have talked with the traditional birth attendants and asked them to bring their patients to the clinic to carry out the deliveries.
We usually charge 70,000 leones ($24) for a delivery, but in these cases we just want to observe and be able to step in if there is an emergency - we don't charge any money to the birth attendant or the patient.
It's difficult find out how much birth attendants charge, but it's thought to be between 40,000 leones ($14) and 100,000 leones ($34) - a higher fee for a boy than a girl.
Sometimes the attendants do come here with their patients, but most of the time they don't.
When I see them in the street and ask them why they didn't come to the clinic, they tend to invent excuses: "Oh, the woman's family called me, and when I arrived at her house the baby immediately fell into my hands - there was no time."
I think there are two reasons why they avoid the clinic.
Firstly we do not allow them to bring their herbs.
But, more importantly, they fear that by bringing their patients to the clinic, other traditional birth attendants will get to hear about the delivery.
They will then turn up uninvited in the delivery room, impose their help and then expect a share of the money.
