At midnight an ambulance arrives at Zwedru's Martha Tubman Memorial Hospital in remote Grand Gedeh County. It brings a woman in labour, desperately needing a Caesarean section to save her and her unborn child.

Minutes later, staff in the hospital emergency room (ER) radio Penny, Merlin's Project Coordinator. They tell her there's no surgeon to perform the operation - the hospital doctor is away and there's no public health surgeon in the entire county right now, let alone Zwedru town. It's at this point, with crackling radio in hand, that Penny wanders into our front room where I'm sitting.

Penny calls Wellington Dweh, the hospital administrator - also just woken by the ER. He knows of a new surgeon who is working with a local charity and is on his motorbike within minutes, making his way across town to wake the surgeon to see if he will help.

Penny and I wait anxiously, willing the radio to sputter an update.

Usually Dr. Amagashie would step into the breach. He's the on-call surgeon and the hospital's only doctor. He's also Acting Medical Director, as well as the only eye specialist for the six counties of the South East Region.

Not one of these roles is his official job: Dr. Amagashie is in fact the County Health Officer (CHO). This week he is in the capital, Monrovia, attending meetings at the Ministry of Health and Social Welfare, fulfilling his CHO responsibilities.

With Dr. Amagashie away, Penny starts running through alternatives if the newly arrived surgeon cannot perform the Caesarean. There is only one: the mother will have to go to Ganta, a five-hour drive away.

"She will die," Penny says, looking at me anxiously. "She's already travelled for more than two hours on bumpy roads - by the time these cases reach us they are so urgent."

The radio crackles into life; it's Wellington, asking permission for a Merlin vehicle to collect the surgeon and take him to the hospital. Penny sighs, relieved, and can't speak her approval into her hand-held radio quick enough.

Soon we hear the Merlin driver affectionately report that he's reached the Old Man's House - he's talking about Mr Desuah.

Mr. Desuah is 66 years old. He is Grand Gedeh's only anaesthetist and will have to be in attendance for the surgery to go ahead.

Employed by the ministry, his on-call allowance isn't measly in comparison to many of his hospital colleagues'.

Still, at an extra U.S. $40 a month it's not even enough to buy a sack of rice in Zwedru. He told me: "I practise medicine because of my people. Yes, you need money to live, but a life comes first."

With Mr. Desuah and the new surgeon in the emergency room, the Caesarean goes well. Around an hour later, we find out mother and baby are fine.

By now it's 1:30 a.m.. The whole episode has taken just an hour and a half but we're wrung out. I watch as Penny trundles sleepily, but satisfied, back to bed, radio as ever in hand.

My mind turns to Dr. Amagashie and Mr. Desuah; they must be exhausted yet this is their life, day in, day out.

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