I sat weary and alone at my desk – another endless morning at the outpatient clinic at a small mission hospital in Kerala, south India.

As the only doctor at the hospital in the back of beyond in 1980, juggling clinical work and administration, I longed for the comfort of an uninterrupted night’s sleep. The water we drank came from a nearby river and had to sediment for a day before we could see our hands in it. Insects, half-a-foot long, snakes on the living room rafters, filaments glowing eerily in incandescent bulbs – it was like walking backwards into history.

The door opened and she stepped in.

She was small, but very pregnant. She was dressed in the traditional white cotton blouse and mundu, a garment wrapped around her waist like a sarong and falling to just below her knees. Her feet were crusted with mud. In the crook of her arm, she held a cloth bundle.

I greeted her tiredly and asked her to sit down. She preferred to stand, wiping the sweat from her brow with the end of a towel she had over her shoulder.

Softly she said, “I want to have my baby in the hospital and then have the operation.”

She was obviously a tribal woman and I was surprised that she had come all the way from her village with such a precise goal. The surrounding terrain was unfriendly, heavily forested mountain slopes and rivers overflowed their banks with every monsoon. Elephants, wild boar, deer and an astonishing variety of snakes populated the forests. Her determination to plan her family and provide the best future for her children had brought her to our hospital.

I told her that we would do all we could to help and called out to the nurse to admit her into the antenatal ward.

An hour later, she was brought into the labour room for examination. She was at term and having mild contractions. The baby was normally positioned and in good health. I reassured her and told her she would probably progress fairly quickly and we would keep close watch on her condition.

She had been more communicative with the nurse than she had been with me. Her name was Chakki. She was 32 years old, married and had two children, both born at home, the last two years earlier. She had never had antenatal care but both babies had done well.

She had walked from her village, which was many miles away.

A little after one, an agitated nurse rushed into my room and exclaimed, “Doctor, Chakki has locked herself in the labour room and is refusing to open the door.”

We sped to the labour room.

I shouted through the door, “Chakki, open the door please, we are here to help you.”

She called back, “Don’t worry, doctor I am fine.”

We studied the door; it would require serious manpower and equipment to break it down. There was a window to the outside but the hastily summoned watchman could not reach it.

Nothing in my training had prepared me for this.

I pleaded, threatened, begged, prayed to no avail.

Suddenly, there was the wail of a newborn baby. We gasped in relief, but then the old lectures kicked in – adherent placenta, post-partum haemorrhage, perinatal asphyxia ...

I resumed my one-sided conversation with her but received only silence in return.

An hour later, she opened the door.

The baby lay in her arms. She was fully clothed. The room was spotless.

“It’s a girl,” she said proudly.

Three days later, I tied her tubes.

A week after the baby was born, she stood in my office again. Now she had a bundle in the crook of each arm.

She bent at the waist, smiled the most beautiful smile I have ever seen and said: “I thank you.”

Moments later, she was gone.

That incident was a re-evaluation of all that I had learnt in the posh state-of-the-art medical school where I had trained. Doctors had all the knowledge, the power, the skill we were taught; we always knew what was best for our patients.

And yet, Chakki didn’t do too badly.

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