I spent a significant amount of time working at the ‘foundation’. This is a hospital funded mostly by a wealthy family that owns home appliance stores. People pay minimal fees (3-12 dollars for an ER visit) to receive care. The hospital has a well respected neonatal intensive care unit as well at both inpatient and outpatient services for women and children. One case in particular stuck with me. A woman came in after a failed home delivery. She had delivered her first 6 children at home but subsequently lost 2 of them to respiratory illness within the first 2 months of life. She had been laboring since the day before and kept saying, ‘I can’t, I can’t’. She knew something was wrong and that this did not feel like her other deliveries. We immediately took her to the back OR where women delivered. While the patients labored in shared rooms and walked the halls with their husbands and families, for deliveries they were wheeled back to the OR where they were placed in stirrups and usually received episiotomies (a procedure no longer routinely practiced in developed nations). This patient kept begging for her husband and went so far as to crawl off the table and walk toward the door with her IV in tow. Someone finally went to get him and dress him in the surgical garb required in this area. Almost immediately she calmed down and started following the doctors instructions. They had her stand next to the operating table and try to deliver in this more traditional position, without success. Eventually she was taken to surgery where a baby was born. He subsequently spent weeks in the NICU until he was released to his family. The fact that this child and his mother were able to survive certainly makes this a success story. However, I learned many lessons for my future practice. For example, patients are better able to work with the medical staff if they feel safe. It can be inconvenient to have family around, but their presence can add a calm that makes medical efforts much more effective. Also, patients often tell us what they need. This patient had delivered many babies by herself and in retrospect, it was very unlikely that she would deliver simply because of a change in venue. Perhaps we should have immediately taken her to c-section. One thing that caused the doctors to delay this decision was that the patient is charged more money for surgery and this can be a large burden. However, the NICU is also expensive and perhaps the baby would have been in better health when born if the surgery had not been delayed.