Carol Perks does not believe in miracles. If you want to stop babies becoming sick and dying in remote villages in poverty-stricken Laos, you put your faith in science and pragmatism, not superstition. You set up a primary health-care program. You teach the village midwives to do away with traditional birthing methods: no more cutting the umbilical cord with the first sharp implement to hand; no more stoppering the wound with mud from a wasps' nest in the belief that it will stop the wind blowing into the child's stomach. No, you use a Perks-designed birth kit, which contains a sterile razor blade, soap, a scrubbing brush, cotton wool and a clean strip of fabric to tie off the cord.
Ideally, you take the expectant mother to a clinic or district hospital that Perks, a 64-year-old nurse from Frankston, Melbourne, has helped establish over the past 21 years. But if there's neither time nor transport, the birth kit should keep mother and baby alive long enough to benefit from the next stage in Perks's health program: the teaching of proper breastfeeding habits and immunisation of the infant.
In 1991, having just finished a degree in maternal and childhood health and infectious diseases, the qualified nurse took a job working in Communist-controlled Laos for Save the Children. She couldn't speak a word of Lao, didn't know a soul on arrival and discovered a health crisis that threatened to overwhelm her.
"In Melbourne, if you could do my sort of work you got a job and that was that. It was taken for granted there would be people with these skills," says Perks. "But here it was a very different matter."
Her 10 years of nursing in Melbourne's public hospitals kicked in. She mapped out her priorities: preventing postnatal tetanus caused by unhygienic birthing procedures, and controlling the spread of malaria.
For people here, their education standard was so poor they thought contraception amounted to eating elephant placenta
Based in a little room at the shabby hospital in the town of Sayaboury, the province's capital, she devised a system of health care that saved hundreds of lives in the first two years of operation. Wherever the Perks system has been applied across the province, thousands more have been spared premature death.
"It couldn't have been worse when I first arrived," says Perks. "For people here, their education standard was so poor they thought contraception amounted to the eating of elephant placenta. When things are so low, the only way is up.
"Most of the local population are subsistence farmers, growing corn or rice. There's chronic stunting here because they don't eat enough fruit and vegetables. A bowl of rice can be a whole meal. They eat raw blood and leaves."
In 1991, 19 per cent of patients at Sayaboury Hospital had malaria. After Perks encouraged locals to sleep covered by nets infused with insecticide, the rate dropped to 12 per cent within five years. Now it's virtually zero.
"I intended coming here for two years but, by the time two years was up, we were starting to get good results. It's a powerful thing to save people's lives. You feel needed," she says.
And that's as emotional as Perks gets.
Built in the 1960s with US aid money, Sayaboury Hospital was starved of resources - and medications - when Perks arrived. Without overseas aid, health care would be virtually non-existent.
Perks set up a child and maternal health-care centre under the Sayaboury Hospital verandah. By night she lived in a house provided by the Lao government where rats ate the stitching from her shoes and picked at the stuffing in her mattress. She took in a cat, Molly.
The town's generator provided only three hours of electricity a day. "You had to rush around doing the washing, cleaning, the ironing," she says. "There were no phones to communicate and co-ordinate things."
Initially, only a few people a day showed up at Perks's verandah clinic, but she wasn't deterred: she trained nursing staff in preparation for when the number grew. She traipsed to the furthest reaches of the province to talk about modern health practices, enduring seven-hour boat trips on the Mekong in small, leaky vessels to visit the remotest villages.
Now 50 mothers a day come to Perks's verandah clinic to sit in rows of plastic chairs, babies in their laps, waiting for vaccinations for polio, measles, whooping cough and diptheria. They travel hours for treatment.
"That has been the great thing about being here," says Perks. "The people want to change and improve their lives. They really embrace it."
In Australia, the infant mortality rate - children who die under one year old - is 4.1 for every 1000 babies born. In Laos, the World Health Organization claims the national average is 59 per 1000. Save the Children puts the figure much higher at 70 per 1000, and 94 per 1000 for children under five.
In the 11 districts of Sayaboury, where the Perks program has been implemented, the infant mortality rate has fallen to 11 per 1000, and for children under five, 18.5 per 1000.
The United Nations puts per capita income in Laos at $US883. Perks reckons it is much less than that in remote areas. "Some people don't have any income at all," she says. "Just what they can grow in a field."
Some are so poor, so desperate, they have asked her to adopt their sick babies because they can't afford the hospital fees and medicine. In these cases, Perks pays the fees herself. "There are very few babies that are not wanted in Laos," she says.
Perks has overseen construction of seven permanent clinics in outlying parts of the district, as well as mobile clinics for remote areas. Places like Ban Namphone, 150 kilometres south-west of Luang Prabang, where, in a long hut without walls, 200 people, mostly mothers and children, take off their mud-caked shoes, bow to the nurses and watch a video promoting breastfeeding. Children are given vitamin A pills and de-worming medication.
All women aged between 15 and 45 - child-bearing age - are given tetanus shots. If they want it, the UN provides free contraception by injection, and condoms are provided free to prevent STDs.
Without these mobile clinics, many communities would receive no health care at all. In 41 of the remotest and poorest villages, Perks, in partnership with the Lao Department of Health, is arranging for the installation of water-supply systems and toilet blocks with septic tanks.
Perks would prefer permanent clinics over mobile ones, places like the new four-room clinic in the village of Phongesaart, 50 kilometres south of Sayaboury town, that each year will treat an estimated 11,750 people from the 11 local villages. Staffed Monday to Friday by a full-time medical assistant, it was built and fitted out with $55,000 raised from a "dollar a day" scheme created by Sydney marketing specialist Sophie Bartho called 1$day. The idea is that people in wealthy countries such as Australia take the loose change they usually forget about and make a charitable donation with it. Says Perks, "If I had another $55,000, I could build another of these clinics in another village. And do it in five months using contractors from Sayaboury."
For $300,000, she could build a hospital and maternal and child health centre in another village, where a rundown, rented five-room house serves 55,000 people in a 3000-square-kilometre area. It's not a hospital in the Western sense, and no surgeon is available.
Trouble is, the Perks model is struggling to survive because of lack of money. The global financial crisis has depleted the charitable instincts of wealthy Westerners. Even her headquarters, Sayaboury Hospital, needs another $80,000 to fix its leaking roof. The toilets don't work. It can't afford bedding, or food.
People suffering from scrub typhus, a deadly disease transmitted by mites, sleep on beds without mattress. They lie on dirty wooden slats, their intravenous drips suspended on old broomstick handles. On average, eight babies are born every day, but there's only one incubator for premature births.
If funding doesn't improve, Lao law and the country's strict visa conditions may force Perks to leave. The authorities won't allow her or Save the Children to remain if it can't fund its operations. By the end of the year she might find herself back in Melbourne, where she doesn't want to be. She can't envisage adapting to suburban life again and predicts she'd quickly accumulate a house full of cats.
Perks feels more at home in Laos than she does in Australia now. It is where she feels needed. "I suppose it's become home to me," she says. "Here's where I can best be of use, rather than be a mad cat lady."
The writer and photographer travelled to Laos with the assistance of Save the Children Australia.
To learn more about Save the Children, and to donate, visit savethechildren.org.au.
This article first appeared in Good Weekend.