Less than 24 hours after giving birth, Christina Paulus is lying on the floor of a busy corridor in Papua New Guinea's main hospital.
Nurses hurry around with charts.
A cleaner wheels a mop bucket past her head.
Beside her on the linoleum floor, another woman's baby starts to cry.
As she rolls over to settle her newborn, Christina winces in pain.
She lost more than a litre of blood during the birth.
"The wounds are there. So when I'm sitting on the floor, it's uncomfortable," she says.
Around her, dozens of women and their babies are in the same predicament — sprawled on the floor in hallways and cramped in front of a reception desk.
Blocked sinks, broken walls and toilets that don't work properly
It's a scene that obstetrician Glen Mola is confronted with every morning when he walks into the maternity ward at the Port Moresby General Hospital (PMGH), where he's worked since 1987.
The once-charming wooden building — known fondly as the Susu Mamas clinic — was erected in 1958, when Papua New Guinea was under Australian colonial rule.
"It's all PNG hardwood. It will never collapse," Dr Mola says, tapping the scuffed timber beneath his feet.
But he says the facility is in a state of severe neglect due to a lack of investment by hospital management.
"The walls are broken. The toilets are not working well. Some of the sinks are blocked. Lights are not working, taps don't work," Dr Mola says.
"There's no soap in the soap dispensers, no paper towels, so we dry our hands on our trousers. We need to do better.
"We're losing the ability to cope."
A key part of the problem is PNG's rapidly expanding population.
"The facilities we have here are sufficient for about 10,000 women a year. And we exceeded 10,000 back in the 90s," Dr Mola says.
While the country hasn't held a reliable census in more than 24 years, estimates put the total population between 12 and 17 million.
It's clear that the capital, Port Moresby, is growing faster than many services can keep up with — Dr Mola's maternity ward included.
"People move into this city. I would say more than 1,000 a day, possibly," he estimates.
Thousands of women treated on hospital floor
Frustrated with the conditions, Dr Mola and his team began documenting the state of care in the maternity ward last year.
In 2024, they found more than 7,000 women — about one in four — who visited the hospital to give birth received at least some of their care on the floor.
"Not being able to provide a bed for medical care is not just challenging from an ethical, social point. It's undignified, it's almost against rights, actually," Dr Mola says.
It also makes the work nearly impossible for staff.
"There's no way a midwife can sit down or kneel down on the floor beside you when there's blood and urine and [amniotic fluid] and faeces," he says.
"Having a baby is a bit of a messy procedure — we need a bed with proper sort of hygiene and asepsis."
Over the Easter long weekend, two women and two babies died, at least partly because of insufficient capacity, according to Dr Mola.
He explains that a relaxed, comfortable environment is crucial for promoting positive birth outcomes.
"Birthing women require quietness, calmness, an ambience that makes them confident and feel as though everything's OK and they're being looked after," he says.
"Anxiety and fear are very anti-having-the-baby. If you have a lot of anxiety and fear, then women don't birth well."
Maternity ward upgrade ditched for hotel
As Dr Mola nears the end of his career, he is disappointed to see how things have gone downhill.
He's adamant it shouldn't be this way — and if everything had gone according to plan, he believes the clinic would be in a much better state today.
In 2022, the Japanese government committed $37 million in grant funding to revamp the Susu Mama wing with a new perinatal clinic that included more beds, a specialist ICU and laboratory.
After more than 10 months of consultation with midwives, doctors, the Japanese embassy and developers, a comprehensive plan was presented to the hospital board.
But it was rejected because, according to Dr Mola, management believed it "did not fit with their vision for the future development of PMGH".
"The CEO looked at our plan and saw that it was going to be on this site and not on the site that he wants … so he can use this site for the hotel and shopping precinct," Dr Mola says.
He says the hospital's alternative plan is to build a new maternity wing in an eight-storey tower at a different site — which he argues is impractical.
Hospital management wants to upgrade smaller hospital
PMGH chief executive Dr Paki Molumi declined to answer questions posed by the ABC.
In a statement, National Capital District governor Powes Parkop said the Japanese grant was not refused, but PMGH management believed the money should go towards upgrading a smaller hospital on the city's outskirts.
"With more available land and growing infrastructure, [it] is ideally positioned to handle primary maternity and child health services for the city's rapidly growing population," Mr Parkop said.
He explained it was part of a larger plan to transition PMGH to a "level 6" hospital that will focus solely on specialised referrals and teaching, rather than serving direct admissions like maternity and child health cases.
In the longer-term, the provincial health authority wants to bolster smaller hospitals around the city to deal with primary care.
But Dr Mola says the maternity ward needs urgent relief.
PNG's Prime Minister James Marape has, in principle, thrown his weight behind the call.
Mr Marape summoned Health Minister Elias Kapavore to discuss issues at the hospital on Friday — a meeting Dr Mola described as "very positive", with the PM pledging funding or the cause.
"There is a need right away. We need to attend to it. So, we will attend to the immediate need as well as the long-term need," Mr Marape told ABC.
And with the average woman in PNG having at least four children in her life, Dr Mola, and the women he cares for, are depending on that promise being fulfilled.
