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The smooth process of referring women and newborns from the rural and semi-urban areas for further treatment at other health facilities is hampered by the challenges associated with the healthcare delivery system in those areas. As a result, many patients do not get the care they need in a timely way. The Gomoa West District in the Central Region has had its fair share of challenges with maternal and newborn health care and below are experiences shared by frontline health workers from its sub-districts about referral. Madam Juliana Duker (a.k.a. Auntie Julie), a midwife at Gomoa Oguaa Health Centre, described an incident that took place in her facility and how she was able to save the situation. According to her, Esi Brago, a 17-year-old girl who was pregnant, visited the Gomoa Oguaa Health Centre for antenatal care, and she was advised to go to a higher-level health facility when she reached full term because her laboratory investigations showed low haemoglobin and her sickling was positive. Referral Because the midwife could not determine her genotype, she referred her to St Luke�s Hospital, the district hospital in Apam. In addition, her young age, as well as her small stature and pelvis, required that she should be referred to a higher facility. Unfortunately, Esi did not heed the advice and stayed at home until she was due for delivery. One evening, Auntie Julie was at the health centre when Esi was rushed in by her mother. On her arrival, she was bleeding; her condition was so critical that Auntie Julie decided to refer her to St Luke�s Hospital. �While I was completing her referral form, I was also preparing for delivery in case she started pushing,� Auntie Julie explained. �In no time, the baby started coming � just after, she started bleeding copiously. Oh God, obviously the girl was dying! I needed to act fast to save her life.� Ambulance service Gomoa West District had no ambulance service then. Considering Esi�s acute condition, Auntie Julie realised she might die on the way to the district hospital if she were transported in a taxi. She therefore set up three drips on Esi�s two arms and leg for quick transfusion with 10 ampule oxytocin and IV fluids. She also pressed her abdomen to aid uterus contraction. �I stood for about one and a half hours administering the drips with both hands,� Auntie Julie recalled. �I asked the security man at the facility to help squeeze the drip to enable effective administration. I had to do this because the girl was dying. In fact, she was almost gone. The mother who was observing us also collapsed. �When Esi�s condition started improving, I had to run home barefooted to bring mother and daughter some beverage because there was nobody at home. I turned my attention to the baby when Esi�s condition stabilised. The baby was bleeding from the umbilical cord and I had to put pressure on the cord with a bandage until the bleeding ceased. Through Auntie Julie�s quick intervention, Esi survived and her son�s life was saved. Another incident Another incident that happened involved Lydia Edzii, a community health nurse at Osedze Health Centre at Osedze, another sub-district in Gomoa West District. A woman came to the health centre complaining that she had fibroid; allegedly as a result of practising family planning. The nurse referred her to St Luke�s Catholic Hospital in Apam. Again, the patient did not comply, but came back at a later date complaining about abdominal pains. The nurse gave her paracetamol and advised her to go to a higher-level facility if the pain worsened; as it turned out, the woman was pregnant. She was finally sent to the district hospital and there she gave birth to a baby girl. In some instances, patients were sent to the district hospital in taxis in order to receive the urgent needed care. Challenges These stories highlight some of the challenges with the referral process in some districts. Although the health centres did refer the women to the hospital, there were no proper structures in place to ensure that the patients reported to the required destination/hospital. Lack of transportation, lack of money, poor attitude of some health workers towards their colleagues who accompany referred patients to the hospital, fear of surgery and death, poor road and telephone networks, and lack of access to ambulance are some of the contributing factors that hinder or delay the referral process. It is worth mentioning that the district director of health service and his team are working tirelessly to improve early referral in the Gomoa West District of the Central Region. The Ghana Health Service, the National Ambulance Service and other stakeholders are also working assiduously to improve referral processes in the entire country. It is therefore necessary to support the efforts of these frontliners by building their capacity and also enhance access to better quality care to save our mothers and their newborns from dying.