The Incredible Challenge of Counting Every Birth and Death Worldwide

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The roads surrounding the Jerusalén-San Luis Alto Picudito Indigenous Reserve in Putumayo, Colombia , are treacherous on a good day. Made mostly of gravel and mud, they shrink to barely the width of a small truck in some places, and in others, especially after a storm, they give way almost completely to the many rivers with which they intersect. They also twist, turn and bump non-stop. So, in the most difficult months of her pregnancy, when everything tasted like cardboard and it hurt even to sit or stand, Marleny Mesa completely avoided traveling. This meant skipping exams at the Villagarzón clinic, which could take two or more hours to get there. But Marleny wasn't too worried. A nurse assured her early in her pregnancy that her blood tests were good and everything was fine. As a midwife herself, Marleny knew making the trip would be riskier than missing a few doctor visits.

But now, in the last days of her pregnancy, she could no longer shake the feeling that something was wrong. She could barely breathe, for one thing. On the other hand, his anxiety and physical discomfort were approaching what seemed like an unbearable peak. Her husband, Andrés Noscue, called an ambulance. Hours passed and no one came. He had tried to find a car to take her to the hospital. He had also summoned Marleny's sister, Omaira, a prophet from their church, to come and pray on her womb. That seemed to do the trick. Marleny's breathing stabilized and about a week later she delivered a wriggling baby boy with jet black hair and soft, inquisitive eyes. The couple named him Eliad.

Marleny thought he was perfect, but his mother, a retired midwife, insisted the placenta contained a hint of cloudiness. He was way too big, she said, and Eliad was too small, probably because he didn't have enough room in his stomach to grow. His grandmother thought he might need an incubator. Marleny thought he was fine, but when the baby was a few days old, she and Andrés took him to Villagarzón for a checkup, just to be sure.

That turned out to be more difficult than they expected. The baby could not be seen in the hospital until he had an ID or civil registration number, which he could not obtain without a birth certificate, which the hospital could not provide as the baby was born at home. Go to the registrar's office, the nurses told Marleny and Andrés. But the registrar's office only sent Andrés back to the hospital, where another nurse told them to try the notary's office instead. It was then almost noon. The only bus for the day would soon be returning to San Luis; if Andrés and his family missed it, they would have to shell out more money for room and board in town than they normally spend in a week. So they went home.

The couple returned a few days later, but the registrar's instructions were different and more complicated this time. They would need two witnesses from their reserve, he said, and several documents – including one with the baby's blood type and another showing the medical care Marleny received during her pregnancy – in order to prove that he was born within the borders of the country and that he was, in fact, their child. The man seemed suspicious, Andrés said, and asked many questions he didn't ask the first time. “There was nothing we could do,” Andrés told me one sweltering July afternoon as we sat in the shade of his family's covered wooden porch. "They didn't believe the child was ours, so we went home." The couple planned to return to Villagarzón as soon as they could spend the night, so that they could settle everything once and for all. But before they had the chance, Eliad developed a terrifying rash - with blisters on his head and face - and began to gasp for bre

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