On 2 July 2026, health workers from over 60 countries joined Teach to Reach 15, The Geneva Learning Foundation’s peer learning event, where ten local responses to climate shocks were read aloud, each one a line a health worker had written down after a crisis and its fix. This is the third article in a series of six from that convening, and it stays with one of those ten lines. Where the earlier articles map the pattern and let the room speak, this one reads a single solution closely, from Kolda in southern Senegal, and asks what it reveals about who notices first, what leadership looks like under a flood, and who pays for the call. The next Teach to Reach, number 16, takes place on 6 August 2026.
The floods took the roads first.
In Kolda, in southern Senegal, the tracks that pregnant women used to reach the health centre washed out in the rains, and the appointments stopped happening.
Not slowed.
Stopped.
“The women all missed their appointments,” Malick Ndome reported.
He is a project manager working in Kolda, and his account was one of ten local solutions read aloud at The Geneva Learning Foundation’s Teach to Reach 15 session on 2 July 2026, each one a line a health worker had written down after a climate shock and its fix.
Most of the ten described moving people: boats borrowed from fishermen, motorbikes hired out of pocket, porters carrying patients across flooded bridges.
Ndome’s was the one that gave up on moving people and moved the advice instead.
“We provided telephones to facilitate contact between women in labour and the midwives,” he wrote, “who were able to give useful advice while waiting to receive them at the health centre.”
Read it quickly and it sounds small.
A phone is not a road.
It does not drain a flood or rebuild a track or deliver a breech baby.
What it does is refuse the premise that a washed-out road has to mean a woman labouring alone with no one who knows what she is doing.
The midwife cannot reach her.
She cannot reach the midwife.
So Ndome put a line between them and kept the clinical relationship alive across water that had cut everything else.
What the phone reveals
Three things sit inside that one sentence, and each one answers a question the global climate conversation keeps asking as if it were open.
The first is who notices.
Ndome did not read about missed antenatal appointments in a surveillance report months later.
He watched a cohort of women disappear from his schedule in real time and understood immediately what a missed third-trimester visit means in a place where the road may not come back before the birth does.
That is the earliest reliable signal there is, and it exists only because someone whose job is those women was counting.
The second is what gets done with no budget line for it.
Nobody funded a telemedicine innovation programme in Kolda.
There was no platform, no app, no procurement cycle.
There were phones, midwives, and women who needed them connected, and Ndome connected them.
This is the pattern the Teach to Reach report named as its finding about self-organisation, the seventeen kinds of local action documented across emergency response and resilience.
Ndome’s phones belong to the same family as the pirogues and the community-built clinics.
They are what care looks like when the formal system’s assumptions, chiefly that patients can travel to it, stop holding.
The third is the cost that never appears anywhere.
Somebody bought those phones.
Somebody paid for the airtime that carried a midwife’s voice to a woman in labour.
Ask the report where that money came from and the answer, across account after account, is the workers and communities themselves.
TGLF’s recommendation to record out-of-pocket spending exists precisely for solutions like this one, where the ingenuity is visible and the invoice is invisible.
Why this is leadership, not coping
There is a habit of calling what Ndome did resilience, as though it were a quality of the community, like patience, rather than a set of decisions somebody made.
He made decisions.
He decided that a woman’s safety in childbirth would not depend on the state of a track in the rainy season.
He decided that the useful thing a midwife could offer, when she could not offer her hands, was her judgment down a phone line.
He decided which women to prioritise and how to keep the connection open.
Read against TGLF’s new local leadership framework, those are not the reflexes of a victim adapting.
They are the acts of a practitioner leading: reading the situation before the season turned, acting inside a hard constraint with what was at hand, and holding a relationship with the community that the emergency could not sever.
At the same session, Tina Iroghama Agbonyinma was asked what surprised her about solutions like Ndome’s.
Nothing, she said, because this is what field workers do before the state arrives.
She meant it as fact, and it is one.
It is also the whole problem.
A midwife giving birth instructions down a borrowed phone, because the flood took the road and no one else was coming, should not have to be routine.
That it is routine is the finding.
What Kolda proves is that the knowledge and the will are already on the line.
The question the funders now hold is whether anyone will help pay for the call.