Monday, December 15, 2014

Saving babies’ lives in remote Cambodia

By Anne-Sophie Galli

© UNICEF Cambodia/2014/Anne-Sophie Galli
“Giving birth is like crossing a river.” Many Cambodians consider giving birth the most dangerous moment in a woman’s life
KRATIE, Cambodia, 25 December 2014 – It was the middle of the night when Ol Sary Sol felt strong contractions. All preparations had been made, so with her husband, mother and uncle, they rushed onto their motorbike and into the darkness heading for the health centre in the next town, more than an hour away. Twenty-four year old Ol Sary Sol was afraid that she might give birth too soon – in the dense forest or on the dusty road where she could get bitten by a snake. But then the pain took over. The next thing she remembers is a midwife holding up her newborn son. “So we made it!” said Ol Sary Sol.

Ol Sary Sol was fortunate to reach the health centre in time. Cambodia has one of the highest mortality rates of expectant mothers and babies in Southeast Asia. Although the country has reached the Millennium Development Goal of reducing the number of women who die in childbirth or pregnancy by 75 per cent and over 70 per cent of Cambodian women deliver in a health centre or hospital, many women living in remote areas still give birth to their babies at home, in a rice field or somewhere in between. Expectant mothers and babies in hard-to-reach areas risk death due to unsafe deliveries and poor post-natal hygiene and care. During delivery these women are often supported only by a traditional birth attendant, usually an older woman who learnt her trade from a relative or friend. With unwashed hands, these birth attendants push the woman’s abdomen, pull the baby’s head and stretch the vulva by hand. Then, they cut the baby’s umbilical cord with an unsterilized knife or a piece of bamboo, and to treat the wound they put ash, cow dung or spider’s web on the exposed part of the umbilical cord.

© UNICEF Cambodia/2014/Anne-Sophie Galli
Ol Sary Sol and her older son comfort the younger son who just received his tetanus vaccine.

© UNICEF Cambodia/2014/Anne-Sophie Galli
After driving through the darkness for an hour, here is where Ol Sary Sol gave birth to her second son.

There is a Khmer proverb that says, “Giving birth is like crossing a river.” Delivery is considered the most dangerous moment in a woman’s life. To give more women in remote areas a safe passage to the other shore, UNICEF with funding from the German Committee for UNICEF is financing outreach teams in each health centre. These teams visit every remote village at least four times a year to educate women about the importance of a clean delivery with a skilled midwife. Nearly half of all newborn and maternal deaths occur in the first 48 hours of childbirth. Two thirds of them can be prevented if babies receive 24 hour care from a trained health worker using sterilized equipment, their umbilical cords are clamped and cut at the appropriate time; they are kept warm, dry and clean; they receive the required vaccines, and are immediately breastfed.

It was an outreach team, consisting of a midwife and a nurse, which convinced Ol Sary Sol to deliver her second baby in the health centre. They encouraged her to make arrangements to have transport ready as soon as the labour began. Outreach teams also provide antenatal care to pregnant women to ensure that both mother and child are healthy. This includes free tetanus vaccination because tetanus is one of the main causes of death among newborns and new mothers in remote areas with poor maternal hygiene. Tetanus is transmitted via bacteria and it painfully tightens muscles all over the body. Once infected, most people die, even if modern intensive care is available. If a mother is vaccinated, however, she and her baby are almost fully protected against tetanus.

© UNICEF Cambodia/2014/Anne-Sophie Galli
Outreach teams provide free ante-natal care to pregnant women in villages like Ol Sary Sol’s above that are more an hour away from a health centre.

© UNICEF Cambodia/2014/Anne-Sophie Galli
An outreach team midwife exams a pregnant woman in a living room in a remote village.
El Rany, 50, is a mother who has experienced the devastating consequences of tetanus. After delivering six healthy girls with a traditional birth attendant at home, her first son contracted tetanus after being born on a dirty floor. On the eighth day of his life, he could not swallow when El Rany tried to breastfeed him. This is an effect of tetanus: lock jaw. For the first time in her life, El Rany went to the hospital, two hours away from her home by motorbike and ferry, on a small island in the Mekong River. “Your son has tetanus”, the doctor said in the emergency room. “It’s too late.” Her baby died the same day.

For the birth of her youngest child, El Rany was encouraged by a village health support volunteer to deliver at a health centre. Since 2013, UNICEF, with funding from the Korean International Cooperation Agency, has supported training for one or two people in each village to educate their community about the importance of safe deliveries in health centres or hospitals and ante- and post-natal care. These village health support volunteers complement the work of the outreach teams and health facilities.

El Rany had a safe delivery however, not a day passes when she does not think of her firstborn who died of the disease. It is the reason why she is making sure that her eldest daughter, 24 year old Kry Srey Noch, who is eight months pregnant, also gets her tetanus vaccines and goes to health centre regularly for antenatal check-ups.

© UNICEF Cambodia/2014/Anne-Sophie Galli
El Rany (right) with her pregnant daughter Kry Srey Noch (left) and her youngest child, who had a clean and safe delivery at a health centre.

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