Thursday, February 26, 2015

Impressions of the field: visiting UNICEF supported maternal health programs in Mondulkiri

By Jemma Somervail and Bunly Meas. 

Travelling here can be tough, dust makes our windscreen dirty and large holes in the road mean driving can be slow. We only travel one hour from the provincial capital of Mondulkiri, Sen Monorom but it feels very isolated.
© UNICEF Cambodia/2015/Bunly Meas
MONDULKIRI, Cambodia, 26 February 2015 - Driving through the dusty roads in north-eastern Cambodia, you’ll find the province of Mondulkiri. Although it’s only 380 kilometres from the capital Phnom Penh, it takes us seven hours to get there by car, and I am told the road is much better than it used to be. We are here to visit UNICEF-supported maternal health centres and outreach programs in remote parts of the province. Residents living in villages within Mondulkiri rely on the 11 health care clinics that are located throughout the province. For many, if these centres did not exist, the alternative would be travelling up to one hour or sometimes longer to the provincial hospital.

We start our day by heading out to Poutert village in Bousra commune about 33 kilometers (one hour drive) from the provincial capital, Sen Monorom. Recent data shows that many women are receiving care from the commune’s health clinic. In 2014, 68 per cent of mothers received antenatal care, 52 per cent of women delivered their babies in a health centre and 30 per cent received postpartum care (Source: Health Information System {HIS} 2014).

We had to change our route while travelling to the village as our driver decided the water flowing across this road was too deep to drive through. For people living in the community, this is a challenge they often face.
© UNICEF Cambodia/2015/Bunly Meas
Upon arriving, the village chief takes us to meet 30 year old Chrav Ngav who gave birth at home to her fourth child, a few weeks ago. “It was dark and I was in pain so my husband and I decided to stay at home and get support from our elderly relatives,” she said. It went well, however, it was not her plan. She had regular maternal health checks and vaccinations from the health care centre and planned to deliver her baby there.

Chrav Ngav and her young baby rest on a wooden bed, with hot coals burning underneath her. The ‘roasting’ of hot coals is a traditional practice performed after women have given birth. It is said to warm their veins, which have cooled during labour.
© UNICEF Cambodia/2015/Bunly Meas
At the same commune meet a young couple who were recently married and expecting their first child in two months. While preparing for the birth 24 year old Sro Non and 19 year old Chheap Phot asked members of their community for advice. Their parents told them to take traditional herbs, however the village chief, who is also a health volunteer, persuaded them to go to a health centre. “I took my wife to see health workers three times, and she was given tablets and vaccinations; I am happy that she is healthy; we will go there again for the delivery,” said Non.

Sro Non (left) and Chheap Phot (right) are farmers living in Poutert village, Bousra Commune, Mondulkiri province. Like many of the residents here, they are from the ethnic minority Phnong.  
© UNICEF Cambodia/2015/Bunly Meas
Many women in these isolated villages are cautious of delivering their baby in a health clinic. Some prefer to follow traditional practices and therefore do not understand the role of midwives, while many also feel shy and uncomfortable receiving support during delivery from people they do not know.  Previously, the common practice was to give birth at home with a traditional birth attendant (usually a woman from the community who the mother knows). However, traditional birth attendants use practices which can put the mother and baby in danger. This is why UNICEF-supported village health volunteers provide outreach antenatal care services to explain to expectant women why they should give birth at a health centre with skilled midwives to supervise clean and safe deliveries.

Health volunteer, Trout Veth (centre with book) talks with new mothers in Pou Treng Village, Dak Dam commune. The volunteers are trained in Community Care for Mother and Newborns. Through this type of education, many women will decide to give birth in the health care clinic with a midwife. 
© UNICEF Cambodia/2015/Bunly Meas
It’s these traditional beliefs which health workers and volunteers are attempting to change. In Pou Treng village, Dak Dam commune, we met with women who are a trained as village health volunteers (through a UNICEF-supported programme). One of them was Trout Veth whose role is to talk with local women in the village (all from the ethnic Pnorng community) and explain the benefits of antenatal care, the importance of delivering at the health care centre with a midwife, and how to care for their babies after the birth. She says it can be a challenge to try and convince her indigenous community to change traditional harmful behaviours. For example, putting ash and dirt on the umbilical cord when the baby is born, is still practiced here. But the custom puts babies at risk of death from tetanus which is transmitted via bacteria. Mrs Veth makes an effort to conduct antenatal meetings every three months for the women that she is unable to visit at their homes. “It does not need to be a proper gathering, I talk to them at a village well, wedding receptions, religious ceremonies, or at shops… I just want to help,” she said.

Web Phally (30) is one of the mothers who attends the village health meetings. 
© UNICEF Cambodia/2015/Bunly Meas
Web Phally is expecting her fourth child next month and therefore regularly participates in village health meetings. Ten years ago, six months into a pregnancy, she lost her baby. During that time she was not having regular health checks, but now she knows to make sure to always get advice from health care workers. “I take iron tablets, I get my belly checked, and I have prepared transportation and clothes for the delivery,” she said.

This field trip to Mondulkiri showed me how important it is to work with communities at a grass roots level, in order to achieve a common goal. I saw how UNICEF field officers took into consideration the particular village’s religious, cultural and environmental needs, never resorting to a ‘one size fits all approach.’ Women in the community were generally very open to changing their habits on maternal health, as they were being educated by other women from their community who they knew and trusted.  Although these villages are isolated, I saw how UNICEF’s equity focus means that no-one is forgotten in its efforts to improve maternal and newborn health, not even the hardest-to reach.

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