Tuesday, October 25, 2016

Children and Mothers in Hard-to-Reach Communities Receive Essential Care

By Navy Kieng

The health centre midwife Chhim Ren provides antenatal care to Min Phath at Tmat Peoy village community centre 
©UNICEF Cambodia/2016/Kieng 

Min Phath, 27, is six months pregnant with her second child. She’s lying down on a colourful mattress under the thatched roof of Tmat Peoy’s community centre in Preah Vihear Province, northern Cambodia. A trained health midwife from the Takoeung Health Center gently examines her belly. Though this is Phath’s second pregnancy, this the first antenatal check up she’s ever had. The World Health Organization recommends a minimum of four antenatal care appointments to protect both the mother and child.

But this type of care has simply been out of Phath’s reach.

“Because of poverty, I have to work every day and have no time to go to the health centre,” she says. “It is too far.”

Takoeung Health Centre is 17 kilometers away. This might not seem like much, but in Preah Vihear Province, where Tmat Peoy is located, this distance could take an hour: women like Phath would need to walk to the main road and wait for a shared taxi or motorbike taxi to navigate the dirt roads and rugged terrain.

During the rainy season, travel time to the health centre is even longer. Another issue is cost: the journey would cost about 15,000 riels (US$3.75), a steep sum for a family like Phath’s.

Still, this is a vast improvement: until the Takoeung Health Centre was built last year and roads were improved, the nearest health centre was 40 kilometers away and the ride even rougher.

That’s why today’s visit by Takoeung Health Centre’s mobile health outreach team is so important. The Provincial Health Department, with support from UNICEF, has been sending teams like these to remote communities at least once a quarter for the last five years, providing key health prevention services including education about safe pregnancy and the importance of vaccination, along with direct services like immunization for children and women, antenatal and postnatal care, and vitamin A, de-worming and iron folate tablets.

The mobile health care team talks to villagers about the importance of health care for 
themselves and their children, including services like vaccines 
©UNICEF Cambodia/2016/Kieng

But the cost to care for all of Cambodia’s remote villages is great. To ensure as many mothers, newborns and young children get the care they need, UNICEF supports mobile teams in 10 villages, providing 6,078 people including 188 pregnant women and 605 children younger than 5 (of them117 babies under 12 months), with essential supplies such as vaccines and vaccine storage materials. UNICEF support also covers the outreach team’s travel costs.

Back in Tmat Peoy, outreach staff have set up their work stations and the space is hustling and bustling with the large crowd of children and adults. The team has divided the centre into small sections, each offering a different service. Health staff do their best to check each person’s registration card and identify those who aren’t present, so they too can be located and treated. 

Like in many rural Cambodian villages, Tmap Peoy’s population is scattered, so in addition to offering services at the community centre, health staff travel house to house to reach community members who haven’t made it to health centre.

Before immunizing pregnant women and infants younger than 1, the health staff conducts an education session. It focuses on the vaccine schedule for children and women, the benefits of antenatal care, danger signs during and post pregnancy, and proper nutrition for expecting mothers and children.

“If the health staff wasn’t here, I would have had no antenatal care like during my first pregnancy,” Phath says. “The health staff informed me that it is safer to give birth at a health facility with skilled midwives, so now I’m trying to save some money to do that.” Her first child was delivered at home with a traditional birth attendant, putting herself and her baby at risk of infection or worse.

Tmat Peoy is home to about 338 families, with a population of 1,282 people. Of those, 121 are younger than 5, including 24 under a year old. Most villagers eke out a daily existence conducting agricultural activities; during the annual rice harvest, many families spend as long as two months in the fields, meaning mothers, children and pregnant women miss important check ups at the health centre or during the mobile outreach.

Antenatal care and delivery coverage are very low compared to other villages in the health centre’s catchment area: in the first six months of 2016, only five women received prenatal care and just two babies were delivered at the centre. Villagers have low knowledge of the importance of appropriate care due to Tmat Peoy’s remote location, low access to mass media (TV/radio) and low education levels.


Rim Soary waits with her 15-day-old infant to receive postnatal care and vaccines
©UNICEF Cambodia/2016/Kieng

UNICEF and the Provincial Health Department hope their outreach work, by educating the community and building trust and confidence in the health centre over time, will reduce the village’s morbidity and mortality rate among women and children.

Rim Soary, 28, holds her second baby, who is 15 days old, on her lap. She delivered the child at the health centre but received no prenatal care. She says, “My first child was delivered at home, no antenatal care, no vaccinations for either of us. I work in the farm and forest, away from the village, and often take my children with me. Thus, we always missed the chance of health outreach services such as immunization.”

Like many women, Soary could not afford to travel to the health centre for regular health services. And when the outreach team visited, she often missed them.

The health centre staff now has a clear outreach communication plan, informing the village health support group one or two days before their visit, so villagers can plan to stay home for the treatment when possible.

“Today, I’m happy to meet the outreach team to get a second postnatal care treatment and the tetanus vaccine. I did not go to the field to work today, I just stayed at home.”

Nout Noun, 27, has a five-month-old baby boy. She left school after Grade 7. While pregnant, she went to the health centre four times for antenatal care and vaccinations. “At school, the teacher provided some information about nutrition for pregnant women and children. After I got married, I received information from the village health support group and health staff during antenatal care visits about the benefit of prenatal care, nutrition and safe delivery at health facilities. I know the frequency of tetanus toxoid vaccination and the number of vaccines my son needs.”

Nout Noun is helping others in her village learn about the value of appropriate health care 
©UNICEF Cambodia/2016/Kieng 

Noun and her child were vaccinated against tetanus; now, she is trying to motivate the pregnant women in her village to also receive antenatal care and deliver at the health centre for healthier, safer pregnancies and births.

Chhim Ren is a midwife from the Takeoung Health Center who travels village to village providing women and children with care. She has been a midwife for three years. In Tmat Peoy, she describes the challenges of her work: “I really struggle to explain and persuade people to use health services.”

But she keeps doing what she can to help and show women the importance of appropriate health care. And she is starting to see some positive changes. “More people get vaccinations now, including children. More pregnant women travel to the health centre for services. For this village, only 30 per cent of pregnant women received antenatal care, but compared to last year’s percentage, coverage is improving. Things are improving, one woman and baby at a time.”


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