Tuesday, January 24, 2017

Only when villagers understand, they use health services

By Bunly Meas

A small wooden raft is used to cross a stream to reach Koh Chbar village.
©UNICEF Cambodia/2016/Bunly Meas 

Five years ago, newly-graduated midwife Chande Nhek made her first visit to the remote village of Koh Chbar to provide health care services to villagers.

The Sambo Health Centre she operates from is only accessible by journeying down a 20 km bumpy, narrow road and then by raft across a small stream.

It is situated 60 km from Kratie town in the north-eastern region of Cambodia.


Ms. Nhek and her team of five medical staff and health volunteers originally came to the area to provide outreach services.

When they first arrived, only a few villagers came to the centre and there was general indifference to their health care provision.

“I learnt from the villagers that they simply did not know if they needed our services,” Ms. Nhek said.

Outreach health teams now provide check-ups and care for mothers and babies during pregnancy and post- birth. Vaccines against preventable diseases including vaccination against tetanus are also offered free of charge.

The health workers also stage knowledge sharing sessions to explain healthy practices. Topics include hygiene, nutrition, infectious diseases such as tetanus and acute respiratory infections that particularly affect under-five children.

Ms. Nhek  and her mobile team visit Koh Chbar village every
 two months to undertake health outreach work. 
©UNICEF Cambodia/2016/Bunly Meas 

Ms. Nhek said she felt demotivated at first with the lack of response from villagers, but later realized she needed to work harder to engage them.

The 29-year-old midwife and her team now return to the village at least once every two months.

On a normal day, they provide services to between 10 to 20 women and their children.

They move from homes to homes to reach as many people as possible.

One of the places they always stop by is the home of 58-year-old village elder Kimsoeun Phorn. This is an ideal place to impart knowledge as it has a large front yard containing a big mango tree to shade villagers from the sun on hot days.

Mrs. Phorn is more than pleased to offer the space and she enjoys observing the sessions too. Without realizing, she has absorbed most of the key health and wellbeing messages disseminated by the clinic staff.

“I know that pregnant women need regular check-ups, medication and importantly to prepare themselves to deliver babies at a health centre,” she said.  

However, the maternal health care guidance is different from her own childbirth experience. She delivered all of her ten children at home with traditional birth attendants.

Village elder Mrs. Phorn encourages pregnant women to take advantage of
 maternal health care services that were not available when she was pregnant.
©UNICEF Cambodia/2016/Bunly Meas

She said never took conventional medication but instead consumed herbs and tree roots from a nearby forest.

After each delivery, she was told to rest on her bed with a small fire underneath to warm herself for at least a week.

“We just followed our elders’ advice. I was safe in all my deliveries, but it was not always the case for other mothers,” she said.

In 2014, only about 50 per cent of all pregnant women in Kratie province delivered their babies at a health facility with skilled medical practitioners – this is far below the national average of 89 per cent.

Mrs. Phorn advises the young generation to take advantage of the outreach health care services and she refers them to skilled medical staff.

Mrs. Peoun breastfeeds her healthy two-month-old daughter
 who was delivered at the Sambo Health Centre.
©UNICEF Cambodia/2016/Bunly Meas   

Twenty-one year-old Srey Leak Peoun is one of many young mothers who have adopted the modern approach to child birth.

She gave birth to her first child at the Sambo Health Centre two months ago.

Before the delivery, she went to the clinic four times for immunization, iron tablets and pregnancy check-ups.

She also received tetanus vaccines when she was single.

“All I wanted was a safe delivery and a healthy child so I put efforts into that,” she said.  

Mrs. Peoun has witnessed many complicated and fatal deliveries among pregnant women in her village and has taken the advice of medical staff to avoid complications with her own childbirth.

Despite her new found medical awareness, Mrs. Peoun had not completely abandoned the traditional ways of childbirth. One of these is to apply ash to the child’s umbilical cord in the hope of healing it.

This harmful practice concerns Chief of the Provincial Immunization Programme Soda Thun who visited the village to prepare for an upcoming outreach session.

Mr. Thun advised Mrs. Peoun to stop this tradition immediately.

“Putting a wasp’s nest and ashes on a baby’s umbilical cord can lead to tetanus. It can also be fatal if not treated properly,” he said.

“Although some still exercise harmful practices, there are now more people who understand about health issues,” he added.

Samin Choeun, a mother of five children, is another villager who now understands the importance of health services. She gave birth to all of her children at home and her children did not receive any vaccines.  

“I did not know where the health centre was and we never discussed about getting health services in the family,” she said.

Mrs. Choeun feeds her one-year-old son who is the first among
 her five children to be vaccinated for routine ailments.
©UNICEF Cambodia/2016/Bunly Meas
Earlier this year, her one-year-old son had a respiratory infection. She was advised to take him to the provincial referral hospital in Kratie town where her son was treated and provided with vaccines.

With her son’s recovery, Mrs. Choeun knows the benefits her family can gain from the health outreach team and she plans to join the sessions in her village.

This greater understanding of health issues among the villagers motivates medical specialist Ms. Nhek to keep on working to raise awareness.

The Ministry of Health, with support from UNICEF, has provided training sessions, and budgets for medical workers and volunteers in the north-eastern provinces so they can expand essential care for villagers in hard-to-reach, remote areas.

Their dedication to go that extra mile is helping pregnant women in marginalized rural communities get indispensable maternity care which can mean the difference between life and death for their newborns.

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