© UNICEF Cambodia/2016/Kieng
By Navy Kieng
For women in the remote Cambodian village of Tmat Peoy, getting pre- and postnatal care is neither common nor easy. The journey to the nearest health centre can take over an hour, and many women cannot afford the cost of transportation. Learn how mobile health teams are reaching these communities to provide much-needed maternal and child health services.
PREAH VIHEAR PROVINCE, Cambodia/HONG KONG, 24 October 2016 – Min Phath, 27, lies down on a colourful mattress under the thatched roof of Tmat Peoy’s community centre in Preah Vihear Province, northern Cambodia. Chhim Ren, a trained health midwife from the Takoeung Health Centre, gently examines her belly.
Phath is six months pregnant with her second child, but this is 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.
“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.”
The Takoeung Health Centre is located 17 kms away, but in Preah Vihear Province a journey this distance can easily 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 costs about 15,000 riels (HK$29.25), a steep sum for a family like Phath’s.
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. The teams educate mothers and pregnant women about safe pregnancy and the importance of vaccines, and provide direct services like immunization, antenatal and postnatal care, vitamin A supplements, deworming and iron folate tablets.
Spreading the word
Tmat Peoy is home to about 338 families, with a population of 1,282 people. Of those, 121 are younger than age 5, including 24 children who are under 1 year old.
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.
This is due in part to Tmat Peoy’s remote location – low education levels and limited access to mass media (TV/radio) mean that many villagers are unaware of the importance of appropriate care. Most villagers also eke out a daily existence through agricultural activities, and during the annual rice harvest families can spend as long as two months in the fields. Mothers, children and pregnant women miss important check-ups in this period.
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.
The mobile teams also get a boost through word-of-mouth in the community.
Nout Noun, 27, has a five-month-old baby boy. While pregnant, she went to the health centre four times for antenatal care and vaccinations. She received information about healthy pregnancies at school, and after she got married, the village health support group and health staff told her about the benefits 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,” she says.
Now, Noun 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.
A wide range of services
On health outreach days like today, the community centre is usually bustling with the large crowd of children and adults. The staff set up their work stations and the team divides the space 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 year old, 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. Her first child was delivered at home with a traditional birth attendant, putting herself and her baby at risk of infection or worse. “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.”
Phath’s midwife Chhim Ren is one of the many Takoeung Health Centre staff who travels village to village providing women and children with care. Though she says she sometimes struggles to explain and persuade people to use health services, 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.”