© UNICEF
Cambodia/2016/Kieng
Midwife Chhim
Ren performs an antenatal check-up on Min Phath at the Tmat Peoy village
community centre. Ren is part of a mobile outreach team from the Takoeung
Health Centre that travels to remote villages to provide care.
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, 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 (US$3.75), 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.
© UNICEF Cambodia/2016/Kieng
Members of the mobile health care team offer checkups and
other services to villagers, including vaccinations. They also conduct
education sessions focusing 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.
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.
© UNICEF Cambodia/2016/Kieng
Nout Noun sits with her fivemonthold baby boy. After
receiving antenatal care and vaccines for both herself and her son, she
is now helping others in her village learn about the value of
appropriate
health care.
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.”
Navy Kieng
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