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Linking Villagers to Health Services

Leangkim Theng (right) and another health volunteer discuss maternal and newborn health with a Unicef health officer. Unicef Cambodia/Bunly Meas Unicef Cambodia/Bunly Meas

Cambodia’s village health volunteers play a crucial role in educating villagers in remote areas on maternal and newborn health, and encouraging safe delivery practices. Supported by Unicef, they are also periodically trained to be peer educators, writes Bunly Meas.
On the day 55-year-old Leangkim Theng was selected as a village health volunteer, she was not sure she could do it.
The work required her to educate women on maternal and newborn health in Serei Sokha village of Kratie province. While she did not feel she had enough knowledge, she accepted the role and now, 20 years later, she is still in the job.
“What keeps me going is to help mothers to give birth safely with healthy children,” she said.
Mrs. Theng receives training from health officers at the Kantuot health center and Kratie provincial health department. She is part of a Unicef-supported initiative to encourage safe practices and prevention of maternal and neonatal tetanus.
One or two volunteers are selected from each village and periodically trained to be peer educators. They do not get a regular salary, but they receive a small amount of financial support to organize peer education session.
Recently, health officers visited Mrs. Theng and asked her about what she had learnt.
“How many times do women need a vaccination to avoid tetanus for their whole life?” they asked. “Five!” Mrs. Theng answered quickly.
“And how do we take care of a newborn’s umbilical cord?” they continued.
“The cord is healed itself, parents just keep it clean and avoid traditional practices such as putting wasp’s nest and ashes on it. This leads to tetanus,” she explained.
The conversation went on and Mrs. Theng was confident of what she said. This is information she tells women in the village, including her daughter.
Soriya Cheur, 26, Mrs. Theng’s daughter, was sitting in a hammock with her two-month-old baby. She talked about her mother’s repeated advice.
“Get regular checks at the health center, get vaccinations and deliver my grandchild there. Do not give birth with a traditional birth attendant [TBA], it is risky,” she remembered.
There is a reason for her mother’s concern about TBAs. Mrs. Theng herself delivered all her five children with TBAs, and although everything was safe, it was still uncertain.
In Cambodia, maternal mortality rate has decreased from 472 per 100,000 live births in 2005 to 170 per 100,000 live births in 2014, according to Cambodia Demographic and Health Survey 2014. This is because more mothers have delivered babies at health centers with trained midwives.
Even with these improvements, giving birth is still dangerous. In Khmer language, “birth delivery” literally means “crossing rivers”, and for some women from remote villages, this is actually the case.
In Sampong village, on the other side of a stream from Mrs. Theng’s community, going to the health center used to be risky. The journey involved crossing the stream on small boats and a 10-kilometer trip on a bumpy dirt road.
Mun Muth, 70, knows the dangers all too well. A TBA for more than 20 years, she attended deliveries at home, on roads, and even on boats.
“Women preferred my service to crossing the stream and going a long way to the health center. It was risky and they were not prepared for it,” said Mrs. Muth.
The other barrier was that people neither understood about maternal and newborn health nor knew if there was support available at the health center.
In 2012, a small bridge was built over the stream, allowing villagers to access the health center more easily.
Three years ago, Mrs. Muth discontinued her work and referred all cases to the health center.
What motivated her was the work of a village health volunteer, Sinet Ung. She told Mrs. Muth about maternal and newborn health and involved her in educating other women.
Mrs. Ung, 51, started working as a health volunteer in 2008. As a mother of three, she was struggling to feed her family after her husband died in the 1990s. She could hardly read and write and was rarely in contact with her community.
After receiving training from health officers not only on health issues but also communication and facilitation skills, she became more confident in managing her family and running her awareness campaigns.
“I learned a lot from this job. I can now read and write. I tell people and my children about health issues and I am happy when they follow my advice,” she said.
One of the important messages she and her team always tell mothers is to spot “danger signs” of acute respiratory infections among their under-five children and take them to nearby health centers or referral hospitals with no delay. The symptoms includes cough, rapid or difficult breathing.
Mala Sor, chief of the Kantuot health center said having volunteers such as Leangkim and Sinet was really helpful in bringing more villagers to the center for services.
“It was the case that only nearby villagers knew and used the center’s services; but volunteers help bring more people from remote villages. For example, there are 20 babies delivered here a month compared to just one in the past,” he said.
The Ministry of Health, with support from Unicef, is increasing health volunteers’ knowledge so that they can better contribute to saving lives of women and children, especially those who live far from health services. Unicef Cambodia

The bridge allows villagers to commute to the health center. Unicef Cambodia/Bunly Meas 

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