Village mothers and babies

 

A message from Denise

 

LifeOptions, under the direction of Gary Love and me, has been operating in the western world for 24 years to support families in identifying how they wish to live, and how to develop the skills they need to be strong in their commitment to their family choices.

 

Gary has senior management skills, and I am Registered Nurse in Australia with a Master’s in Nursing,  and worked with indigenous people of Australia 38 years ago when the village had only known “westerners” for 10 years.  I have continued working as nurse in many different environments, and in the past 28 years have worked as a Birth Consultant to many organisations, establish Doula Training in Australia, and consulted to 3 major hospitals in Bangkok implementation of baby friendly status, and uninterrupted birth.  II currently consult to a Cambodian non-profit organisation called Woman’s Health Cambodia, run by local midwives. 

 

As an Australian registered charity (LifeOptions Inc NSW CFN/21718) we consult to organisation in developing countries.  We have been mostly self-funded. We currently have some funding from Dynamic Share to do a base line survey about Pain in Cambodia.  There is almost no medication for physical or mental pain. 

 

Initially I was invited by a Khmer midwife, Chong Nai Hy who learnt her skills during her 10 years in the “camps” and has been a senior midwife in Cambodia for 24 years. She asked that I come and teach kindness to midwives. This seemed such an underwhelming request, but has proved to be amazing challenging! 

 

I have worked in other countries of the world, but have never met the challenges we face in Cambodia. 

Below is the outline of where we got to at the end of last year, but we have downsized our operations, and a document will follow explaining this.   

 

Considerations that are different to most other countries observed

 

  • An entire population of educated people was wiped out as well as all education material

  • Books and study text in Khmer starting to be developed

  • Little remembered history or understanding of the way things were pre Pol Pot

  • Education that is not bought of cheated is only just being developed

  • When we use terms like nurse, midwife or doctor, it has limited meeting in our understanding.Many have no formal education.

  • Very few Professional role models or mentors

  • All doctors have studied in French

  • Most Nurses study in English, ever though most are non-English speaking when they begin their studies

  • Midwives who are studying now experience little clinical practice.May be seeing 2 births whilst they study. They almost exclusive buy the exam and the answers (this has been my experience)

  • People agree with everything you say…….huge fear of authority

  • The need to please the Westerner so they will bring money and or “like you”.

  • Medical facts are insignificant compared to Karma and ghosts and spirits. E.g. Mother spirit takes babies, so each baby is guarded by a knife…..nothing to do with birth practices or bacteria.

  • Girls do not want the role of TBA in the communities. TBA’s have great value in the villages, even if they are not attending birth as directed by WHO and Cambodian Ministry of Health

  • With WHO recommendation and Cambodia Ministry of Health mandate that all woman are attend at birth by skilled birth attendants, Health Centres and skills of midwives were and are not upgraded, therefore they are overwhelmed with the responsibility, but loving the added incomeHealth Centres are very under resourced.

 
 
Women’s Health Cambodia – Khmer Midwives Driven   

                                                             

  • Reduce the rates of maternal and infant mortality and morbidity

  • Look at a find solution to physical pain and mental health pain in the communities we work in

  • Offer welling children checks, treatment and referral to children

  • Offer English classes, as education and opportunity are the way out of poverty

  • Build capacity in Hospitals and health Centres under the direction of the Ministry of health

  • Address gender issues as they are identified by the community

  • Mentor capacity to change when required by the community of health staff

  • Maintain sustainably

  • Capacity build the whole of a community to move toward the direction they choose to lead their lives

  • Offer safe living environment whilst the village steps through change that is occurring through the opportunity to earn money of mothers.

  • Enhance the lives of village people under their own direction

  • Identify changes that are quickly happening to the web of life as the opportunity to work outside the village arises and find safe sustainable solution

 

Our model

  • By living in the community, developing a deep understand of the lives, needs and wants of a community serviced only by Health Centres where there is no doctors.

  • Directed by the community, mentor and clinically support the implementation of change requested

  • Maintain really clear motive of sustainability and capacity building

  • When objectives of the project are achieved, roll it out to other health centres that ask for support and change.Most villages on assessment are facing very similar challenges

 

We stand beside (this is a major difference) the Health Workers in rural villages to develop kindness to the families they serve, safe practice and skills, and to support them in identify the needs of the people in the commune they serve.  We do not see ourselves as educators

 

Village Mothers and Babies – where are we up to!

 

  • Empowering midwives to be the best they can be.Safe well trained midwives is our goal

  • Training of Volunteer Health Workers to support in Post Natal home visits and accompany woman to the birthing space.

  • Many of the women, who attend the Commune Health Centre, live up to ¾ of an hours motor bike ride from the health centre, and they have limited funds to pay for petrol.   Most vulnerable time for a woman post birth is in the first 48 hours.  Very vulnerable time for babies is in the first 10 days.  We have been to visit 3 babies in the past three months who died between visits and have not been reflected anywhere is data.

 

Also pre-eclampsia is another major contributing factor to maternal and infant death, and village health workers have the capacity to check blood pressure, assess her wellbeing and contact midwife for support if needed.

These workers are now on a small wage that in time will be maintained by the Health Centre when earnings of the health centres have increased because of increase in earning.  There is huge corruption with in Cambodia and health centres Money is distributed between staff and not used for necessary resources and maintenance.  We are working towards change this, as interested in their job grows, pride in their achievements has been felt and identified, and the true wish and need to contribute to their own and peoples wellbeing

 

Midwifery support

 

Midwives invited us to work with them in 2 provinces in Cambodia for skill building. The most important request is to teach kindness.  We listen to Health Centres and Regional Hospital’s needs, and develop skills, practices and protocols, and medical instruments that support them in their work.   Workshops they say give good information, but they are not sure how to integrate the information into day to day life.  We are committed to standing beside them as they attempt to implement the changes being asked by them from the ministry of health, and the people in the community. One health centre we work in has had one midwife for 15 years, with up to 6 babies being born in one night.  Her average at the moment is 25- 46 per month.   The most difficult and sometime feels impossible to make progress in is, the need and want for the midwives to make money...  Giving woman many calcium injections following the births…..and they change too much money for this unnecessary service….cutting episiotomy so they can make money, and then also charging for sewing them up.   Almost all midwives have their own clinics, so anything beyond an emergency, including birth is sent to their private clinic, and many unsafe practices are happening. We plan to have a village midwifery program by the end of this year. 

 
Volunteer Support Program                                  

We have a volunteer program for medical practitioners to spend 1-3 months in the village health centres and hospitals mentoring Health Centre staff. Many midwives are feeling overwhelmed by their work load increasing since TBA’s are no longer working the areas we serve.  They have very limited skills, and almost no knowledge of why they do things, therefore there problem solving skills are challenging.  Our model of care of “Kindness” is best implemented in work side by side.

 

 

Village outreach postnatal visits

A woman will be visited 3 times in her home. 1st visit is done in the first 2 days. Next visit around 7 days, and then before 6 weeks.  There is huge advantage to visiting a woman in her home.  Knowledge about her poverty status, which helps understand the level of her health risk of her baby and children.  Early intervention of problems is a huge advantage.  Gathering of many people when we visit give us the opportunity to share information regarding “roasting of the mother and babies”, a very dangerous practice where mother and baby and smoked with a fire underneath tem for 7 days.  A routinely alcohol is given to mothers, so we can sit with the older woman and discuss the traditional practices.  We can huge insight into the way people live, there difficulties and they joys. 

 

WOMAN BENG ROASTED….MUCH SMALLER FIRE THAN USUAL!

As the practice of roasting is decreasing other alternatives to heating the baby are being tried.  Tiger balm all over the babies abdomen, and then wrapped in plastic!    The fear of death of babies is still huge, so it is very effective to sit in communities and discuss understanding of the dangers to young children.  With spiritual beliefs so strong, and mother spirit choosing which babies she takes, we have a long road ahead of understanding of bacteria, dehydration and overheating the baby with multiple layers of blankets on the baby. 

 

Building a pre and postnatal room for woman at risk to stay at health centre.

As we discourage birthing at home, finding space in health Centres to house the increase of woman coming to birth is demanding.  Up to 6 per night puts a huge strain on under resourced centres.  The Ministry of health has a plan to build small extra space for birth and pre and post-partum beds, but this will be rolled out over a couple of years. 

Most health centres are overloaded.  Volunteers raise funds to supply a space now with 7 beads space for woman and their babies. 

 
Schools

Following our work in Health, it became clear that if we can educate children at the beginning of life in all aspects of health and nutrition, and give them the opportunity to learn and grow life skills, then Cambodia will change and grow stronger.  We work in a very corrupt society, so also establishing a feeling of integrity, honour and trust is a starting place for inner and community health. 

Some children do not attend school, and some stop school at around 8 to work for a family income.   We have a preschool which gives our midwives an opportunity to observe the young children and the chance for early intervention of problems.  We also have 3 English schools offering tuition to all age groups.  We now have established English for the adults.  We use English teaching as an opportunity to make available information on community health and wellbeing as subject matter.

 

Our schools operate for only 2 hours a day and many bring their baby brothers or sisters to school with them.  It is an amazing space to work in.  We have supplied the first reading books and the opportunity to use colouring pencils and crayons.   Lessons are learnt on a tiny blackboard with chalk! With more resources we can lengthen school hours.

 

Building Capacity of Village People

.  Most men are despairing.  There is no work.  There is little or no money for many families, and if they are lucky enough to grow rice, then it lasts them only ¾ of the year. Many men are drinking and gambling money they borrow to try to get food for the family!  Most want to turn things around, but alcohol dependency stands in the way.  46% of the families we work with live with domestic violence.   We are investing our time money and energy in the women, whilst we support the men in the villages to look for solutions.  They are helping build toilets, water tanks and pumps...but we need much stronger solutions.  In the past few months, many factories have opened in the area offering opportunity for a stable income for the first time.  This is changing the web of life in the village forever.    Still, babies are born, and woman now face new dilemmas…most babies were breast feed for at least 2 years.  Women are now going to work in factories as early as 6 weeks after their babies are born.  Many are still breast feeding at night but with bottles appearing, limited clean water and the cost of formula, we face new challenges.  Old grandmothers are being left with up to 8 very young children to look after. We had sewing circles making menstrual pads for the girls and women...many girls miss up to 2 weeks a month of school during menstruation...we have found a simple solution until now, but all the woman are now at the factories.

 

Transport Problems.   

Many people don’t have transport beyond a bullock.  Some have motor bikes and one person in our village has a car.  We have now supplied 4 tuk tuk ambulances to Health Centres, and regional Hospitals.  All funds for Tuk Tuk ambulances so far have been raised by midwives in Australia.  Thank you!!

 

 

Sanitation and water project

As donations come for toilets we are working toward each family having a toilet.  The family prepares the ground and digs the whole, a builder works with the home owner to construct the septic tanks and build to the level of the ground with a squat toilet and water booth, and the family complete the surroundings for privacy.

Water tanks for health centres are constructed so ample water is available throughout the year. 

 

 

Hand washing stations in common areas of the village and each house will soon have a tippy tap next to the toilet which uses small amounts of water for hand washing. We have 50 installed now.   Many pumps are being repaired, and assessment of water needs is constantly reviewed

Hand washing is a major problem, as is no toilets.  Many of our children die before they are 7 because of simple diarrhoea and influenza.

 

Growing tiny gardens with limited water…in planning using recycled good

For people with limited water as school project this is a great way to bring recycling into our lives, and to open the door to learning about gardens. 

Permaculture

Our dream was that every household would have a small garden for their own use, with 3 coloured vegetables growing  We will now focus on large fruit trees, until we have long term volunteers who can support the development of the program.  The concept of a small sustainable individual vegetable garden for family use is proving to be challenging. 

 
Outreach program for villages – antihuman trafficking

A midwife, and educator for children, and a group facilitator go on the road. 

They spend a day in a village discussing challenges the village might have, offer information women’s health, setting up a small children’s play and education area, and generally covering all aspects of village health.  Sanitation, human trafficking, gender issues, violence in the village, nutrition, and all aspects of village life that is challenging.  The van is a canvas for the youth in the village to paint during workshops.  We are attempting to bring traditional music and dance also back into the normal village life. 

 

Donations

 

Our children have nothing.  Many don’t wear clothes to school.  They have not enough food, and live with worms, no shoes and work hard to support the family. Anything you can give to help them grow into strong, caring adults would be amazing!!  1 in 7 do not live to age 7.  Many die in the first 6 weeks of life, and many don’t make it to their 2nd birthday. 

This is a hot harsh country.  We need the love and care of other from around the world as we build strong communities.

Want to help?  Wear you daggiest clothes to school and remember children in Cambodia would be glad to have them….many don’t own their own clothes. 

Have a fund raising event.  Talk to your local organisations that support projects

Corporate sponsorship.  Monthly direct debit…..if every person that I knew offered $10 per month, we could fulfil all the dreams on education and safe birth we are being asked

 

$1            feeds a hungry family with a new baby for a day.  Pays for short tuk tuk ride to health centre, emergency

                 Mini black board for each child to have to write on

 

$2           builds a simple hand washing station outside a family toilet (diarrhoea kills our young children)

                6 cakes of soap to hang from the washing station

 

$5           supplies petrol for a tuk to tuk to do post natal visits for new mothers in the attempt to reduce infant

                and maternal deaths

3 L of petrol for generator to pump water to hand washing station at health centre and school

 

$10         one week of a part time teacher’s salary               buys bananas for each child at school each day

 

$25 feeds a very poor family for a month with a new baby to give the mother and baby and chance of survival…..we work with very poor rural families

Fuel for tuk for emergency trip to hospital for mother or baby

 

$60         builds a toilet to ground level for one family.  The family completes the job (95 families with no toilet.  We have now have built over 100 there were 8 toilets in the village when we came!

 

$80         new bed for rural small hospital    4 walls on a poor family tiny dwelling

 

$120       English teacher’s salary for a month   We have 3 small under resourced school     

 

$130       Supplies Mental Health medication for poor people in a community for basic care

 

$150       well and water pump.  We have a huge water shortage. Supplies new roof to a small dwelling.  

 

$500       tanks for a health centre

 

$1500   builds a room with 4 beds for maternity emergencies

                Supplies medical equipment for volunteer health workers who do checks on new born babies

 

$2200   a Tuk Tuk ambulances

 

$5000   builds a small birth room