'If she hadn't come here, she would have died'

Baby Sros Vathip at just three hours old. (Photo: Sylvia Varnham O'Regan)

Having a baby in a developing country poses a lot of risks and for women living in rural Cambodia, access to vital healthcare can be limited.

Baby Sros scrunches up his face and takes a deep yawn.

Wrapped in a blanket and just three hours old, he is blissfully unaware of the desperate situation unfolding around him.

On a metal bed nearby, Sros' mother Bo is having emergency surgery to stop a bleed that started shortly after she gave birth. Haemorrhages like this are a common cause of death among new mothers. 

Nurses and midwives in candy-pink scrubs huddle round Bo's legs as they work to control the bleeding.

A pink screen has been set up at the end of the room to block the sunlight streaming through while a cool breeze drifts from a door at the other end.

All this is taking place inside a small clinic in the Kampong Chhnang district in northern Cambodia, about 90km from the capital Phnom Penh.

The clinic sits at the bottom of a long, dusty path surrounded by wide open space. It was set up in 1999 to give people in the area, mainly women, access to the healthcare they desperately need.

As the clinic staff continue to work on Bo - her life now hanging in the balance - baby Sros wriggles on his back and opens his eyes.

It's one of the first times he's seen the world.

Man on a mission

Mr Sun Lun is the clinic's chief. Dressed in white scrubs and a matching cap, he smiles easily and offers us bottles of water from a pink plastic basket on a table out the front. If he is worried about Bo's surgery going on in the next room, he doesn't show it. It's all part of the job.

He's proud of the work his team does at the clinic - which is funded mostly by the government and partially by donations through World Vision - and the people they are able to help.

"Being the doctor, I can help the people who are sick without any discrimination over whether they are from any groups or they are poor," he says.

"I can help the people cure their sickness and also reduce the number of women delivering their babies at home."

There are a number of clothing factories in the area surrounding the clinic and Mr Lun says many of his patients come from them, including Bo, who works at a shoe factory a short drive away.

The clinic is open seven days a week and offers maternity care, general check ups and vaccinations. Factory workers in the area usually work Monday to Saturday, so Sunday is typically a busy day for the team. 

In 2014, 320 babies were delivered at the clinic and 598 children were given vaccinations. Mr Lun says he hopes those numbers will grow.

High risk

Giving birth in Cambodia carries a lot of risks and a lack of access to health services is one of the key problems.

Steve Cooke, of World Vision Cambodia, says transport is also an issue.

"Transportation is expensive and sometimes not available," he says. "Some communities are even cut off from the mainland by water for about six months of the year and proper boats are not available to transport a woman in labour. Other times, a motorbike on a bumpy road is the only option for emergency transport.

"Regrettably, even after making such journeys there is no guarantee that a health facility would be open or equipped to handle complication in pregnancy and child birth."

According the 2008 Cambodia Census, an estimated 1,700 women die each year in Cambodia during pregnancy, delivery and after birth.

The number has been steadily decreasing in the past 30 years and World Health Organisation (WHO) data shows that Cambodia's maternal mortality rate has gone down from 1,200 per 100,000 live births in 1990 to 170 per 100,000 live births in 2013.

Despite Cambodia's progress, the country still has one of the worst maternal mortality rates in the region and it looks unlikely to achieve its Millennium Development Goal of reducing maternal mortality by three quarters in 2015.

Vietnam, by comparison, had a maternal mortality rate of 140 per 100,000 live births - a maternal mortality ratio of 140 - in 1990 compared with a ratio of 49 in 2013.
Steve Cooke says that the widespread use of traditional birth attendants as opposed to midwives and other trained health workers also causes problems.

"One of the traditional practice still occurring is called 'roasting'," he says, "where following delivery the woman is placed on a bed above hot coals and fire. This causes excessive bleeding as blood vessels expand in the heat." 

"Another concerning practice if the food given to women after delivery – often their diet consists only of peppers or salt or ginger with a little pork for around three months – this can result in anemia and malnutrition." 

Saving lives

Back at the clinic an ambulance parked out front rumbles to life and begins to drive down the path to the main road.

It had been on hand in case Bo's situation became critical and she needed to be taken to a larger hospital.

Thankfully, it won't be needed today.

One of the midwives who had been working on Bo, Mrs Ouk Chansim, walks out of the room and into the fresh air. She looks worn out but relieved.

"I'm very happy to have saved her life," Mrs Chansim says, speaking through an interpreter.

The experience serves as a reminder of how important health services like the clinic are in Cambodia.

"If she did not come here she would probably died because of the seriousness of the bleeding," the midwife says.

Inside the room, Bo's mother sits cross-legged on a bed, watching over baby Sros.

Wearing floral pink pyjamas, the 49-year-old smiles broadly as we approach and ask her through an interpreter how she is feeling.

"Happy," the interpreter tells us.

"She says she's very happy."

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