In the Ksach Kandal community, Cambodia, giving birth takes a village
Nean (background) and Onn volunteer in the Ksach Kandal community, helping expectant and new mothers.
Distance makes all the difference as life moves by dirt road in rural Ksach Kandal
, a community that is a two-hour drive from Phnom Penh, the capital of Cambodia
. The road grumbles under the weight of passersby. It bakes silently under the sun. It reanimates when it rains, turning back into sticky dough. Vengeful and grasping, it dares a traveller’s next step. For a couple of women in particular, the question of how far someone is has more than one meaning: how far does she live and how far along is she? Sharing the road today are two regulars: Nean and Onn.
The two women diverge from the road but the soles of their shoes don’t leave the earth as they enter under the thatched roof. Nean, 40, and Onn, 46, have matching long black hair, and wear the airy attire of their culture. The women greet the group awaiting their arrival, and then peer into a hammock held up by two supporting beams: a baby. His name is Manara and he was up at five this morning. The three-month-old wanted the company of his mother, Kanchara, 23.
Kanchara holds her child, Manara.
Manara was the second pregnancy for Kanchara and her husband, Poch Sor, 26. Their first ended af- ter a terrible accident. Kanchara slipped and fell while carrying some water. She miscarried and only then did she realize she was pregnant. Kanchara didn’t go to the hospital. Instead, she turned to her mother-in-law, a retired midwife. “She took care of me like I was a woman who just had a baby,” Kanchara says.
Her faith in her mother-in-law is a testimony to the history of midwifery and home births in the region. But her mother-in-law would not be the one to deliver Manara, or even manage Kanchara’s second pregnancy. Instead, when Kanchara was pregnant again, her mother-in-law took her to a nearby clinic twice a month for checkups and prenatal pills. During this time, Nean and Onn also visited Kanchara at her home.
Paired up, the two women have been making rounds in this village for more than five years. Nean wasn’t looking for the opportunity—she didn’t drop off her resumé. She didn’t have any formal education in health care and she hadn’t ever had a previous job. Onn recruited her “because she is patient, humble and friendly, and can help in the village.” In other words, it’s all about Nean’s ability to network.
From left, outside the weighing station: Nean and Onn.
The pair’s connection to their village—their ability to take in information and spread it through every nook and cranny—is a critical component of their success. That’s their role as part of a World Vision-supported village health group and it’s something they do better than nurses or doctors. The two visit pregnant women, and children under 24 months as part of World Vision’s commitment to child and maternal health within the Ksach Kandal community, in the southern Kandal province. The women bring with them diagrams for presentations, and track weight and remind parents to take their kids for immunizations. The two take part in frequent health training that World Vision provides. Then they pass on what they’ve learned to mothers in the community. This week, Onn and Nean learned about hygiene and sanitation. They’ve already begun the transfer of information to other mothers.
With guidance from her mother-in-law and Nean and Onn, Kanchara knew how she could ensure a healthy and safe birth. She decided to have Manara at the clinic. When the time came, Kanchara and her husband left home, and hit the road.
The San Lung Health Centre.
San Lung Health Centre
Sros, 29, is pregnant with her third child. Her clothing falls off from her rounded belly. She waits to be examined. Her visits are important because she has high blood pressure. She says the pregnancy is causing anxiety and stress. The staff at the San Lung Health Centre have been advising her how to cope. “The workers encourage me to come here,” she says. “I visit twice a month.”
Sros plans to have her child delivered at the health centre in two months. The delivery will cost her nothing, though women often make a small gift of US$10 or a sum they can afford as a thank you. Sros’ two older children are nine and four years old. They were born at a different clinic. The San Lung clinic was opened in 2010 and is closer, so Sros comes here now. The difference saved in travel is 1.5 kilometres.
Downstairs is Socheata, 24, and Uch, 58. They are midwives at the clinic. “It has helped a lot,” Uch says. “Pregnant women can deliver somewhere closer to home. Before the centre, they would have to go somewhere further, and the streets were not good.”
At the moment, some babies are waiting to receive vaccination shots. On the 6th, 7th and 8th of each month the centre provides the service.
Socheata and Uch also deliver babies at the centre, including Kanchara’s. “I remember it took only about two hours to deliver Manara,” Socheata says. Kanchara’s delivery was free of complications. The two most common complications the doctor and midwives see are high blood pressure, and HIV or AIDS. Depending on the severity of a complication, mothers may be referred to a hospital.
"I rented a room in Phnom Penh and stayed there for almost a month. My husband went with me,” says 32-year- old Vanny Paeng, who relocated to complete her pregnancy. Her husband of 10 years, Thong Thos, was on board. Vanny needed to be close to a hospital to deliver. By that time, Vanny had already had seven miscarriages.
“I cried. I was very upset when they happened. I was worried I couldn’t have a child,” says Vanny. The hardest miscarriage was the last one. She had been pregnant for seven months. “I was hopeless. I heard an elder say that if I miscarried that many times, I would not have a baby.”
The elder was proven wrong.
Vanny holds Ichin at their home.
In a wicker basket, suspended from strings attached to the supporting beams of the house, Ichin chews on her tiny fingers. She is six months old.
Although Vanny’s last miscarriage happened at seven months and was especially hard on her, it also gave her some hope. Her other pregnancies had lasted only two to three months. She knew she had been doing something different, something that helped.
“I had [prenatal] pills. The other times, I didn’t have them,” she says. However, Vanny believes that while they helped, they didn’t quite do what she needed. When she was pregnant with Ichin, she went to the centre and picked up some other advice: take it easy. Vanny didn’t cook or clean. Other than for her stay in the city, or for visits to the health centre, she stayed home. In her own words: “I didn’t do anything. That’s why I kept Ichin’s life.”
Nean travels on a bicycle; Onn on a moped. They came to check up on Ichin. Today, she is too small for her age. Onn pulls out a graph and points to where the child’s weight is, touching the orange zone; it should be in the green. Onn charts Ichin’s weight as Nean tells Vanny how to cook a type of banana porridge for her baby. Shortly after, Onn and Nean move on to their next appointment.
Nean weighs a child as his mother looks on.
Onn tilts her head down and peers over the rims of her glasses at the multicoloured chart before her. She makes notes. Nean places babies in a blue basket. They have set up at a local villager’s house to weigh children. They are on the corner of an intersection. The red dirt road extends each way, intersecting at right angles.
Aware of the weigh station, residents begin to appear: a girl in pink with a baby on her hip; a grandmother also with a baby; and a bunch of children, here to take in the commotion. Not far down the road, two more travellers come by motorcycle: a mother holds her baby snug against her torso. Their journey today is but one stop along a different road that stretches far past the growing crowd.
This article originally appeared in the Spring 2014 issue of Childview.