Cambodia

Citation

(2005), "Cambodia", International Journal of Health Care Quality Assurance, Vol. 18 No. 5. https://doi.org/10.1108/ijhcqa.2005.06218eab.007

Cambodia

Cambodia

Midwives learn life-saving skills

Keywords: Maternity services, Obstetrics, Midwifery, Midwives, Cambodia

In Cambodia, midwives trained by EngenderHealth ensure safer maternal health for more Cambodian women.

Chan Sophal had no reason to believe that the delivery of her seventh child would be any different than that of her previous six. As with her other children, she gave birth in her one-room thatched house, on the bamboo mat where she and her husband sleep. She was attended by the village traditional birth attendant (TBA), a trusted member of the community who had delivered her other babies, as well as the babies of her sisters and all of her friends.

Sophal was in labor for two hours before she gave birth to a healthy baby girl. But then something went terribly wrong. Her placenta had not been released by the uterus and she began hemorrhaging badly and lost consciousness. The TBA had never received medical training and did not know how to handle this emergency. But because she had attended a health-education session with the local midwife, who was trained to recognize pregnancy danger signs, the TBA knew Sophal needed to go to the local health center immediately. She notified Sophal’s husband and, together with a neighbor, they carried her in a hammock the 5 kilometers to the health center, where midwife Mey Nary was on duty.

Mey Nary immediately recognized that this was a life-threatening case of placenta retention, which is one cause of postpartum hemorrhaging, the most common and catastrophic cause of maternal death in developing countries. Because she had recently undergone the Reproductive and Child Health Alliance’s (Racha’s) Life Saving Skills (LSS) training program supported by EngenderHealth, Mey Nary knew exactly how to manage this emergency. By manually removing the placenta from Sophal’s uterus, she was able to stop the haemorrhaging and save Sophal’s life. After a four-day recovery period, Chan Sophal was able to return home to care for her seven children.

Recognizing a need

Stories like this one are all too common in rural Cambodia, where the maternal mortality ratio is 437 per 100,000 live births. Seventy percent of Cambodian women still deliver their babies at home, and most, like Sophal, are attended by untrained traditional practitioners. Because TBAs do not have the necessary skills or equipment to manage obstetric emergencies, too many women die when complications occur. Compounding the problem is the poor condition of roads in rural Cambodia, which limit access to health centers, especially during the rainy season.

Since 1993, the Royal Government of Cambodia has been training midwives – who are officially employed in government-run health centers and also have private practices in their communities. At first, much of this government training was minimal and hurried, and because women rarely used health facilities, many midwives had little opportunity to practice the skills they had learned. Racha recognized that with quality training, midwives could play a crucial role in preventing maternal death. In 1999, in partnership with the Ministry of Health (MOH) and the American College of Nurses and Midwives, Racha pioneered emergency obstetric training for midwives in Cambodia with the establishment of LSS training centers in the cities of Battambong and Phnom Penh.

Increasing access through training

Racha’s LSS training program is a competency-based, two- to three-week course that emphasizes personal, hands-on training. Students receive intensive, one-on-one instruction, and are required to demonstrate skills competency in order to graduate from the program. A key component of the training is systematic follow-up by Racha and MOH staff, who continue to monitor and guide trainees and provide continuing education after graduation to ensure that the trainees implement their new skills.

At the core of the LSS training is instruction in how to handle potentially life-threatening obstetric complications. This clinical training is supplemented by instruction in antenatal and postpartum care, breast-feeding, and birth spacing. Trainees also learn how to pass on this information to their communities through health-education sessions. Racha manages an LSS-TBA linking and training program, in which TBAs are trained in all aspects of safe delivery, including how to recognize pregnancy danger signs.

As demonstrated by the case of Sophal, the information that midwives pass on to the TBAs can play a crucial role in saving lives. By increasing midwives’ capacity to deliver both high-quality clinical services and health education, Racha is arming hundreds of midwives to reach out to rural villages, a key strategy for increasing access to health care in Cambodia.

Racha’s LSS training has proved so effective that other Cambodian nongovernmental organizations (NGOs) are enrolling midwives in the program. Since the program began, Racha and other NGOs using Racha trainers have trained 314 midwives in the LSS program, and to date, these midwives have attended more than 17,000 deliveries and served approximately 300,000 clients. As the number of trained and dedicated midwives like Mey Nary continues to grow, more Cambodian women will experience safe home births and have access to quality obstetric care when emergencies arise.

For more information: www.engenderhealth.org