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The crisis in Cambodia

In 2012, when we founded Hospitals Beyond Boundaries (HBB), a tiny non-profit, non-governmental organisation based in Malaysia, only few youths were interested in the idea of an organisation that goes into poor countries to build health centres sustained by local communities. Many preferred the action and adventure of emergency response to war, crisis and natural disasters. The long term commitment to serve the same community year after year not only seemed less appealing, but also too ambitious to be undertaken by youths. HBB believes that short-term emergency interventions are crucial and immensely important, but we also realised that efforts to rebuild a community after these periods of turbulence are usually small. We wished to be different by focusing on long term sustainable efforts that last for a lifetime. We wished to stay.

Today, we exist in the same community we started assisting four years ago, serving them with sustainable health initiatives that improve the general health of community members and providing employment to a country lacking job opportunities. As of this writing, HBB runs a general outpatient, a maternal and child as well as a minor surgery clinic to more than 3000 community members in Chraing Chomres, an area mainly populated by the marginalised ethnic-minority of Cambodia called the Chams. The Chams population have their own unique set of cultural and religious practices compared to the rest of the Cambodian population. HBB also provides job employment to two local Cambodian medical doctors and four supporting staffs that include nurses, midwives and laboratory technicians.

As the ethnic minority of a generally poor population, the Cham people have not only economic pressure, but social pressure as well. In the past, the Cham people have suffered under the Khmer Rouge (KR) Regime from 1975 – 1979. The KR regime disproportionately targeted ethnic minority groups, resulting in the extermination of almost half of the Cham population (estimated around 500,000 people). Today, after more than 30 years the end of KR regime, the majority of Cham people remain impoverished and still lack educational opportunities. Being an ethnic minority in a newly developing country, they particularly fall behind in terms of education and health.

We first identified the urgent need for the care of pregnant mothers among the Chams back in 2012 during our first volunteer project. Although we provide a wide range of medical services, we paid special attention to maternal and child health. We all knew that motherhood should be a time of anticipation and delight for a woman, her family, and her community. But as what we saw in the community however, was giving birth perceived as a risky proposition. The inadequate and limited access to health care during pregnancy, childbirth, and early childhood combined with cultural practices that override modern medical alternatives increase the risk of death for mothers and their children. Although improving dramatically for the past few years, Cambodia still has one of the highest maternal mortality ratios in the region. Each year an estimated 1,700 women die during pregnancy, delivery and post-childbirth. When a woman dies, her child, her family, her community and ultimately the country lose one of their most valuable sources of health, happiness and prosperity.

There is still widespread use of traditional birth attendants as opposed to midwives and other trained health workers. Only 71 percent of women in Cambodia had access to a skilled birth attendant in 2010 and just over half of births take place in a health facility, increasing a pregnant woman’s risks and decreasing her chances of accessing life-saving interventions during childbirth. Even when mothers can access health care, the overall quality of care is deficient, magnifying the challenges women face in overcoming potential health problems during and after birth. Even for complicated pregnancies, access to obstetricians remains a rare occasion for them.

Our presence in the community has slowly changed this trend. Increased accessibility has broken down their barriers to healthcare for the first time. Since the launch of our clinic in June 2015, more than 500 patients were treated and received follow-up care at our health facility. A total of 132 Malaysian volunteers were engaged, 582 local community members were health screened, and a total of 24,899.20 USD was spent to treat the poor from June 2015 to February 2016.

Looking forward, we are in the midst of constructing a complete six-bedroom maternity health centre with two labour suites and an operating theatre. A maternal health centre will cater to women of child bearing ages who are planning to become pregnant, expecting a baby or have already given birth. We want to ensure that they get the best healthcare services under one roof. This way, they do not have to go to different clinics and hospitals for their pregnancy and delivery experience, which proves to be daunting to some women, especially to those who have no access to transportation and live in remote parts of Cambodia. This concept is also a very efficient for women to receive personalised care by the same group of healthcare personnel throughout the her pregnancy and birthing experience. It will also be a community centre and a meeting point for these women to socialise, share experiences and communicate with us, the dedicated health professionals who want to offer a better health and delivery experience. We hope this will lead to further improvement in the health of the community and open new doors for the improvement of their socio-economic status as a whole.

Mohd Lutfi Fadil Lokman
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