Above: Toni Stokes and colleague Prak Sinet prepare to check the heart rate of Ly Tevy's baby as part of her antenatal check up.
Starting with the basics - infection control and staff confidence - Serei Saophoanis Hospital in Cambodia is making great gains towards improving maternal and child health.
A new mum washes with water from a bucket. There's no shower in the run-down bathroom block of the maternity ward. She wears a sarong because the broken doors offer little privacy.
Conditions in rural Cambodian hospitals aren't always welcoming for new mothers. Serei Saophoanis Referral Hospital once had nothing but a rigid, flat birthing bed for the long hot labours, as staff and patients sweltered in the summer heat with no air conditioning. Running water could not be guaranteed.
Yet in this challenging environment, a small but hardworking team of midwives delivered 50-70 babies each month.
Despite remarkable progress in the past decade, maternal and child health continues to be a major development issue in Cambodia. Far more women die in childbirth (170 per 100,000 live births) than in Australia (6 per 100,000), while infant mortality is estimated at 34 per 1000 births.*
In Cambodia, the Australian Volunteers for International Development program is working with the Ministry of Health and partner hospitals to increase access to quality health services for the poor, with a strong focus on delivering programs that address maternal and child health.
Midwife Toni Stokes arrived at the Hospital in May 2013 expecting to dive straight into teaching midwives about emergency obstetric care. But it soon became apparent that finding solutions to the practical challenges, such as access to running water for hand washing, would be a key part of her assignment - and just as important in helping to address child and maternal mortality.
"The single most effective thing you can do to prevent infections in hospitals is wash your hands. That goes for staff and patients," says Toni. "That's a tricky thing if the taps are broken and the toilets don't work."
Toni's first task became infection control. She helped to build relationships with NGOs and hospitals in Cambodia, while also developing partnerships with Australian organisations. Toni's friends and family as well as midwives from Cairns Base Hospital and staff from Platinum Health Group, also in Queensland, donated equipment to improve infection control in the hospital.
Sinks and toilets throughout the hospital were repaired and a shower installed in the maternity bathroom block. This led to hand-washing gel and alcohol being made available at the working sinks, and posters were pinned up to reinforce the practice. In time other changes followed: fresh paintwork, air conditioning, and a new birthing bed. An infection control committee was also established and a sterilisation room set up.
While all this activity was underway, Toni also supported staff to adopt government protocols that guide midwives' practices from pregnancy through to newborn care.
"Toni has advised staff to focus more on newborn baby stress and the importance of it," says Dr Sy Peng Tann, Deputy Hospital Director.
Dr Tan cites other areas where staff have new knowledge: breastfeeding and patient education; the use of partographs, a simple tool that can help to prevent a prolonged labour and its complications; monitoring a baby's vital signs; and caring for premature or low birth weight babies.
"When we have a volunteer it helps us to reflect on our current practical to match with theory standards. We're proud to have her."
While so many physical, visual changes occurred at the hospital during Toni's assignment, they were driven by the staff team, whose confidence increased steadily.
"I think staff now have more confidence in their ability to solve problems and they understand the importance of relationships with stakeholders and how they can support the hospital," Toni says.
For Toni, working in Cambodia was the cross-cultural challenge she'd always wanted. She set out on a path almost 20 years ago to prepare herself for international development opportunities, having lived in the Great Victoria Desert where she worked for an Aboriginal-managed health service, and spending several years honing her midwifery, family planning and clinical education skills in Townsville. Having finished her AVID assignment, she is now based in Lebanon with the International Committee of the Red Cross, supporting refugees from the Syrian conflict, and the Lebanese community who are hosting them.
"When you work in developing countries, when you do a very small thing, it can have an amazing impact. And that is so wonderful," she says.
Another AVID volunteer has arrived to build upon Toni's work at Serei Saophoanis, while one of the Cambodian midwives was recently supported by the staff at Cairns Based Hospital to visit Australia for a two-week study tour. Armed with this new knowledge and better facilities, and with some ongoing support from local NGOs and Australian partners, Serei Saophoanis will continue to create a safer and healthier environment for mums.
* World Health Statistics 2014, published by the World Health Organisation
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Photo: Australian Red Cross/Tiet Ho