Saturday, January 4, 2014

Home visits

Home visits

Each day we climb aboard a small, motorcycle driven tuck-tuck to visit women who have recently had a baby.  We drive down small, sandy roads with rice fields on either side, twisting and turning until we arrive at the mother’s home.  The driver, who was born and raised in the commune where we are working, comes to know each home and village.

The country of Cambodia is divided into provinces.  Each province is divided into a district and each district is divided into a commune with about eight to ten villages.  Each commune has a health center with a small birthing room and about five government paid midwives.  Each district has a referral facility, which takes higher risk mothers, and each province has a hospital that can do C-sections.  Each commune has a vehicle for transports.  The commune health centers appear to be about 10 to 20 miles apart but I am sure it varies throughout the country.    The commune center also has a government office and a central market.   They do not have doctors for general consultations but rather men who have some basic healthcare training.  There is a limited pharmacy and no lab.   There are special days for immunizations, eye checks and other special testing.  The system seems efficient, well spaced throughout the countryside and well accepted by the community. 

All the home visits I have done, so far, have been out in the villages where we find a cluster of homes; one of which may have a very small front yard market.  A local businessman rides his bicycle out to the villages to sell some particular items; a special fruit or fish or an ice cream bar.

The typical house is on stilts (the higher the better) with various ladders to reach the main part of the house.  They are made of tightly woven banana leaves that are lovely to look at from inside.  The roofs might be woven, wood, tile or corrugated metal.   The floors are wooden and lined with colorful bamboo mats.  When we visit, the new mother is inside resting on a mat.    The upstairs is one large room for communal sleeping; bedrolls rolled up for the day and mosquito nets hung on the wall.   There do not seem to be many personal possessions.  

Other women are sitting on a large platform under or next to the house where much of the day’ activity takes place.   They are platforms to keep children, cooking, resting up out of the dirt and rain and are the center of activity.   There are almost always several hammocks for afternoon naps and rocking babies.  All cooking is done outdoors with a small wood fire.   There are large clay pots for collecting water during the rainy season.  The more pots you can afford, the less water you will have to carry when the dry season arrives. 

The cows sleep under the house and are highly prized.  Children gather grass for them and make hay from the rice stalks.   They are only eaten for meat and not milked.  They are large, white animal who are integrated into family life.  At night, someone sleeps beside them in a hammock.  Children walk with them to the fields.
At night they build fires to keep them from getting mosquitoes.

When I go with the midwives to visit a baby that everyone was worried about, all the village women and children were at the home, sitting on the platform and visiting.  The translator said they all get together to play cards in the morning.  I am not sure but they are all there, watching my every move with an entertained smile of amusement.  There is free education but it seems to be for very few hours of the day so children are always around.   The schools are far away and always there are parades of children on bicycles going to and from school.

This baby has a heart murmur.  I try to explain that he is okay now but needs to see a doctor.  She took him to the health center and was given a medicine.  I look and see that it is liquid Tylenol.  I explain that this will not help the problem and she will need to go at least to the Province Hospital or even Phnom Penh.  The cows move in closer to the house and stare at us.  They are a middle class Cambodian family. They have a house that does not leak, many cows and a bicycle but I can see that going to a doctor seems unlikely.  She is young and beautiful with a daughter who climbs into her mother’s already full arms.   There are grandmother and aunties and cousins. 

In Cambodia, one in eight children will never reach their 5th birthday.   Worldwide millions of children never reach their first birthday.   They die at birth from prematurity, at birth because no one helps them to breathe, from infection, dirty water and anomalies.   Although most will die within 24 hours, many more will quietly die in their mother’s arms in a small village with no clear reason why.

The babies, born at the health centers, leave and do not return for 6 weeks.   Without home visitors to encourage breast-feeding and help assess problems, the mothers and babies and village women are left to sort out the babies as best they can.   Because many of the village women come to the home visits, it becomes a perfect opportunity for education and support.

Many women have not been given a basic education in anatomy and have little understanding as to how one gets sick.  Like women everywhere denied an education, they are forced to turn to the supernatural to explain the presence of disease.  They look to spirits to protect them and so each child wears the familiar red string around their wrist and each home has a small alter to protect the house and the family.   Many of these customs are very precious. I myself, have several red and orange strings blessed by monks around my wrist.  I love the spirit boxes outside each house but the thought that another person or a spirit could cause you harm (as well as a lack of doctors and education) leaves this and other babies vulnerable.   Blame is laid, not on the mosquitoes or contaminated water or lack of safe sex but on the individual or a spirit. 

If this baby dies, it would not have been because of an easily repaired heart problem but because of some lack of piety towards the ancestors or spirits.  

The baby’s stomach is swollen and tight.  It is not normal for a breastfed baby.  I ask if the baby has been given anything else.  I see the mother look at her own mother with worry and answers, “no.”    I suspect he was given something, as is the custom.

The children who gather show signs of malnutrition; the red in the hair, swollen bodies sores but not starving.  There is a seasonal pond in front of most houses with lotus flowers, cress and fish.  They seem to serve as a place for rain to go during the rainy season; ancient bio swales.   During this season there is more food but not enough to last all year long.  The cows, well cared for, are a lifeline.  It is no wonder then that they sleep with the family. 

Another baby is congested from the fires that burn under the house.   Children have runny noses. 

The homes we pass are lovely and have been designed to preserve and protect through the dry and rainy seasons.  They collect rainwater; have bio swales, fruit trees and bicycles.   Light filters through the roof into the family sleeping quarters. 

Those who can, have a small business outside their home, selling something as a way of making a little extra money.  Beyond the village are rice fields as far as you can see.  We bump along from house to house, white women coming to visit.  The babies are weighed, blood pressures taken and questions answered as we rest in sweet delight with the women of the villages.  

In town, the space under the house is crowded with motorcycles, cooking and storage.  In time, some have been filled in to make a downstairs with doors and windows.  As the factories claim more and more women, these lovely homes where women and children gather each morning will fade.  The large airy sleeping lofts become bedrooms and beds replace the bamboo mats.

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