Cambodia, like many other low and middle-income countries, maintains persistently high neonatal mortality rates, with some of the highest rates recorded in rural areas. Interventions across levels – from villages to referral hospitals – are required to prevent neonatal deaths. These interventions must be socially and culturally acceptable, practical, appropriate and aligned to the communities’ needs.
To develop and facilitate such interventions and programmes, it’s critical to understand what influences neonatal health and care-seeking behaviour. In Cambodia, however, there is currently a lack of data on the topic.
In order to identify barriers and facilitators to neonatal health and care-seeking behaviours, AHC’s Saving Babies' Lives Programme led focus group discussions with 85 community health workers and conducted a thematic analyses.
It is a typically busy morning at Rovieng Health Centre in Preah Vihear Province; dozens of motorbikes are parked outside and many mothers and children sit beside the designated obstetrics, antenatal and delivery room building.
That previous night, three babies had been born, adding to the buzz of activity. The Saving Babies’ Lives (SBL) team has been visiting the health centre every month since SBL started, to train the staff on neonatal healthcare.
Acute lymphoblastic leukaemia (ALL), or cancer of the blood and bone marrow, is one of the most common cancers found in children. Currently, AHC is the only facility in Cambodia treating ALL, a treatment that is split into five phases over the course of three years.
AHC’s two oncology fellows, Dr Korb Sreynich and Dr Samly Vannak, lead treatment for ALL and all other cancer cases at AHC, making them two of only a handful of local specialist paediatric oncologists in Cambodia. Dr Sreynich and Dr Vannak receive expert guidance and support from international oncology experts in weekly online case conferences.
Experts from Wisconsin Children’s Hospital, Seattle Children’s Hospital, Boston Children’s Hospital, and St Jude’s Children’s Research Hospital helped develop the ALL programme at AHC. It’s designed specifically for a low-resource setting.
Chemotherapy medications available in modern healthcare systems are much more intensive than the medications available in Cambodia.
“We have had to add an extra phase into our treatment plan,” says Dr Sreynich. “This means patients stay longer at the hospital, sleeping in the ward, and experiencing further symptoms.”
One of those patients is Sanga.
He is in the final stage of his three-year-long chemotherapy treatment. Every month for the past half-year, his family has taken an eight-hour one-way bus journey to AHC from their home in Kampot.
They sleep overnight at AHC’s Oncology ward as Sanga receives treatment.
“My son has had some difficult times,” says Dary.“It was hard to watch him as he became skinny and weak. He looks so different today.”
Sangha still has over two years of daily chemotherapy treatment, with monthly visits to AHC for follow-up treatment. Dr Sreynich and Dr Vannak are confident Sangha will fully recover from ALL, with 90% of ALL cases cured worldwide.
“I know we still have a long road ahead of us, but I can already see a positive change in my son,” says Dary, “because of treatment, he has been allowed to be a kid again.”
Narith was born with a cleft lip-palate. He first arrived at AHC when he was only six days old, born in a health centre in rural Cambodia. When his mother first saw Narith she was shocked to discover Narith looking up at her with a cleft lip and palate.
While a cleft palate is one of the most common birth defects in the world, children require a range of specialty treatments often not available in low-resource settings like Cambodia.
Narith's family’s circumstances are similar to many families who visit AHC every day: living outside of Siem Reap, often from poor, rural communities where education and access to healthcare is low.
They make the three-hour long journey from their rural village to AHC each month to receive treatment from a multidisciplinary team of specialists who work together to treat Cambodia's cleft patients, known as the “Cleft Squad”.
"Early treatment of cleft is crucial for a child to recover fully. If a child has access to the necessary care from birth then the soft tissue around their mouth can begin to be molded, and they can feed properly to gain weight, in time for life changing surgery."
Dr Chern Chern, AHC Orthodontist Volunteer
The "Cleft Squad" consists of five specialist units from around the hospital, including nutrition, orthodontic & dental, surgical, physiotherapy, and social work units.
Without this full range of cleft treatment, children like Narith would not be able to have their cleft repaired, leading to major dental, speech, growth, and social issues in the future.
Our orthodontic and dental units use Nasoalveolar Molding (NAM) to reshape the gums, lip and nostrils of a cleft patient. It is nonsurgical, using a plastic plate inserted into a child’s mouth to reduce a cleft in the months before surgery, decreasing the number of major surgeries a child needs to repair their cleft. NAM also improves the shape and position of the lip and nose.
Narith will require many surgeries over his life to repair his cleft lip and palate. AHC’s surgery team will initially repair Narith's cleft lip. Over the coming years, the team will then slowly repair his cleft palate by moving bone from his hip to the roof of his mouth.
It has made an invaluable difference for Narith to have his cleft treated from birth by the necessary specialists, including NAM treatment, which will allow for effective surgeries and full recovery of his cleft.
Narith still has a long road ahead to repair his cleft palate. But with help from AHCs "Cleft Squad," he has every chance of growing to be a normal, healthy young boy.