Know more about MDGs (Please refer to Vol.139 "What is MDGs?")
Goal 4: Reduce child mortality
Kampong Luong Floating Village, Cambodia
By Mr. Masaya Takahashi (Yonezawa Church, Niigata Diocese)
Kampong Luong Floating Village is floating on Tonle Sap Lake which is the biggest lake in South East Asia and located at the center of Cambodia. The people live in the boat houses there. Excrement of human and animals, waste and oil are mixed with the lake water and the people use it for the domestic water. Many infants die in the unsanitary environment as their immunity is weak.
Most of the women give birth in their boats being assisted by midwives. As they are not educated midwives but traditional ones who have experiences of only childbirth assistance, the mother and child sometimes face the risk of their lives. According to 2009 UNICEF statistic, sixty eight babies out of one thousand died under one year old. (Ref. http://www.unicef.or.jp/library/toukei_2011/m_dat01.pdf) As there is a gap between city area and countryside, it is suspected that one baby out of ten dies in Floating Village. For comparison, the mortality rate of babies under one year old is two-one thousandth in Japan.
The situation of environment is very serious for infants in Floating Village. They die very easily here.
Under the said circumstance the mother and child health program was started in June, 2009. The obstetrician and gynecologist come to the classroom of literacy education in the morning every Saturday and Sunday and conduct medical check up for infants and pregnant women. All together 278 pregnant women and 431 infants (monthly average is 11 and 18 respectively) have come to the clinic in these two years.
We hold the monthly workshop, too. Mothers gather at the workshop and the staffs from Village Health Center give talk under the topic of mother and child health such as health control before and after childbirth, sign of dangerous disease during maternity period, how to keep power milk and contraception. They also vaccinate the infants and mothers (against tetanus and measles), distribute iron supplement and vitamin A and so on. The health education is provided to the mothers. Having appropriate knowledge protects infants from risks and saves their lives.
The mother and child health program is partially supported by the Global Citizen Foundation（HP http://www.gcf.or.jp/）.
<Danger of powder milk >
There is a powder milk support in the mother and child health program. However, we support it only in special cases as the powder milk is dangerous with high risk to kill infants and it is even called "baby-killer". The risk is so serious that it has been taken up in UN. Why is the powder milk dangerous while it is commonly sold in Japan?
In poor areas in Asia the powder milk is used by many people. It is the effect of the CM of TV and free sample distribution by makers. It is natural for parents to want to give good stuff to their children. If they see the CM "Rich in nutrition" and "It helps babies' growth and helps them growing healthy and bright," they surely get eager to buy it. If a mother sees others' babies fed with powder milk growing faster and bigger than her baby, she normally gets envious.
BUT! Different from the breast milk, the powder milk needs a bottle. Many people cannot keep the bottles clean. Germs in dirty bottles sometimes kill babies. So does the water used for the powder milk. Rain water and river water cannot be fed directly. For sterilization, water and bottles must be boiled. Many uneducated mothers, however, do not care as it is troublesome or the water looks clean. Moreover some families are so poor that they cannot afford to buy firewood to boil the water. In many cases the poor families live in unsanitary environment and it is impossible for them to clean germs.
As a conclusion, it is better not to use powder milk. Ms. Chender from our clinic says, "Every mother has breast milk and can make more by massaging if not enough. Babies must be grown only by breast milk." She has been working in the village health center as a midwife for many years and involved with childbirth and child-raising in the floating village. From her experience of seeing many mothers losing their babies, she asserts "No!" to powder milk.
Basically human have been raising children by breast milk since ancient time. The breast milk contains ingredients to strengthen the immunity. The modern material civilization created the demand of powder milk but its benefits are granted to only few people who can afford to buy it continuously, read the direction stated on the milk tin, keep bottles clean and live in the place where the clean water is available. These conditions do not apply to the people in the floating village. Therefore, the village people should not use powder milk in principle.
We support powder milk only to babies without mother or to mothers who do not have breast milk or cannot feed their babies on breast milk due to diseases. I discuss with Ms. Chender who is anti-powder-milk to decide which mother to provide powder milk to. When we distribute powder milk, Ms. Chender hands the powder milk directly to mothers or guardians and gives them instructions. At the same time we monitor the growth of their babies. We are very cautious about supporting powder milk.
The other day a lady member of sick people support group in the church told us, "I want you to support powder milk to my neighbor, a young mother." I asked her the reason and she said, "She is very poor and her three children died. She has just given birth. Please support powder milk to her." As I could not understand the reason, being poor, I asked her "Why did her children die? Doesn't she have breast milk?" She did not know about it and I decided to visit the mother with Ms. Chender.
I entered her small house and saw a very small baby sleeping. It was one month old. I asked the young mother sitting beside the baby, "Do you want powder milk?" She answered, "Yes. I have no money to buy powder milk." I asked her, "Don't you have breast milk?" She murmured, "Well, a little." Ms. Chender immediately told her, "Show me whether you have breast milk or not. Squeeze your breast!" The young mother obeyed her. The breast milk rushed out. "Since you have breast milk, raise your baby by it. Yours is enough," said Ms. Chender. The mother thought that her milk was not nutritious enough and wanted to use powder milk as well. But her family was too poor to do it. It is impossible for a family with monthly income of less than fifty Dollars to buy powder milk which costs ten Dollars a month.
We also worried about the fact that she is twenty three years old having born already five babies and three of them died. Ms. Chender and I suspected that the cause was the powder milk given to the babies in the unsanitary situation. We thought it was partially due to the mother's ignorance and Ms. Chender explained to her that the powder milk was dangerous if it was handled wrongly. In addition, she has been pregnant many times with no interval since marriage, which is the great burden for her body and the delivery will be risky. Ms. Chender explained it to her with some case examples familiar to her. The mother listened to her with attention. So far no body had taught her such things. As she had never been to the village health center, she did not know about vaccination and distribution of iron tablets at all. We explained to her about the workshop and vaccination to be operated on the next day and got her to attend.
"By the way, do you have the certificate of poverty?" I asked her. She answered, "What is it? I don't have it." "Oh! You can get it since you are so poor." I told her about the certificate. Medical treatments for those with the certificate are free in Cambodia (except for some private hospitals). There are only once in two years to obtain the certificate. I immediately introduced her to a staff of the village administration and made arrangements to get the cert for her and fortunately she was granted at that time. She was very grateful for our help.
I was very happy to see that our mother and child health program was a bridge between the public administration and residents.
[Mr. Masaya Takahashi was sent to Cambodia in November, 2005 and has completed his mission for five and half years on 28th July this year. We would like to express our gratitude to those who supported him.]
We will present "Goal 5: Improve maternal health" in the next issue. The articles will be on Cambodia and East Timor.