“My name is Alzbeta Nemcova, I am 28 years old and I am a midwife. I have five years of experience at the Apolinar Obstetric Hospital in Prague, specializing in high-risk pregnancies and complicated deliveries. I like my work and I also like to travel, that’s a big part of my personal development.”
Alzbeta is recently back from her second two-week health mission to Cambodia. These trips, which she and her colleagues undertook to Southeast Asia in January 2022 and earlier this year, were part of the “Czech Perinatology Hands to Cambodia” project. Its aim is to reduce maternal, neonatal and infant mortality which is high in the country. The project is implemented by the Czech Development Agency in cooperation with the Vita et futura Foundation.
“Our first trip was more of an exploratory, inspection visit by a small team of obstetricians from our clinic. Our second trip, in January of this year, was conceived as an educational workshop based on the information we acquired. The team included obstetricians, anaesthesiologists, neonatologists, bioengineers and IT specialists who were there to educate Cambodian doctors and midwives, to provide know-how that would help reduce maternal, neonatal and infant mortality. Access to education is very complicated in Cambodia, given the country’s history. So we provide them with videos and other educational materials, and we organize e-learning conferences. For instance we show them how to use ultrasound and other devices that they often get from international donors but don’t know how to use properly. The aim is for the health workers trained by us to pass on the information, we jump-start the process and then want them to learn from each other.”
Ratanak, a Cambodian bioengineer who has settled in Czechia, is the team’s liaison officer – who translates all the materials and lectures into Khmer. Alzbeta says he is a key member of the group.
“Language is a vitally important factor for the success of this project. If we presented everything in English, the Cambodian health workers would only grasp about 5% of the information because most of them don’t speak good English”, explains Alzbeta. She says that even French is not widely spoken in the country today.
Compared to France, Germany, but also China or South Korea, Czechia is one of the smaller donors involved in the reconstruction of the 17-million-strong Kingdom of Cambodia. The country is still recovering from the brutal terror of the Khmer Rouge. After the overthrow of the genocidal regime in 1979, Czechs made a major contribution to establishing basic medical care in the country.
But the Czech-Cambodian story goes further back to 1962, when the country’s current king – then nine-year-old Norodom Sihamoni came to Prague to study. He spent twelve years in Czechoslovakia studying dance and claims that to this day he speaks better Czech than Khmer.
Barbora Žák Vlasová from the Czech Development Agency talks about other Czech footprints in Cambodia:
“Czechoslovakia was one of the twenty countries that recognized Cambodia’s pro-Vietnamese regime in the 1980s. Development cooperation in the field of health dates back to this time. That is why if you travel around Cambodia today you can still see Czechoslovak-Cambodian Friendship hospitals in the provinces. Czechia is a leader in the field of maternal and child care, so this is one of the key issues we are addressing in Cambodia.”
Cambodia has experienced rapid economic development in recent years. While the poverty rate has fallen from 50% in 2009 to around 15% today, 8 million Cambodians still live on the poverty line and infant mortality remains high, explains Barbora Žák Vlasová:
“Our research, conducted in 2018, shows that 6,000 new-borns die in Cambodia every year. Given that local statistics are not really well-kept, the actual mortality rate is probably higher. I myself travelled around Cambodia in 2018 and tried to verify the official figures. I found that hospitals don’t record a lot of cases at all. In some cases, women with potentially complicated births were sent home so they wouldn’t be included in the statistics as cases that didn’t go well.”
Cambodia does not have a health insurance system. The availability and quality of health care, including for pregnant women and new-borns, depends on the given family’s financial situation and where they live. While the National Paediatric Hospital in the capital Phnom Penh provides an excellent level of care, in more remote areas of the country there are often only health centres with no doctors and no ambulances, explains midwife Alžběta Němcová:
“As part of the project, we are working to improve the level of health care in Kampong Chhnang province and at the National Paediatric Hospital in Phnom Penh. In that province, which is about the size of Central Bohemia, there is only one hospital where it is possible to do a Caesarean section. In the health centres you will only find nurses. We wanted to visit these places to see how they work, what care they provide in the event of complications. In our province, there is only one ambulance and two people who are able to drive it. Otherwise, they come to us on a tuk-tuk or scooter. Almost everyone who comes to the hospital gets an IV. And then they leave with it. So you often see a man on a scooter with his pregnant wife behind him holding an IV bag, as they make their way back home.”
Czechia renovated the provincial maternity hospital in Kampong Chhnang and also equipped the neonatology ward at the National Pediatric Hospital in the capital. This is currently the only Cambodian facility with incubators for premature babies, and Czech doctors have been working there for a long time as part of the “Czech Perinatology Hands to Cambodia” project. The program seeks to encourage mothers with high-risk pregnancies to come to this specialized facility to give birth.
As part of this cooperation, a group of Cambodian medical professionals will come to Prague in March and the whole project will culminate in the autumn, with the last mission of Czech experts to Cambodia. This should focus, among other things, on the use of telemedicine, Alžběta Němcová explains:
“The experts create educational materials, which are translated into Khmer, and our IT specialists develop three types of apps. One of them is aimed at the general public, i.e. women, who will use it as a pregnancy guide. The second is for health professionals and will contain professional information and videos. The third would be used to collect data. In Cambodia, even poor people have quality smartphones, so the dissemination of information via apps definitely has a future here.”
Czech Early Warning System EWS 1294 saves lives in floods
Another successful Czech project in Cambodia is based on the use of digital technology.
It was developed by the humanitarian organization People in Need, which has been operating in the country since 2008. It is called the EWS (Early Warning System) 1294, named after the toll-free telephone line via which Cambodians can log into the system.
Twenty-three-year-old Sin Seouli and his family were saved by the early warning system.
“I’ve been in several floods. In the last one, we got a message to evacuate via the system. When I came out of the house, I saw the water rising. It rose higher with every passing hour. So I and my wife collected our personal belongings, took the kids and went up the hill.”
Davy Tith, a local teacher, lives in a small fishing village in Kampot province, southern Cambodia, on the nearby Gulf of Thailand, where, among other things, the famous Kampot pepper is grown. This village on the banks of the Praek Tuek Chhu River is often hit by floods and typhoons.
“I signed up for the early warning system in 2017, on the advice of my neighbour,” says the young woman. “On July 16, 2018, I received a voice message on my phone about flood danger. I packed my things and we went to my mother’s house, who lives further away from the river. I also warned the neighbors before leaving.”
Cambodia is among the 15 countries with the highest risk of natural disasters in the world. Recurrent flooding is a hazard that affects more than 25% of Cambodia’s population. After the devastating floods that hit most provinces in 2010, People in Need developed a unique early warning system. Frenchwoman Anouk Chaptal has been working for People in Need in Cambodia for several years and is now the manager of this project, which is supported by a number of international donors. She explains how the system works:
“We launched the system in 2013 in collaboration with the Cambodian government, the National Committee for Natural Disaster Reduction. We first tested the technology in the province of Pursat, which was one of the high-risk areas in the country. Then the system was extended to the whole of Cambodia.
“Solar-powered sensors are placed on bridges over rivers. These monitor the level of the rivers in real time. The moment the river starts to rise dangerously, the system informs local authorities via the internet and they can send a message directly to registered residents in the areas at risk.”
These warnings help people prepare for various natural disasters, evacuate in time and secure their property. The warning system was also used during the Covid pandemic. According to Anouk Chaptal, the system is constantly being improved to maximize its reach:
“We have several communication channels. People can sign up to the system on line 1294 and automatically receive an alert from us in the event of imminent danger. 140,000 people already use this service. We also disseminate messages through radio broadcasts and public loudspeakers installed in cities at high risk of flooding. We are currently working to expand the system through the social network Telegram, which is widely used in Cambodia. In cooperation with the country’s largest mobile operator, which has over 8 million customers, we want to launch text message warnings. These would go to the mobile phones of all people in the risk area, including those who are not registered in the EWS.”
Extreme weather events and associated flooding claimed more than 400 lives in Cambodia between 2011 and 2013, before EWS 1294 was launched. The system sent out a total of 275,000 warning messages during the heavy rains that hit 14 provinces in the northwest of the country in 2022.
People in Need and the Czech Development Agency are implementing many other projects in Cambodia, such as youth education, inclusion of people with disabilities, support for farmers and biomedical development.