When being healthy is an odd thing

“Who among these young children are unwell?” asked the health officer during a field visit to a remote village. “This one: the tall and big one; he is abnormal and needs to be treated,” answered the concerning parents unhesitatingly.

I laughed at first at this seemingly comedic anecdote told by my colleague who has been working for over 20 years on maternal and child health in Northern Cambodia. But as I come to understand more and more about remote communities, this is sadly a common case happening in reality. It may seem absurd to us that this happens, but it is only because we have a clear understanding of what a healthy child should look like (we may have taken it for granted). In these remote villages, almost all children are small, thin, and short (unhealthy) and so this abnormality is often perceived as a normal standard. Occasionally there are taller and bigger (healthy) children, but then they will just stand out as the odd ones. This kind of fundamental problem is exactly why health among these communities is often in jeopardy.

Figures showing the level of malnutrition among children in Cambodia

Source: https://www.globalnutritionreport.org/files/2017/12/gnr17-Cambodia.pdf

Acknowledging this situation, one of the aims of the EMBRACE Program is to reduce the number of unhealthy children, specifically the ones suffering from acute malnutrition (rapid weight loss or fail to gain weight). Beside conducting outreach activities to educate and sensitize communities on child health and nutrition, EMBRACE alongside the Minister of Health has been running child growth monitoring programs to identify children who are affected by moderate acute malnutrition (MAM) and severe acute malnutrition (SAM), which can increase children’s risk of death. The programs, upon taking body measurements (e.g. weight, height, arm circumference), will send identified SAM children to nearby health centers for immediate treatment (e.g. high-calories therapeutic food) while advice caregivers of MAM children on the right diet and nutrition.

Therapeutic Food

Health Center 1

Health Center 2

Therapeutic food for malnutrition;

Health Centers (too few to serve too many remote villages and lack adequate resources)

This system looks simple on paper but it is much easier said than done in practice. One of the biggest challenges is that many villages are not easily accessible and are far apart so it would take health centers much time and effort to carry out even the simplest monitoring program. For the same reason, health problems in the remote villages are generally hardly attended to or even get noticed in the first place due to short of staff and means of transportation. This is why the network of Village Health Support Groups (VHSGs) within each village in Cambodia is instrumental to the overall success of community-based health programs. VHSGs are comprised of people from the village acting as a focal point for all health-related activities in the village (e.g. providing health education and ensuring the regular flow of health information between the community and health center). In the case of the child growth monitoring program, malnourished children can then be identified by trained members of VHSGs and taken care of inside the village or referred immediately to the health center when necessary. So while it is true that it takes a whole village to raise a child, it takes even more than whole a village (literally) to keep the child nourished and healthy. And this perfectly exemplifies the fact that empowerment at the most local level does go a long way in improving the overall well-being of communities.

meeting 1

meeting 2

meeting 3

I sat in a child malnutrition workshop with officers from the Provincial Health Department, staffers from the health center, and health workers from VHSGs from seven villages in the Choam Ksant Commune, Preah Vihear Province, Northern Cambodia.

body measurement 1

body measurement 2

During the workshop, we were provided training on how to measure the height and weight of infants and young children, how to take mid-upper arm circumference (see pictures above), and how to use the weight and height scoring system to categorize the level of malnutrition.

Shoes off

Obligatory introduction

Fun fact 1: With the "shoes off Khmer culture", one can take attendance without going into the room

Fun fact 2: There is a round of introduction in every community meetings, which allows me (forces me) to become quite proficient in introducing myself in Khmer