VOA标准英语2009年-Cambodia Struggles to Save Mothers, Even a

By Robert Carmichael
Phnom Penh
10 November 2009

 
Mother and child in Cambodia
Cambodia is one of the poorest countries in Southeast Asia. Given its turbulent past, decades of civil war and the devastating¹ policies of the Khmer Rouge² to name just two, it faces extra hurdles³ on its way to improving health care for its citizens.

Cambodia is working to reduce the number of women who die in childbirth and to lower the number of infants and children under age five who die.

The figures in the two efforts reveal an anomaly: While Cambodia has succeeded in dramatically cutting the ratio of children who die each year, the maternal⁴ mortality figure has not dropped in a decade.

Around 460 Cambodian women die in childbirth for every 100,000 births. The country had hoped to bring that figure down to 140 deaths per 100,000 births by 2015 as part of its commitment to its Millennium⁵ Development Goals, or MDGs.

Dr. Lo Veasnakiry, who heads the Ministry⁶ of Health's planning unit, blames the lack of success, in part, on a shortage of funds and expertise⁷, but he also says the target was excessively optimistic. "The global MDG said that [each] country had to reduce two-thirds of the baseline information when they started the MDG. From a global viewpoint [it's] not only Cambodia - a lot of countries have not made significant progress in terms of maternal deaths," he said.

A study in 2005 found that around half of the Cambodian women who die in childbirth succumb⁸ to massive blood loss. A quarter die from eclampsia, which is a problem related to high blood pressure.

Malalay Ahmadzai, the mother and child healthcare specialist for UNICEF in Cambodia, says both conditions require rapid treatment - in the case of blood loss a woman can die within a few hours.

She says the onset⁹ of maternal complications is unpredictable, and the response is often slowed by what health experts call "the three delays". "The first delay is decision-making in the family whether to seek care or not. The second is the roads - roads counts as one of them - but costs, costs, roads and access. And third is the quality of care," she said,

The solution is a mix of better resources, more trained medical staff, and better roads - the logic¹⁰ being that the quicker patients get to a clinic, the better their chances of survival.

Cambodia's inability to save mothers contrasts with its success in lowering infant and child deaths.

The country aims to reduce the ratio of infants dying before their first birthday to 50 per 1,000 live births - or five percent.

Ten years ago the rate was almost twice that. Today's rate is six percent, putting Cambodia well on its way to hitting its target.

It is a similar story with deaths among children under five; the rate has dropped to 83 per 1,000, down sharply from 124 a decade ago.

Lo says the government's financial commitment to the health sector¹¹ has proved vital to saving children. He also credits the cash and technical help from health partners such as UNICEF.

Ahmadzai says other factors play a part, too. "One has been the strong performance of the national immunization program. That has been one key promising¹² intervention¹³ identified. Second has been the improvement in breastfeeding practices, and that goes back to a lot of community work plus support to the health centers and so on," she said.

Tackling maternal mortality, on the other hand, requires that good quality care be quickly available at health clinics. And in much of Cambodia, the quality of care is insufficient¹⁴.

One problem health care providers have here is getting good data on the maternal mortality rate. Some officials say it actually could be anywhere between 300 deaths and 700 deaths per 100,000 births.

A more accurate figure will emerge next year when the five-yearly nationwide health survey is taken.

The Ministry of Health's Lo is optimistic that the new data will show an improvement in the rate.

That is because every one of Cambodia's almost 1,000 healthcare clinics now has a midwife. A year ago around 90 percent did.

Also, more women receive care before giving birth than ever before, and more midwives are present at births.

But even Lo does not expect the improvement will bring the goal of 140 deaths per 100,000 births within reach. He recently proposed that the government raise the target to 250.

While that rate is far from ideal, Lo points out that the lower rate will still be a significant improvement for Cambodian families.

1 devastating   

adj.毁灭性的，令人震惊的，强有力的

参考例句：

• It is the most devastating storm in 20 years.这是20年来破坏性最大的风暴。
• Affairs do have a devastating effect on marriages.婚外情确实会对婚姻造成毁灭性的影响。

2 rouge   

n.胭脂，口红唇膏；v.(在…上)擦口红

参考例句：

• Women put rouge on their cheeks to make their faces pretty.女人往面颊上涂胭脂，使脸更漂亮。
• She didn't need any powder or lip rouge to make her pretty.她天生漂亮，不需要任何脂粉唇膏打扮自己。

3 hurdles   

n.障碍( hurdle的名词复数 )；跳栏；（供人或马跳跃的）栏架；跨栏赛

参考例句：

• In starting a new company, many hurdles must be crossed. 刚开办一个公司时，必须克服许多障碍。 来自《简明英汉词典》
• There are several hurdles to be got over in this project. 在这项工程中有一些困难要克服。 来自辞典例句

4 maternal   

adj.母亲的，母亲般的，母系的，母方的

参考例句：

• He is my maternal uncle.他是我舅舅。
• The sight of the hopeless little boy aroused her maternal instincts.那个绝望的小男孩的模样唤起了她的母性。

5 millennium   

n.一千年，千禧年；太平盛世

参考例句：

• The whole world was counting down to the new millennium.全世界都在倒计时迎接新千年的到来。
• We waited as the clock ticked away the last few seconds of the old millennium.我们静候着时钟滴答走过千年的最后几秒钟。

6 ministry   

n.(政府的)部；牧师

参考例句：

• They sent a deputation to the ministry to complain.他们派了一个代表团到部里投诉。
• We probed the Air Ministry statements.我们调查了空军部的记录。

7 expertise   

n.专门知识(或技能等)，专长

参考例句：

• We were amazed at his expertise on the ski slopes.他斜坡滑雪的技能使我们赞叹不已。
• You really have the technical expertise in a new breakthrough.让你真正在专业技术上有一个全新的突破。

8 succumb   

v.屈服，屈从；死

参考例句：

• They will never succumb to the enemies.他们决不向敌人屈服。
• Will business leaders succumb to these ideas?商业领袖们会被这些观点折服吗？

9 onset   

n.进攻，袭击，开始，突然开始

参考例句：

• The drug must be taken from the onset of the infection.这种药必须在感染的最初期就开始服用。
• Our troops withstood the onset of the enemy.我们的部队抵挡住了敌人的进攻。

10 logic   

n.逻辑(学)；逻辑性

参考例句：

• What sort of logic is that?这是什么逻辑？
• I don't follow the logic of your argument.我不明白你的论点逻辑性何在。

11 sector   

n.部门，部分；防御地段，防区；扇形

参考例句：

• The export sector will aid the economic recovery. 出口产业将促进经济复苏。
• The enemy have attacked the British sector.敌人已进攻英国防区。

12 promising   

adj.有希望的，有前途的

参考例句：

• The results of the experiments are very promising.实验的结果充满了希望。
• We're trying to bring along one or two promising young swimmers.我们正设法培养出一两名有前途的年轻游泳选手。

13 intervention   

n.介入，干涉，干预

参考例句：

• The government's intervention in this dispute will not help.政府对这场争论的干预不会起作用。
• Many people felt he would be hostile to the idea of foreign intervention.许多人觉得他会反对外来干预。

14 insufficient   

adj.(for，of)不足的，不够的

参考例句：

• There was insufficient evidence to convict him.没有足够证据给他定罪。
• In their day scientific knowledge was insufficient to settle the matter.在他们的时代，科学知识还不能足以解决这些问题。