Scared of Coronavirus, Pregnant Women Avoid Hospitals

A factory on National Road 6 in Phnom Penh, Cambodia, gives priority on work leave to pregnant women , April 03, 2020. (Hean Socheata/VOA Khmer)

A baby born during the Year of the Rat 2020 is lucky, Phorn Sreyroth’s parents told her, so she and her husband had been excited to welcome their daughter in late May. But now that the coronavirus pandemic has hit Cambodia, everything has become more complicated.

Heavily pregnant, 27-year-old Sreyroth agonizes about giving birth amid the ongoing COVID-19 crisis.

“Thinking about it, I am scared,” she said. “It is my first time being pregnant, so I am already worried about how I’m going to go through the delivery, whether by labor or cesarean section. Now COVID[-19] concerns me even more.”

Respiratory disease COVID-19 has claimed more than 70,000 lives worldwide and infected more than 1 million people. There are 120 official cases in Cambodia as of Saturday. But with a population of 15 million and a lack of transparency by the government about the testing, critics voice doubts whether those numbers are accurate.

WHO recommends prioritizing pregnant women who appear to have symptoms of COVID-19 for testing as they might need specialized care.

While preparing for one of the most intense and emotional experiences of her life, Sreyroth questions everything: where to deliver, who should be there with her, and, after all, if it will be safe.

Had she initially planned to go to a private clinic in central Phnom Penh, she is now not so sure.

Phorn Sreyroth, 27, talks to VOA Khmer via video call sharing her concern on pregnancy care during COVID-19, on April 02, 2020. (Hean Socheata/ VOA Khmer)

The spread of the coronavirus in the country pushed the saleswoman to move to her parents’ house some 30 kilometers away. Her husband still lives and works in Phnom Penh, adding another layer of stress.

Besides not shopping at markets to avoid crowds, Sreyroth has also canceled her prenatal appointment at her clinic in Phnom Penh for fear of getting infected.

With this, Sreyroth is not alone. Health workers told VOA Khmer that a growing number of women canceled their appointments.

Seap Bel, head of the Maternity Department in Khmer-Soviet Friendship Hospital, said that of the 52 beds that were normally all occupied, more than half had remained free in recent weeks.

“Since COVID-19 patients are placed in this hospital, people without a severe case [of illness or pregnancy complications] don’t come,” he said.

It is the only hospital in Phnom Penh that collects samples for coronavirus testing. But while the government has urged the population to prevent COVID-19’s spread by exercising proper hygiene, the state-run hospital seems to lack appropriate measures.

FILE: People walk out of the Soviet Hospital, the only public hospital that has a mental health department in Phnom Penh, Cambodia on October 16, 2018. (Hor Singhuo/VOA Khmer)

Visitors can enter the Khmer-Soviet Friendship Hospital without having their temperature checked or having to disinfect their hands. There are no hygiene instructions. Sanitizer bottles hang in front of most hospital rooms, but many of them are empty – including the ones at the maternity ward.

The public can also wander from one department to another.

Before coming to the hospital, 63-year-old Vann Vong did not know that the hospital accommodates COVID-19 patients. On Monday, she traveled 85 kilometers from Angkor Borei of Takeo province to accompany her daughter, who encountered pregnancy complications.

“We are worried, but we do not know what to do,” she said.

She said the hospital sprayed disinfectant on the bed once a day, but unreliably so. “Sometimes when there are too many [patients], and they run out, they come late,” she said. “We have to use our own and spray [the bed] by ourselves.”

But Chem Panhchaksith, deputy head of administration at the hospital, denied the allegations.

“Following the WHO’s and Ministry of Health’s recommendation, the hospital has applied preventative and protective measures,” he said. “At each department, we have a temperature-scan area, an alcohol-spray tray, and every staff and official has their own [bottle of] alcohol.”

Asked why some alcohol bottles were empty and no temperature was taken at the entrance of the hospital, he asked the reporters to visit the hospital again. “We have applied these measures even before the COVID-19,” he said. “And since COVID-19 we are more careful.”

The bottles were also empty during a visit to the hospital after the phone call, and no temperature checked.

A hospital staff, who spoke on conditions of anonymity for fear of repercussions, said that some visitors stole the sought-after liquid.

While the public hospital seems to lack sanitizers, some private clinics appear to have implemented better hygiene practices - but have also seen a drop in pregnant women visiting their clinics.

At the entrance of Mearda Maternity clinic in Phnom Penh’s affluent neighborhood Tuol Kork some 5 kilometers further north, a sink was installed just weeks ago. Clients have to spend at least five minutes on procedures before entering the clinic, including getting their temperature checked, disinfecting their hands, followed by instruction on hygiene.

The clinic’s doctor Ty Sovannaroth, who has been working in the fields of obstetrics for about 15 years, said the number of visits had decreased by around 20 percent over the past weeks.

“Some women called us asking to delay appointments, if not cancel them,” she said.

Dr. Ty Sovannaroth, who has been working in the field of obstetrics for about 15 years, talks to VOA Khmer at Mearda Maternity on pregnancy during COVID-19, in Phnom Penh, Cambodia on April 02, 2020. (Khan Sokummono/ VOA Khmer)

For Sovannaroth, it’s too early to see the impact of women not checking up during prenatal care, but she suggested women continue at least consulting via phone.

She said the government had not issued any clear guidance on childbirth practice in times of coronavirus. “But I keep following updates from the ministry, as always,” she said.

In the meantime, pregnant women should do their best to boost their immune system, she said. This included being more vigilant in their hygiene, reducing the time of going out as much as possible, having a balanced diet, sleeping enough, and being physically active, she said.

Although hygienic standards at the clinic seem to be higher in private clinics than at public hospitals, many economically disadvantaged women cannot afford them. At Sovannaroth’s clinic, delivery costs about $580 - not an unusual price for clinics in Phnom Penh, and about triple the salary of a garment worker.

Garment worker Mun Syna, 29, earns around $190 a month. On the first day of her three-month maternity leave in early April, she felt relieved: Her factory employs hundreds of workers, making it impossible to follow social distancing, and she said not everyone was wearing masks.

WHO suggests wearing face masks, washing hands regularly, and keeping physically distanced as much as possible.

In about twenty days, Syna expects to deliver a son.

“I am worried because a doctor told me that a pregnant woman is vulnerable to getting infected,” she told VOA Khmer.

The science behind this is disputed. A World Health Organization (WHO) spokesperson in the Western Pacific Region told VOA Khmer that although there was no evidence that pregnant women were at higher risk of severe illness than the general population, they can be at higher risk of infection due to changes in their bodies and immune systems.

“We still do not know if a pregnant woman with COVID-19 can pass the virus to her fetus or baby during pregnancy or delivery,” the WHO spokesperson said, adding that small studies have found no virus in samples of breast milk or the liquid surrounding the fetus.

Ministry of Health spokesperson Or Vandine said pregnant women simply needed the same protection as the general population and declined to comment further. Health Ministry spokesperson Ly Sovann could not be reached.

FILE: Or Vandine, Ministry of Health spokeswoman, speaks in a news conference about Covid-19 at the Ministry of Health in Phnom Penh, Cambodia, February 5, 2020. (Malis Tum/VOA Khmer)

With uncertainty concerning the virus and not much money to spend, those less well-off struggle to find suitable options. At first, Syna was sure she wanted to deliver her baby at the Khmer-Soviet Friendship hospital.

“My supervisor recommended Russian [Khmer-Soviet Friendship] hospital,” Syna said, explaining that the hospital had enough facilities to take care of pregnant women even when complications occurred.

“But my husband said Russian Hospital is loaded with many patients [including COVID-19 patients].”

Depending on the actual circumstances when she’s due, she said she might have to give birth at a nearby clinic or invite a midwife for a homebirth.

As private clinics are more costly and have smaller capacities, and because she did not trust the skills of traditional midwives, Syna worried about her options.

In 2018, about 320,000 women gave birth in Cambodia. A large majority of those delivered at health centers, nearly 12,000 at home with the help of health workers, and about 900 were helped at home by traditional midwives, according to the Ministry of Health. Women in Cambodia have been encouraged to seek delivery service at health facilities instead of at home to reduce the risk of complications, and childbirth practice at home has declined over the past decades. In previous generations, women often sought the service from traditional midwives who went from door to door to deliver babies in the villages, but this posed significant health risks.

FILE: Garment workers take lunch break at Propitious (Cambodia) Garment Ltd, in Kandal Province, March 20, 2020. (Kann Vicheika/VOA Khmer)

Adding to the complication, a new “State of Emergency” law might soon give the government authority to impose a lockdown and restrict movements of the population.

“It’s going to be a difficult job for us,” doctor Sovannaroth said of the lockdown scenarios. “If women encounter complications, we need to ensure we have the equipment to help them. That means they have to come to the hospital as some equipment cannot be mobilized.”

But Sreyroth cannot imagine giving birth at home. To her, the traditional childbirth practice, like how her mother gave birth to her at home 27 years ago, is already out-of-date and unsafe.

Being aware of the additional risks the virus poses, Sreyroth and her family have paid extra attention to daily hygiene. Straight after work, her father takes a shower before talking to his daughter or joining the family’s dinner. He believes he could contract the virus from outside, so he wants to make sure not to transmit the virus to his daughter.

Sreyroth often asks questions in the Khmer Facebook group “Smart Mother”, an almost 70,000-member-strong-group in which women share their knowledge on maternity and childcare. Now, they also discuss the coronavirus. Sreyroth gets her mental and emotional support from the group.

Psychotherapist Yim Sotheary understands the worries. Citing a Cambodian saying that “labor is as dangerous as crossing the river”, the mother-of-two said it was natural for pregnant women to be concerned about their baby’s well-being in normal times. Facing additional uncertainties about the virus, she said, “doubles their concerns”.

Being in home-office for three weeks amidst the coronavirus pandemic, Sotheary recommends pregnant women to stay active as much as possible to avoid mental stress.

“I understand that COVID-19 is unusual, but please keep your routine,” she said.

She urged the government to guarantee hygienic standards to make women feel safe at health facilities.

Psychotherapist Yim Sotheary gives an interview with VOA Khmer on COVID-19 pandemic and mental health impacts on Cambodian pregnant mothers. She talks to VOA Khmer on video call during her telework period, on April 05, 2020. (Photo screenshot)

In the meantime, Sotheary said pregnant women could exercise, do yoga, or meditate to reduce stress. Music could be soothing too, she said. A pregnant friend was knitting her future infant’s crochet toys, she said.

“Do what makes you happy,” she said.

But women like Syna cannot afford special exercises for pregnant women. Instead, she does household chores to keep herself physically active.

Once in a while, when it all feels like too much to handle, Syna said, she tries to get her head free outdoors.

“I ask my husband to take me out somewhere to an open space that is windy,” she said. “Too much news makes me feel anxious.”