Health, women and environment in a marginal region of north-eastern Cambodia

Abstract

With a population of 70,000, the province of Ratanakiri, close to southern Laos and western central Vietnam, is inhabited by proto-Chinese ethnic minorities who all practice slash and burn cultivation. Despite its natural wealth (wild forests, precious stones, fertile basaltic lands), the region is still a relatively unexplored and deserted area. The geographical isolation of the hilly territory has been worsened by the politico-historical background of the country during the Khmer Rouge regime, and up to now accessibility remains difficult due to the acute guerrilla warfare in the surrounding provinces. In 1994 a few NGO's were implemented and the Cambodian government faces complications in providing proper sanitary and social infrastructures. The health situation is one of the poorest in Cambodia: malaria (vivax and falciparum), typhoid fever, Japanese encephalitis, pneumonia and leprosy are the most dreadful endemic diseases in the tribal villages. The infant mortality rate, even if not available exactly, is desperately high and the health delivery system is restricted to the provincial hospital in the capital and to small dispensaries located in the eight districts, run by an under-equipped paramedical staff which suffers from a permanent shortage of drugs. The dispersion of the (non-permanent) hamlets and the inadequacy of mobile health workers also prevent any improvement in the general living conditions.

Among the various activities connected with itinerant agriculture and with the gathering of forest products, women play a major role. They are more careful and harder workers than men (who mostly hunt, fish and undertake difficult physical activities), in the sense that the latter are responsible for the field culture maintenance and supervision and that they regularly go in the forest to pick up various products. Women collect firewood and water, take care of the animals living in the village (pigs, hens, buffaloes and dogs) and have to manage all the traditional domestic duties. The woman's living conditions lead to different exposures to an important number of diseases. In the remote areas, goitre is endemic and low nutritional status is rampant, even if there is no regular food scarcity. Pregnant women do not have any opportunity to slow down their daily activities; they are bound to start working as usual just after delivery, and in case of any health problems, men will never stand in for them and perform female activities. The understanding of gender and environment relationship is therefore an important issue to promote necessary social changes and to improve the health and awareness of the women in Ratanakiri.