"The current emergency in our community is not like the raging storm that tore apart our country in the 1970's but more like the slowly rising flood waters from broken levees that are silently drowning our people," Theanvy Kuoch, chair of NCAHI, wrote in a 2006 open letter. "We are now dying from diabetes, stroke, depression and post-traumatic stress disorder (PTSD) in large numbers. What we are seeing is the ongoing degenerative effect of genocide, because these illnesses have their roots in the violence, starvation and torture of the Killing Fields."
I had the opportunity to speak with steering committee member Bun Hap Prak before I left Florida in March. While the initiative specifically targets Cambodian communities in the United States, its goals are no doubt applicable to many other Cambodian populations.
"The mind has a very powerful effect on the body," Prak, a Banteay Meanchey native, told me. Over 60 percent of adult Cambodians in the United States suffer from chronic disorders and diseases caused by trauma, he added.
But cultural taboos and lack of information prevent many Cambodians from seeking mental health help. That is why NCAHI developed a strategic five-year plan in 2007 to address health needs in the Cambodian American population. The coalition strives to bring attention to ailments afflicting Khmer Rouge survivors and train Cambodians to provide services in their own communities.
"Because of their experiences under the Khmer Rouge, many Cambodian Americans still don't trust government," Prak said.
For some, it's hard to have faith in anything.
"Many refugees learned that they had little control over their lives during those times, and fatalistic attitudes that carry over to today create barriers to optimal healthcare," according to a study published by the U.S. Department of Health and Human Services in 2006.
The study, which focuses on diabetes in Southeast Asian refugees, stresses the importance of psychologically empowering those suffering from chronic illnesses.
A consultant with Vietnamese populations is quoted in the study saying he often received phone calls from wives whose husbands ignored doctors' instructions about their diabetes.
"The husbands would say things like ‘diabetes cannot be cured' and ‘I am going to die anyhow' to justify the lack of interest in their own health," according to the study.
Along with fueling fatalistic attitudes, the history of trauma may have more direct physical effects. According to the 2006 study, there is some evidence constant stress and anxiety can result in long-term hormonal changes. Elevated cortisol levels, for example, may lead to insulin resistance - a precursor to diabetes.
Prak thinks it's logical. Untreated psychological illness can only weaken the body, he said.
For many KR survivors, "their lives are still difficult," he said. "They go to sleep stressed all the time and that makes them vulnerable."