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Logo of Phnom Penh Post newspaper Phnom Penh Post - Crossroads for Khmer mental health

Crossroads for Khmer mental health

"Her name was Si Noun. She was 18, 20 years old. She became psychotic. She was

worried and so afraid .... she could not adapt to the new society and the Khmer

Rouge accused her of malingering, that she was not really sick. They took her

away to kill her. "

Twenty years ago Ka Sunbaunat (right) was a

22-year-old medical student pretending to be a simple villager in Kompong

Chhnang. By the time he watched the Khmer Rouge drag Noun away to her death,

Sunbaunat had decided that if he ever survived, he would become a

doctor.

There were 12 psychiatrists in Cambodia when the KR took power in

1975. With them, died the country's entire mental health service.

Today,

Sunbaunat is the chairman of the Health Ministry's mental health subcommittee

and the first of ten doctors training to be the country's new generation of

psychiatrists.

"During the Khmer Rouge regime all of us had degrees of

mental problems. Even after we had a change of regime and society, people were

strained and had to change their behaviour," he said in an interview at the

psychiatric department of Preah Sihanouk Hospital.

Sunbaunat says his

own mental anguish began when his older brother, a soldier, was killed in 1971

during a battle with the Khmer Rouge.

"I cried and cried. During the

daytime, I didn't cry because I didn't want my parents to feel more sad. But at

night, I regretted it too much. I know how people suffer from

bereavement."

"After 1979, I saw some of my relatives that had problems.

They changed. They cried easily; became angry easily. Nobody took care of that.

We were looking for food, for money. After 1979, we hoped that things would be

better, but we still suffered because of the war." Cambodians, he says, are

still suffering.

The country currently has no qualified psychiatrists,

no in-patient services for the mentally ill, no counselling for war veterans and

virtually no community services for the population of nine million.

When

the Health Ministry and the World Health Organisation got together earlier this

year to create Cambodia's essential drug list - the guide for all basic drugs to

be used at the country's hospitals - they neglected to put any psychiatric drugs

on the list. There was no one to prescribe them.

"When children are

dying from common diseases like diarrhoea and measles, you can't expect the

country to deal with mental health - particularly when there is no one saying:

'This is my field,'" said Dr. Kirsti Oskarsson, a Norwegian psychiatrist and

coordinator of the Cambodian Mental Health Training Program (CMHTP) at Sihanouk

Hospital.

There are no definitive statistics on mental health problems

in Cambodia, but local doctors and visiting experts agree that after more than

two decades of war the country has an unusually high rate of stress-related

mental illness. Depression, anxiety and aggression are common, as is

Post-Traumatic Stress Disorder (PTSD).

Oskarsson says she believes

Cambodia has roughly the same rate of schizophrenia and manic depression as

other countries, but personality disorders are more prevalent. However, she says

people tend to ignore their stress because they know many of their neighbours

are coping with the same problems.

Dr. Patricia Walker of the United

States-based Centre for Victims of Torture, says her work with Khmer-Americans

shows that long-buried mental anguish is more likely to surface "at year ten or

15," long after physical pain has healed.

"That's absolutely been our

experience in the US. For the first few years, people are dealing with simply

surviving... It's only when they're feeling a bit safer with their personal

family needs, or in a government context, that then these problems

emerge."

Both painful memories and current money worries appear to have

driven 47-year-old Em Sophana over the edge, says her doctor, Ang Sody. She lost

her first husband and two children during the Pol Pot time. With her second

husband, a soldier, away often, Sophana (not her real name), found it hard to

support her family. Soon, her in-laws took her four sons away.

"She

began to suffer insomnia, headache. She would talk nonsense. When she came here,

she could not sit still. She was singing... There are many patients like her who

come to see us," says Sody, the only woman among the trainee psychiatrists at

Sihanouk Hospital.

Sophana, who suffered PTSD in the past, has now been

given a tentative diagnosis of manic-depression. Medication has alleviated her

symptoms, but she has complained of lost appetite and nightmares.

Family

breakdown and domestic violence are two side-effects of life under the KR, says

Sody. "In the 1960s, the behaviour of the people was not like now. Today, people

are more aggressive. The Pol Pot regime did not teach children to respect each

other. It broke up husband and wifes."

The pressures of raising children

alone is one reason the hospital and 11 clinics in Pursat's Krakor District see

a high number of women complaining of anxiety, sleeplessness and depression,

says Chea Sambo, district health director.

"Some, their husbands died in

Pol Pot time. Some, their husbands found a second wife. Others were rich and now

they are poor. We try to educate them not to think about it," says Sambo.

Rather than forget, many of the patients are more likely to try their

luck with traditional healers, monks, or village elders.

Many treatments

- such as the use of silver pendants, prayer or sprinkling with holy or 'magic'

water - are benign. However, Sunbaunat says: "some hit the patients with small

sticks, to chase the spirits or the gods out of the body of the patient. That is

not good. It excites the patient more."

The Sihanouk Hospital clinic,

funded by the University of Oslo, was set up to give the CMHTP trainees

practical experience. It's attracting roughly 100 new patients a month since

September, 1994.

None of the cases has ever been officially closed,

because there is no follow-up service to monitor patients' progress and no other

way most of them would be able to keep taking medication.

"I dread the

day when we have to say we can no longer take new patients. That day will

definitely come," says Oskarsson.

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