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A child is screened for hearing loss during a consultation at the Institute of Audiology and Primary Ear Health Care in Phnom Penh earlier this month
A child is screened for hearing loss during a consultation at the Institute of Audiology and Primary Ear Health Care in Phnom Penh earlier this month. HONG MENEA

Hearing calls for help

Of the 51,000 profoundly deaf people in Cambodia, less than 2,000 have access to deaf services. “The other 49,000 are standing out in the rice fields right now, thinking they’re the only deaf person in the world,” said Charlie Dittmeier, director of the NGO Deaf Development Programme (DDP).

When Dittmeier arrived in Cambodia more than 10 years ago, there were no programs for the deaf in Cambodia and not a single deaf person had finished high school. “There was no deaf community in Cambodia, there was only a deaf population. Ninety-eight per cent of deaf people in Cambodia had never met another deaf person – even if they did, they could not communicate,” Dittmeier said.

Cambodia – along with Vietnam and Laos – was part of French Indochina until the mid-20th century. Both Vietnam and Laos have long-since had sign languages, schools and services for the deaf, but until the past two decades, Cambodia lacked all three.

Even now, there is no official sign language in Cambodia. Krousar Thmey, an organisation helping disabled and deprived children in Cambodia that has now opened five schools for the deaf, previously used American signs to convey Khmer words, while DDP, since its infancy, has been working on developing a Cambodian sign language.

Students practise sign language with one another at the Mary Knoll Deaf Development Programme in Phnom Penh this month
Students practise sign language with one another at the Mary Knoll Deaf Development Programme in Phnom Penh this month. HONG MENEA

Both organisations have recently been meeting three times a week, reconciling the two sign languages currently in use in Cambodia.

“We’re actually developing a common sign language now, and we plan to get it recognised by the government,” Dittmeier said.

For most of the population, not much is known about deafness in Cambodia. Generally, the Khmer word for “deaf” is paired with “dumb” – associating deafness with an inherent inability to speak. It is also common for deaf people to be identified as having a mental disability, although nothing is wrong with them save their lack of auditory sense.

Dittmeier remembers going out to rural villages seeking out deaf people. His team would ask village chiefs if they knew of any deaf villagers. Their response was, “no, but we know a crazy person. They don’t listen to their parents and they make weird noises.” Dittmeier and his team always knew the “crazy” person was not suffering from a mental imbalance, they were suffering from deafness.

DDP runs an 11-month schooling program educating deaf people with ages ranging across six decades. The program now runs for two years, but they are on the verge of adding a third year.

“First, we have to teach them sign language. When they come here, they have literally no language. They have often never been to school a day in their life, so the first three months is really intensive sign language,” Dittmeier said.

After the sign language training, the students learn simple reading and writing in Khmer, mathematics and life skills such as hygiene, family relationships and other things they need to know to survive.

When DDP began working with a job-training centre that agreed to take on deaf people, they decided to wait nine months to review the progress of their students. However, after three months, the job-training centre beat them to it, calling them to say the deaf workers were their best and they wanted them to send more. Unfortunately, this was not possible due to a lack of interpreters.

Struggle for education
Heang Sreytouch, 30, is one of four sisters from Kampong Cham province; three of them are deaf. When the girls were babies, their mother would clap her hands to get their attention, but she and her sisters never reacted to the sound.

“It was very difficult for me when I was living in Kampong Cham, because I could not communicate with other people. I would stay at home and communicate with only my twin sister who is deaf; we never went out for any social activities,” Sreytouch said.

At the time, there were no services for the deaf in Kampong Cham. Sreytouch and her sister went to mainstream school and were ignored, because they could not understand what the teachers were saying; they felt abandoned and alone.

With the lack of education for Sreytouch and her twin and their father’s difficulty in finding a job, the family decided to move to Phnom Penh in 2003. A few years later, Sreytouch’s mother heard an announcement about DDP on the radio. The girls’ father took them to the school to study sign language and get an education.

“I studied at DDP from 2006 to 2008, when I graduated. I stayed at home for one year. After that, I heard from our former teacher, who is now a project manager, that there was work at DDP, so I applied,” Sreytouch said, adding that she has tried to apply for other jobs but many do not accept deaf people and those who do, offer them extremely reduced wages.

“Also when I go to the market to buy things, I cannot speak, so I try to use my sign language and the shopkeepers think I’m crazy. I’m not crazy, I’m trying to make signs to explain what I’m trying to buy,” Sreytouch said. “I would like everyone to know that both hearing people and deaf people are equal and should have equal rights.”

Healthcare vital
Sign language and deaf education are vital for those who have permanently lost their ability to hear, but 50 per cent of hearing loss is preventable as long as it is recognised early on.

A reference for students learning sign language at the Mary Knoll Deaf Development Programme
A reference for students learning sign language at the Mary Knoll Deaf Development Programme. HONG MENEA

“If hearing loss is not identified or addressed in the first years of [a person’s life], then they’ve lost the essential development years. The first years are so important for development of not only language but also cognitive development and communication skills,” said Hannah Chroston, head of administration for All Ears Cambodia, an NGO offering primary ear healthcare and audiology services as well as refurbished hearing aids for those who have already suffered substantial hearing loss.

Glyn Vaughan, the director and founder of AEC, is an audiologist from the United Kingdom with nearly 20 years’ experience in the developing world. When he was working in London, he would utilise his extended vacations to build up audiology centres in Southeast Asia and East Africa.

When Vaughan came to Cambodia 12 years ago, he “saw the massive need for audiology and ear healthcare and decided to start [AEC] to address the problem.” It has been a decade since AEC registered as an NGO, and it now partners with about 50 NGOs who refer deaf people to one of their four permanent clinics in Phnom Penh, Siem Reap, Kratie and Battambang provinces. AEC also has quarterly clinics in five provinces and eight clinicians who had 15,000 consultations just last year.

“In Prey Tralach, it’s a rural clinic; it’s in the middle of nowhere. It’s hard to get to, very isolated, but it’s our most visited clinic. Clinicians can have 70 or 80 people turn up in one day. People will walk for 10 miles to come, because they’ve heard of the services – it’s an extremely well-regarded service in that area,” Chroston said.

Audiology is not just a one-time, easy fix. Someone with hearing loss is essentially a patient for life. A person with a hearing aide will need battery replacements, hearing aid adjustments and counselling services, none of which are widely available to Cambodians.

AEC opened a school last August to train Cambodians in ear healthcare and audiology. A high school education is required, along with a commitment and unwavering passion to help people. It follows the World Health Organisation-approved methodology for addressing hearing loss in the developing world.

“There is a desperate need for more professionals,” Chroston said. “We’ve taken on eight students and we’re trying to move toward a fully accredited course so that we can take in a larger pool of students, but as a two-year course, it takes a little time.”

The two-year course is a way to build human resources in Cambodia and is meant to equip the students (future clinicians) with the ability to deliver audiology services and primary ear healthcare to those who need it in the country.

“What we would like to see in the future is systems run by Cambodian people; that’s why the schooling is such an important approach to it, it’s about long-term provision – by Cambodians for Cambodians. Our senior clinicians here now work as teachers to our students, that’s what we want to see grow; [we want to] reduce reliance on external sources,” Chroston said.

Khourn Samel, manager of AEC’s clinic in Kratie province, said the majority of Cambodian people aren’t concerned with ear health simply because they aren’t aware of it.

Students mimic sign-language cues from their teacher at the Deaf Development Programme in Phnom Penh this month
Students mimic sign language cues from their teacher at the Deaf Development Programme in Phnom Penh this month. HONG MENEA

“We do not have a study yet, but if we compare our situation to other countries, perhaps only three or four per cent of the population understands ear-related problems,” he said. “This is because public health information is not widely spread [in Cambodia] and the level of ear healthcare education is still very low.”

“In order to raise awareness about ear healthcare, the Health Ministry and health departments in every province should broadcast more about this,” Samel said. “If we can add ear health to study programs, students will learn about ear healthcare and disease at a young age.”

Due to a lack of research, it is difficult to accurately determine the prevalence of hearing loss in Cambodia. Using WHO figures, Chroston said Cambodia could be home to as many as 850,000 people living with disabling hearing loss. This does not include hearing loss in just one ear or low-level hearing loss. If it did, the number would likely be closer to two million, nearly 14 per cent of the population.

“It is a huge problem and one that is often overlooked, because hearing loss is not something you can see,” Chroston said.” You can’t see if someone is deaf, so it tends to be the forgotten, ‘hidden’ disability sometimes.”

National plan
Although the Ministry of Social Affairs, Veterans and Youth Rehabilitation put in place a law to further the involvement and accommodation of people with disabilities in 2009, the Law on the Protection and the Promotion of the Rights of Persons with Disabilities has not been implemented quite as hoped.

A group of 20 organisations that focus on different disabilities met in mid-May to go over the law as well as the National Strategic Development Plan (2009-2013) and came up with suggestions to better enact the national law and strategy.

It was noted in a report made from the stakeholders’ meeting that the 2009 law would require five subdecrees and 11 prakas to be effectively implemented. “As of May 20, 2013, however, only four sub-decrees and two prakas have been issued,” the report reads.

A fault found in the national development plan is that a national budget is mentioned for those with disabilities, but the Social Affairs Ministry, which is responsible for “strengthening and expanding welfare and rehabilitation services for disabled people” per the 2009 law, has not specifically earmarked any amount for this.

Numerous calls to ministry staff resulted in no comments, and no response was received after the Post sent an official letter to the ministry.

Drawing inspiration from the UN Convention on the Rights of Persons with Disabilities, Prime Minister Hun Sen took a keen interest in the deaf and hearing impaired and last year called on Cambodian television stations to create programming to accommodate the deaf so that they could follow the news. But only two stations – TVK and Bayon – followed suit.

Although this was a step in the right direction, Sreytouch doesn’t believe Cambodia’s deaf population is benefiting much from the broadcast sign-language interpreters, because they use American Sign Language rather than Cambodian signs.

“The government has been little help integrating sign language on TV stations; people from DDP [who learn Cambodian sign language] can understand very little of it,” Sreytouch said.

The Cambodian government may have made small attempts to include deaf people into society but it is more the work of people within the deaf community and those who are closely related that have made strides in the past two decades. With minimal government attention, this might just be the ticket to equality for those with hearing disabilities.

“More and more people are aware of the deaf population and aware that deaf people can be educated and that there is somebody in Cambodia that is educating them,” Dittmeier said. “So the awareness in society has increased – minimally. It’s not where it should be, but it’s much better than it was.”



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