Years of war and deprivation mean that many Cambodian men and women suffer psychosomatic

disorders, according to mental health NGOs and psychiatrists. However, the Ministry

of Health said a lack of funds meant that expanding the country's limited services

would be difficult.

"These people suffer mentally, but they have clinical symptoms that are physical,"said

Dr Ka Sunbaunat, one of the first psychiatrists to graduate in Cambodia since 1975.

Dr Sunbaunat explained that many physical ailments really stemmed from mental problems.

"The way people experience mental health here is very physical," agreed

Ellen Minotti, who has spent nine years as an advisor with the Social Services of

Cambodia (SSC). "In the West, people might say that they are anxious, but here,

they can't sleep or eat."

Dr Sunbaunat said that not talking about one's feelings was specific to Cambodian

culture.

"To talk about suffering is to show weakness," he said. "During the

Pol Pot era, people were not allowed to talk about their problems. There is a Khmer

phrase, dam doeum kor, which literally translated means 'planting the kapok tree',

but in this case means keeping quiet to survive.

"During these years of silence, there were somatic complaints due to psychological

suffering."

Kann Kall, managing director of Transcultural Psychosocial Organization (TPO), a

mental health NGO, said that educating people about the physical-mental health connection

is just one of the many challenges that faces the fledging mental health system in

Cambodia.

"Our main aim is to raise awareness and [for people] to see that there is a

relationship between their problems and their situation," said Kall. "It

is a vicious cycle: hopelessness [leads to] unproductivity, which leads to poverty

and then further hopelessness."

Both TPO and SSC run self-help groups in provinces such as Pursat, Battambang and

Kampong Speu to help people find their own means to cope.

"[The goal of the self-help group is] to help people to discover and develop

their capacity to solve their own problems," said SSC's Minotti.

TPO selects and trains members of individual communities to recognize particular

symptoms such as depression and anxiety. These community health workers then act

as a liaison for TPO.

"They are the resource that exists in the community," said Kall. "They

are well-known and well-respected in their community. They are our key informants."

Community health workers are just part of a new generation of psychiatrists, psychiatric

nurses and social workers who are building Cambodia's mental health system. Ten psychiatrists

graduated in 1998 under the Cambodian Mental Health Training Program, now called

the Cambodian Mental Health Development Program (CMHDP). Ten more psychiatrists and

ten psychiatric nurses will graduate at the end of this year.

Although the number of trained mental health personnel has increased, more are needed.

"There are not enough psychiatrists and nurses," said Dr Mam Bunheng, secretary

of state for the Ministry of Health, which only recently added a department devoted

to mental health. "There is a big need for qualified people."

Besides insufficient staff, another difficulty when providing mental health services

is a lack of facilities. Both Dr Bunheng and Dr Sunbaunat agreed that more mental

health facilities were required in the provinces.

"We want to expand services," said Dr Bunheng. "We want to integrate

[a mental health department] into general hospitals in each provincial town."

"The budget is very limited," said Dr Sunbaunat. "Some money comes

from the government and other money comes from international donors, but it is not

enough for the demand."