AsiaLIFE

A rural mental health initiative is reaching out to a part of Cambodia that has seen few efforts to help those with psychiatric and psychological problems. Words by Nora Lindstrom. Photos by Isabelle Lesser for Louvain Développement.

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It’s eight o’clock in the morning and the doors of Taing Krasaing health centre in Kampong Thom have just opened. Already, a dozen people are waiting to be seen by the centre’s staff. The nurse in charge is dividing them into groups—those who have a physical illness, and those in need of psychiatric and psychological help. All will receive appropriate care or referrals.

In a country with only 37 psychiatrists, this small rural health centre is unique. Though efforts by the Ministry of Health and international organisations have increased the number of mental health professionals over the past two decades, most existing services are centred in and around Phnom Penh. Few of the ten psychiatrists trained every year want to work in the provinces.

The Khmer Rouge left an evident trauma on the country, and more recent developments are adding to the mix. The Transcultural Psychosocial Organisation has estimated some 35 percent of the population suffers from some kind of psychiatric illness, with another 45 percent suffering from more vague “psychological problems”. Post-traumatic stress disorder features high on the list of national afflictions.

“Despite the prevalence of mental health disorders, there is a lack of information and communication of psychosocial problems,” says Chantal Dorf, Regional Director of Louvain Développement, a Belgian NGO.

“People don’t know which reactions are normal and which are pathological,” she says, using reactions to the Koh Pich tragedy as an example. “After witnessing an accident, it is normal to be traumatised, to have nightmares and ‘flashbacks’ related to what happened during daytime. But occurrence will have to reduce after a few days or weeks.”

The problem is that many people don’t know that. Coupled with social norms that discourage sharing feelings and sensations, Dorf says lack of information about mental health issues leads some Cambodians to think that they have become “crazy” when they react to events in their lives. “They feel ashamed for what may be completely normal reactions,” she says.

For the past six years, Louvain Développement has cooperated with the Transcultural Psychosocial Organisation to strengthen the mental health sector in Cambodia. Their project at the Taing Krasaing health centre and other health facilities in Kampong Thom follows what Dorf refers to as “an integrated, culturally sensitive approach starting from awareness-raising and leading to care as well as after-care”.

“The goal of the joint project is to improve the skills and capacity of government health staff working in provincial clinics,” says Dorf. “We serve 800-1000 new patients annually.”

More than anything, it changes perception about mental health issues by bringing help and support to those who have previously went without. According to Dorf, the project has been successful in increasing the capacity of local health sector staff in providing diagnosis and treatment for mental health disorders, and that many have changed their attitude towards those seeking their help. “The patient’s first contact with the hospital is going more smoothly,“ she says. “Staff now welcome patients and their families with empathy.”

There is a long way to go. Mentally ill children and adults are still found chained to their beds or locked up in cages. There is also a common tendency to regard the prescription of medicine as more effective than counselling in “curing” mental illnesses.

While Dorf estimates Louvain’s project in Kampong Thom could benefit as much as 25 percent of the province’s population, she feels the project should be replicated elsewhere.

“We hope this project is seen as a model for government on how to improve the mental health services more widely,” she says.  

To find out more about Louvain Développement’s work and how you can support their efforts, visit www.louvaindev.org or call Chantal Dorf: on 092 333 262.

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