PHNOM
PENH: As soon as the clock struck seven in the morning, a commotion broke out
in front of an old, yellow building inside the Khmer-Soviet Friendship
Hospital.
More than
40 people flocked to the main metal door separating them from the waiting area
and consultation rooms. Some craned their neck to look for a sign of staff
inside the building, while others searched for empty spots on the dusty ground
to give their feet a rest.
Coming
from various parts across Cambodia, they all shared one thing in common;
everyone seemed stressed and weary, as they waited to enter the busiest
psychiatric clinic in Phnom Penh.
“We’ll
open at 9 o’clock today,” a member of the medical staff told the patients as
she squeezed through the main entrance. “We have a meeting,” she quickly
explained and continued on a dusty path linking the busy outpatient department
with another building.
For
mental health patients in Cambodia, long waits are far from uncommon at the
state-run clinic. Although its outpatient department is the biggest in the
country, the facility has 13 registered psychiatrists and 12 nurses to treat
hundreds of patients per day. For those with serious conditions that require
continual specialised care, there are ten beds available.
“One
doctor treats about 50 patients each day,” said one of the psychiatrists at the
clinic, Sou Sarifin. The limited resources mean that not every patient can be
seen, consultations last minutes, and treatment is often limited to
prescription drugs.
Mental
health problems are widespread in Cambodia. Some patients are often locked up
at home or chained to trees, as their family members do not know how to deal
with the symptoms. Health care services exist but are hard to access,
particularly in rural areas. And some patients are dropped off at the clinic
with their hands and legs tied, Sarifin said.
Anxiety,
depression, bipolar disorder and schizophrenia are the most common forms of
mental illness diagnosed at the clinic. And a number of patients are survivors
of the Khmer Rouge regime, whose legacy has left them with deep mental scars.
"They
still have bad memories; some of their family members were killed during the
Khmer Rouge regime," Sarifin added.
Under the
Communist Party of Kampuchea (CPK), Cambodia was radically transformed into an
agrarian society with no social classes. Its citizens were stripped of their
basic rights and driven into forced labour in the countryside, while religions,
education and financial system were abolished. Between 1975 and 1979, prisons
and execution sites popped up across the country, as starvation, diseases,
exhaustion and capital punishment killed nearly two million people.
And for those who have survived, many find it hard to deal with the psychological scars.
“I FELL
UNCONSCIOUS WHEN THEY STARTED TO RAPE ME”
Some of
the Khmer Rouge survivors with mental health problems are old people who still
have fresh memories of the past.
One of
them is Leang Korn. Her husband was killed in 1975, she said, 20 days before
their baby was born. Both were accused of conspiring with the Central
Intelligence Agency (CIA) against the Khmer Rouge.
“I
couldn’t see my husband but heard his voice through the air. How scared and
painful he was. We all couldn’t do anything but only whisper,” the 57-year-old
widow said.
After
giving birth to her child, Korn joined other Cambodians who were sent to work
in the fields.
“One
evening, several men came to me and said Angkar (the Khmer Rouge’s ruling body)
wanted information about my work. There were about 10-12 men there. I fell
unconscious when they started to rape me. They were like animals, not human
beings,” Korn said.
Over the
past 37 years, the old widow has been trying to live a normal life and forget
her past. “But I can’t forget. My feeling is attached with something, something
unclear, like a shadow.”
Mental
health issues in Cambodia, however, affect more people besides Khmer Rouge
survivors such as Korn. A number of mental health patients at the Khmer-Soviet
Friendship Hospital have a long history of alcohol and drug use. Social factors
such as poverty and gender-based violence also play a key role.
Of the
over 15 million population, an estimated 40 per cent suffer from mental health
and psychological problems, according to Transcultural Psychosocial
Organization Cambodia (TPO) – a non-profit group that promotes mental
well-being among Cambodians.
But
despite high incidence of mental disorder, Cambodia's public health care is
still lacking. It is estimated that only 0.02 per cent of the country's health
budget goes to mental health, based on a report by the Leitner Center for
International Law and Justice.
"Public
mental health care in Cambodia is a little bit better now but there are still a
lot of issues. Services provided are poor and to access them is difficult.
There is only one hospital in Phnom Penh that provides mental health
care," said Sek Sisokhom, Head of the Psychology Department at Royal
University of Phnom Penh.
"People
don't know about psychology because the concept is very new in Cambodia. When
they encounter mental health problems, they often seek help from monks at the
temple or spiritual healers," Sek added.
A 'VERY
CHALLENGING' SITUATION
The
mental health situation in Cambodia is "very challenging", according
to Sek. The sector is only allocated a small amount of funds from the national
budget and "there is no quota for recruitment of psychologists into the
public sector," he said.
New
graduates often face difficulties finding jobs in the mental health industry.
In the entire nation, there are only a few state-run psychiatric clinics. One
of them is located in the capital city and five more in Banteay Meanchey,
Ratanakiri, Kampong Cham, Kampot and Battambang. "Mental health is not the
government's first priority," Sek added.
Moreover,
mentally ill patients at state-run facilities often receive bio-medical
treatment rather than psychological or psychosocial treatment. "And this
means the government services mainly lack counselling, psycho-education and
community-based intervention that addresses the issue through a holistic
approach," said Dr Sotheara Chhim, senior consultant psychiatrist and TPO
executive director.
"There
are huge needs for mental health care."
In a bid
to improve mental well-being among Cambodians, many NGOs have set up their own
mental health care facilities in response to the limited resources.
In 2015
alone, TPO’s treatment centre provided more than 6,500 consultations. But the
group also aims to promote non-medical treatment through its several programmes
targetting different groups of mentally ill patients, including the likes of
Korn.
For
several years, the Khmer Rouge survivor has been receiving mental health
support from the NGO, which provides her with counselling every two months. Her
conditions continue to improve over the years. Korn is now more open to discuss
her past and fully aware of the problems she is facing.
Still,
many mentally ill patients in Cambodia are struggling to live a normal life.
“They’ve never received support from the government,” Sarifin said before
rushing back into his office, as more patients streamed into the mental health
clinic.
But soon,
the door would be closed, and those who did not make it to the psychiatrists
would have to come back again the following day.
Pichayada
Promchertchoo
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