TAKHMAO CITY, Kandal province – Southeast Asia’s first insane asylum, the famous Prek Tnot hospital in Kandal province now houses the Center for Child and Adolescent Mental Health (CCMH)—Cambodia’s only mental-health facility dedicated to children.
During the Khmer Rouge era, the hospital rooms were used as prison cells. Now, the wards are color-coded—pink, blue and yellow for psychological illness, epilepsy and intellectual disability, respectively.
Each week, the CCMH treats between 130 and 140 patients, and registers between 10 and 15 new arrivals, according to Kao Sambath, the center’s chief of services.
Before the CCMH was established in 1991, “we didn’t have anything that provided services exclusively for children with [physical] disabilities or mental disabilities,” Dr. Sambath said. “This is the first and only one in the country.”
Although the 2013 Cambodian Socio-Economic Survey found that mentally and physically disabled people make up just 4 percent of the population, the World Health Organization and World Bank say that in developing countries such as Cambodia, this figure can be far higher.
And due to Cambodia’s disproportionately young population—the result of years of genocide and civil war—a significant fraction of those suffering here are children.
“Consistent with the overall population distribution, more than half of Cambodia’s persons with disabilities are under the age of twenty. As such, the coming years are a critical period for the development and implementation of programs addressing children with disabilities,” says a 2009 report by Unicef and Hagar International.
Experts say the government has long shirked its responsibility to the country’s disabled youth, and despite an accumulation of laws, sub-decrees and “strategic plans” on the subject, underfunded and inadequately staffed NGOs are left to provide the majority of care for handicapped children.
According to Vivath Chou, the WHO’s technical officer in disability and rehabilitation in Cambodia, there are 11 physical rehabilitation centers in the country that last year treated 27,725 patients. Of the total $2,350,000 the centers cost to run each year, a mere $628,000—27 percent—comes from state coffers.
At the CCMH, the government pays the salaries of just a third of the center’s 26 staff members—doctors, nurses, psychologists and physical therapists among them—and provides only 2 to 3 percent of the 700,000 anti-epileptic tablets distributed to patients every year, Dr. Sambath said.
In 2008, the Ministry of Education published a “Policy on Education for Children With Disabilities,” which includes a list of goals including “to ensure the equal rights of all children with disabilities [and] an equal education with non-disabled children.”
Specifically, the policy aims to increase awareness and acceptance of disabilities, increase enrollment of disabled children in schools, and provide rehabilitation services and life skills training.
Six years after its conception, the policy has produced few results, said Kong Vichetra, executive director of the Komar Pikar Foundation (KPF) in Phnom Penh, an NGO that works with disabled youth.
“Something has changed where [schools] are supported by NGOs, but in the other schools not supported by NGOs, [the government] did not do anything…the curriculum still [has not been] adapted,” he said.
Mr. Vichetra, who was partially paralyzed by a bout of polio as a boy, added that retrofitting schools with handicapped toilets and accessibility ramps to accommodate physically handicapped students would not be prohibitively expensive. “I feel that [the public schools] think that children with disabilities are supplementary, the extra responsibility,” he said.
In an interview in August, Education Minister Hang Chuon Naron said the 2008 policy was only ever meant to improve the livelihoods of physically handicapped children.
“We focus on integration with the child with [physical] disabilities but not with mental disabilities,” he said. “We don’t have the facilities; they need special care.”
According to Nhean Saroeun, director of the Ministry of Education’s special education department, special education classes are offered at only seven public schools in the country: three in Phnom Penh, and one each in Kandal, Kratie, Kampot and Pursat provinces, serving a total of 371 disabled students.
Un Siren, deputy director of the department, however, said that without the help of NGOs, “these schools would not run, because we do not have sufficient resources and technical [expertise] to teach them.”
These NGOs, KPF’s Mr. Vichetra noted, are in turn reliant on international support.
Each year, the University of South Australia in Adelaide sends its fourth-year occupational therapy students to KPF to train the organization’s teachers, who otherwise must simply learn as they go.
“They do not try change their teaching methodologies…. Many don’t let [the disabled students] go out and play with other students,” Mr. Vichetra said of KPF’s fledgling teachers.
He attributed this attitude to the stigmatization of disabled people in the country, where knowledge of specific disorders is almost nonexistent—due in part to the fact that there are no child psychiatrists or child neurologists in Cambodia.
“I was talking with one mother in the province. She has a child with a very severe cerebral palsy,” he said. “She told me that her neighbor said to her, ‘Why should you take care of a child with that body?’ She said some people say, ‘Why don’t you kill him?’”
As result of this mentality, Mr. Vichetra said he felt “hopeless” as a child.
“They treat me as a funny boy and sometimes they imitate the way I walk, talking and laughing.”
Sor Rattanak, 31, has been traveling to CCMH in Kandal with her 8-year-old daughter Khil Khemvy from their home in Takeo province for the past two years. Khemvy suffers from hydrocephalus, brain swelling resulting from an accumulation of fluid in the skull.
Waiting to meet with a physical therapist at the center, Ms. Rattanak offered a different explanation for her daughter’s condition.
“This is our karma from a previous life,” she said.