Mental Health Care Taking Slow Steps Forward

Before she got the help she needed, Kolap, 36, used to run out of her Kompong Speu prov­ince house naked, talking hysterically to herself until spit ran like foam from her mouth.

“She used to hear something and see something that other people didn’t,” said her counselor, Pok Sa Em.

Kolap (not her real name) was diagnosed with schizophrenia, a mental illness that causes people to see things that don’t exist, say strange things or behave in confusing ways.

Not much is known about the psychotic disorder, and in Cam­bodia there’s little help for the patients who suffer from it.

“It is very hard. Some people say counseling is useless and there’s no way to cure mentally ill patients,” said Pok Sa Em, a 58-year-old social worker at Social Service of Cambodia, an NGO providing mental health services to 500 clients in Kompong Speu province.

Some psychiatric care was available to patients in Cambodia in the past, but during the Khmer Rouge years many doctors were killed as the regime purged the country of its intellectual class.

A formal training program didn’t reappear in Cambodia until 1998, when the first class of 10 psychiatrists graduated from the Cambodian Mental Health De­vel­op­ment Program.

Most of those doctors work today at the old Russian hospital, Preah Bat Norodom Sihanouk Hospital, where they treat up to 200 patients a week. A second class of 10 more psychiatrists is scheduled to graduate in De­cember.

Their services will be greatly needed. The number of people suffering from mental illness in Cambodia is increasing, health experts say.

More than 2 million of Cambodia’s 11.6 million people suffer from serious mental illness and depression, according to a World Health Organization report issued this month at a conference on mental health issues in Cambodia.

Millions more suffer from differing levels of post-traumatic stress syndrome, substance abuse and anxiety brought on by poverty and despair over the future.

“Almost three decades of our history, many of us have been suffering from all kinds of trauma like disasters, political conflicts and unstable economics,” said Minister of Health Hong Sun Huot, speaking at that mental health conference. “The awareness about mental health in public is still low and unclear.

“Poverty is another major factor. Mental health has consequences to the patients and their families such as stigma and discrimination, which is a main obstacle for the healing process and prevention.”

The government plans to spend $43 million on health care in 2002, up from $36 million in 2001, according to Dr William Pigott, country director for WHO.

Since 1998, the amount of money set aside for health care overall has climbed from $0.69 per person to $2.50. Although a marked improvement, the additional funding has done little to combat mental health problems since less than one percent of the health budget is spent on mental health care.

The mystery that surrounds schizophrenia often leads to bizarre and dangerous cures in villages where medicine and medical knowledge is unavailable, said Pok Sa Em. Ten of the people she counsels were first treated by traditional healers in their home villages, to no avail.

Several of them were tied to a banana tree or a pole and shot at. The cure, meant to scare the evil spirits out of the afflicted person’s body, requires that the gunshots just miss the person.

An even more disturbing traditional healing technique was tried on a 36-year-old woman who later came to Social Service of Cambodia for help: she had been doused with a bucket of human feces by a healer who said it would cure her.

Some traditional methods are reliable and can work for patients, said Heng Srey, a staffer at Social Service of Cambodia. But there are more dangerous techniques that should not be used.

“We can’t reject traditional ways,” she said. “Monks and traditional healers are very influential in the village, so we work with them.”

Dr Helen Herrman, a WHO adviser based at the University of Melbourne, said mental health problems often go unreported because they are not as easy to see as physical illnesses. The symptoms may be simple complaints that all people deal with from time to time,.

“They can’t concentrate, [or they] wake up during the night, thinking about negative things,” Herrman said. “They lose judgment and feel lonely. They push family away and don’t take care of themselves.”

Another concern is that over 1 million Cambodian children and adolescents are likely to have mental disorders because of post-war social problems, according to Dr Bhoomi Kumar Jegannathan, director of the Center for Child Mental Health.

Most of the children at risk are street children, working children, rag pickers, child sex workers, homeless children, orphans and children of AIDS sufferers, in addition to those who suffer from domestic violence, alcoholism among parents and poor school environment.

A survey conducted by CCMH, which is located at Chey Chumneas hospital in Takhmau district, Kandal province, showed that perhaps 2 percent of the nation’s children get the mental health care they need.

That leaves more than 1 million untreated cases, health experts say, since it is estimated that about 15 to 20 percent of Cambodia’s 5 million children suffer from psychiatric problems.

Pok Sa Em, the counselor at the Social Service of Cambodia, said that fortunately the women she knows who were mistreated by so-called traditional techniques were able to recover after they went to Sihanouk hospital and received medication.

Today, Kolap is a cook and a waitress at a restaurant along National Road 4, about 40 km from Phnom Penh.

“She cooks 15 kinds of meals a day,” said her employer. “She works very hard and cleans, but is very slow. She is quiet now. Before she talked alone a lot.”

While earning just $15 a month, Kolap is planning her future house. “I live with my uncle and seven other people,” Kolap said, with a smile.

(Additional reporting by Saing Soenthrith)


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