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Friday, September 23, 2011

New Book Explores Cambodia’s ‘Hidden Scars’



"Many people who are affected by trauma would never think
 to go to a psychiatrist or a psychologist, but in fact
they would go to a “kru” or go to a monk."

[Editor’s note: “Cambodia’s Hidden Scars” delves into the trauma caused to the Cambodian population by the Khmer Rouge, even today. One of the authors, Daryn Reicherter, is a professor of psychiatry at Stanford University’s School of Medicine. He has researched mental health and human rights issues in Cambodia, Haiti, Indonesia and other countries. He spoke to VOA Khmer about the reasons such study in Cambodia deserves closer attention.]

What is the book mainly about?

The book is about the idea that human rights violations, armed conflict and war cause psychological and psychiatric outcomes. Many Cambodian survivors were affected by the war and the trauma in terms of their psychological outcome. The book is really meant to be more an advocacy piece, not just to highlight statistics about how trauma has affected Cambodians but to start a dialogue on how psychology affects the [UN-backed Khmer Rouge tribunal] process and affects the victims as they go through the court’s process. The last part of the book looks at what measures have been done, and what measures can be done, to provide more resources for people who were affected psychologically by the war.

Why was this study important to undertake?
I actually work in California with refugees, survivors of human rights violations, from all over the world. Specifically, I work with the Cambodian population in the [San Francisco, Calif.] Bay area. And that population really has increased incidents in mental health disorders as compared with some of the other refugee population overseas. Their symptoms are profound, even though the trauma was years and years ago.

How are individual Cambodians affected by this trauma and how has Cambodian society been affected over all?
The first part of the book is really devoted to answering that question. On the individual basis, every person is different, and everybody’s experience is different, but there tends to be characteristic outcomes for everybody that has been exposed to terrible violence. What we see in Cambodia are very high statistics of people with distress after Pol Pot.

The other chapter of the book looks at the multi-generational affect. Cambodia has a very high percentage of people exposed to extreme violence, and people who have negative psychological outcomes because of that. We could imagine that those psychological outcomes cause areas of dysfunction, like problems with their family, problems with employment, problems with their personal lives, and you can imagine the ripple effect by having so many people exposed. It’s not just the individual who is having a hard time functioning, it’s more a community of people who are having a hard time functioning together.

When you have been exposed to trauma, and now you have some mental health issues, the parenting style may be different for people who are survivors as compared with people who are not. One of the chapters examines the concept of how the generations that have come after Pol Pot have been affected by their parents and are having different behaviors. In other words, they have different parenting strategies because of their experience and that translates into the next generation.

What are the treatments for post-traumatic stress disorder?
The book is a little bit unspecific on that point. When we are treating PTSD in mental health in the West, there are some evidence-based practices that we understand, and we use medication and psychotherapy. The specific concept that is used in mental health in the United States may not always be 100 percent applicable in Cambodia.

In Cambodia, it is not necessarily just a mental health issue; it’s beyond mental health. Many people who are affected by trauma would never think to go to a psychiatrist or a psychologist, but in fact they would go to a “kru” or go to a monk. There really needs to be a hybridized approach to address this problem in Cambodia, because if you just put money into the mental health system and just expect people to show up at the office of a psychiatrist, we are not necessarily going to see that. But there really needs to be some dialogue between disciplines.

Is it that people don’t understand PTSD, or that they better trust traditional means of treatment?
I think both are true. First of all, there is a large stigma around mental health in Cambodia—and also other places. They don’t know that they have a disease that would be something that could be treated by a psychiatrist or psychologist, but in fact, very often they are going to religion or to folk medicine or even the primary care doctors.

The other issue is access. If somebody who lives in the countryside in Cambodia did recognize their symptoms as a mental health disorder, and they wanted to get treatment in mental health, really there is no access to it. The people would not understand that mental health disorder, because there is not a very good public advocacy campaign to explain what mental health is.

What is the role of the tribunal in helping address this problem?
One of the things that the prosecutors did in the opening day of the trial was to talk about the potential reparations that may come out of the court, and one of the reparations that was suggested was the improvement in the resources for mental health. And as far as I know, this has not been suggested as a reparation in other courts like this one. I don’t think the court is going to create a mental health clinic, but the court could be an advocacy piece.

If the court finds at the end that reparations are important and that mental health should be considered, reparation could be directed at the government to make changes or improve the status of mental health delivery, or to the international community, to say, Cambodia has been struggling with this issue and the court has recognized this and recommends that international donors consider more funding toward this issue of trauma mental health, which is really behind many social problems that are happening in contemporary Cambodia.

Where will the book be distributed?
The book will be distributed in Cambodia. There are specific targets where we are trying to make the book available for free, but for other people, they’ll have to buy it through the Documentation Center of Cambodia. In order to have powerful advocacy, you have to make your information available. Some specific parts of the book are being translated into Khmer. Some of the concepts and recommendations that we made will definitely be translated into Khmer.

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Sam Ransey appeals defamation sentence

Sam Rainsy’s lawyer yesterday asked the Appeal Court to overturn a defamation and disinformation conviction against the opposition leader for his allegation that Foreign Minister Hor Namhong had run a Khmer Rouge prison.

No decision was reached by Presiding Judge Seng Neang, but Hor Namhong’s lawyer, Kar Savuth, told the court he hoped “100 per cent” the two-year jail term imposed on Rainsy in April this year for alleging his client ran the Boeung Trabek prison would be upheld.

“The penal procedure code states clearly that whoever files the complaint must be present at the hearing, and Sam Rainsy was not present,” Kar Savuth said.

“If the culprit [Rainsy] was not present, the opposition’s complaint must perish uselessly and the court must keep the old verdict.

“Therefore, I believe the court dares not to change the old verdict.”

Rainsy was convicted of making the allegations, which he has repeated in his autobiography, Rooted in Stone, during a memorial at the Choueng Ek Killing Fields in 2008.

He was fined US$2,000 in addition to his jail sentence.

But Choung Choungy, the attorney representing the SRP leader, who lives in France, told the court that Rainsy had never mentioned any specific names when he made the allegations in 2008, accusing a government off-icial of having run a prison for the Khmer Rouge.

“Excellency Hor Namhong and Excellency Sam Rainsy are public individuals who cannot avoid criticism. If he [Namhong] wants to avoid criticism, he does not need to hold a public position,” Choung Choungy said.

Seng Neang said the court’s verdict would be announced on October 5.
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UCC To Mark 34 Years Serving Cambodian Community

By Stephanie Minasian
From helping residents receive groceries to providing English as a Second Language classes to those in need, the United Cambodian Community (UCC) has spent 34 years assisting people from all over Long Beach. The anniversary will be celebrated on Sept. 28.

With one of the largest Cambodian populations outside of Cambodia, more than 300,000 people migrated to this area in the 1970s to escape the persecution of the Khmer Rouge. About 1.5 million Cambodian people, who were killed, starved or held captive in labor camps during the Khmer Rouge’s reign.

In 1977, UCC was formed in Long Beach.

“Refugees came here, and they are sometimes bitter towards the government because of what happened to them in Cambodia,” said UCC executive director Sara Pol-Lim, M.S. “When they immigrate here, the number one barrier is the language and the inability to access health care.”

She added that many of these Cambodians go without health treatment, and many times, their conditions become chronic and deadly. This is where UCC steps in, said Pol-Lim.

“If you don’t ask for help or get treatment until the condition becomes chronic, then you can die,” she said. “We are now an organization that mobilizes and shows people what is good for them.”

UCC has received a grant from the California Community Foundation for subsidized food to give to families in need. UCC was able to give $50 gift certificates to 700 families to use at grocery stores in the area. One woman who received the $50 was able to provide food for her husband’s funeral, Pol-Lim said.

“We hand out food twice a month for those who are in critical need,” she said. “Those who benefitted from the $50 for food were able to buy some extra things for their families.

The grant also helps the organization train residents on issues in public policy and how to advocate for social services in their community. UCC also has worked with the California Health Endowment’s Healthy Communities Initiative in Long Beach.

“What’s healthy for the mainstream may not be healthy for ethnic groups,” she said. “We are now an organization that mobilizes and shows people what’s good for them… It’s either you can stay in a poverty-stricken neighborhood because you didn’t stand up for something better, or you can change these beliefs of the ethnic communities.”

Some of the additional programs the organization provides are a women’s focus group, youth services, English as a Second Language classes, monthly community meetings, citizenship education and more.

When seniors or young people arrive on their first day at UCC, they pledge a commitment to the community — whether it be to volunteer or just be a good citizen. Each of them writes their pledge on a colorful square fabric to place on the wall.

“It’s really a cool piece here,” said UCC project coordinator Chad Sammeth about the quilt. “All of the people on this quilt range from ages 13 up to 75 years old.”

To commemorate its 34 years of service, UCC is hosting a seven-course dinner to honor and celebrate Supervisor Don Knabe and Dr. Christina Lee, for their dedication to the Cambodian community, Pol-Lim said.

The dinner will begin with registration at 6 p.m. next Wednesday, Sept. 28, at Hak Heang Restaurant; 2041 E. Anaheim St. Tickets are $50 per person, or $60 at the door.

“We are so grateful that for more than 30 years, we have sustained,” Pol-Lim said.

UCC is at 2201 E. Anaheim St., Suite 200. For more information, call 433-2490.
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