By Alex Meibusch
This story looks at TPO Cambodia’s fundraising campaign for Operation Unchained. You can donate to the campaign here.
As a nation, Cambodia has endured an extraordinarily traumatic past.
The horrors of the Pol Pot’s Khmer Rouge regime have directly or indirectly affected every member of the population.
In 2008, figures published in the Phnom Penh Post estimated 30 per cent of all Cambodians suffer from some form of mental illness, but that figure spikes to 60 per cent for Cambodians who survived through this period.
During the Khmer Rouge era, the country’s only mental health hospital was turned into a prison and the country’s only two psychiatrists were murdered.
After Pol Pot was ousted, the mental health of the country continued to be neglected. There were no psychiatric hospitals in Cambodia between 1979 and 1994.
Today, there is still a gap between what Cambodians need and what can be provided in mental health care due to insufficient and unstable funding.
Cambodia has only 35 trained psychiatrists, 45 psychiatric nurses and only two psychiatric inpatient units with a total of 14 beds to service the entire population.
Mental health services are particularly scarce in rural areas where roughly 80 per cent of the population live.
NGOs such as the Transcultural Psychosocial Organisation (TPO) are attempting to fill that gap.
Current Executive Director of TPO, Dr Sotheara Chhim, was in a group of ten graduating psychiatrists in 1998, the first graduates in Cambodia since the regime.
It was up to this group to develop Cambodia’s mental health service.
TPO Cambodia was founded in 1995 as a branch of TPO International.
They have a number of projects, including support for victims of gender-based violence and sexual assault, which is funded by the Australian Department of Foreign Affairs.
Unchaining Patients
One of TPO’s most recent initiatives is Operation Unchain, which aims to help some of the most vulnerable in Cambodian society.
Launched in June 2015, the goal of Operation Unchain is to treat people with mental illnesses who have been chained or caged by their family members.
“We set up this program. It’s not aimed at sustainability but to relieve the burden of the family,” Dr Chhim said.
So far, TPO staff have been able to treat 47 chained patients.
“We are the only NGO providing mental health service for Cambodians, we cannot overlook this issues,” Dr Chhim said.
Most of the patients live in rural areas, and receive no form of care other than from TPO.
Staff travel to villages with chained patients, and attempt to treat the psychotic symptoms of the patient as well as educating their families to identify symptoms of relapse, to comply with medication and to reduce stigma.
Of the 47 people who have been identified and treated so far, 24 are now unchained.
Mental Health: A Global Issue
The improper restraining of the mentally ill can be found in many parts of the world. The aim, though misguided, is to keep people with mental illness safe from harming themselves or others when resources and options for treatment and care are scarce.
While the practice can seem confronting in countries like Australia, mental health nurse and Monash University professor, Wendy Cross, says that it was, and in a way still is, part of our approach to mental health care.
“It’s a feature of a number of cultures and in fact it was a feature of our culture until the late ninetieth century. We still use restraints in mental health services today. But of course it’s highly regulated and well-structured and we have to document it very thoroughly,” Ms Cross said.
But it’s not just historical parallels that can be drawn to Australia. Similar practices have been seen as recently as 2015 when a primary school in Canberra was reported to the ACT Government Education Directorate after a cage was used to confine a young boy with autism.
Ms Cross explains that while the practices of seclusion and restraint can be severely traumatising experiences for the patient, the reasons for the existence of these practices around the world can be linked to stigmas associated with mental illness.
“What happens in some cultures is that people with mental health problems and particularly psychosis, it’s been seen culturally as a punishment from God or that person has been inhabited by spirits or demons and from that point of view people are highly stigmatised. The families are very often ashamed.”
Ms Cross also says that stigmas surrounding mental illness are only less prevalent in countries like Australia due to the tireless work of mental health foundations as well as television campaigns.
“[In Australia] we try and moderate our language but of course it still rears its ugly head from time to time.
“So if in enlightened countries we still hold those sorts of attitudes, then it’s pretty understandable that in developing countries they are still chaining people up or hiding them or locking them away.”
The Australian Connection
Australians Anthony Adair and his wife Karen have supported TPO Cambodia since about 2010 after meeting Dr Chhim while he was completing his PhD in Melbourne.
“We admire the work he does. We admire him both personally and professionally and we have been able to give him a modest amount of support,” Mr Adair said.
Mr Adair was able to have a first-hand experience of TPO’s work in Operation Unchain when he travelled to Cambodia in January this year.
“I was impressed by the sensitive care and attention offered to the patients and their families,” Mr Adair said.
He accompanied Dr Chhim and his staff on a three hour journey from Phnom Penh to visit five patients living in different villages near the Vietnamese border.
“Consultations involved key family members such as parents and siblings, who had found it very difficult to manage these troubled individuals.
“Most of them were literally chained up during the day while the family went to work in factories in the Special Economic Zone nearby or in the fields. Some were chained when we arrived at their homes. It was an eye opener for me.”
Mr Adair also saw how much the access to care meant to the family members.
“One abiding memory is of a young woman who was in tears talking with Dr Chhim at the end of a consultation about her mentally ill younger brother.
“I asked Dr Chhim why she was crying, was she distressed at her brother’s condition and despairing about how they would cope?
“He said that she crying tears of happiness because she now had hope that her brother was getting medical care.”
Mr Adair is currently trying to set up a funding connection for TPO with Rotary Australia.
“We’re trying to get a project established in Australia for Rotary to provide support for TPO. Whether it be one arm or project of the organisation, these things take a while to get organised,” Adair said.
Funding Operation Unchain
Dr Chhim says the biggest challenge for TPO to continue this type of work is funding.
TPO currently receives funding from a number of organisations and from private donors, as well as raising revenue from training courses.
But the staff working in Operation Unchain still have to do so on a voluntary basis.
“Patients live far away from each other, they live all around the country, therefore it take us more time and resource to travel to each place.
“There is not government mental health services close to the patients’ home. Therefore, they will travel hundreds of kilometres to seek treatment which most patients cannot afford their time and money for transportation and also to pay the hospital fee.
“We want to reach our service to the unreachable, we want to bring them back their dignity, and have the rights to enjoy their life as everyone else.
“If we cannot get more funding from private donors, then we may close the operation,” Dr Chhim said.
According to TPO’s donation page, the costs associated with unchaining one individual is roughly US$170.
Until healthcare services in Cambodia improve, TPO will continue to be reliant on external funding and assistance for its projects.
TPO is currently crowdsourcing donations for Operation Unchain. You can donate here.