A glance at disability at Koh Dach island part one

June 2015 was my first trip to Cambodia. From the moment I stepped through the arrivals gate at Phnom Penh airport and was greeted by the warm smile of the pick up guy Piseth Nuth I fell in love with the Kingdom of Cambodia. During my first week I was intoxicated by the city’s chaotic yet charismatic atmosphere and the spirit of the Cambodian people. 

Despite the Khmer’s turbulent history of bloodshed, poverty and political instability the Khmer have still managed to keep a smile on their faces. The happiness and compassion of the local people has resonated so deep within me that I now consider Cambodia to be my home or “phteah” in Khmer. I often tell friends and family or those willing to listen Cambodia stole my heart and when I’m away from the Kingdom of Cambodia I certainly long to be back home. 

An accomplice to stealing my heart is Koy Phallany, executive director of Khemara Organisation. During my short spells in Cambodia I have had the honour of working alongside this fantastic grassroots organisation. Khemara’s work in the local community is endless, from running free daycare centres for disadvantaged children to running AIDS/HIV prevention projects. 

On a Sunday morning Phallany met my boyfriend and I to take us to Koh Dach (Silk Island) located just a short drive away from the capital. After taking a ferry across the Mekong river Koh Dach island is a different pace of life from the capital. With dirt track roads and traditional stilt houses painted in various shades of blue with the Brahman cows munching on hay with their bells gently ringing in the breeze.

Although the island sounds idyllic many of the residents here suffer from high levels of unemployment and poverty. The purpose of our visit was to see the Khan family who were struggling to make ends meet. The mother had just given birth to a baby girl who was just four weeks old and the father who is disabled is unable to find work. 

Before the mother gave birth the parents drove 160 km everyday to pick snails to sell where they roughly earnt $2 per day to feed a family of six. However with a baby to care for their combined wage is limited. The father struggles to find work due to his disability although a decree was signed in 2010 where state-run institutions must employ one disabled person per 50 employees, while private companies are obligated to employ one disabled person per 100. However these quotas are barely filled and disabled people are often subjected to discrimination and are unable to find well - paid secure jobs. If disabled people are able to find jobs it’s often in low-paid and dangerous work. 

Phallany heard about the family through one of Khemara’s daycare centres where two of the children attend whilst their parents are at work. Hagar International kindly donates $50 per month to the family as well as rice to help the family during these desperate times.

Unfortunately stories such as these are far too common in Cambodia. Our next stop was evident of this as we were off to see a family who live five minutes around the corner. Single mother Chenda and her two children who both attend one of the daycare centres run by Khemara on the island. Her youngest child Bopha is disabled when we arrived he had just taken a tumble trying to run around with his friends and was seeking a kiss and cuddle from Mum for his grazed knee.

This courageous little boy aged four was born with a disability, when I ask his mother “What did the doctor’s diagnose him with?” she responded “I don’t know”. Unfortunately services for disabled people are still very limited and the healthcare sector are unable to provide key services such as assistive devices, medical rehabilitation, physiotherapy, education and training. Virtually all services for disabled people in Cambodia are delivered by NGO’s and with the current uncertain funding climate many charities have had to cut back resources leaving many families without access to healthcare services. 

Bopha’s fingers and toes are locked into a fist leaving him some difficulties with his day to day life. Through the Public Health programme run by Khemara in partnership with Projects Abroad Bopha is now able to walk, previously his sister and mother carried him but with encouragement from the staff he is now up and about with his friends causing mischief. The teachers also provide him with basic physiotherapy which means his fingers are still flexible which will be extremely important for the future. 

Stories such as Bopha and the Khan family are just the tip of the iceberg. As in most developing countries, accurate statistics on the number of disabled people in Cambodia are not available. Nevertheless it is estimated that Cambodia has one of the highest rates of disability in the developing world (UN ESCAP 2002). Disability and poverty are inextricably intertwined.It is estimated that 36% of the population in Cambodia live below the poverty line of US $0.40-0.63. Poverty is a significant cause of disability. It is poor people who are often victims of mine and UXOs (unexploded ordnance) as they are forced to live near mine areas and collect food or firewood. They are also unable to access basic healthcare meaning that simple infections, illnesses and injuries often result in permanent disability because they go untreated. For example, untreated childhood ear infections are a major cause of permanent hearing loss in children. 

Although there are some fantastic NGO’s supporting the local community such as Action on Disability and Development (ADD), Handicap International and Khemara (who are looking to extend their services for disabled children) a greater understanding and awareness of disability in Cambodia is needed. 

Throughout my blog I have criticised the development sector for not including disabled people within mainstream development and Cambodia is another prime example. It is critical that organisations engage with the disabled sector, that the government is supported to resume more responsibility for its disabled citizens and that disabled people are empowered. 

If we were to witness changes such as these perhaps little Bopha and the Khan family will be able to lead a life where they have access to a secure job and healthcare. I certainly think they deserve all the happiness in the world and more. 

My next blog will be about my trip to Tboung Khmum Province in Cambodia. 

If you would like to find out more about Khemara please visit their website and to donate please visit their JustGiving page.

* Names have been changed.

The Invisible problem in Development: Part 2

The World Health Organization (WHO) estimates that schizophrenia, bipolar disorder, depression, and alcohol-use disorders affect around 450 million people and account for 12 percent to 14 percent of the global burden of disease, measured in disability-adjusted life years (DALYs) (DALYs represent the total number of years lost to illness, disability, or premature death within a given population). This number doesn’t include the 47.5 million people who have dementia or those who live with social anxiety or obsessive social compulsive disorders.


Although the World Health Organisation estimates that mental and neurological disorders are the leading cause of ill health and disability globally, there is a severe lack of interest from governments and NGO’s.


One of the reasons behind this is a lack of funding in development for mental health initiatives. Due to the market-driven nature of aid, mental health isn’t appealing to donors and projects are strongly correlated to how marketable they are to the general public. Mental health charities struggle to raise money as they are not part of the three big C’s ‘cancer, cats and children’ which tug on heartstrings and consequently purse strings. With mental health it’s harder to generate empathy, mental health problems are not always obvious therefore do not always create the snapshot image for your latest fundraising event.


Social stigma surrounding mental health restricts the formation of any real social pressure to affect governments or individuals into action. A mhGap (Mental Health Gap) report lead by the WHO in 2008 states “The stigma and violations of human rights directed towards people with these disorders compounds the problem, increasing their vulnerability; accelerating and reinforcing their decline into poverty; and hindering care and rehabilitation”.


Research by Christoph Lauber in 2007 shows that comparable to Western countries, there is a widespread tendency to stigmatize and discriminate people with mental illness in Asia. But the problem of social stigma is not just an issue in Asia, Nora Mweemba, who works for the WHO in Zambia, explains that many people suffering from mental health problems don't come forward for treatment because "communities still regard mental health as a misfortune in the family or some sort of punishment [from God]". The pathway to care is often shaped by scepticism towards mental health services and the treatments offered and families tend to turn to traditional healers. There are significant cultural barriers which need to be overcome and further research by organisations to deliver effective mental health policies.


Many of the countries do not have the legal infrastructure to protect those with living disabilities. Although many countries have signed the ‘Convention on the rights of persons with disabilities’ institutions still lack funding, training and the resources to adequately care for their patients. Unfortunately this leads to human rights violations where patients are locked, chained, isolated and denied their basic human rights.


One of the other barriers to the development of mental health services has been the absence of mental health from the public health priority agenda. The report for mhGap launched by the WHO research shows that this has serious implications for financing mental health care, since governments have allocated meagre amounts for mental health within their health budgets. But with so many health concerns facing developing countries mental health is not always top of the agenda.


Although mental health problems account for almost 13% of the world’s total disease burden and costs the world some $ 2.5 trillion per year, yet the amount invested in treating mental health problems is barely a fraction of this. Less than two percent of the health spending in most low and lower-middle income countries.


Gary Belkin, Executive Deputy Commissioner, New York City Department of Health and Mental Hygiene says;

“The challenge is we have in the order of a billion people on the planet who will have a mental health problem in their lifetime and not get evidence based care for it. A response to that sort of problem needs action at a global level. It needs the sorts of global structures we’ve created for malaria and HIV to be created for mental health as well”

However the problem isn’t just a medical concern, in a recent report by the APPG (All-Party Parliamentary Group) highlights how mental health problems are a brake on development as they cause (and are caused by) poverty. This is part of a wider development concern as not addressing mental health fuels social failures including poor parenting and school failure, domestic violence,and toxic stress, preventing people with problems and their families from earning a living.


Although there have been some recent efforts to raise the profile of mental health as a development issue. In 2008 the WHO launched the Mental Health Gap programme and mental health has been included within the SDG’s in 2015 (Sustainable Development Goals) . The mhGap has praised improvements in countries such as Guinea where they are running a services to support ebola survivors and improving care across disaster - affected regions such as the Philippines.


However the response to mental health in the development sector is still severely lacking. There are very few global organisations leading the way for mental health issues. Basic Needs and International Corps are two international charities which are mental health focused and are calling for governments and aid agencies to address the issue.


In order to tackle the growing mental health crises governments and NGO’s need a collective response. Mental health should not be left to the public health or development sector - schools, hospitals, community groups, charity groups and government bodies should work together to tackle mental health at a global level.