siem reap town – Depression has become an easily treatable illness in many Western countries. But in Cambodia, where up to 70 percent of people may be suffering from it, many physicians can neither identify nor treat it.
One hundred and four Cambodian doctors and a US university hope to change that.
The physicians, participants in a training program in mental health run by Harvard University’s refugee trauma program, are to become the basis of a nationwide community mental health care system. Health officials hope these doctors will be able to treat thousands of sufferers and reintegrate them with their communities.
“There are tremendous medical advances going on,” Richard Mollica, director of the Harvard trauma program, said Saturday. “It is very important that countries like Cambodia aren’t deprived of moving into the 21st century in terms of the care of the mentally ill.”
Fifty-two doctors and medical assistants graduated Saturday at a ceremony at Angkor Wat, the second and final group to complete the two-year training program, funded by USAID and the Nippon Foundation.
Since March, the physicians from provincial and district hospitals throughout the country have traveled to Siem Reap every month for a week of study. They have learned how to identify symptoms, interview patients, and diagnose and treat illnesses, project director Savuth Sath said.
For many of the doctors, it was an eye-opening experience, Savuth Sath said. The trainees, he recalled, suddenly realized that unidentifiable symptoms that in the past were given the broad label “neurovegatative dystonia” were actually signs of depression.
“We had many patients suffering from depression but I did not know what to do,” said Dr Thong Ra, a Sihanoukville provincial hospital physician who participated in the second training group. “Sometimes we gave them medicine, but it was the wrong medicine and bad for the patient.”
Although no survey has been conducted in the country, experts believe as many as 70 percent of Cambodians may suffer from depression and 55 percent from post-traumatic stress disorder, based on a study by Harvard in 1990 at the Site 2 refugee camp on the Thai border.
James Lavelle, international programs director of the Harvard School of Public Health, said the combination of life during the Pol Pot era, decades of civil war and an ongoing state of poverty have all contributed to the high rate of mental illness in Cambodia.
But despite the prevalence of mental health problems, mental health has remained less important than malaria and AIDS in the minds of the country’s policy makers, said Savuth Sath.
Until early this year, Cambodia had only one psychiatrist, a Russian-trained doctor who runs an outpatient clinic in Phnom Penh. In March, 10 psychiatrists—the first to be trained locally—graduated from the Norwegian funded Cambodia Mental Health Training Program.
There has been no mental hospital in Cambodia since one in Takhmau was shut down during the Pol Pot era. Outpatient clinics are now operating in hospitals in Siem Reap and Battambang. But many rural residents cannot afford to get there, Savuth Sath said. Those who suffer from schizophrenia are often locked or chained up by family members for the protection of everyone.
Harvard officials hope their graduates will be able to fill that gap by offering treatment within their communities, as well as providing family counseling and public health education.
The graduates are enthusiastic but warn that a lack of cash for medicine may hinder the lessons they have learned.
Mam Bun Heang, a secretary of state for Health warned in a speech to the graduates Saturday that the ministry “cannot solve all the problems right away.” Afterward, he suggested they may have to substitute medicines for those that are unavailable.
Savuth Sath agreed it will be a long process to develop a mental health care system. But with doctors now trained in each province, he hopes an outpatient clinic in every province is not far off.
“Even if a doctor could just see patients one day a week,” he said, “It’s a start.”
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