In times of great uncertainties, danger, and stress, mental health becomes an issue of public concern. Yet, the problem does not quite get the needed response in terms of public health programs, facilities, and services. In this context, the initiatives taken by private individuals and organizations are extremely important.
An inspiring example is that of fifty-four-year-old Cambodian psychiatrist SOTHEARA CHHIM. He was only seven-years-old when the Khmer Rouge took power in Cambodia in 1975 and forced the people of Phnom Penh and other cities to rural camps for a regimen of slave labor and reeducation. Children, like CHHIM, were separated from their parents to work in these camps. It took more than three years before CHHIM was reunited with his family when Phnom Penh was liberated in 1979.
Amid the psychological devastation wrought by a genocidal rule that claimed 1.7 million lives, CHHIM studied medicine at Phnom Penh’s University of Health Sciences and was among the first Cambodian psychiatrists to graduate after years of war. The challenge that faced CHHIM was forbidding. It is said that 40% of Cambodians suffer from mental health problems. Yet, even today, the resources needed to address the problem are direly lacking. Only 2% of health centers and 59% of referral hospitals offer mental health services to outpatients. There are only two psychiatric inpatient units with a total of fourteen beds to serve a country of about 15 million.
In 2002, CHHIM assumed a leading role in mental health as executive director of Cambodia’s Transcultural Psychosocial Organization (TPO). (The organization started as a branch of Netherlands-based TPO International but became an independent organization in 2000.) TPO Cambodia is the largest non-government organization in the field of mental health care and psychosocial support in Cambodia. Based in Phnom Penh, it has more than forty medical professionals and staff and has satellite offices in four provinces. It is guided by these principles: it is community-based, psychosocial (takes mental health in the context of community and society), capability-building (empowers people to survive and thrive), and integrative.
TPO worked on the “Truth, Trauma, and the Victims of Torture” project at the time the Khmer Rouge Tribunal was investigating the Cambodian genocide (CHHIM took part as an expert witness). TPO conducted treatment and training in post-traumatic stress disorder (PTSD) in tandem with Documentation Center of Cambodia, the organization devoted to documenting the genocide. As a method of trauma assessment and treatment, TPO practiced “testimonial therapy,” a localized version of an internationally recognized treatment method developed for PTSD cases resulting from mass, organized violence. With the help of therapists, survivors put into writing their traumatic experiences. A formal testimony is produced, which is then presented by the survivor in a public ceremony presided over by a monk. It is a ritual with healing, spiritual effects. At this time, CHHIM also developed the Cambodian concept of baksbat (broken courage), a post-traumatic state of fear, passivity, and avoidance. Deemed more nuanced and appropriate to the Cambodian experience than “post-traumatic stress disorder,” it is now used by TPO for trauma assessment and treatment.
TPO-Cambodia’s activities include gender-based violence counseling for victims of rape, forced marriages, and other forms of violence against women; a hotline service that provided counselling and referrals during the Covid-19 pandemic; and Operation Unchain, which provided treatment to mentally-ill patients locked up or chained at home and educated families on how to better care for these patients. The TPO Clinic in Phnom Penh has served thousands of patients. It is not, however, the center of CHHIM’s work. CHHIM says: “When I work in the clinic, I see only individuals, one to one with a patient. When I’m in the community, I see the people, the whole family, and the community.” This is where the mental health worker should be.
In electing SOTHEARA CHHIM to receive the 2022 Ramon Magsaysay Award, the board of trustees recognizes his calm courage in surmounting deep trauma to become his people’s healer; his transformative work amidst great need and seemingly insurmountable difficulties, and for showing that daily devotion to the best of one’s profession can itself be a form of greatness.