Civil society has a vital role in nation’s future Thida Khus Monday, 09 April 2012
Dear Editor, Before the ASEAN Summit in Phnom Penh, the Cambodian government emphasised the importance of an independent civil-society sector. I believe most Cambodians dream of a prosperous future in which every citizen has the right and opportunity to reach their potential. To help make this dream come true, we must realise that today’s world is very complex and there are many external and internal forces pushing and pulling our country. The government must understand the need for every citizen to help manage, and prepare for, those challenges. Cambodia cannot compete successfully on this global stage without empowering our society. Many global investors are looking at how Cambodia’s government respects and grows with its civil society as an indicator of how foreign investors will be treated here. We need to recognise that Cambodia is a nascent democracy, and we are still struggling with the core concepts of human rights. This problem is especially acute among the ruling elite and their subordinates. These powerful forces claim the right to rule Cambodia, but do not seek, or encourage, active participation by the public. The day Cambodia’s ruling elite truly respects the right of civil society to organise and participate is the day human rights is finally understood and celebrated in our country. Cambodian civil society views the government not as an adversary, but as a partner and the designated authority elected by the people to represent its citizens’ best interests. Civil society does not seek to replace the government, but to exist as a broad, independent grouping of institutions that will help guide the government’s actions. Every citizen has a right, and a responsibility, to make our country better. As a country, we need to celebrate diversity and encourage greater participation, not less. This message may be difficult for the powerful people to hear, but civil society’s growth will help create a stronger, more intelligent, creative and competitive country. Without that understanding, Cambodia will always struggle, because any strategy based on the desire to micro-manage an entire country will disastrously repeat the paranoid mistakes
made by the Khmer Rouge. That must never happen again. Thida Khus Send letters to: newsroom@phnompenhpost.com or PO Box 146, Phnom Penh, Cambodia. The Post reserves the right to edit letters to a shorter length. The views expressed above are solely the author’s and do not reflect any positions taken by The Phnom Penh Post.
Age is no barrier to lending a hand Post Staff Tuesday, 10 April 2012
Every April 7 is World Health Day which also marks the anniversary of the founding of the World Health Organisation in 1948. This year WHO Cambodia honours malaria field officer Yean Chheang as it celebrates the day with the theme “Good health adds life to years”.
YEAN CHHEANG. AT 73, HE STILL BRINGS A MISSIONARY ZEAL TO HIS FIELD WORK ON MALARIA DETECTION. PHOTO BY WHO/ MOEUN CHHEAN NARIDDH
Age seems to be no barrier to malaria field officer Yeang Chheang, and neither is the option for retirement. At 74, he still brings a missionary zeal to his work in an emergency intervention to contain and eliminate artemisinin-resistant malaria parasites that have emerged along the Cambodian-Thai border. This containment project is led jointly by the Cambodian government’s National Malaria Control Centre and the World Health Organisation, together with its partners. Uncle Chheang, as his colleagues fondly refer to him, is one of the field team leaders in the pilot Focused Screening and Treatment that tries to detect and treat any hidden cases of malaria in remote villages, even in people not showing signs of the disease. “I am happy with the work; I am happy in the village,” he says, with a smile before gesturing at a mother and daughter to go for blood screening for malaria in Pailin province’s O Ro’El village in western Cambodia. Uncle Chheang attributes his good health to working in the field. “I work in the field and it keeps me busy and makes my mind active. It’s like doing exercise,” he adds. He says he will continue working as long as he is strong and healthy and wants his legacy to be the passing on of his skills and knowledge on malaria to younger Cambodians. “I have taught a lot of people after the brutal Khmer Rouge occupation and passed on my medical skills,” he says.
In 1960 Uncle Chheang was sent to study in the Philippines, when he was a 23-year-old entomologist technician at the Ministry of Health’s National Malaria Control Centre, under the government of Prince Norodom Sihanouk. Ten years later, in a tragic turn of political events, following the overthrow of Prince Sihanouk’s government in 1970, Uncle Chheang found himself forced into the army of Field Marshal Lon Nol in the civil war against the Khmer Rouge. “I was carrying guns instead of syringes,” he says, raising his hands in a shooting gesture. He adds: “I always slept in the trench, [while] we were on guard to prevent the Khmer Rouge from advancing to the capital.” When the Khmer Rouge took over the capital Phnom Penh, in 1975, Uncle Chheang’s life was spared with a stroke of luck. The Khmer Rouge also needed him to fight malaria. Uncle Chheang recalls that the Khmer Rouge used herbal and other traditional medicines instead of proper medication to treat malaria and other illnesses. “As a result of this, many people died,” he adds. His personal suffering under the Khmer Rouge was also tragic. Uncle Chheang’s wife died in 1976 when she was 31 and he also lost his youngest son who was about one month old. Both died due to lack of food and medicines. His mother and a sister were taken away by the Khmer Rouge and are presumed dead. The Khmer Rouge also killed Uncle Chheang’s two brothers – a police officer and a soldier in Field Marshal Lon Nol’s government. “That period was the most difficult in my life,” he recalls sadly. Before 1975, there were more than 500 medical doctors and health workers working on malaria in Cambodia. But less than 100 of them survived the Khmer Rouge. Uncle Chheang points out that only 10 had returned to work at the National Malaria Control Centre. Uncle Chheang managed to pick up the pieces of his life after the war against the Khmer Rouge in 1979. He married his late wife’s younger sister, Nong Bunny, who was then working as a lab technician in the National Malaria Control Centre. From that marriage he has one daughter who now works in the tourism industry. His eldest son from his first marriage is a medical doctor in the United States while his other son is a professor of Khmer linguistics at the Royal University of Phnom Penh. Today, Uncle Chheang works in the former Khmer Rouge stronghold of Pailin – the epicentre of multiple drug-resistant malaria – and frequently comes across former Khmer Rouge fighters who surrendered to government forces in 1996 and were granted an amnesty. When asked about this, he replies: “Forgiveness and compassion are the greatest human virtues. If we don’t help these people with malaria, we cease to be humans
Evictees’ plea: New petition chugging along to ADB Chhay Channyda Tuesday, 10 April 2012
Evictees’ plea Families evicted from their homes by the rehabilitation of Phnom Penh’s stretch of the national railway said they had filed their second petition in two weeks to the Asia Development Bank yesterday, seeking help to improve living conditions at their resettlement site. Ros Bopha, representative of the 160 families forced to relocate to Por Senchey district’s Trapaing Anchang village, said the letter made the same basic requests as the one delivered last Monday, which called for more compen-sation and infrastructure development at their relocation site. The villagers were relocated from Tuol Sangke and Kilometre 6 communes in Russei Keo district on March 6 by a US$143 million rail rehabilitation project funded partly by the ADB. A spokesman for the ADB said it had received the villagers’ first petition last Monday but had not yet received the second. “We are providing a reply to the first letter this week in close consultation with the IRC [Inter-ministerial Resettlement Committee], who are fully aware of the situation and are taking action,” the spokesman said yesterday.
Ieng Sary team turns up pressure on Duch David Boyle Tuesday, 10 April 2012
Ieng Sary’s defence lawyer, Michael Karnavas, yesterday picked up where Nuon Chea’s defence team left off last week, hammering at the credibility of testimony given by the most potentially damaging witness in Case 002, convicted Khmer Rouge prison chief Kaing Guek Eav, alias Duch.
IENG SARY IN COURT. PHOTO PROVIDED BY ECCC POOL
In an at times testy session of court, Karnavas suggested that gaps in Duch’s first-hand knowledge of events had been filled in by his exposure to Khmer Rouge documents and history books. He forced the former chief of the Khmer Rouge’s notorious S-21 interrogation facility to concede that, in a statement made to the court’s co-investigating judges, he said he avoided work to the “maximum” and “thus never grasped anything concretely”. “If we were to reflect back on a day in the life of comrade Duch, your existence was more or less S-21 and then back home?” Karnavas at one point asked. Karnavas put forward examples of statements Duch had made to the court’s coinvestigating judges, indicating limits to his knowledge in a line of questioning that was frequently objected to as leading by international deputy co-prosecutor William Smith. Specifically, Karnavas focused on whether Duch could provide any concrete evidence suggesting that Ieng Sary was consulted on arrests in his role as minister of Foreign Affairs. “In practice, I do not know,” Duch said, insisting that he knew Ieng Sary was involved because, following the principles of the regime and its rigid hierarchy, he had to have been. Duch resisted efforts by Karnavas to make him concede that he had relied on secondary evidence to formulate what the prosecution is arguing is unique and reliable first-hand
knowledge of the inner workings of the Khmer Rouge. But Karnavas did demonstrate there were limits to what Duch, who conceded that he had subsequently read history books about the regime, remembered about events. “The saying goes that mind your own business. I must know what is happening at S-21. [Things outside of S-21], that is not my business,” Duch told the court. He also conceded that in one document he submitted to the court’s co-investigating judges, he referred to himself as a “researcher”, again furthering a line of questioning pursued by Karnavas in his attempt to discredit the first-hand nature of Duch’s testimony.
Borei Keila demolition thwarted Khouth Sophakchakrya Wednesday, 11 April 2012
A gorup of police officers, security guards and Prampi Makara district authorities were unsuccessful yesterday in their attempts to demolish the remaining makeshift living quarters that are being inhabited by families in the Borei Keila community.
A WOMAN SITS UNDER HER TEMPORARY SHELTER IN BOREI KEILA YESTERDAY. ABOUT 100 POLICE OFFICERS AND AUTHORITIES YESTERDAY PULLED DOWN A FEW SUCH SHELTERS ERECTED BY FORMER RESIDENTS. PHOTO BY HONG MENEA
PEOPLE EVICTED FROM THE BOREI KEILA COMMUNITY SIT UNDER TEMPORARY SHELTERS YESTERDAY AFTER LOCAL AUTHORITIES PULLED DOWN SEVERAL SUCH SHELTERS AND ORDERED INHABITANTS TO LEAVE. PHOTO BY HONG MENEA
Chum Ngann, representative for the evictees living at the site where their houses were bulldozed in January, said a group of about 100 police officers and authorities armed with shields, electric batons and axes descended upon the site yesterday morning. She added that residents struggled with the forces, who managed to destroy a few of their makeshift shelters before retreating.
“We haven’t had shelter since January 3. Our plastic tents under the roof and stairs are filled with the bad smell of the waste from our last shelters,” the representative said yesterday. Deputy governor of the Prampi Makara district, who was at the scene yesterday, expressed his concern for maintaining public order in the area. “This kind of set up is tent anarchy, and will affect the environment in the Borei Keila development area,” he said. Tim Sakmony, a resident who helped to repel the authorities yesterday, said the evictees would not be is such a dire situation if the Phan Imex company followed through with their promise to construct 10 buildings in which they could be housed. Phan Imex only constructed eight of the 10 promised housing structures. “Who could be happy and wants to live in a terrible situation? We have no choice, so we struggle to live and are waiting to receive a fair solution from the authorities who made us this way,” Tim Sakmony said. Secretariat director for the Housing Rights Task Force Sia Phirum said the authorities are aware of the struggles that the evictees face, but have merely chosen to ignore them. “Until the residents start to live in houses and have proper businesses, they will live in tents and under stairs. When will the authorities stop this eviction plan and provide additional compensation?” he asked. <div>Please enable JavaScript to post a new comment</div>
Real-time malaria detection via SMS Post Staff Tuesday, 10 April 2012
Moeun Chhean Nariddh reports on a mobile phone-based frontline reporting system for detecting malaria cases in Kampot province.
From her house in Snay Anchit Village, about five kilometres from the health centre in Kampot provinceâ&#x20AC;&#x2122;s Chum Kiri district, 20-year-old village malaria worker Kong Lida can clearly hear the noise of a generator roaring in the distance. This generator is an important source of power where Lida and other villagers have their car batteries charged every day so that their houses can be lit up at night from electric lamps and at the same time charge up their mobile phones. But soon Lida and other village malaria workers in her village and other communes will not need to pay the generator owner to have their car batteries charged any more. Now, all these VMWs will get their power from a ubiquitous source of energy â&#x20AC;&#x201C; namely solar power. As part of the countryâ&#x20AC;&#x2122;s malaria elimination strategy, the National Centre for Parasitology, Entomology and Malaria Control (CNM), with technical support from the World Health Organisation and Malaria Consortium, has launched a pilot program to train VMWs in Kampot, Siem Reap and Kampong Cham provinces on how to send simple mobile phone
text messages (SMS) to report in real time on detected malaria cases. These SMS messages also support the paper reporting that feeds into the health information system from the health centres. CNM and Malaria Consortium also provide each of the VMWs with a solar panel and a lamp together with a mobile phone and a charger since there is no electricity in their villages. “This collecting of data from villages and its analysis at the most peripheral level at either the health centre or at the operational district is a major achievement,” said Dr Charles Delacollette, WHO’s coordinator of the Mekong Malaria Program. Cambodia is currently seeing a revolution in communications with the roll-out of affordable wireless services to much of the rural population. The potential of approaches based on mobile phones and web-based technology to address the gaps in field data collection for malaria is now widely recognised. “I think using a mobile phone is good, because I can report immediately when I come across a malaria case,” said village malaria worker Lida. Previously, the VMWs would record the data in a logbook which they would then report to the health centres at the end of every month before it was sent to the operational district hospitals and finally to CNM. InSTEDD, an innovative humanitarian technology NGO, designed the system, utilising SMS messages in Khmer script that interact with mapping software to generate maps on the World Wide Web for the locations of malaria cases reported by the VMWs. These malaria cases are also known as Day Zero cases, to indicate the locations of the patients before they are given appropriate and effective treatment. “The web-based system uses simple SMS, which is four to five digit codes in the case of VMWs,” said Malaria Consortium’s information systems manager Steve Mellor. “In addition to the targeted alerts, all cases are displayed on-line which allows registered users to view cases,” added Mellor. The SMS from the village malaria worker only includes a code for the type of malaria, the patient’s sex, age and the village name to indicate the sick person’s location. The InSTEDD-designed system, Mellor pointed out, has a unique threshold feature which allows it to be used in low transmission settings to promptly identify the last few remaining cases and can also be used in high transmission settings to identify possible malaria outbreaks as they occur. “The system allows for VMWs and health centre staff to alert the relevant (based on location) district, provincial and national staff to malaria cases as they are diagnosed facilitating a prompt response,’’ he emphasized. This project also highlights the effective co-operation with the private sector for a public good with low start-up cost that is estimated at US$100 for each VMW, which includes a mobile phone, SIM card, solar charger and training. “Due to the collaboration between CNM and Mobitel, all SMS messaging is free which
essentially results in zero maintenance cost,’’ noted Ngor Pengby, Malaria Consortium’s data manager. “Mobitel have pledged SIMs and free SMS for all VMWs and health facilities in Cambodia should CNM decide to scale up the system in the future,” he added. One of the consequences associated with the delays in paper-based reports is frequent stock-outs of essential anti-malarial drugs in the health facilities that can deprive target populations such as migrant workers of access to effective treatment. Deputy Director of CNM, Dr Chea Nguon, said the SMS reporting would also help identify mobile migrant workers so that the district or provincial hospitals could request more antimalarials when they detect an increase in migrant workers in certain locations. “If we request the same amount of medicines, we might have a stock-out if there is an increase in the number of malaria cases among the mobile migrant population,” he added.
Remnants of war still undermining mental health Post Staff Tuesday, 10 April 2012
A dearth of trained mental health workers, a history of conflict and a lack of coordination has resulted in a weak and fragmented mental health system, while survivors of trauma continue to seek explanations for the horrors they experienced or witnessed.
PHOTO BY COURTESY OF DC-CAM
PHOTO BY COURTESY OF DC-CAM
IRIN The psychological fallout from one of the worldâ&#x20AC;&#x2122;s heaviest bombing campaigns, genocide and two decades of conflict, coupled with chronic poverty, have left a heavy mental health burden that medical services are ill-equipped to handle, experts say. Lack of funding, human resources, national vision and leadership, as well as poor coordination of groups working in mental health, are among the biggest challenges.
Sareth Mon, 58, takes anti-anxiety medication regularly, obtained from the Preah Kossomak public hospital in Phnom Penh. Soon after the Khmer Rouge took power in 1975, Sareth’s one-month-old baby died in her arms as she was no longer able to breastfeed. Her three-year-old daughter died from illness. “There was just no medicine available then,” she said. “I brought them into this world, but could not protect them long enough to keep them alive.” But it is not only the genocide – which killed at least two million people, or one-third of the population then – that haunts survivors, but also the violence that preceded it, said Chhim Sotheara, a psychiatrist and head of one of the main NGOs working in mental health, Transcultural Psychosocial Organisation (TPO). “We have all been touched by trauma. Our psychological courage has been broken,” he said. Cambodia is the most heavily bombed country in the world - and more so than previously thought, according to 2006 research by Canadian human security scholar Taylor Owen, based on declassified US government records. Rather than the oft-quoted half a million tonnes, Cambodia was bombarded from 1965 to 1973 with 2.7 million tonnes, dropped on about 100,000 sites, at times less than one kilometre from villages, Owen learned by mapping the US Air Force data. Just over 10 per cent of the bombing was indiscriminate, with some 3,500 sites listed as having “unknown” targets and another 8,200 sites listing no target. Budget Although the government has declared mental health a priority, adopting a 2011-2015 mental health and substance-abuse plan, the 2012 mental health budget accounts for a mere 0.01 per cent of the nation’s yet-to-be-approved US$2.6 billion budget, or $300,000. This is a more than four-fold increase over last year’s budget of $70,000 and $13,000 in 2010, but still only a fraction of the 20 US cents per person other low-income countries spent on average last year. The budget amounts to two cents per person in a country where the national legacy of violence is a “heavy burden of trauma mental health”, as noted in Cambodia’s Hidden Scars, which was published last year by the Documentation Centre of Cambodia (DCCAM). And most of the budget goes to methadone “maintenance”, used to treat the growing number of injecting drug users, Chhit Sophal, deputy director of the National Program on Mental Health, said. Daily doses of methadone, a pain reliever, have been shown to help wean off injecting drug users by blocking drug-induced euphoria and blunting their withdrawal symptoms.
Meanwhile, most mental health disorders, including trauma, are still overlooked and undertreated. “Right now, we are providing basic services ... giving pills and sending patients home,” said Chhit. Among patients seeking care, their diagnoses range from anxiety (39 per cent), depression (29 per cent), psychosis (18.5 per cent), epilepsy (5 per cent) and substance abuse (3 per cent), according to the National Programme on Mental Health. Services While mental health treatment is available in hospitals, most staff and NGOs trained in providing such services are in the capital. As of 2010, 50 out of 84 referral hospitals and 18 out of 967 health centres nationwide (about 2 per cent) offered mental-health services. There are two psychiatric in-patient units in the capital with 14 beds to treat the most difficult cases. General health staff provide most services; mental health specialists work in only 10 sites located in eight provinces. There are no health services in northern provinces, including Preah Vihear, said Chhit, because “we don’t have the human resources to send people up north”. In the capital, seven health facilities are medicating some 250,000 out-patients. About 120 trained mental health workers serve 500,000 patients nationwide as of February. “The budget my department receives is not an issue,” said Chhit. “Even if I had $1 million, I wouldn’t be able to use the money because I can’t find skilled professionals.” Training To date, 300 doctors and almost as many nurses have undergone basic mental healthcare training. The first group of 15 counselling students graduated from the Royal University of Phnom Penh last year. There is little or no counselling in public health centres. “Our mental health programme is still [in its infancy],” said Chhit. Since 1994, almost 300 students have completed the royal university’s undergraduate psychology program. Few, however, work in clinical settings, with most opting for NGOs or non-clinical jobs. Lack of co-ordination According to a 2010-2011 unpublished evaluation of mental health in Cambodia by the International Organisation for Migration, committed mental health professionals are at risk of burnout due to how “rising demand and low supply of mental health treatment have created a high potential for work overload and burnout, subsequent decrease in quality of care with higher volume of patients and less time for continuing education or supervision opportunities”. One of the country’s first trained psychiatrists after the genocide, who is a practising clinician in the capital, said the national mental health program exists in name only: It lacks
structure and a clear vision. “I worked with the national program, but became increasingly uncertain about the roles of different agencies. There is insufficient co-ordination among the top leaders. Who is responsible for what? It [mental health services management] is not well-organised and [getting what you need] all depends on whom you know. Where can staff turn to for professional growth? As a result, the motivation for mental health system development is stifled.” Chhit acknowledged the need for structure and highlighted lack of co-ordination with NGOs as a problem. Respondents to IOM’s evaluation cited “the need for a strong, charismatic leader” to unite different actors. Suggestions included using the World Health Organisation to broker communication between the two sides. Other suggestions from almost 40 local mental health professionals responding to two recent independent surveys of how to improve the mental health system included greater NGO involvement in mental health policy; more regular interagency co-ordination meetings, which have lapsed; increased collaboration between oft-segregated mental health disciplines; moves away from over-medicating mental illness; mental health mobile teams to expand services to underserved, mostly rural areas; more training; and involving more government ministries that can hold sway in the healing process, such as religious affairs and education. Others suggested pushing for mental healthcare as reparations through the ongoing Khmer Rouge war crimes trial. But the Supreme Court closed off this option in a February 3 ruling, saying the court could not force the government to pay for health services. For Hong Savath, 47, thoughts of suicide still arise intermittently. “I saw my parents tied and sitting on the ground in front of the hole [in 1979]. I could see bodies all around them and in the hole. They killed my mother first with a bayonet and then my father,” she told TPO in 2010. Raped at age 14 by the same guards who killed her parents, she has since married and had a second child at age 46 – but still seeks answers to decades-old questions. Days before a life sentence verdict was handed down for Kaing Guek Eav, the former chief of Tuol Sleng security prison-turned-torture chamber, she said: “If I could address Duch, I would ask, ‘Who ordered this?’ I saw my family killed with my own eyes. I want to know who is responsible. I would get over my sadness if I knew who did this. And why?” Muny Sothara, a psychiatrist in Preah Kossomak hospital, said the weight of such questions can make healing difficult. “Meaning can help heal. A survivor of a tsunami has a scientific explanation of death and destruction. A genocide survivor – many survivors – seek the same.”
Start with sanitation Post Staff Tuesday, 10 April 2012
Improved health practices and sanitation are an obvious starting point for improving health in rural Cambodia, writes John Macgregor. A shift in thinking away from rigidly rational development models to a more random, spirited approach may also help, he argues.
A FAMILY IN KAMPONG CHAM PROVINCE STRANDED BY LAST YEAR’S FLOODS. PHOTO BY VINCENT MACISAAC
The most visually striking thing about rural Cambodia might be the abysmal state of people’s health. If you were someone who liked log-frame diagrams, you might have arrows emanating from poverty, dirty water, outdoor defecation and poor nutrition to pictures of listless adults, kids infested with parasites, and just about everyone some inches shorter than their optimal height. In villages far from a main road, that’s certainly the visual which hits you in the face. In some places, nearly everyone is sick. Work is slow, and learning largely absent. Ratanakkiri province, for example, has worse child stunting, and child mortality, than Sierra Leone. Battambang province has more of a mixture of pluses and minuses. Knach Romeas commune on the Thai border, for example, has high rice production – but no clean water. A recent study there by the NGO I work with, Lom Orng, found that residents spend 18 per cent of their disposable income on expensive, untreated, trucked-in water. This water (and sanitation in general) is so bad that villagers spend another 27 per cent on medical bills. At a guess, bad water might steal away a third of local income. But every aid practitioner knows that single issues are a bit of an illusion. How do you tease water apart from sanitation, or sanitation from education, or education from income? And what if you overlay factors like high birth rate and global warming? Or the downstream effects of the latter, such as the flooding of the Mekong Delta and the millions this will
displace on Cambodia’s doorstep? At this point your log-framer might start to go mad (assuming log-framers aren’t this way already). Given the infinity of problems, and the finitude of money, the best anyone can do is to arm themselves to the teeth with a love of the poor (incidentally, a solution par excellence to Western neuroses), and to pick the high-yield targets. The US$1.4m After the Flood project – being run across three northwestern provinces by four local NGOs – is providing seeds and training for a quick short-term rice crop, restocking chicken coops and vegetable gardens, and building food-dense Permaculture “safe grounds” above the flood line. It is also repairing schools, education being the specialty of one consortium member, PKO. The psychological software is being addressed as well: here we judged that poor hygiene and sanitation habits are the most compelling target, given that they poison both water sources and food. In lieu of crowding people into rooms with whiteboards, the hygiene trainers have opted for a little drama. Perhaps 40 villagers are brought together to draw a map of the village in the dirt. Various coloured sands are provided to represent walkways, homes, streams, and so on. They are then asked to mark areas where they shit. (I’ll use that word rather than “defecate”, as our Khmer teams are rather taken with its naughtiness, which chimes well with colloquial Khmer. They now laughingly refer to themselves as “shit experts”.) Drawing a village map can take all morning. Trainers might step in sometimes and ask, for example, what people make of the fact that they are shitting within a few feet of their water source. But mostly they allow villagers to draw their own map and reach their own conclusions. Then walks are done to outside toilet areas, and shit collected. Flies are observed gathering on it, and then on people. It’s mixed with drinking water in a plastic bottle, and offered round as a drink, to general guffaws. Basic facts about the fecal-oral route of water and food contamination are introduced – but 95 per cent of it is letting villagers describe their own patterns of behaviour, see them in a slightly new light, and make their own connections. We haven’t gauged results yet, but this Community-Led Total Sanitation training is certainly confronting enough to grab villagers’ attention. And as they are driving the process; they feel free to have noisy debates. Getting a birds’ eye view of things seems to be another clincher: seeing the relationships in graphical form. After the Flood has no consultants, no SUVs, and one meeting a month, which no one enjoys. It is succeeding partly because it is lean, but mostly because my Cambodian colleagues are so good at what they do. While they possess the Khmer impatience with theory and detail – and so tend to jump straight in – this is because they know their communes like the backs of their hands. These are the men and women who jumped into boats with supplies last October, and saved 6,000 inundated people from malnutrition, disease and death – on two days’ notice. The project to date has been characterised by cross-fertilisation. The CLTS training was taught to the other NGOs by Ockenden, which has experience in it. Lom Orng has shared
its knowledge of short-term rice cropping and horticulture; while DCO – more of a nuts-andbolts operation – racked up large tallies of ponds, safe grounds, chicken coops and vegetable gardens in the first month, spurring everyone else to get moving. Several times staff from the various NGOs have pooled their salaries to build houses for flood survivors they found living on the dirt. The project is having some effects beyond its bounds. Its Permaculture demonstration farm, begun by Ockenden in Battambang’s Rukha Kiri district, will long outlive the project, and will hopefully become a permanent feature of the country’s agricultural landscape. For Lom Orng, After the Flood has strengthened our grasp of the link between water and health, and we have drafted a plan to bring cheap, reticulated water to scores of communes – using the profit from one commune to seed a venture in a neighbour: a kind of commune-leapfrogging revolving fund. Seeing a village boy with tuberculosis last week – the disease that killed my grandmother back in 1931, a decade before antibiotics – reminded me of the distance left to travel. Much of that distance will be covered in a motley rather than a rational way. But leaving certain things to the gods of randomness is the heart of Asian psychology, and if we mean what we say about allowing local communities to design and lead their own development, allowing for some happy accidents would be in the spirit of things. John Macgregor is communications director at the Lom Orng Organisation (formerly the Cambodian War Amputees Rehabilitation Society). Lom Orng is part of a consortium of NGOs running After the Flood in Bantheay Meanchey, Battambang and Pursat. The others are Ockenden Cambodia, Disadvantaged Cambodians Organisation and Puthi Komar Organisation.
Volunteers key to saving lives Dani Mcdonald Tuesday, 10 April 2012
Training of village volunteers and support for health centres has helped halve the infant and maternal mortality rates over the last decade, Dani McDonald reports.
VILLAGE HEALTH VOLUNTEER SITHA NIM. PHOTO BY DANI MCDONALD
Dane Toe lies in a hammock in the cool shade below her house in Pom Thol village, in Kampong Speu province’s Oudong district. She is just five days old. Her mother, Sokly Torn, 34, lies on a bamboo platform next to her, watching her every breath. Just two metres away a cow stands beneath a tree, seeking respite from the glaring sun. This is Sokly’s first child, and her and her daughter’s health are testament to the startling decline in infant mortality rates, made possible – in part – by support from village volunteers, more effective health centres and a co-ordinated effort by non-governmental organisations like the Reproductive Health Association of Cambodia (RHAC). Between 2000 and 2010, the infant mortality rate fell from 95 to 45 deaths per 1,000 live births, according the 2010 Cambodia Demographic Health Survey. RHAC has played a key role in this. The USAID-funded NGO was established in 1996 with just 10 staff. Last year it had 700 spread across14 provinces where they supported 475 government health centres, servicing 6.87 million men and women. RHAC associate director Dr Chivorn Var summed up its work as supportive of local health centres and the physical and social infrastructure necessary to improve them. Its staff train village health volunteers and provide health centres with equipment, allowing health centres to operate more effectively. “We also help at the district level, with training and mentoring to improve the capacity of health centre staff,” he said. Chivorn Var pointed out that in 2009 only 48 per cent of the 300 health centres RHAC was supporting had family planning services. “After mapping out
which health centres did not have the capacity [for teaching family planning], we trained them, provided the equipment and then worked with local authorities to promote our services,” he said. Maternal mortality For Sokly, undergoing her first pregnancy at age 34 was not something to be taken lightly. Childbirth is still a danger for women in Cambodia despite the steep fall in the maternal mortality rate to 206 per 100,000 births, according to the 2010 CDHS. RHAC project officer Bunseng Khun said poverty and lack of access to education left families in rural areas vulnerable because they could not afford healthcare and were unaware of how to ensure safe pregnancy and birth. Sokly benefited from regular prenatal check ups by a village health worker who also urged her to attend antenatal sessions at the local health centre. “The health centre taught me to take care of myself and to eat more nutritious food. They also provided me with iron pills and a tetanus injection,” she says. Sokly attended the Damnak Smach health centre after a village health volunteer Sitha Nim advised her to. Sitha Nim also runs a small shop where posters explain the importance of safe water, birth spacing and the signs that precede going into labour. She has worked as a village health volunteer for RHAC for three years, roaming house to house on a monthly basis educating families about family planning, birth spacing, prenatal and antenatal care. She uses colourful and simple posters advising pregnant women to eat fresh fruit and green vegetables, take plenty of iron, and avoid alcohol, riding motos, or carrying water. “The main thing is contraception and then providing the information to the pregnant woman,” she says. “I like to help the people in the village. I want to explain to people about the safe service in the health centre and to not use traditional birth attendants,” she added. Traditional birth attendants [TBA] are now a thing of the past in Oudong, according to Bunseng. Damnak Smach Health Centre �hief �urse Narint Hou says he has noticed an improvement in deliveries and an increase in antenatal care during the last couple of years. Damnak Smach village has a population of 956. On record there are 471 pregnant women, 29 infants, and 28 children under the age of five. The health centre has eight staff, three of which are primary midwives, meaning they can perform deliveries but not caesearans. It also provides family planning, antenatal care, delivery, prevention of mother-to-child transmissions of HIV, counselling and health education.
Staff work five days a week, but a rotational duty calendar allows the centre to remain open on weekends. Infant mortality rates are 0 per cent, Narint said, but if the delivery is difficult the patient is referred onto the referral hospital. RHAC pays for transport for mothers to attend their antenatal care four times throughout their pregnancy. If a family is poor, Narint said he finds the support from the commune council to pay for transport to the hospital or health centre for delivery because the council has a budget for this. Health centres need more support The health centre is not fully supplied and Narint purchases medication himself. He is reimbursed with user fees. Despite the increase in patients, midwife Simorn said there was still a lack of midwives to treat each patient. An antenatal check takes 15 to 20 minutes per patient, and on average the health centre receives10 patients a day. RHAC midwife Thearin Ung agreed. “They do not have enough midwives in the remote areas. There are fewer midwives in the health centres. Clients can access the centre, but the problem is the provider. “They just have one or two people so when many clients come, we can’t provide a service on time. It depends on the district and the workload in the health centre – it’s a lot of work and when we have less staff, one person needs to serve many,” Thearin said. In Oudong there are three health centres in the remote areas: each has two midwives. As of February, there were 681 women using family planning services. In 2011, the clinic distributed family planning services to 893 women. Over the next year, the clinic aims to continue to improve the quality of family planning services in order to continue to attract couples who are seeking safe, voluntary, high quality services. Despite the positive turn around of clients using the health centre, Narint said he would like to see some improvements on the actual centre itself. He said no improvements had been made to its structure since it was built in 1996. He would like to see more space to serve patients – currently the waiting room is in the same area as the consultation/delivery room. Safe water is another necessity for the health centre. It relies on a pond behind it, which dries up during the dry season.
Narint carries the water to the centre for cleaning purposes. He said he buys clean water for drinking, but sometimes is forced to boil pond water. Still, for Dane, lying in her saffron hammock, her peaceful sleep is the result of the great effort made to ensure her survival. She will be part of Cambodiaâ&#x20AC;&#x2122;s future, rather than an alltoo-brief part of its past.
NGO brings libraries to prisons May Titthara Wednesday, 11 April 2012
Prisoners nationwide will be given the chance to boost their literacy levels, with French NGO SIPAR signing an memorandum of understanding with the Ministry of Interior yesterday to operate libraries in prisons. SIPAR director Hok Sithik said the MoU covered a three-year project from January this year to build libraries in every Cambodian prison. The US$500,000 project would be funded by the Europ-ean Union, Hok Sithik said. “We decided to operate the libraries in prisons because some prisoners who are detained are youths, and we want to give them a chance to study in prison so they can integrate with the community when they are released,” he said. Previously, SIPAR had established libraries in prisons in four provinces, including Battambang and Siem Reap, and the Prey Sar correction centres, Hok Sithik said. Prison guards would also be trained by SIPAR to double as librarians, he added. Nuth Sa An, ministry of interior secretary of state, said the project would allow prisoners to improve their knowledge while detained. “It is a good opportunity for prisoners; if they are interested to read a book, they can come to read in the library or they can borrow to read in their cell,” he said. Licadho senior investigator Am Sam Ath, who works with prisons in 13 provinces, welcomed the initiative but highlighted the need for prison officers to consider how to schedule time for prisoners to read and research.
Tempers short as Duch questioning continues David Boyle Wednesday, 11 April 2012
With his credibility once again on trial yesterday, Kaing Guek Eav, alias Duch, reacted irritably to further suggestions by defence lawyers in the tribunal’s Case 002 that he had provided contradictory accounts to the court. Clearly growing weary of the sustained attacks he has endured for days as a witness under examination by the counsel of all three co-accused, Duch provided bizarre answers or flatly refused to respond to questions from Khieu Samphan’s co-defence lawyer, Arthur Vercken. Vercken sought to establish the nature of Duch’s relationship with Khieu Samphan, the former nominal head of state of Democratic Kampuchea, as well as with former industry minister Vorn Vet and others. But the tone of the proceedings quickly degenerated after Vercken began questioning Duch over why a statement he gave to a 1999 military tribunal appeared to show the former S-21 prison chief had given contradictory testimony during the trial. “In that paper, Duch says: ‘I had conversations with people who had already been interrogated – including [Chhim Sam Aok alias] Pang,’” Vercken alleged. “And here right now, you are telling me you hadn’t spoken to Pang after he was tortured.” Duch flatly refused to answer further questions about Pang based on the military tribunal statement, employing the curious argument that it accurately summarised his comments about multiple people but could not be used to talk about one individual specifically. Trial chamber president Judge Nil Nonn, Ieng Sary co-defence lawyer Michael Karnavas and deputy prosecutor William Smith all weighed into the dispute, with the latter two directing sharp criticisms at each other. After Judge Jean-Marc Lavergne intervened to settle the situation, effectively eliciting from Duch that the military tribunal statement was only partly accurate, further complications arose. Questions surrounding a special pass that allowed Duch to travel freely during the regime, issued by a figure named “Kang”, led to an extended debate about a confusing string of nicknames and signatures that the witness alleged confirmed it was signed by Khieu Samphan.
UN taps English barrister to join KRT’s prosecution Post Staff Wednesday, 11 April 2012
A barrister from England has been appointed by the United Nations to its team of senior prosecutors at the Khmer Rouge tribunal. Keith Raynor, 47, has no known international criminal tribunal experience, but the court’s legal communications officer Lars Olsen said he would bring significant experience to the prosecution team. “Mr Raynor will bring over 25 years legal experience to the court, in particular in respect of complex criminal trial work in England and Wales,” he said. Raynor, who was one of 12 to emerge from a larger pool of candidates to make the interview process, told the Derby Telegraph he had always been interested in internat-ional criminal law and was delighted by the opportunity that would see him focusing on the very large Case 002 against the Khmer Rouge regime’s three most senior surviving leaders. “I am particularly looking forward to working with Cambodian and other international lawyers. It will be a challenge, but I like to be challenged,” he told the Derby Telegraph. “It is a significant change for me and my family, but there will be opportunities for all of us in Cambodia and the chance to experience a different culture.” <div>Please enable JavaScript to post a new comment</div>