I’ve told you about the the work that is being done here to help physical illnesses and injuries. We’ve seen abnormal growths, at-risk births, respiratory problems and a slew of other physical conditions. But there is another side too – the mental side, that we mustn’t ignore. I’m talking about mental health.
The mission team was lucky to have a talented group of mental health professionals that set up a mental health clinic within the hospital grounds. The team consists of Poorni – from Team IWA and a psychologist, Naomi – a psychiatrist, Chris – from Team IWA and a clinical social worker, Candy – a clinical social worker, and two Cambodian medical student interpreters. As with every other team of doctors, they make due with what little resources they have. They managed to find a “quiet” and “private” place in an outdoor hallway attached to the pharmacy area. They have no doors that close – no rooms to themselves. Their delicate endeavour is out in the open and they make it work.
Today I sit with them for a while to get a better understanding of what they face. They see cases of everything from depression to anxiety. Human problems seem to be the same everywhere, don’t they? Poorni graciously lets me sit near her counselling area so that I may respectfully observe nearby, with the permission of the patients. A 35 year old woman arrives and sits down with Poorni and her team. After asking questions about her physical symptoms, Poorni learns that this woman is experiencing headaches, anxiety, heart palpitations and sweating. She determines the patient has noise-related anxiety and panic disorder with agoraphobia.
Then Poorni tells her patient about some options that can help her work through it – coping mechanisms such as exposure-based therapy. The translator explains to the patient in Khmer, and the woman nods to indicate that she understands. It’s at this moment that I realize how difficult their job is. They can’t rely on medicines like we do in the States, because there is no access to mental health meds here and they wouldn’t be able to afford them even if they were. So then they are left with other tools to help, such as the example above. And even that is tricky, because not everything is culturally appropriate. It’s as if they are finding their way through a maze blindfolded – and still finding their way.
The medical student stands up and leads the woman to a large poster that has a drawing of a body. Written on it are Khmer symbols pointing to different parts of the body. Poorni sits beside me and I ask her what they are doing at the poster.
“This is a mental health poster that shows the effects of stress and anxiety on the body,” Poorni says. “Many of the patients can’t read, so the translators explain it to them in Khmer. In Cambodian culture, the word for mental illness essentially translates to ‘crazy’. So to work around this stigma, we focus on how things affect the body.” This makes sense to me as I realize that much of the questioning dealt with her physical symptoms and this helped them get around the cultural stigma of mental illness while getting the woman to open up.
It’s time for me to get back to my post at the pediatric station so I thank them again and head back. I could tell how much every one on the mental health team wanted to affect real change and after spending some time with them, I have a deeper respect for the challenges of giving cross-cultural therapy – and through an interpreter to boot!