By Setarreh Massihzadegan
Medill News Service - Northwestern University, Chicago, Illinois
(Medill News Service) Nearly three decades after arriving in the U.S. as a Cambodian refugee, Saveth Yem still can see her uncles taken away to be killed by the Khmer Rouge.
“We [have a] very tough, very rough life in Chicago,” Yem said through a translator. “I want to work but I’m unable to work. I have a very emotional stress.”
Yem, who suffers from depression, said she sees her doctor every two weeks for tests but sometimes forgets to go. She also has diabetes.
Yem fled to Thailand with her five children before reaching the U.S. She is one of many reasons members of the U.S. Cambodian community conducted a video conference Monday at the Cambodian-American Heritage Museum and Killing Fields Memorial in Chicago to confront health issues among their people.
“There’s not just a problem, there’s an emergency,” said Mary Scully, clinical director of Khmer Health Advocates in West Hartford, Conn. “People are dying because they can’t access care and they can’t access care because of language [differences] and also because many providers don’t understand the trauma with high rates of diabetes, stroke and post-traumatic stress disorder.”
The National Cambodian-American Health Initiative brought together Cambodian communities in Chicago; Lowell, Mass.; Long Beach, Calif.; Portland, Ore., and central Connecticut with health experts via video to discuss increasing health concerns of the estimated 150,000 to 300,000 Cambodians in the U.S. Of those, about 7,000 are in Illinois, the Cambodian Association of Illinois reported. The meeting also was broadcast by Web to 25 sites.
Cambodians and experts present for the meeting began by discussing the trauma Cambodians suffered under the Khmer Rouge regime of the 1970s, during which survivors like Yem told their story and pleaded for help.
One other survivor said, “I’m free right now and depressed, stressed.” Khon Thang of Connecticut, speaking through a translator, added, “Sometimes I want to commit suicide myself … Everyone please help me, I don’t know how to speak English in my life, I don’t want to die,” she said to the camera.
The Khmer Rouge Communist regime, aided by Viet Cong and North Vietnamese troops, took control of Cambodia from 1975 to 1979, during which they initiated the genocide of Cambodian doctors, lawyers, clergy and teachers, among others. In all, experts say about 2.2 million people were killed.
Members of the Khmer Rouge regime are expected to go on trial for their crimes in 2007. The testimony expected at the trial may be a gateway to the truth of what happened to Cambodians, said Theanvy Kuoch, chair of the health initiative. Even so, many worry the trial will reopen wounds of the past.
“On one hand someone might naively think that was 25 years ago, but a trauma like that stays with you lifelong,” said John J. Tuskan of the U.S. Department of Health and Human Services, who was on a panel at Monday’s meeting.
April 17 was chosen as the day of national meeting because it marks the date the Khmer Rouge took over the country, Kuoch said. Both health experts and Cambodian community leaders agreed the meeting was necessary, after the Cambodian-American Health Initiative declared a state of health emergency within the community in November.
“It’s the year 2006, we have the knowledge, we have the technology, there’s no excuse why these people are suffering,” said James Lavelle, a social worker who worked to develop a training program for physicians in Cambodia. “It’s pathetic that both the mental health and physical health in [the U.S.] don’t have a systematic approach to countries that have [experienced] genocide.”
Monday’s discussion focused on how Cambodian refugees and their families suffer from the effects of post-traumatic stress disorder and other health problems. A study published by the Journal of the American Medical Association in August found 62 percent of Cambodians who emigrated to the U.S. before 1993 after living under the Khmer Rouge suffer from post-traumatic stress disorder.
Experts and health commissioners interviewed Monday spoke of Cambodians’ misunderstanding of the relationship between physical and psychological problems and Cambodians’ poor access to care as a result of language and emotional barriers, among other reasons.
“There are large numbers of Cambodians, but also other southeast Asian populations who have diabetes, high blood pressure, heart disease- chronic diseases that were not common in the homeland but are increasingly common here in the United States,” said Jane M. Kelly of the Centers for Disease Control and Prevention. “The combination of a chronic condition and mental health has a much greater impact,” Kelly said.
Many Cambodians are not aware that it is required by federal law that foreign patients have access to a translator, Kelly said. Instead, many use their children as translators, which can be very ineffective.
“Can you imagine the number of things that don’t come out if your child is translating for you?” Kelly asked. “How open are you with your health care provider?”
Cambodians are often silent about their health problems and past, and are therefore reluctant to seek help, experts said.
“There’s nothing extraordinary about it when we talk to each other,” said Prolung Ngin, a survivor of Cambodian genocide and a commissioner at the meeting. “If I were to talk to you, an outsider, it’s too unbelievable.”
Ngin talked not only about the reasons many Cambodians hesitate to share their stories, but also how the stigma of mental illness makes seeking services additionally difficult.
Ngin and her mother are both survivors. When Ngin asks her mother to get help, her mother asks: “What, do you think I’m crazy?” Ngin said she has looked for a culturally sensitive therapist without much success.
Cultural differences such as those outlined by Ngin have made for wider barriers to health care, experts have found.
Based on her work in the Massachusetts Cambodian community in 2004 and 2005, Leakhena Nou, assistant professor of sociology at California State University at Long Beach, said she found that Western health care providers were insensitive, condescending and unavailable to Cambodian patients.
“They reported that oftentimes they had a lost soul, that their soul was floating somewhere, that their job was to find their soul,” without which they could not be better, Nou said. This sentiment was not respected by providers, Nou said.
Experts and commissioners also discussed the need for more accurate and specific data related to Cambodian health, as Cambodians are often classified as part of the larger Asian-American category. They addressed the need for second-generation Cambodians to become involved in their parents’ health issues and learn about their parents’ plight.
Kuoch said she hopes the next two phases of this call to address health care will end in a congressional hearing.
Cambodians and health experts agreed on the resilience of the Cambodian people. “The word survival is not just surviving,” said Khatharya Um, associate professor of Asian-American studies at the University of California, Berkeley. “It takes on a whole different meaning when you put it in the context of this history.”
