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Home arrow Language & Literature arrow The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health
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Challenges for TPO

Some of the issues TPO Cambodia faces have parallels to those of organizations in the Western world: identifying staff with needed competencies, knowledge and personal qualities, for example, leadership, creativity, and ability to work as part of a productive team who adhere to the organization’s values; managing staff in remote teams; and accessing financial resources; to name but a few. The most significant difference is the context within which TPO works, which is very dissimilar, for example, the impact of the Khmer Rouge period on human capital and critical thinking (Nee and McCallum 2009), and the current lack of a developed mental health care system as in the West (Agger 2015). In this part of this chapter, I will focus on two areas where East and West meet: (1) funding and (2) working directly with non- Cambodian ‘experts’.

Funding/Donors

Poor mental health can cripple communities. Communities living in poverty and/or adjusting to experiences of war and trauma have a heightened vulnerability to poor mental health. Both of these factors are present in Cambodia. With no funding from the government for psychosocial work, NGOs approach donors for finance. Typically, donors are from outside Cambodia, and therefore accessing funds requires NGOs to shape programmes to meet the donors’ priorities, which may be reflective of development priorities defined within the country of origin rather than Cambodia. This has led to a shift in TPO’s programmes away from community development towards addressing gender-based violence and access to justice for women. The Khmer Rouge tribunal and work on truth-telling reconciliation, as part of the nonjudicial measures for people involved in this, are trends TPO has responded to. Mental health remains as the core activity of the programme, but how this is framed has been altered in response to priorities defined outside of TPO and, often, Cambodia.

A common request from donors is that the project they are supporting needs to be sustainable. This seems like a reasonable aspiration, but it is important to explore what exactly is meant by this? What exactly is ‘sustainable’ within the current Cambodian context? Income from the provision of mental health services is limited. People cannot afford to pay and there is no internally funded system that could provide sustainable funding for them. In discussions with Dr Chhim, he highlighted his sense that funding mental health has never been a priority for donors. This has made it challenging to access finance to support mental health work. He is also aware that there is fickleness within the field of international donors, with the focus typically shifting to countries that have had more recent traumas and/or disasters. The Khmer Rouge period is receding in the minds of the international community, but its legacy in Cambodia is very present; this presents a worrying future for accessing funding for mental health NGOs.

Reviewing TPO’s website in 2015 and previous organizational reports, it is notable that, despite being Cambodian-led and their awareness of Cambodian idioms of distress, predominantly Westernized terms are used in their descriptions of their work. I discussed this with Dr Chhim and asked about his work on Baksbat. His reaction was, ‘I dare not take the challenge to the world who support PTSD.’ His hope is to gradually introduce it into their research projects. ‘Then I will try to see how (they) react and use the term before introducing it into clinical work.’ He has no desire to challenge the concept of PTSD and sees its benefit clinically, but he is keen that Khmer concepts such as Baksbat are integrated into clinical work and that the Western concepts complement, rather than dominate.

The argument here is not who is right and who is wrong but about how best to treat, how best to heal, what it is that the person is seeking help for. An opportunity for healing is lost if the less dominant voices are silenced. Despite a growing number of academics and clinicians highlighting this (Agger 2015; Hinton et al. 2013; Van de Put and Eisenbruch 2002; White et al. 2014), it seems within mental health the voices of the Western funders are so strong they are drowning out Cambodian voices, even within Cambodia.

 
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