Wednesday, October 15, 2014

Disability in Cambodia – An Overview

“In Cambodia, a higher percentage of the population lives with a disability than anywhere in the world, due to a perfect storm of tragic events and circumstances.” (Connelly. U.B. 2009)


At Epic Arts in Cambodia, we work with disabled and non-disabled people on an equal level, but the true situation for people with disabilities in Cambodia is very different outside the walls of the arts center. In order for people to get an understanding of the context within which the inclusive arts work at Epic Arts is based, I feel it is important to present an overview of the disability situation in Cambodia.

Due to the effects of war and poverty, the general standard of living for most people in Cambodia is low and for those with disabilities, it is even harder. There is limited awareness of disability in society, religious implications and although there are resources, provisions and government support, this is not equal to the amount of people with disabilities in the country and is still at a developmental stage.

“No other country in the world has a higher percentage of physically disabled people, no other country has a higher percentage of amputees” (Pilger. J. 1993)
The after effects of war and the Khmer Rouge Regime continue to be seen and have made an impact on the health and well being of the population from one generation to the next. The lack of nutrition and the physical affects of the regime on the population continue to be seen in disability statistics today.

“Because the Khmer Rouge period was one of war, starvation, and violence, it is reasonable to expect that it had an impact not only on mortality but also on morbidity” (Walque. D. 2006)

A small child in Cambodia leads her blind father along the beach as he begs

How many people have a disability in Cambodia?

As I started to write this background blog post on disability in Cambodia, I found that even finding basic and accurate facts was a challenge for a number of reasons. Firstly there has never been a national survey of disability in Cambodia, although the most recent census in 2008 did produce some information, but how accurate this is, is difficult to determine.
“The most reliable statistic is that 4.7% of the population has one or more impairment. The 2008 Census shows the total population in Cambodia is 13,388,910 people, thus there are an estimated minimum of 629,279 people with disabilities living in Cambodia…. However, this is likely to be an underestimate as the census did not cover the whole population including people living in institutions.”. (Handicap International France. 2009. p1)
The official percentage of people with disabilities in Cambodia is 4.7% of the population, but many people believe that this is much higher. Firstly, people in institutions were not included in the census and secondly the lack of knowledge of disabilities in Cambodia was echoed in the people collecting data.
It has to be noted that if enumerators for statistic collection are not trained sufficiently on identification as well as other disability researchers, the result cannot be totally reliable. We may expect a much higher total. A national disability survey would give more accurate figures.” (Handicap International France. 2009. p1)


This lack of knowledge about disabilities is something I am very familiar with working here at Epic Arts; in the West people have a good basic knowledge and awareness of disabilities and different conditions such as Downs Syndrome, but here doctors themselves have not been able to diagnose this. One staff member at Epic Arts has a son with Downs Syndrome and he was not diagnosed until he was 2 years old and this was only because he came in to contact with a Western special education teacher. Awareness and knowledge of disabilities is low even in the medical profession in the country as well as in the general public. It is possible that many people with disabilities were not counted in the census, as they were not seen as disabled as it wasn’t immediately obvious or people were unaware of their condition. Overall there is limited knowledge of disabilities in Cambodia, in particular learning difficulties, medical knowledge is poor and this often leads to misdiagnosis or no recognition of a condition at all.
….. health professionals’ early detection of disability was very poor. Few community health workers were found to diagnose conditions accurately, such as Downs Syndrome in children, and provide referrals to appropriate disability services.”  (Walji. F. 2012)

  
The other element to consider with the official statistics is that many families don't always register their children at birth, so many people do not have an official identity that can be counted in a census.


“According to the Cambodia Demographic and Health Survey (CDHS) 2010, just over 62 per cent of children under five are registered in Cambodia. There is gap between the rich and the poor as well with only 48 per cent of the poorest children registered as opposed to 78 per cent of the richest.” (Unicef Cambodia Issue Brief: Birth Registration: For Every Child The Fundamental Right to and Identity)

People with disabilities in Cambodia often sit in the poorest category of the population in the country, so if only 48% of children in this area of the population are registered at birth in Cambodia, the figure for people with disabilities in the country must be much higher than the census predicts. There is also no universal registration system for people with disabilities set up in Cambodia, so trying to determine a countywide figure is near impossible. So what IS the most accurate figure? The World Health Organisation estimates that 10-15% of the population in Cambodia are disabled.


“...others have estimated national disability prevalence at closer to 10-15 per cent” (World Health Organization. 2011)
This might be the closest number to reality that can be officially stated, but my guess is it is much higher.



What are the causes of Disabiltiy in Cambodia?

There are a number of causes of disabilities in Cambodia, all of which reflect the history of the country, the war and the effects of the Khmer Rouge Regime:

  • Health Care
  • Road Safety
  • Poverty
  • Landmines
  • Health and Safety


Health Care

There are many perceived causes of disability in Cambodia, much of them stemming back to the Khmer Rouge Regime where everything was destroyed including hospitals and medical knowledge. The country went back to the stoneage and doctors were killed or ‘re-educated’ along with other intellectuals.

The health care system was entirely destroyed, and it took years to rebuild it because only about ten physicians survived from the 500 who practiced before Pol Pot” (Guillou. A. 2004. p9 and 10)



With the death and disappearance of doctors, the tearing down of hospitals and burning of medications, Cambodia was left with no way to treat its sick. The Khmer Rouge ‘re-educated’ many doctors and replaced them with young children who were seen as pure and able to treat the sick, as they were not ‘contaminated’ by Western ideas.
“After 1977, it was not unusual to see 10 or 12 year-old children with dirty syringes, imitating nurses and injecting dubious substances into terrified patients”. (Guillou. A. 2004. p9 and 10)

When the Khmer Rouge were overthrown and the country began to pull itself out of the trauma of what has happened, it had only 10 trained physicians left in the whole of the country. These physicians had themselves lived through a terrible ordeal and were rebuilding their lives, to then piece the medical system back together with no proper medical facilities and no money to rebuild any of this, was nearly impossible.


“The recent turbulent history of Cambodia has left the legacy of a high number of persons with disabilities of all ages and conditions. Health and social services as well as educational facilities have been destroyed, and there are no financial means or the human resources to cope with the overwhelming needs of disabled persons.” (Japan International Cooperation Agency Planning and Evaluation Department. 2002).

As Cambodia has developed and grown, its doctors have begun to train again, but knowledge is still limited and often money plays a big role in how patients are treated. There have been a number of times whilst I have lived here that I have seen first hand the impact of the country's history on the medical situation in Cambodia. Firstly when I had to assist in in the delivery of a baby of one of our deaf staff members. Things got complicated and an emergency caesarean was needed straight away, but not until I was asked to pay up front for the surgery. Once she woke-up from the surgery, she was told not to eat any meat, as it would get stuck in her stitches and inside where the baby had been and she would have to have another operation (which would incur further costs). On another occasion one of our students was taken to a clinic with stomach and back pains, he was told a bone had broken in his chest and had 'old blood on it' so he needed an operation straight away. After a quick drive to a Western training hospital, he was diagnosed with kidney stones, was treated with medication and two days later was better.
  
“…lack of access to basic health care means that simple infections, illnesses and injuries often result in permanent disability because they go untreated or are mistreated. (Thomas. P. 2005)

This limited medical knowledge and poor access to quality health care has resulted in many of the disabilities that the students I work with have. One student believes that he is deaf because his mother was given pills by a ‘doctor’ when she was pregnant that caused him to be born deaf, consequently when he was born his father left his mother as he was ashamed of his disabled son.
“What is more common is women who give birth to a disabled child, or who themselves become disabled, being abandoned by their husbands.” (Thomas. P. 2005)

Other students often tell the story of how they had earache or an eye infection or ‘got sick’ as a child and then they couldn’t see, hear or walk. Many did not seek medical help due to their rural living or when they did, they were not given the right care or advice, resulting in their disabilities.

Road Safety

Along with poor health care, road accidents account for 7% of all disabilities in the country and 48% of all reported injuries are related to road accidents. (Cambodia National Road Safety Action Plan 2011-2020.) Motorbike accidents cause 77% of all road traffic accidents in Cambodia and result in an average of 4 deaths per day. The roads, and those who drive on them, are a direct cause of disabilities in Cambodia with many people driving motorbikes without helmets on poor roads that are unlit at night.
Motobike accident in Cambodia

“Motorbikes comprise 84% of the vehicle fleet in Cambodia and the majority of road crash fatalities are motorbike riders, 67%. Additionally, 90% of persons with long-term injuries are due to road crashes are motorbike riders.” (Sann. S. 2013)

It was in response to these facts that Epic Art developed the educational performance and workshop ‘Moto Moto’, to highlight the issues of drink driving, speeding and not wearing a helmet.
'Moto Moto' Poster

Poverty

“Disability and poverty are inextricably intertwined. Poverty is a significant cause of disability.” (Thomas. P. 2005)

The poverty in Cambodia has a major impact on disability in the country, from poor sanitary conditions that lead to illness, to the inability to afford medical care, to poor nutrition; all these contribute to a higher prevalence of disabilities in the poorer communities, particularly in rural areas.
Lack of money means that food is limited resulting in vitamin deficiencies, the lack of access to clean water causes illness, which can not be treated due to the cost of medical care and the need to make money pushes people in to unsafe areas of work or areas of land that are home to landmines. It's a vicious cycle of poverty causing disabilities and disabilities causing poverty. Once someone becomes disabled in Cambodia, there is limited support and provision to work and this in turn creates a situation for poverty and for further illness to develop and it continues in this way from generation to generation.

One staff member at Epic Arts is from a rural family who do not own land of their own and live in very basic housing with no electricity or water. As a child she got sick with an ear infection. With no money to be able to pay for transport to visit the doctor and no money to then pay the doctors fee and buy medication and unable to wash in clean water, a simple ear infection resulted in the young girl becoming deaf. Now as a young deaf woman with limited communication, finding work to support herself is difficult and her child now lives in the same situation that she was born in to, with very little money and limited access to food, clean water and health care. Fortunately Epic Arts has been able to provide her with simple business skills training to develop a small creative business that can provide her with an income an enable her to become self sustaining in the future. Maybe in this situation the cycle of poverty and disability can be stopped.

Landmines

“It has been estimated that (in Cambodia) there is a landmine for every 1 of the 7 million people in Cambodia” (Pilger. J. 1993)

A lot has been written on landmines in Cambodia, but here are some of the facts:    

  • Over 64,000 landmine casualties have been recorded in Cambodia since 1979, and with over 25,000 amputees Cambodia has the highest ratio per capita in the world. (www.halotrust.org)
  • For years, Cambodia has ranked among those countries reporting the highest numbers of landmine and ERW casualties worldwide, with 875 casualties reported in 2005 (Landmine Monitor Report. 2006)
  •  In Cambodia, one of the worst affected countries, children account for about half of all landmine casualties. (www.unicef.org)
  • 32% of the landmine survivors reported having no regular income (Lopes Cardozo. B, Blanton. C, Zalewski etc. 2012)


Children play near a landline site in Cambodia

Landmines continue to affect people in Cambodia and result in disabilities for many people in rural Cambodia. It's a very real story that I have come in to contact here at Epic Arts. One member of our staff members, Sok Kret, picked up a landmine when he was a child and did not know what it was, as he took it apart to find out more, it exploded and he lost both his arms. Sok is now a successful administrator and teacher at Epic Arts, but a direct casualty of the use of landmines in Cambodia.

Sok Kret

Most weeks I read of another victim of landmines in Cambodia, mostly in rural areas. People go out in to the rice fields to work and stand on mines, or children pick them up not know what they are. Heavy flooding in rural areas unearths mines each year and they move around only to be stepped on somewhere else. Landmines are an everyday reality here in Cambodia and these have a high impact on the amount of people with disabilities, many of which would have not been a statistic if it were not for the use of landmines.

Here are a few recent articles about Landmines in Cambodia:


http://www.phnompenhpost.com/national/teen-loses-both-legs-pailin-blast


http://www.phnompenhpost.com/national/land-mine-casualties-see-spike



Health and Safety

Another lasting impact from the Khmer Rouge Regime was the destruction of infrastructure including the labour sector. Once this was gone, all knowledge of how to manage a stable and safe labour force was lost too.

“During the terror regime, infrastructure in all sectors, including the labour sector was destroyed. People were deprived of their basic rights and freedom and were forced into overworking, starving and inhumane safety and health conditions” (Department of Occupational Health and Safety Ministry of Labour and Vocational Training. 2011)

An electrician repairs a wire in Cambodia

Without strict health and safety guidelines for companies to adhere to here in Cambodia, work related injuries resulting in disabilities are also a large contributing factor to the many causes of disability in the country. It wasn't until 2009 that an ‘Occupational and Health Master Plan’ was created by the Cambodian government which highlighted a need for health and safely rules in workplaces and the need for the education of the general public of safety at work issues.

“The Cambodian labour force in general is characterized by low levels of education and skills. Of the total labour force in Cambodia, only 23 percent have any schooling above primary school, and around 29 percent have no schooling at all. As a result, much of the labour force is low paid, labours in poor working conditions, including environments with many occupational safety and health (OSH) challenges.” (Pandita. S. 2012).

Builders work on a site in Kampot, Cambodia

One student at Epic Arts has experienced disability as a direct result of this lack of awareness of health and safety at work. After leaving school to earn money for his family, the boy went to work on a building site aged 16. With no safety policy implemented, conditions were unsafe and within a year he had lost both legs from stepping on a live electricity cable on the work site. By age 18 both his legs had been amputated and he could no longer walk. He was confined to his house with no hope of ever working again, his friends saying he might as well kill himself as he would have no life now. Now he is a student on the Inclusive Arts Course at Epic Arts and has a promising career ahead of him as a performer and workshop leader, but for many people the story is very different.


“In a 2008 survey of the construction sector in Cambodia, the majority of workers (72.3 percent) stated that their workplace did not have any kind of safety committee” (Pandita. S. 2012).

Eventually the Cambodian ‘Occupational Health and Safety Plan’ will begin to move in to the work place at all levels. With the realisation of more international building projects in the country. it is also hoped that international health and safely standards will improve in the country to prevent more work related disabilities from occurring.

UK Electrical safety poster


Access for people with Disabilities in Cambodia

Access for people with disabilities is poor in Cambodia, many buildings are built on stilts in rural villages meaning that many people with physical disabilities cannot access buildings to work or learn. This has a huge impact on the education of people with disabilities in Cambodia and following this their ability to access a University or a work place once they have finished schools is affected.

“Cambodia’s physical environment contains many obstacles for persons with disabilities. The majority of public building entrances and exits are inaccessible to persons with disabilities. Similar problems are seen in hospitals, schools, and institutions with multiple levels as they typically have several flights of stairs.” (Japan International Cooperation Agency Planning and Evaluation Department 2002).

Even though Cambodia is a country under construction with many new buildings rising in the cities on a daily basis, disability access is still not a main consideration. Many of the staff and students at Epic Arts have stories of not being able to access school because they could not physically get in to the building and of not being able to accept a job as it was on the top floor of an office block with no lift. Many of the people involved with Epic Arts were only able to access schooling and University through sheer determination to do it. One member of staff tells the story of working all day in a factory and then climbing 10 flights of stairs each night to go to her University class.…she had polio as a child and uses a crutch to walk.

The location of most houses in rural Cambodia are down dirt tracks. This is the same of Epic Arts Centre, the center itself is fully accessible, but the village it is based in is not and the road to the center is extremely difficult for a wheelchair or crutch users, but this seems to be the norm in Cambodia.

“While these roads were passable all year round…many were narrow dirt tracks which in the rainy season were quickly transformed into slippery and sticky mud paths, difficult even for motorbikes, let alone wheelchairs, to navigate. Furthermore, amputees found walking on muddy paths with prosthetics difficult, preferring to walk with a crutch.” (Gartrell. A. 2010)
Stilt house in Cambodia

Cambodia is certainly not disability friendly in its infrastructure. Moving around in villages is difficult for those with a physical impairment and those who are blind must relay solely on others for help to leave the house. Transport outside of villages for those with disabilities is often seen as impossible. Cambodia does not have a national transport system, so the idea of people with disabilities traveling in the country is inconceivable to most people.  Cambodia is very unlike the Western world where there are provisions for disability access to buildings and transport systems, the very idea of this is a complete surprise to staff and students at Epic Arts and gasps of amazement can he heard when we show them the facilities available in the UK for those with disabilities.



Disability access for travel in the UK


Attitudes to Disability in Cambodia

The Khmer Rouge also made an impact on people’s attitudes to people with disabilities. Within the regime those who were elderly or disabled were useless, they could not work, they could not add to the country in any way, they had nothing to offer in terms of labor and were therefore unnecessary.
“In this totalitarian system, the sick person,….. was not well thought of. First of all, because the uselessness of the individual is a characteristic belief of totalitarian regimes. And also because the supreme ideal, according to revolutionary sloganizing, is to die of exhaustion at one’s workplace.” (Guillou. A. 2004)

A man with a disability sleeps on the streets of Phnom Penh

Unfortunatley this attitude is a hangover from the past fuelled by present day limited education about disability for the nation and limited interacted with people with disabilities in schools, Universities and the workplace. Social stigma is attached to those with disabilities that affects not just them but their families too. Families are often disgraced if they have a child with a disability and are  isolated from the community; many parents do not even recognise that their children can be active members of society.
“Some parents do not even think to send a disabled child to school and instead keep their children hidden at home. Parents believe their children are unable to remember what they learn; investing in their education is seen as a waste. Informants with disability since childhood describe their struggle to attend school, crawling along the road, being carried by siblings or convincing parents to take them.” (Guillou. A. 2004)

A boy begs on the streets with his disabled sister in Cambodia

With little information or awareness of disabilities, many people in Cambodia see those with disabilities as unable to learn or perform basic tasks. Recently a staff member from Epic Arts attended a conference in Phnom Pehn, as she entered in her wheelchair, she was first greeted with stares of disbelief that she had even been able to travel to the city and when she was given the registration form to complete, it was quickly taken away from her and filled in by a staff member as they thought she would be unable to do it herself.
“Disabled people are often believed by others to have impaired brain and nervous function, to be emotionally erratic and unaware of the social norms of behavior. They are seen as lesser people – the embodiment of poor character.” (Guillou. A. 2004)

It is a sad fact in Cambodia that many people do not even know what disabilities are; even those with a disability don't always know that they have one, or that there are others like them in the country and around the world. With a lack of knowledge fuelling fear in many people, terrible treatment of those with disabilities often occurs.
“Severely disabled children, although given basic care, are often hidden away, given less food and are sometimes encountered by fieldworkers living without clothes, unwashed and even tied up.”
(Thomas. P. 2005)

A teenager with a mental health problem is chained to a tree in a village in Cambodia

The video below is probably one of the most shocking I have come across in my research in to disability in Cambodia. This little girl with Downs Syndrome is locked in a cage each day as her parents go out to work. They have no understanding of her condition, they have no other option and it is the only way they have found to live with a child with Downs Syndrome.
(‘Down in Cambodia” - https://www.youtube.com/watch?v=r3on2x2f_UE)
Without knowledge and awareness, superstition is rift and parents who have a child with a disability are often told it is because of something they have done before the child was born, from eating meat during pregnancy, to leaving the house when pregnant, doing something bad in a past life, to naming their child before they are born. Children with disabilities often become a huge financial and time consuming burden on their families and are often the source of discrimination against the family from other community members.
“Family members and the wider community routinely call disabled children names related to their disability rather than the names given to them by their parents. Anecdotal evidence suggests that some children who are born with severe disabilities are never even given a proper name, and are referred to only by their disability name.”(Thomas. P. 2005)

A child with a disability learns to draw in Cambodia

I have seen this first hand at Epic Arts with one of the students from the Special Education Project who has Down Syndrome. With no understanding of his condition, his parents thought he looked strange and unusual when he was born and likened him to a lizard as that was the only why they could explain him. The name stuck and he became named lizard in Khmer because his parents thought that was what he looked like - he has never been given a real name.
“When answering the question, ‘What is disability?’, Khmers responded with a list of impairments (such as blindness, deafness, and loss of limbs), while others gave answers closer to the social model of disability, listing disabled people as ‘those who could not work in the fields or get married’ (Disability Action Council (DAC) 2001)

A student with Downs Syndrome at Epic Arts Cafe in Cambodia

I think that this idea that people with disabilities in Cambodia cannot do anything is very obvious here and it is something we are constantly faced with at Epic Arts. Khmer people see those with disabilities as people who just cannot; they cannot work, they cannot learn, they cannot love or marry, they cannot have a family. The work that Epic Arts tries to do aims to combat this attitude by showing that people with disabilities can do many things and can do it to the same level as those without disabilities.
“…..public awareness and mass education campaigns on the inclusion of people with disabilities in the country’s mainstream are almost non-existent. The lack of such awareness means that numerous superstitions and misinformation regarding disability linger in Cambodia.” (Connelly. U.B. 2009)

Fortunately there are many stories of families going against the grain and of unconditional love winning out over the opinions of society. This along with disability awareness programmes and the introduction of education in schools on this subject, means that the tide of negative attitudes toward those with disabilities in Cambodia is slowly turning. As much as there needs to be help and support for people with disabilities in Cambodia; it is just as important to focus on the education of parents, communities and even medical professionals to improve life for people with disabilities throughout the country.
Work in Cambodia
This year, the Cambodian Prime Minister Hun Sen unveiled a five-year National Disability Strategic Plan, which contained positive plans for people with disabilities in Cambodia. The government is recognizing the importance of people with disabilities and is beginning to make legislation for them. The importance of the arts for people with disabilities is also mentioned in the policy;
“Persons with disabilities participate in quality social activities and social venues including art, sport, culture and customs… “ (National Disability Strategy. Disability Action Council (DAC) 2014)


Prime Minister Hun Sen speaks at the launch of the National Disability Strategy

The National Disability Strategy is a big step forward for people with disabilities in the country, but it is likely to take many years to implement. The strategy sets out a number of positive aims for people with disabilities, one of which aims to have 2% of the government workforce to be made up of people with disabilities which has been set to move in to line with the governments perceived 2.6% of the population who live with a disability in Cambodia.
Hun Sen did point out that the Ministry of Education would be exempt from this target as teaching is believed to be too difficult for those with a disability.
“Among 190,000 civil servants, there are more than 110,000 teachers,” Mr. Hun Sen said, noting that many disabled people cannot stand for long periods of time, and therefore are not fit to teach. “So if [we] put two percent into the Ministry of Education, it could kill the Ministry of Education. This is a problem we must think about. (Robertson. H and Khy. S. 2014)
Audience at the launch of the National Disability Strategy

One of our staff members at Epic Arts has applied to be a teacher with the Ministry of Education a number of times without success. He has a physical impairment that affects his arms; he can stand, can write on the board and can use a computer with as much proficiency as anyone without a disability in the organisation and yet it is against the law for him to be a teacher. The criteria set out by the Ministry of Education for the recruitment of teachers in Cambodia clearly states that,


Recruitment must be made among candidates of either sex, of Cambodian nationality, who have clear bio data, good health and are free of disabilities and who are not serving the public sector yet.” (Ministry of Education, Youth and Sport (MOEYS) 2012)
The National Disability Strategy

Overall, work for people with disabilities in Cambodia is difficult to obtain, many are not able to access buildings and many training programmes focus on vocational training for what is called ‘small work’ in Cambodia.


“Employment that is highly valued, referred to as ‘big work’, is appropriate for people with economic resources and social networks. ‘Small work’, on the other hand, is undesirable and performed by those who cannot access ‘big work’. (Gartrell. A. 2010)
‘Small work’, doing simple work tasks, seems to be the area in which disabled people are ‘allowed’ to work, with ‘big work’ being the realm of people without disabilities. Often those with disabilities are told that they can only do small work and that is the work they are given or trained in without the option to work in other areas.
“Women, children, elders and disabled people typically perform ‘small work’. It requires minimal physical strength and skills and is home- or at least village-based, enabling women in particular to combine such work with their domestic and childcare responsibilities. ‘Small work’ is physically and socio-culturally suitable for elders and for disabled people because it places minimal demands on mobility and strength. “(Gartrell. A. 2010)
As a lot of work in rural Cambodia is agriculture, people with disabilities are often unable to participate, leaving them without employment or with meager pay from ‘small work’ jobs. Add in to the access issues previously discussed and there are often limits placed on how and where people with disabilities can find training to improve their employment prospects.
 
Cambodian woman with a disability sifts rice at home
“A major factor restricting the full participation and equality of opportunities of persons with disabilities is the prevalence of perceptions and practices that prevent them from functioning as full members of society.” (Japan International Cooperation Agency Planning and Evaluation Department 2002).

The thing that affects people with disabilities the most in Cambodia is other people’s perceptions of those with disabilities and their ability to work. Society perceives people with disabilities as incapable of working and therefore the opportunities are often not provided to enable training and professional development. Many people with disabilities are excluded from work, because they fit in to the ‘disabled’ category, regardless of whether they are capable of doing the job or not.

Religion and Disability in Cambodia
The Khmer understanding of, and attitudes towards, disability are in many ways shaped by the national religion – Buddhism, a religion that centers on reincarnation. In Buddhist belief, disability is the result of bad actions that the person has committed in a previous life. This belief is often given by Cambodian people with disabilities and international staff working in the disability sector as a significant cause of the discrimination faced by disabled people in Cambodia.
Monks at a temple in Cambodia

“More than 85% of Cambodians practice Buddhism. People believe in "Karma: Committing good, receives good. Committing bad, receives bad". In Buddhist theory or teachings, disability is the outcome of a bad deed that a person committed in his/her previous life. (Japan International Cooperation Agency Planning and Evaluation Department 2002).

At Epic Arts, staff and students with disabilities often share stories of personal experiences at pagodas (temples) or when meeting monks. They are often told that their disability is the result of something bad that they did in a previous life. Many parents of children with disabilities at Epic Arts also have the same stories to tell. With lack of medical knowledge and general disability awareness in the country many people turn to religion and superstition to provide answers for why people are born disabled or become disabled in later life. A curse, or bad karma is the traditional way of offering a solution and hope is given by encouraging the person with a disability to gain ‘good karma’ throughout this life to ensure they are not ‘cursed’ by disability in their next life.


Buddha statue at a temple in Cambodia


“As a predominantly Buddhist country, many Cambodians believe that the cause of disability is a person’s previous actions, and it is assumed that only past sins could lead to a current state of disability. This belief reduces the amount of sympathy and tolerance shown to people with disabilities. Another traditional belief attributes mental disabilities to angry spirits and ancestors, and herbal remedies or ceremonies to honour such spirits are believed necessary to cure this state, rather than medical treatment.” (Connelly. U.B.2009)

The belief that disability is a result of bad karma or angry spirits often calls for many different ceremonies to ‘cure’ the person with a disability or to rid the family of a curse and with Buddhism being the official religion of Cambodia with an estimated 96.9% (www.cia.gov) of the population practising Buddhists, its easy to see how tradition and religion play a large role in the perceptions of people with disabilities in Cambodia. Although a country’s ‘official’ religion does not mean that all people believe the same in the country, the overall message that disability is bad karma or bad luck does seem to have seeped in to the very fabric of the country, even for those who are not officially Buddhist.

Help and support for people with Disabilities in Cambodia

Although this post may have an overall negative tone regarding the situation for people with disabilities in Cambodia, which I think is a fair overview and an important comparison to standards in the Western world, its not all ‘doom and gloom’.  Cambodia is a country that is developing at high speed, the attitudes to disability are changing and there are signs of small steps being taken appearing around the country each day.

Disability access and parking at ACLEDA bank in Kampot Cambodia

“Cambodia considers disability rights a priority, and there are both short- and long-term goals in place. The country has made progress towards addressing disability rights. Most recently, the country signed the Convention, a public statement to the international community that Cambodia values disability rights.” (Connelly. U.B. 2009)


There are a number of government initiatives springing up and many NGOs (Non-government Organisations) providing education, awareness, support and health care for people throughout Cambodia related to disability. Here are some examples of provisions and organisations in Cambodia:



Disability Action Council (DAC) – www.dac.org.kh/en/

Disability Action Council is the national coordination and advisory mechanism on disability issues which was established in 2009



Cambodian Disabled People Organisation (CDPO)  - www.cdpo.org

CDPO was established in 1994 as a movement of Cambodian people with disabilities. CDPO is a membership-based, non-governmental organization, representing people with disability in Cambodia and workings towards becoming “the voice of People with Disabilities in Cambodia”




Handicap International (HI)  - www.handicap-international.org.uk/where_we_work/asia/cambodia

Handicap International’s goal in Cambodia is to support a better future for people with disabilities and to take action to prevent the causes of disability.




Rehab Craft Cambodia is a fair trade NGO run by and for Cambodians with disabilities that provides support and creates job opportunities by producing quality handicrafts and marketing our products along with products from rural artisans.



The Deaf Development Programme (DDP) – www.ddp-cambodia.org
DDP works to remove the barriers preventing deaf people in Cambodia from achieving equality by providing Cambodian Sign Language research and development, education and job training courses, community development activities, Cambodian Sign Language interpreting services and social services.



GIZ Cambodia – www.giz-cambodia.com
Cambodia has one of the highest rates of disability in the world. GIZ is working with the Cambodian government and local NGOs to promote inclusion of persons with disabilities in the health service.



UNICEF – www.unicef.org/cambodia
UNICEF aims to build a protective environment for children by strengthening systems to safeguard them from violence, abuse, exploitation and neglect, including children with disabilities and those affected by HIV and AIDS



Yodifee - www.yodifee.org
Yodifee assists and supports young Cambodians with physical disabilities to gain access to education at secondary school level and if appropriate tertiary level or access skills training leading to an income earning capacity to ensure self sufficiency



Epic Arts is an international, inclusive arts organisation based in Cambodia and registered as a charity in the UK. It uses the arts as a form of expression and empowerment to bring people with and without disabilities together. It aims to promote the message that every person counts through our inclusive education, community and social enterprise programmes.

Thank you for taking the time to read this blog, please feel free to add comments or to email me at laura@epicarts.org.uk



References

Connelly. U.B. (2009). Disability Rights in Cambodia: Using the Convention on the Rights of People with Disabilities to expose human rights violations. Pacific Rim Law and Policy Journal. Vol. 18 No 1. January 2009. Connelly. U.B. (2009).

Department of Occupational Health and Safety Ministry of Labour and Vocational Training. (2011) The Overview of Occupational Safety and Health in Cambodia. Cambodia.
Disability Action Council (DAC) 2014. National Strategic Disability Plan 2014-2018. Cambodia

Disability Action Council (DAC), 2001 Attitudes Towards Disability: A small-scale survey of Khmer teachers and ethnic people in Ratanakiri Province. DAC, Phnom Penh

Down in Cambodia - www.youtube.com/watch?v=r3on2x2f_UE (Accessed 15.10.14)
Gartrell. A. (2010) ‘A frog in a well’: the exclusion of disabled people from work in Cambodia. Disability & Society, 25:3, 289-301
Guillou. A. (2004)  Medicine in Cambodia during the Pol Pot Regime (1975-1979): Foreign and Cambodian Influences. ""East Asian Medicine under Communism: A Symposium", Graduate Centre, City University of New York, New York: United States.
Handicap International France. (2009) Briefing Paper: Disability facts in Cambodia.  2009, Handicap International France
Japan International Cooperation Agency Planning and Evaluation Department . (2002). World Bank Country Profile on Disability. Kingdom of Cambodia).

Landmine Monitor Report, 2006. http://www.the-monitor.org/ index.php/publications/display?url1⁄4lm/2006/es/survivor.html (Accessed 13.10.2014)

Lopes Cardozo. B , Blanton. C, Zalewski. T  Tor. S , McDonald L,  Lavelle. J , Brooks. R , Anderson. M.  & Mollica . R (2012) Mental health survey among landmine survivors in Siem Reap province, Cambodia, Medicine, Conflict and Survival. Cambodia
Ministry of Education, Youth and Sport (MOEYS) in the Council of Ministers’ Decisions No. 1356/1995, 223/1997, 872/1997, 835/1998 and 39/1999. Taken from Pöyhönen. P. (2002). Training and Employment of People with Disabilities: Cambodia 2002. Ability Asia Country Study Series. International Labor Office.
Pandita. S. (2012). Invisible Victims of Development. Workers Health and Safety Status in Asia Report. Asia Monitor Resource Centre.

Pen. B. (2011). Cambodia National Road Safety Action Plan 2011-2020. National Targets and Performance Indicators. Cambodia.
Pilger. J. (1993) Cambodia - Return to Year Zero (1993).
Robertson. H and Khy. S. (2014). Disability Initiatives Launched as Jobs Quota Not Met. Cambodia Daily. July 2014

Sann. S. (2013). Road crashes and long term disabilities: Implications for policy and its implementation in Cambodia. Public Health and Social Work, Queensland University of Technology. Queensland, Australia.

Thomas. P. (2005) Poverty reduction and development in Cambodia: Enabling disabled people to play a role. Disability Knowledge and Research

UNICEF Cambodia Issue Brief: Birth Registration: For Every Child The Fundamental Right to and Identity. Available from www.unicef.org/cambodia/9-_Issue_Briefs_Birth_Registration.pdf ((Accessed 13.10.2014)

Walji. F. (2012). Barriers to and Facilitators of Health Services for People with Disabilities in Cambodia. Working Paper Series. Number 20. http://ni.unimelb.edu.au/__data/assets/pdf_file/0007/623437/WP_20_web.pdf

Walque (2006) The socio-demographic legacy of the Khmer Rouge period in Cambodia, Population Studies: A Journal of Demography, 60:2, 223-231. 2006

World Health Organization (WHO). (2011). World Report on Disability. Geneva: WHO. Available from 





www.cdpo.org (Accessed 15.10.14)


www.cia.gov (Accessed 15.10.14)

www.dac.org.kh/en/ (Accessed 15.10.14)

www.ddp-cambodia.org (Accessed 15.10.14)

www.epicarts.org.uk/cambodia (Accessed 15.10.14)

www.giz-cambodia.com (Accessed 15.10.14)





www.rehabcraftcambodia.org (Accessed 15.10.14)


www.unicef.org/cambodia (Accessed 15.10.14)

www.yodifee.org (Accessed 15.10.14)