Delegation to Vietnam and Cambodia
by Norine Johnson, PhD
In November of 2006 I had the opportunity to lead a People to People professional delegation of psychologists to universities and hospital sites in Ho Chi Mien City in Vietnam and Phnom Penh in Cambodia. We were the first official delegation of psychologists to visit these particular university and hospital sites. Founded by President Eisenhower, People to People is mostly known through its high school student exchange program and was established as a way to forge peace in the world through cross-cultural exchanges.
During the course of the delegation, one of my responsibilities as leader was to suggest discussion topics and to invite fellow psychologists with interest and expertise in those areas. The professional program I planned included significant dialog about post-traumatic stress as well as, sexual abuse of women and the impact of psychological issues on health.
In Ho Chi Minh City our professional exchanges included the Vietnam National University and Benh Vien Tam Than, a large public mental hospital. In Cambodia the programs we visited were all located in Phnom Penh. These included the Royal University of Phnom Penh, the Khmer-Soviet Friendship Hospital, and the Cambodian Women’s Crisis Center. The following description of our professional visits is drawn in large part from our delegations’ journal which was compiled by the delegation’s co-leader Cammarie Johnson and edited by Dr. Mary Halas. I asked Cammarie, a specialist in the psychological treatment of autism spectrum children and adolescents, to co-lead the delegation.
Vietnam National University
At Vietnam National University three faculty members, Dr. Nguyen Phuong (who trained in the United States), Dr. Huang Mai Khanh, and Nguyen Thi Thanh Hang informed the delegation of the structure of higher education in Vietnam, the Vietnamese family structure and the education and training of psychologists. We learned that the study of psychology in Vietnam currently culminates in a BS or BA. At the Educational Psychology Department at the Vietnam National University, there are 170 program graduates and 100 students currently enrolled
Present day Vietnamese education is overseen by the Communist Party Central Committee, National Assembly and the Ministry of Education and Training. Although there is currently an increased emphasis on higher education, with increased funding and greater autonomy, access to higher education is still low with 6 to 12% of the population receiving some exposure to higher education. Presentations from our delegation at Vietnam National University included a description of Uri Bronfrenbrenner’s ecological model as a culturally sensitive assessment tool, description of the use of a Participatory Action Research framework as a valuable multicultural approach to activate parents within an educational setting, discussion of PTSD, and discussion of challenges of the 21st Century.
Benh Vien Tam Than Hospital
Dr. Le Quoc Nam, Chief of the Community Psychiatry Department presented us with information about Benh Vien Tam Than, the HCMC mental hospital. Summaries were recorded by Drs. Mary Halas and Ellen Faryna for our journal. This small hospital is the only inpatient mental health facility servicing the 8 million people in Ho Chi Minh City and the staff of 317 health care professionals is responsible for the 16% of the population with mental health disorders -- over one million people.
During our tour we saw the range of issues this dedicated staff faced daily. The physician guiding my section of the delegation informed us the line of people that stretched all the way down a long hall and curved around the pharmacy, was the approximately 400 patients who came weekly for their medications. Most were standing, some were lucky enough to wait on benches, and almost all were accompanied by their families. We learned that a family member frequently stays in the hospital with a patient and that each small cot size bed was shared by three patients. Not all the beds had mattresses
A tour of the pharmacy revealed a small room, similar to a 1950s drugstore with painted white open shelves and a small wooden desk. The shelves were practically empty. The chief psychiatrist shared openly their needs for medication, sufficient staff to service their clients, and for increased personnel and training in psychotherapy which does not currently exist.
When members of our delegation talked later, each one of us expressed tremendous respect for the staff. We have committed to telling their story in the hope of interesting others in helping to provide ongoing ways for the staff to receive the journals, books, consultation and training in current methods of psychotherapy appropriate for their population, medication, and other medical and psychology tools (which research has indicated valuable in helping patients with a range of mental health issues).
Khmer-Soviet Friendship Hospital
At the Khmer-Soviet Friendship Hospital in Phnom Penh, the capital of Cambodia, we again met dedicated staff, committed to servicing the needs of their patients. Cambodia has had the benefit of more interaction with other countries -- several of the staff had been educated abroad and they spoke of the educational support they received from European countries. The staff had a broad understanding of both the needs of their patients and the current methods for treatment. What they lacked were resources As our recorder, Dr. Mary Halas wrote in our journal, the staff expressed these needs explicitly; “We are hungry for knowledge...we do not have Internet access in the hospital; our state run library for the hospital has no books. We want books (in English) on sexual abuse, drug abuse, and domestic violence.... We would like to learn more and more.”
The hospital director reinforced this. After 1979 there were only 50 doctors left in Cambodia and no psychiatrists. In addition, there is still significant stigma attached to mental illness, especially in women. Mental health patients are primarily supported by their families except for victims of domestic violence who do not receive family support. We also learned that Cambodia has a program to train general practitioners in psychiatric disabilities. During this visit members of our delegation had presentations on health psychology.
Cambodian Women’s Crisis Center
Cambodia, not yet recovered from the ravages and inhumanity of the Khmer Rouge, continues to suffer from violence perpetuated today upon some of its women and children both by family members and by sex traders. Statistics vary, but hundreds of kidnapped women and children are returned to Cambodia monthly after being expelled from Thailand and other neighboring countries when disease makes them no longer marketable in the “sex trade industry”. In addition to these victims, untold others are abused regularly within their homes primarily by male relatives.
The Cambodian Women’s Crisis Center was established to provide safety, recovery, and training for abused women and their children. With staff, such as Sin Ly Pao, who was one of the Centers three founders, they treat 1800 clients a year, providing a full range of services beginning with assessment, daily counseling, expressive therapies, and medical assistance (as well as training women in marketable skills). We were privileged to be allowed to visit one of the secure homes for the women and had an opportunity to see the children studying, playing, and seemingly happy with their mothers inside a barbed wired compound in the outskirts of Phnom Penh. The location of the compound is kept secret for the women’s protection. During this visit, our delegation members presented work with holocaust survivors with a focus on counter transference issues.
The Royal University of Phnom Penh Psychology Department
Our final professional exchange was hosted by Ms. Nhong Hema, Head of the Psychology Department at the University of Phnom Penh. In August Ms. Hema will be a guest of the delegation to the APA Conference in San Francisco and we hope that many who are members of the International Psychology Community will join us in welcoming her to the US and hearing her story of psychology in Cambodia. The audience included faculty and students from the Royal University of Phnom Penh along with mental health providers from the community. In addition to the discussion, our delegation presented information on the history of psychology and health psychology.
In addition to our professional exchanges, our group experienced an immersion in the landscape, history and culture of our host countries. Our cultural experiences in Vietnam included a visit to the Vietnam War Museum, a trip down the Megong Delta, shopping, and for the non-psychology guests, while we were engaged in professional meetings, a trip to the country side to see the rubber trees and the startling remmants of the extensive underground tunnels the Viet Cong had dug into the countryside outside of the then Saigon.
In Cambodia, our cultural experiences included visiting cultural settings such as the Angkor Wat ruins, and sites of the terrors of the past including Security Prison 21 in Phnom Penh and the Killing Fields of Choeug Ek outside the city. The horrific murder and displacement of Cambodian citizens during the Khmer Rouge rule defies imagination. The people we met in Cambodia had all suffered enormous, brutal loss of numerous family members. Their strength and forbearance attest to the resiliency engendered by their valuing of family, both immediate and extended and the role of religion in their lives. Although the professionals and students spoke often of how they are resource poor and need the input of our knowledge, we certainly have an equal amount to learn from them.
Members of our delegation have kept in touch since our return as it will take a long time to absorb what we saw and learned in both Vietnam and Cambodia. I am particularly thankful that APA has such a vibrant community interested in International Psychology. Please join us in our gathering in San Francisco and we would like to hear from any of you who have traveled professionally to either HCMC, Vietnam or Cambodia, for we have learned that you make the road by walking it. Ψ
Norine Johnson, PhD, is a former president of the American Psychological Association (APA). Dr. Johnson has authored more than 95 publications and presentations in areas of women, child, and adolescent psychology. She received her doctorate in clinical psychology from Wayne State University and did her postdoctoral work in a two-year program for mental health planners/administrators sponsored by Harvard Medical School.