Feature

Starfish and seeing hands

Decades of war and disruption have left rural communities in Cambodia with a legacy of disease and disability. Geof Rayner reports on projects that are helping disabled people to help each other and earn a living

In 1975, five years into a murderous civil war, the Cambodian port of Sihanoukville witnessed fierce fighting between Pol Pot’s Khmer Rouge and American special forces. The Vietnamese arrived four years later, driving the Khmer Rouge to the border areas, but it was another decade before the last few surrendered.

The tourist industry in Cambodia is finally reviving after more than quarter of a century of war and disruption, as people come to see ancient sites such as the temple complex at Angkor Wat. While places like Sihanoukville, with its port and beachside tourist industry, are in recovery the poverty around them is stark. The average income in the town is around $US60 a month, but in rural areas it is half that – a dollar a day. And the decades of war have left a legacy of disease, disability and distress.

Despite the many international NGOs, and the lingering involvement of the UN, malnutrition persists. Last December, UNICEF reported that Cambodia was one of four non-African nations with the highest rates of under-five child mortality. Malnutrition was the principal cause, followed by diarrhoea, acute respiratory infections, dengue fever and malaria. Average life expectancy is 54.4 years.

On top of this, an estimated four to six million landmines and other unexploded (mainly US) ordnance remain scattered across countryside areas. Landmines have claimed 45,000 victims, although mine clearance means the number of new victims is decreasing.

Landmines attract international publicity, but the 1997 Cambodia Socio-Economic Survey showed that the most common causes of disability were illness or disease (30 per cent), congenital (25 per cent), accidental (13 per cent), war or conflict (13 per cent), and landmine explosion (8 per cent).

Given this combination it is not surprising that Cambodia has the highest rate of disability in the world. Surveys have variously estimated the number of people with disabilities to be up to three per cent of the population.

With a GDP estimated at US$238 in 2000, Cambodia does not have the resources to cope. Annual government expenditure on health is around $1 per person; unsurprisingly, health system performance is ranked 174th among member states of the World Health Organisation.

In a country where able-bodied people scramble for work, disabled people lose out badly. The dominant religious belief, Theravada Buddhism, may emphasise justice, equality and non-violence, but it also teaches that disability is the result of bad actions in previous lives, reducing public awareness and understanding.

What can be done? External economic support represents around half of Cambodia’s GNP. Realistically it will be years before the country can become self-sufficient. That means the rehabilitation and support provided by NGOs, often financed by foreign governments, is critical. But while the medical aspects of disability can be addressed, disabled people also need to be able to earn a living.

Two NGOs in Sihanoukville, Seeing Hand Massage and the Starfish Café and Bakery, show different ways this can be done, based on building up disabled people’s skills, self-confidence and self-worth, and creating new community self-help networks.

Seeing Hands massage

Developed from similar schemes elsewhere, the Association for the Blind in Cambodia (ABC) trains blind people in Shiatsu and Anma massage and conversational English in a shop front premises on Sihanoukville’s dusty high street. The project sees about 125 clients a month, mostly foreigners attracted by the town’s beaches. A payment of $3 goes to the masseur, with the charity supporting other costs, including accommodation. After six months of subsidy, the aim is to make the project self-sustaining.

Starfish café and bakery

The idea of the Starfish café and bakery project arose three years ago when two community workers, a Cambodian and an American occupational therapist, wanted to find new ways to help their clients. They found the limitations imposed by large charities blocked progress in addressing families’ needs. For example, one larger charity, the Cambodia Trust, could provide prosthetics and occupational therapy but could not provide funds for an operation.

Then a third person, Deidre O’Leary, a young US ‘dotcom refugee’ provided the financial acumen to establish a business where disabled people could be employed and the profits ploughed back into supporting other disabled or vulnerable people.

The bakery supplies restaurants, hotels, and businesses in Phnom Penh. The flour comes from Australia, because it is not available in Cambodia. There are now eight people on the Starfish payroll, including two field workers. Starfish has helped around 300 to 400 people and raised more than $20,000 in grants.

The problems with which Starfish deals are not principally due to the policies of the bigger charities; it works with religious charities like Maryknoll and the American League of Friends (Quakers). But the war years destroyed trust, weakened social bonds and led to ineffective, often corrupt public services. Bribery supplements the miserly pay of public servants. The result is that an operation in a public hospital requires payment and given the poverty of the state, as well as the people, there is simply no means to get grants to meet the basics of human need, such as housing.

O’Leary explains: ‘We can provide and organise things with other NGOs. What we see as the outcome of the support we offer is clients starting to help each other and the creation of a real network. It is not uncommon to find incapacitated people who have been abandoned but a bit of support – for an operation, to help buy a fishing boat or to thatch a roof – can make a real difference.’

The Cambodian people have shown enormous survival instincts. The practical support that groups such as Starfish or Seeing Hands offer NGOs might seem small. But they apply the principle of sustainability in practice – something richer countries could do well to copy. They help vulnerable and disabled people to develop the skills, confidence, and capacity to generate an income, which, in a very poor country, is the capacity to survive.

The Association for the Blind in Cambodia would like donations of braille books in English. Contact abc@bigpond.com.kh