~WFMH Collaborating Center~
Harvard Program in Refugee Trauma (HPRT)
On 12 December 1998 fifty primary care physicians graduated from the HPRT Cambodian program in an elegant ceremony held at Angkor Wat in the main building called the Temple of a Thousand Buddhas. The first graduation ceremony, also for fifty doctors, took place a year earlier. Each of the country’s provinces now has four or five primary care physicians capable of practicing psychiatric medicine at the community level. The training initiative has been extensively evaluated by HPRT as well as by independent evaluators from Australia, Derrick Silove, M.D., and Mr. Meng Eng Thai. The outside evaluators’ report contained useful and positive feedback, and described HPRT’s effort as “a jewel of a program.”
HPRT began its work with the Cambodian population almost twenty years ago, when it made the first epidemiological survey to document the magnitude of psychiatric distress and psychosocial disability in a refugee community at the Thai border (May 1990). HPRT’s assessment led to its support of indigenous Cambodian mental health efforts in the refugee camps, and to the training of Cambodian refugees to support other camp residents during repatriation.
After the UN-brokered election in 1993 a private foundation enabled HPRT to establish a psychiatric clinic, known as the Harvard Training Program in Cambodia, in Seam Reap City. With this foundation’s active support HPRT trained a core staff of three Cambodian primary care physicians and six family-child mental health workers. The core staff developed a successful mental health program which attracted the attention of the surrounding community and local politicians and administrators. This in turn led to the program to train 100 of the country’s 1400 primary care physicians in mental health, with the support of a generous grant from a Japanese donor and USAID/Cambodia.
Based on HPRT’s observations and on advice from international NGOs and the Cambodian Ministry of Health, the program emphasized building psychiatric care capacity throughout the country, not just in the major urban center of Phnom Penh. All of the country’s 21 provinces were represented. The program was also designed to avoid creating a structure which duplicated existing activities of the Ministry of Health.
HPRT hopes to continue to work in Cambodia, and to foster the satisfactory connections which developed during the training initiative. Donors, HPRT, the Cambodian Ministry of Health, and local physicians and staff have partnered in the early development of a community-based mental health system for a society where the mental health needs of citizens are extremely high. Drawing from this experience, HPRT has produced a new model for the role of health and mental health services in the development and reconstruction of other traumatized societies.
–James Lavelle, LICSW.