(c) M.J.Trapman '95
(This Project was implemented in Cambodia in the period '98-'99, and has resulted in a Cambodian project named "Cambokids" This project now has its own web-site. In the coming years(2000-2004) this project will be evaluated. The proposal on this page is the document from '95. More information at the home pages .)
Aims : To create a model for the development of games
and activities that allow children to heal
themselves from the mental injuries they suffer
as a consequence of the civil war.
To develop these activities as a core for a
communal process, inducing care and
responsibility between generations.
Area : Phnom Penh, Cambodia
Target In a neighbourhood of about 30.000 inhabitants:
Population : 300-500 children directly traumatised and /or in
other ways affected by the ongoing civil war.
9.000- 14.000 children that endure the
consequences of the Pol-Pot period as
the parents and social environment of these
Strategy : To train Cambodian Young Adults in the
development of specialised, healing, games and
activities for children and for the adults that
care for them.
To train a core group in management skills for a
Cambodian NGO that can implement these
To develop a manual for the implementation of a
training program for these techniques.
Duration : 2 year initiating phase, 1 year growing to
Budget : US$ 226.600
1 expatriate Project Initiator.
BACK TO HOMEPAGE
As in a growing number of countries nowadays, children in Cambodia grow up in a semi-permanent state of civil war and armed conflict. In two ways this is a threat to them, and through them to the future of Cambodia:
First there is the obvious direct threat, caused by the on-going hostilities, by the millions of land-mines that are hidden in the fields, by the economic and ecological disasters resulting of armed conflict. Insofar as the children do not die 4) as a result of these circumstances, many of them loose their families and get adrift through Cambodia, usually in the direction of Phnom-Penh, were they hope to earn a living. Many of them end up begging, scavenging, stealing, being forced into child labour, or abducted into prostitution 5) .
Second there is an indirect threat, caused by the fact that the generation that should be parenting them has lost all necessary skills during the Pol-Pot period, in which family ties were broken down 6) , children and parents separated, the educational system destructed and teachers and other skilled people were systematically killed7) .
The result is that a heavily traumatised generation (now in the age of 15-30) is not only transferring their trauma to the new generation, but also raising this new generation almost without structure or direction8) .
Children form an important category in the war affected population. Their experiences are aggravated by their lack of control and understanding. On the other hand though, they are in a natural phase of growing-up that permits them to adjust and to heal organically if only they are given the opportunity to deal with their experiences and emotions.
The mental health problems that threaten them if this adjustment does not take place will not only affect their own lifes negatively, but also will influence their capability as a generation to cope with feelings of hate and revenge, thus easily forming the base for a new episode in an endless chain of war.
Most of these children, being healthy self-healing beings, would not need professional psychological treatment, if they were enabled to deal with their stresses by providing them with a social therapeutic environment, based on some less evident, although simple, insights as shortly set up in the chapter on the Conceptual Framework .
The base for such an environment can well be created by a nucleus of basically trained grassroots workers involved in restructuring the social life of the war-affected community 9) . Such activities, primarily centred on the children, will consequently have a radiating positive effect on the community as a whole.
The Cambodian Institute for Human Rights and the Khmer Buddhist Society, as well as representatives from the Ministry of Social Affairs, Labour and Veteran affairs and the Faculty of Psychology of the University of Phnom Penh acknowledge a great necessity for such a kind of grassroots-organisation in the Cambodian situation. They feel confident that there is considerable potential among the Cambodian young adults, although at the same time they are very aware that these young people are themselves heavily affected by the Pol Pot period10) .
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This WHO Project proposes to train young adults, detected in co-operation with the above-mentioned organisations, in techniques to design and apply healing games and activities for children and to support them with their development into a well-organised NGO that can multiply itself to work in different places and circumstances in Cambodia, and, once established, can act as a partner for International Agencies that fight the consequences of war.
The goals of the project are:
To create a Cambodian model for the development of games and activities that allow children to heal themselves from the mental injuries they suffer as a consequence of the civil war.
To develop these activities as a core for a communal process inducing care and responsibility between generations.
The project will be organised on neighbourhood-level, starting in Phnom-Penh11) .
An area (neighbourhood) will be selected in which 20-30.000 people live12) (about 9.000 - 14.000 children under 16 years old) and in which one or more projects provide basic care for street-children or unaccompanied children 13) .
After an initial training period, a core staff of about 10 people will be formed that will be responsible for the continuity and the development of the project and its activities, while at any time 20 - 30 people can be involved (part time or full time) for short periods of 1 - 2 months in practical work in the activities with the children. These part-time workers can either use the project to get a basic formation in the care for children, after which they return to their studies, their work and families, or they can get involved in the work of the core-group. Members of the core staff will eventually be able to develop new projects in other neighbourhoods and outside Phnom-Penh 14) . A positive spin-off may be that some of them will continue activities independently on a permanent (commercial) basis because these have proven to comply with existing demand. Within the chosen area, the project will carefully build up its activities in such a way that the reach of the project moves out in steps that reveal the structure of the neighbourhood and the natural boundaries of the reach that the project can have from one location.
The activities will be directed to all the children and not just to those as identified as psychologically and behaviourally disturbed. Through the children, the total population of the target area can be reached15) .
It is the intention of the project that parents, grand-parents and other adults will gradually get involved, on a voluntary base, in the activities for children. This can be in a passive way (as spectators), and in an active way, as participants or getting involved in the co-ordination of activities16) .
At the end of the period of two years, the work on the chosen location should be finished. All children should have been reached and have had enough opportunity for development within activities. The organising young adults should have formed a dependable NGO that is ready to open at least two new locations for work, one of which should preferably be outside Phnom Penh. Funding for this work should have been applied for and granted. They should be able to train new activity-leaders without external support.
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Cambodian Children generally are not traumatised like children in the refugee-camps of Croatia or children involved in recent African conflicts17) . Cambodia is a society in reconstruction, and it has been so for a considerable period, although there are still military conflicts going on 18) The centres that provide shelter for wandering children in Phnom-Penh have regular experience with individual incoming children, sometimes too traumatised for them to handle19) .
Orphanages can only cope with a small part of the unaccompanied children. They feed, clothe and send the children to schools, but can do little else to help the children develop, since orphanage staffs are not trained enough to deal with the special needs of these children20) . Children that do attend school have classes only 3 hours a day, conducted by teachers with, on the average, only five years of education themselves 21) .
The main problem in Cambodia is a traumatised collective that is damaged in its capacity to provide its children affection, space for individual development, direction, and a base for responsibility22) . Cambodians live in an atomised society, with a damaged social infrastructure 23) . Therefore, the fighting of and healing from the consequences of war must become a collective process.
There are many reasons for which the central task at hand is a task for (all) young Cambodian adults. No outside organisation, even with highly trained personnel, can be large enough to handle this problem, in this community the basic force for regeneration will have to be found by the generation of newly responsibles: those who were not primarily involved with the causes of the events that lead to the Pol-Pot period. For these young people also, the lack of perspective in the current society is the most dramatic, since they are currently defining their place in that society, since that society is depending upon them to regain its perspective.
They are the generation that is parenting right now or will soon start to do so, and although, as said earlier, most of them have experienced hardly any parenting themselves, they are living in the same culture as the children, familiar with their language and all other elements that are implicit in Cambodian (Khmer, Chinese, or other) culture24) . It is the prerogative of this generation of Cambodians to take the future of their society in their hands, and the older generations are impatient for them to do so, rather than to have to accept this necessary work from the numerous international agencies that support Cambodia at the moment (WHO included).
Participation in this project proposes a possibility for young adults to take a new, constructive position in the ongoing conflict, a third alternative between negation of - and getting involved in the actual hostilities25) .
Also, the development of social-therapeutic activities for children will permit them (even necessitate them) to gain insight in their own needs, and the organisation they form will naturally serve as an environment that provides them with the support they have lacked themselves. Finally, this project aims to offer them the possibility of acquiring a wide variety of theoretical, managemental and technical skills, as well as many (inter)national contacts that will be of great use to them in their later careers.
There are complications to be expected when involving young Cambodian adults in a project like this, since they themselves are a generation that is heavily affected by its experiences during the Pol Pot period. This means that many memories of terrible occurrences are hidden beneath the surface of their daily routines, in which they seem to cope with the difficult circumstances in the present Cambodia.
To be able to cope with the problems of the children, they will therefore necessarily have to handle their own past and the resulting emotions. The project will have to accommodate this task by explicitly providing an internal support-structure, and to install itself within a wider network of mental health care that is currently being developed in Cambodia26) . Within this wider network, the project will concretely be developed in close connection with the IPSER-programme, already in operation in Cambodia 27) .
A consequence of the position of the Cambodian Young Adults is that all the activities within the project they organise will have to be effective not only for the children, but also for themselves, since they cannot be expected to support a healing process in children without having experienced that same process within themselves.
1. In the chosen area a basic training for potential activity leaders and staff-members will be started. This training will be in seminars and in activities related to those that can be done with children. As soon as possible, these activities will be opened for the participation of children. Initial activities will concentrate on different forms of mapping the neighbourhood28) , to serve two functions: the exploration of the concept of identity, and the introduction of the project to the neighbourhood. In this introduction, the neighbourhood has a very important function, since it either will or will not accept the project29) .
An important 'mapping' task will be the search for social structure: formal and semi-formal30) , because the general observation that 'there is no social structure' can of course only be relative31) .
In this period, accommodation for the project will be developed in which activities can take place as well as seminars, allowing expositions of the results of activities to the inhabitants of the neighbourhood. An important model for this accommodation will be the 'Wats', the Buddhist Temple complexes, that actually form one of the few examples of functioning social infrastructure32) . Of course the accommodation for this project will be smaller in scale.
The concept of 'development' through day to day reporting, critical analysis and consequent alterations in the structure of activities will be the formal topic of the training. Under this concrete level, topics as insecurity, fear to make mistake or to loose face, the need for creation and decision, responsibility, identity and memories of the students will surface as the activities take form.
2. In the second period, that will gradually evolve from the first after maybe 4 - 6 months, the main emphasis of the project will shift to activities with children. One of the effects of the first period must be that the project has become widely known in - and attractive for - the whole neighbourhood. The activities for children will also be developed in phases:
2.1. At first there will be activities that address the physical identity of the children.
This involves the establishment of personal documents, like notebooks filled with memories and drawings of important places for the individual child, records of other activities, and familial background33) . Also it involves existential activities, like meeting nature, physical development, and activities concerning physical health34) . Finally there will be the familiarisation with collective identity through projects involving, for instance, traditional music and dance. Here the basic program may be developed in co-operation with the Royal Academy of the Arts 35) .
2.2. The second phase will address the emotional identity of the children, through the development of specialised games, structured to permit them to gradually address more difficult and 'dangerous' emotions in a safe way, through the use of symbols, or through projection in objects and puppets.
2.3. The third phase will address and reinforce the expression of the children. This is the phase in which the other residents of the neighbourhood will get involved in the activities, either as an audience, or by getting involved in activities. Classes in traditional dance and music will form a basis of departure, and will be open to the public as much as the representations that will result. From this point on the project will also reach out to other parts of Phnom-Penh. Other children that are trained elsewhere will be invited to perform36) , and the children in the project will go out to show their work.
2.4. In the forth phase there will be concentration on emphatic skills . Projects will be structured around interest in 'others', and will gain biographic aspects, for instance of the elderly, the history of life in the neighbourhood. Child-to child projects will be proposed, and professional Cambodian (and incidentally international) artists will be invited to join activities. An explicit project may be the integration of some activities into collective mourning rituals that establish a new relation with the culture that was nearly lost37) .
2.5. In the fifth and last phase of the second period there will be a concentration on the emergence and creation of modern legends. Storytelling, dramatised storytelling, songs38) , writing, expositions, performances will propose epic versions of many different aspects of recent history to a wider audience, whose reactions will show the level of readiness to integrate recent memories in the collective consciousness 39) .
Activities of any phase will not be abandoned when those of a new phase starts. For children that enter the project there will at all time be the possibility to start with first phase activities. The main reason for phasing is, that the staff will need time to acquire the necessary skills, and to develop specific forms for the activities that respond to the Cambodian culture and heritage. Thus, after a certain period all five phases will exist simultaneously.
This second period activities will also train the staff in all managemental skills that are necessary to control and develop the project: a new activity can simply not be started before the staff finds a way to handle it. The project will become the main management training object, but of course there will be separate training sessions and seminars to acquire specific technical skills parallel with and in response to the development in the project.
3. In the third phase the project will close on the first location and open activities on a new location. It is not sure weather a new location will be opened within the first two years. In the third year this should, however, be the target.
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The project will be closely connected to the WHO-IPSER collaborative project on refugee mental health40) , which has one of its sites in Cambodia.
Institutions to be involved in the project are:
The Department of Child Welfare of the Cambodian Ministry of Social Affairs, Labour and Veteran Affairs, The Cambodian Institute of Human Rights, UNICEF-Cambodia,
The Psychological Faculty of the Phnom Penh University, The Khmer Buddhist Society,
and L'Université Royale des Beaux Arts41) .
The IPSER project office will serve as a host organisation during the first stage of the project. As soon as the project accommodation and the development of the Cambodian Staff permit it, the project will become an independent Cambodian NGO42) .
The project will offer a meeting point for all Cambodian staff involved in the work for children, providing space and occasions for social contacts, information, and by being open for participation in training programmes and providing the opportunity for gaining practical experience.
The project will be developed in connection with the primary health care system that is being established. This means that possibilities will be explored to co-operate with physicians and other health care workers in the provision of a kind of consulting service for children and their families.
In the first stage, the main responsibility for the project will be with the Project Initiator, supervised by WHO. He will work in close collaboration with the IPSER Staff, and will regularly report for the purpose of progress assessment.
Recruitment and selection of young adults to participate in the project's staff and team for participation in the first stage will be organised with the co-operating organisations, mentioned above. An advisory board to the project will also be formed, in which representatives of these organisations will be invited, as well as specialists on Cambodian culture, history and philosophy.
There will be three management levels within the project: those of activities, location, and project. Management of activities and of the location must be relatively independent and therefore requires relatively complete management qualities. On all levels though, there will be work with more and less responsibility as to permit 'growing into experience' on an organic base.
This spreading of management responsibilities requires a strong information management. In this two-year period, the foundation will be laid for a system 43) that can proliferate actual information back and forth between levels on a daily basis, even when project locations get spread out over Cambodia and using a rather unstable telecommunications infrastructure.
This internal information-management system should also be able to provide selected actual information for external interested parties as the co-operating institutes and other Cambodian organisations that work in related fields, as well as offer the possibility of contacts with comparable organisations in other countries44) .
There will be three levels of staff-functions:
Central staff, executive in the field of finance, law, administration and personnel management. After having acquired their function, a full-time employment period for 1-2 years should be optimal (or the equivalent of 2, maybe 3 location-projects.) They should always have at least one trainee-assistant. Central staff-members will have no place in the policy developing structure during the period of their employment as such.
Location staff, executive in the field of activities as well as policy developing. Apart from developing general managing capacities, they will specialise in management fields as publicity, communication, transport, contacts with volunteers, supervision of trainees, purchasing of goods, etc. They will co-ordinate all opinion-forming within the project and take care of a policy-producing system in which all participants are involved. They will also be activity-leaders for about 50%. After a trainee period, they can join in the proposal of a new location, for which they will be responsible during its total duration. In this period they will be full-time employees.
Activity leaders have the responsibility for special (groups of) activities. They can be part-time employees or even volunteers. After a training period they can propose an activity and once it is accepted, be responsible for the management of that activity, taking care that it be balanced with other activities. Activity leaders can, once an activity has been successfully introduced, also be invited to another location.
The NGO to be formed will have a legal structure45) in which all involved people can become a member, except the central-staff employees. All members will have a position in which they can take part in the production of policy. They will choose from their midst the majority of the members in a board that will prepare (not take) policy decisions. Other members of this board will be proposed by funding organisations and the Cambodian authorities.
This board will appoint a director and a daily board that will function as the employer of the central staff. Staff members will be installed following their own proposal to open a new location, after being nominated by the board. Activity leaders can be (part-time) employee or volunteer, other activity-organisers will usually be volunteer. All of the staff-members and activity leaders will be members. A thorough introduction in the principles of the project 46) and active participation in the policy making process will be a necessary condition to be a member. Membership is obligatory for staff-members.
General policy is decided upon by a General Assembly to which all members have access and decision-taking power. This assembly also accepts new members. The General Assembly decides on the regular re-formulation of a constitutional document, consisting of this current document to begin with 47) .
Daily policy is developed by the staff-members, as a translation of general policy into practice. Through the daily board, the central staff is responsible for the execution of this daily policy within the developing Cambodian law and regulations.
The development of policy will be a permanent process. This means that the definition of long-term as well as short-term goals is dynamic, and will be influenced by regular analysis of results. Also the criteria to judge the results will be explicit and subject to permanent discussion. The management structure, as a consequence, will be subject to a constant process of evolution and will therefore be a specialised form of management. A very strict and consequent separation between policy-making and policy-execution (between members and central staff) is a necessary prerequisite for this evolution, since evolution demands at least two independent forces- in this case ideas on the one hand and practice on the other.
During the first stage all funds will be channelled through WHO. Responsibility for financial control and reporting will be with WHO. During the project and after consent of external financing partners these responsibilities, as well as the funds, remaining at that moment, will be transferred to the newly to form NGO, after which WHO will assume a supervising position 48) for at least one more year, but not longer than two years. In this period WHO will supervise and support the new NGO in its quest for funding, if necessary.
Financial management will then be structured in a system of budgeting on the three management levels, in which a high degree of responsibility will be delegated to the level of activity leaders. Budgets on this level will have as little structure as possible, leaving the concrete allocation of money and means as much as possible to the judgement of those that participate in the activities. There will be a strong obligation for exact and fast administration on this level, through a user-friendly system, connected to the central administration and evaluation on a daily base.
Bookkeeping will be in Riels, connected on a week-to week basis with the US$, and in US$ when these are used in daily traffic. All budgeting will be done in US$, at least during the first period of two years.
Monitoring, Reports, Evaluation.
Evaluation of the activities will be a continuous and daily activity.
There will be systematic recording of activities, mainly on Video (Hi8), and regular edited general reports (VHS, Pal.). Basic training in videotechnique will be among the first skills that are conveyed within the framework of this project. Written reports on the progress of activities will also be part of routine, as well as photographic and sound recording. These reports will generally be open for interested organisations49) .
Concise narrative reports and general evaluations will be produced each six months for the convenience of supporting institutions (government, co-operating institutions, funding organisations, colleagues etc.).
There will be an annual financial report.
A manual will be developed describing working methods and principles, successful and less successful activities, and analysis, as a base for future work, specified for the Cambodian reality. This manual will also be translated in English for the consecutive use in other communities.
Finally there will be the development of an instrument for evaluation of the community process. In collaboration with the Phnom-Penh University and the IPSER Project some indicators will be chosen that can represent individual and collective positions in the field of mental health.
They will be practical indicators that can be measured organically during activities and manifestations related to the project, like participation, some aspects of interaction between children, and they can be more theoretical indicators that require a research effort outside the project like "Locus of Control"50) , a possible indicator for the process in which children regain their individuality and their own sources to cope with the situation in a healthy way 51) . Indicators can be very technical, like the number of tranquillising drugs that are sold in the area, or based on subjective interpretation, like the registration and analysis of oral history as it is conveyed during the project period, or the impressions of professional healers52) in the district.
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The core of this project is the assumption that children are in essence growing organisms, and that this growing process is an intrinsic power for the regeneration of what they have lost in an environment of violence. This same environment, though, is usually the cause that the child cannot start this process.
Activities, designed to support the child in its autonomous regeneration, are basically social instruments that neutralise these negative outside forces. The design of these activities will always be a process, rather than a product, a progressive development of the social structure (for instance a game) in response to the actions of the children involved.
Activities that are developed for traumatised children and other children in especially difficult circumstances will attract healthy children alike- or even more, and this is very positive: children can support each other. Yet, children that cope with severe mental problems are handicapped in their social functioning, and therefore these activities will have to be designed with a clear understanding of the situation they are in. This understanding leads consequently to a set of simple rules for the development of activities that are, however, not directly evident,.
Helping the child
When we see a group of children on one side of a street with heavy traffic, we can do several things:
We can take care that they do not step onto the street.
We can round them up, and run them to the other side when we see that it is safe.
We can install a traffic light, and just wait and see which child wants to cross to the other side.
In the last case, we can, maybe, identify some children that want to cross, but for some reason, can't. We may lift these children, and take them over in our arms.
All these actions are usually described with the word 'helping', yet they are essentially different actions. This project concentrates on the third kind of 'helping', or 'facilitating'55) (developing the social pendant of traffic lights), and therefore it has to be working in close connection to a structures that offers the fourth type of helping, in non-metaphoric terms: a professional mental health care system.
Helping always implies an unequal relationship, and must therefore by definition be a temporary relationship, a well defined period in which a well described objective is to be reached, after which the 'helping' action is formally terminated and the relationship is balanced.
Individual Mental Trauma
The exact nature of trauma is still not very well known. In this project, traumata are seen as mental injuries, caused by extremely shocking experiences that overwhelm the individual rendering it helpless, and causing a loss of ego-functions and regression56) . Traumata can be considered in the same way as injuries in the physical body 57) . The original shocking experience not only causes trauma, it also an origin of stress. Stress is, in essence, a defensive reaction that permits the mind and the body to function on a very high level of alertness for a while, usually very effective in a shocking situation. Lot of energy are produced, normal emotional reactions are shut off. Stress permits to cope with the situation in a crisis, but is also wearing out the body and the mind.
The result of trauma, or maybe the trauma itself, can be seen as an overload 58) of the human ability to handle emotion. As a consequence, the traumatised person can no longer handle the memory of the events until this overload has been corrected. Whenever the traumatised person relaxes, however, the memory comes back (i.e. in the form of flashbacks), and ignites the original defence reaction: stress. A traumatised person therefore never relaxes, lives in a constant state of anxiety and fear, of fight against the memories that wears him or her out.
The correction process therefore has to deal with the memory of the original, traumatising experience, and with relaxation59) . Only when the memory is allowed to exist and be handled in full detail, the traumatised person can relax, but only when the person can relax, the memory can be approached. This vicious circle can only be broken by inducing relaxation from the outside.
The original experience was, as we assume, too shocking for the personality to handle. Logically, the process in which the memory may be approached can therefore have two directions: the first is to show that the original experience was 'in reality' not that terrible, the second is to permit the personality to develop until it can handle the memory. Certainly in the case of war related trauma, the first direction is not really an option: usually the causes of the trauma were really terrible, and each attempt to belittle them would only be offending. One of the measurable effects of trauma is regression. This indicates that the personality may, in effect, be seen as 'shrinked' by the trauma. The support of a growing process is therefore the essence of all activities in this framework.
Loss of individuality, Identity.
Children are developing not only their general human characteristics, not only the characteristics of their social surrounding, and not only their biological and genetically preconceived characteristics, but also their own uniqueness, their individuality. This individuality is concretised in many details that form the daily life of a child: special preferred toys, secret places where to go or to hide, special relations with special people. In the case of war, and certainly in the case of being driven away from home, usually this whole sensitive network is crushed, leaving the child completely lost from all the elements that proved who it was. The support of a growing process as mentioned above is therefore also the support of the (re)construction of identity, identity defined here as the assembly of all independent choices that a person has made.
Collective Mental Trauma
Even more difficult to understand than individual trauma is the effect of war on the collective. Different from natural catastrophes, violence in war is not so much directed against the people that die as a result of it, but is in effect, more directed to the ones that outlive the ordeal. Violence in war has the explicit intention of traumatising the survivors, of inducing fear (surrender, subjection).
A collective in war can therefore be seen as traumatised to the same extent as is the individual, and it affects the individuals in this collective as much as individual experiences do. Yet, here the individual memory is not the source of resulting stress and other symptoms. Here we deal with the collective memory: the stories, the myths, the legends that were created in and around the war60) .
In the aftermath of war, a whole culture can be threatened in its existence, and this loss, cultural bereavement, affects the individuals comparable to the loss of their own identity, with culturally specific symptomatic results(61).
Loss and Mourning
Many people are confronted with the loss of relatives during war. The resulting process of enduring loss, mourning, may not be mistaken for trauma, although sometimes there is resemblance. This is important, because many times, the 'healing' of trauma will organically result in the start of a 'healthy' mourning process. The individual mourning process needs social support, and is therefore in essence a social process. In the way that mourning is traditionally handled in society, one can find very important elements that are valuable for many other forms of support.
Mourning can also be a collective process, and in the case of collective trauma it is probably a necessary one. This mourning can also surpass generations, and therefore even be necessary for those that have to live with the pain that their parents experience (62).
Guilt and Shame
Guilt and shame are subjective frames of interpretation of the causal chain of events.
They do not only introduce a moral component into the situation, but they also have a very practical effect on the alternatives for social action that are open to the individual. This is true on the individual as well as on the collective level. On the individual level there is not only direct guilt as a consequence of action, but there is, maybe even more important, the survivor's guilt: the shocking consciousness of survival through an ordeal in which other, highly loved ones, have lost their lifes. There are also collective guilt and shame, experienced by every member in a community, since war is not an individual conflict. As a consequence of war, therefore, guilt and shame are connected to roles that were performed in a war, but for children there is a difference: not their own, but the roles of the parents, the family, the tribe, the nation are defining their position as 'guilty' or 'just' in the eyes of the world (63). We can see that in the aftermath of war, guilt and shame get tangled with the collective mourning process. In this process the subjective experience is imposed on the new generation. We can see documented instances of this with the Jews (64), the Germans and the Japanese (65), but this is valid as well for the Dutch and the American youth of that period, raised in the beliefs of being 'the just', or 'the good' (66).
Healing is seen as a process of (re)activation and (re)integration of all the elements that are essential to the personality. Healing is, in essence, done by the personality itself, it is an internal life-force, that can, however, be blocked by circumstances. This blockade can be external as well as internal.
Others can help by removing these blockades- this action is also generally named 'healing'.
The removal of external blockades is in essence a task for the community, since these blockades are by definition a part of this community. This task requires alertness, compassion and careful analysis that can be expected of healthy members of the community (67).
The removal of external blockades and relaxation should ideally result in a spontaneous healing process within de individuals that are thus supported.
When this does not happen, internal blockades may be addressed, but this requires more training and considerable experience with the dynamics of the human psyche. Here too, fundamental knowledge of the culture in which one 'heals' is essential (68).
A grassroots organisation aiming to (re)structure the social environment must therefore operate in close co-operation with trained psycho-social workers (69), who, on the other hand, will gain immensely in effectiveness by the existence of such a grassroots-organisation due to the fact that its programmes can address large numbers of people and identify the people in need of more experienced help in an organic process that also prevents stigmatising them.
Games and Activities
The distinction between games and other activities is, that games are activities that are in some way 'safe' from the rules of the community. Within a game there can be experimenting with actions and emotions that are impossible in real society. To be significant and effective, these actions use symbolic tools (as: dice for fate) or become symbolic themselves (there are many ways of 'dying' in games).
All non-game activities take place in reality, and entail all the dangers of that reality as a consequence. On the other hand they allow real responsibility, and acknowledgement from the society in which they are organised.
Games and activities can, if devised properly, present frameworks in which series of choices are offered to the individual in a collective process. These choices facilitate the expression, the (re)development of the individual identity, and it also permits the collective to recognise and to accept this identity.
There are many aspects of games and activities that can be influenced and developed as a function of their results (70). To support healing, games and activities will have some basics in common, as there are:
Individual entry for children on a voluntary basis.
Activities will have to be attractive for children because they offer certain aspects that are of value to them on that specific moment. What aspect that is, is not predictable. For other children the same activity may be wrong: either too emotional, or not interesting enough. The choice of a child whether or not to participate in a certain activity is in itself a reinforcing action.
Possibility for participation by both traumatised and non-traumatised children.
The support of healthy peers is important in overcoming trauma. Yet, traumatised children are at a disadvantage in normal social intercourse, because they are handicapped in many ways. Activities have to be devised in such a way that children with varying social capacities can mingle without stigmatising the weaker. This means that there must be diversification in forms of participation.
Room for the expression of emotions, individual as well as collective.
Games and activities that leave no space for the expression of emotions are of no use, since an essential element of the healing process is that emotions, induced by the traumatising experience, are unleashed. Specially designed activities have to allow this by offering time, or by providing forms for these emotions (like singing, dancing, etc.).
The absence of competition.
Competition is not really, as one may think, about winning. Competition is all about losing, and loosing is the one thing that victims of war do not have to learn any more.
These rules exclude some important social fields of activities from the projects, like all competitive sport, as well as the obligatory education system, in which the child has to meet externally defined objectives. This is not a problem, however, since this kind of activities are usually self-organising or provided by other quite capable institutions (71). There is a clear need for co-operation with these institutions. Many activities, for instance, are possible and necessary for teachers in schools, being important people in the child's surrounding. Teacher-awareness of the needs of children in trouble is of great importance (72).
All activities should have a goal within the project, and not become regular social services, like for instance kindergarten, within the project. If they are continued as such, they will have to do so as an independent project- but this may be one of the goals of some activity.
The Essence of Results: Process.
We tend to see 'results' as the reason why we do things. We think that we create 'results' by our actions, and that these 'results' are the proof of our success.
In reality however, the 'results' we get are hardly ever the results we set out to reach. This does, however, not discourage us: we simply change history. We select the results we like, pretend that these were the results we always wanted, and then declare 'success'. After 'success' has been declared, we get quite impatient with, and inaccessible for, all other kind of 'results' we also produced, and which cannot be explained as 'success': the unwanted by-products of our actions. These are consequently discarded as the results of 'mistakes' and preferably analysed as the result of personal mistakes, after which 'a person' takes the blame, or looses face.
We would, in fact be much more realistic, if we were to see all 'results' as a by-product of what we really create. What then is it, that we really create? If we look at 'results' this way, it becomes possible to answer the question: we create process: a chain of actions, results that are being fed back to us, and that provoke new actions. In this process, there really are no fixed points, because even the goals of our actions are changing during the process. Yet, in this process there is structure, and it is this structure that we create.
Of course: goals and results are important elements for process , like fruits are for evolution. (We don't create fruit, but we did influence a genetic selection process that changed not only fruit, but also our taste for it.)
Likewise it is with the healing of children from their trauma. As we have seen before, it is not this project that will create 'healing', nor is that done by the young adults that will work in the project. If anybody, the children themselves 'produce' healing.
The importance of results is not denied here: what is stressed is that the process is even more important. Why is it important that we are aware of this?
It is important, simply, because we do not know what a 'healed child' exactly is(73). Not even in Western society, and certainly not in societies that have seen generations of warfare.
It is important, because we must learn to see unwanted results not as the consequence of mistakes, but as important indicators in our work, and be able to search for them, rather than to have to mask them.
It is important because we must learn to see that our standards for 'positive' and 'negative' as regards to 'results' are extremely time- and place- correlated and therefore are subject to process themselves.
Positive and negative results then become beacons, fixed points that can help us to give direction to the development we create. Thus, we can see process as the combination of 'development' (or movement) and 'direction'.
This project is therefore not primarily 'goal' oriented, nor is it 'result' oriented. Of course there is, on the onset, a goal. Of course 'results' have an important function. But essential is, that a viable process is ignited within a society that fights the consequences of war, that this process is not strange to its culture and that it includes the inherent healing force of that culture.
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Ministry of Social Action, Labour, and Veteran affairs
Dr. Hong-Theme (Under Secretary of State)
Mrs. Chan Haran (dept. of Child Welfare)
Mr. Men Run (dept. of International Relations)
University of Phnom Penh, Faculty of Psychology
Dr. Im Koch
Mrs. Nhong Hema
Mr. Poch Bunnak
Dr. Loise Ahrens
Cambodian Institute of Human Rights
Mr. Kassie Neou (Co-Director)
Mrs. Meng Ho Leang. (Co-Director)
Khmer Buddhist Society
Mr. Yin Luoth (Project Director)
Mr. You Kan (Training Co-ordinator)
Mrs. Margaret de Monchy
Université Royale des Beaux Arts
Mr. Lor San (Vice-Rector)
Mr. Khoun Than (Vice Rector)
Krousar Thmey (Nouvelle Famille)
Mr. Benoit Duchateau-Arminjon (Project Initiator)
Mr. Tan Seng Huot (Staff)
Caring for Young Khmer
Mrs. Michiko Nomura (Program Co-ordinator)
Mr. Endo Mamoru (ass. Program Officer)
Kolap Srok Stung Khandal Orphanage
Mrs. Prak Savang (Director)
Red Barna - Cambodia (Save the Children Norway)
Mr. Sigmund Karlstrom (Director)
Mr. Sebastien Marot (Project Initiator)
Mr. Long Sengkimhong (Manager)
Friends for All Children Australia, Khen Kleang Orphanage
Mrs. Sue Gilbey
World Vision drop-in centre
Mrs. Doung Sovanny (Staff)
Dr. George Petersen (A/WR)
Mrs. Ceciel De Sweeme-Ba
Dr. Joop de Jong
Dr. Maurice Eisenbruch
Dr. Kirsti Oskarsen (Psychiatrist, Sihanouk Hospital, IOM)
Mr. Veasna Mao (Philosopher, Ministry of Education)
Dr. Marcel Charles Roy (Tak Mao Centre)
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