TPO ANNUAL REPORTS

 Victims of Torture (VOT) Project: Helping the Victims of the Khmer Rouge

Annual Report

October 2003 through September 2004

Our hypothesis is that by creating a climate allowing victims of torture to come forward, it will be possible to address their physical and emotional needs, as well as the needs of their families.

Executive Summary

A range of affective conditions, including trauma, are the legacy of recent political conflicts, twenty years of civil war, the massive atrocities committed during the Khmer Rouge years, and the grave social and economic problems faced by thousands of Cambodians on a daily basis. This report describes the first-year achievements, challenges, and impacts of the Victims of Torture (VOT) Project, which was designed to address the trauma experienced by victims of the Khmer Rouge.

Results to Date. Since the project began in October 2003, the VOT team has interviewed 144 people in three provinces.[*] Using the Cambodian version of the Harvard Trauma Questionnaire (HTQ), we have identified 49 people (about a third of those interviewed) as victims of Post-Traumatic Stress Disorder (PTSD). The vast majority of those suffering from PTSD lost loved ones during the Democratic Kampuchea regime. All of these victims were referred to TPO for counseling and treatment.

Table 1. First-Year Project Results: Interviews and PSTD Victims

A breakdown of the number of interviews, cassettes and pages transcribed to date is given below by province:

Table 2. First-Year Project Results: Cassettes and Transcriptions by Province

Among the 3,575 pages transcribed, we have completed the transcription of 108 interviews and 189 cassettes. Currently, we are transcribing 72 cassettes from the remaining 36 interviews, which were conducted in August and September of this year. During the project, our volunteers will translate the interviews into English for research purposes.

Preliminary Findings: Two main findings have emerged to date regarding those interviewed, but caution must be exercised when drawing conclusions owing to the small sample size. They relate to whether the person experiencing trauma was a victim or perpetrator, or a man or woman. TPO will analyze these two findings more carefully as the project proceeds.

Soldier vs. Victim Trauma. Forty-five former Khmer Rouge soldiers/cadres have been interviewed to date (1 in Takeo, 5 in Kandal, and 39 in Kampot). Five of them are women. We found in general that there is a smaller incidence of PTSD among this population than among victims. There are a number of possible explanations for this:

• Fear of speaking out: When the regime was toppled in 1979, many villagers took revenge and killed Khmer Rouge. This, coupled with rumors that lower-level Khmer Rouge would be tried at the upcoming tribunal, may have made the former soldiers hesitant to discuss the regime (an article in the October 23-24 issue of The Cambodia Daily quoted an advisor to the government’s task force, however, as saying, “It’s important to reassure people that…the establishment of the Extraordinary Chambers does not mean that people will be combing the villages looking for people with a past associated with the Khmer Rouge.” Others may have been reluctant because of the guilt they carry over their past actions.
   

• Less traumatic experiences: It can be posited that soldiers are less traumatized because they suffered less than other members of the population during Democratic Kampuchea. For example, most of them had enough food to eat on the front lines, lost their loved ones less frequently, were not forced to labor under extreme conditions, and were seldom beaten or tortured.
   

• Military culture: Owing to their strong ideology and discipline, former soldiers may simply be better at denying their trauma than members of the general population, or not perceive themselves as being traumatized. Their culture was one of blind obedience and many believe that their jobs were simply to follow orders, and they feel little or no remorse about doing so.

Women. Women show a higher incidence of PTSD: about twice that of men. Forty-five percent (34 out of 75) of the women interviewed were identified as PTSD victims, as opposed to 22% (15 out of 69) of the men interviewed. Possible explanations include the relatively greater willingness of women to admit, and talk about, the traumas they experienced.

Despite their acknowledgements, however, many women PTSD sufferers had a difficult time discussing their specific traumas. Many did not want to recall their past experiences because they felt no one could help them (some were more forthcoming once the VOT team explained the benefits of the help the project could give them) or because they re-lived the trauma when speaking about it. Others remained mute because they still feared retribution (in Kandal, victims often live nearby the people they suspect killed their loved ones, or beat, tortured, or sexually abused the women).

Challenges and Impacts: The main challenges identified for the project to date include the initial reluctance of Koh Sla villagers to cooperate with project staff (a majority of these villagers are former Khmer Rouge soldiers) and the ability of TPO staff to meet the large anticipated demand for its counseling and treatment services. We have initiated a number of activities in Koh Sla to gain its residents’ trust and are working with TPO to find ways for it to counsel more project clients.

Overview of the Project

To document the experiences of individuals traumatized during the Khmer Rouge regime and to find effective ways of helping the victims cope with their trauma, the Documentation Center of Cambodia (DC-Cam) requested funding from the U.S Agency for International Development on June 20, 2003. On July 10, 2003, DC-Cam revised its proposal for the project to include the services of the Transcultural Psychosocial Organization (TPO). The proposal was subsequently accepted and the project funded.

Our original proposal stipulated that work be conducted in either Takeo or Kandal province, both of which contain a large proportion of victims of the Khmer Rouge. Of historical importance, both provinces were under the control of Ta Mok (the head of the Southwest Zone during Democratic Kampuchea and a candidate for prosecution under the Khmer Rouge tribunal). This, plus the significant numbers of mass graves and prisons these two provinces, provides strong evidence of large-scale human rights abuses, including torture.

However, we subsequently added the pilot area of Koh Sla in Chhouk district of Kampot province to the project. The majority of survivors in this region were Khmer Rouge soldiers. There are two reasons why we chose Koh Sla for VOT fieldwork. First, it is located in the West Zone, a highly controlled area under the Khmer Rouge regime. Second, the addition of this area broadened the project’s target population to helping Khmer Rouge soldiers (TPO and DC-Cam consider the former soldiers to be victims of the Khmer Rouge, as do the soldiers themselves).

The two-year VOT project involves counseling for people who suffered abuse under the Democratic Kampuchea regime (both victims and perpetrators) and are traumatized today. In addition, TPO is providing technical support to project staff during client identification and interviews. Our primary roles are to assist the TPO in its identification of traumatized people for care and to work with the children of those traumatized individuals to assist them in coping with difficulties that may result from their parents’ suffering.

Prior to the counseling, TPO has been assessing each proposed client’s mental health status, level of functioning, and level of distress using standardized questionnaires such as Short Form-12 (SF12), Mental Health Inventory-5 (MHI-5), General Health Questionnaires (GHQ), and WHO-Disability Assessment Schedule 12 (WHO-DAS-12). Actual counseling will begin in January 2005 and continue through December of that year.

We have been considering another activity for the project’s second year: informal TPO orientations for patients, family members, and neighbors. We have discovered that such activities are important in working toward healing the trauma experienced by many victims and perpetrators who lived during Democratic Kampuchea.

Achievements and Progress

The VOT project's overall activities can be divided into five main areas: 1) staff training, 2) field interviews, 3) documentation, 4) reporting and evaluation, and 5) counseling and treatment. Before discussing each of these areas, the following paragraphs provide a brief chronology of project activities from October 2003 through September 2004.

First Quarter (October to December 2003). We completed project logistics arrangements and technical coordination, and formulated plans for the life of the project. This included identifying target areas (Takeo and Kandal, where the majority of inhabitants are victims, and Kampot province, where most are former Khmer Rouge soldiers). With TPO staff members, we drafted questionnaires, set training schedules for basic psychological interviews, and identified intensive training courses overseas, as well as certified psychological experts for staff on-the-job-training and report analysis. We also worked on budgeting TPO's consultancy services for the project. 

Second Quarter (January to March 2004). DC-Cam and TPO held planning sessions and developed interview questionnaires. The questionnaires cover an indrocution to interviewing, questions for obtaining an individual’s history, questions for assessing a person’s emotional functioning based mostly on The Harvard Trauma Questionnaire (HTQ) – Cambodain Version for Identifying Post Traumatic Stress Disorders (PTSD), and questions to solicit opinions on Khmer Rouge tribunal and experiences in coping with trauma-related issues.[†] In addition, TPO professionals presented three training modules to DC-Cam staff on such topics as an introduction to mental health and mental health problems, psychological problems, stress and stress management, concepts of trauma, and loss/adjustment; TPO also prepared materials to accompany the training sessions.

During this quarter, we made two five-day fieldtrips to Kandal Steung district (Kandal province) and Tramkak district (Takeo province). There, we identified and interviewed 13  prospective TPO patients; the 4 people we identified as suffering from PTSD were referred to TPO. We also transcribed 9 interviews (each interview is about 50 pages in length). Based on the number of interviews completed, we estimated that we could conduct 2 interviews each day, and so planned to interview about 238 people with 119 days in 2004.

Table 3. Second-Quarter Results: Interviews and PTSD Victims

Third Quarter (April to June 2004). We completed the last module of TPO training, which began in January 2004. The module addressed communications: basic counseling skills and standardized questionnaires. We also completed a VOT fieldtrip research manual. Consulting Harvard materials and with comments from our TPO partners, our questionnaire includes an introduction to DC-Cam and the VOT project, methods for eliciting personal background, and a set of questions on trauma events, as well as views on justice and reconciliation.

In May, we conducted 11 interviews in Kampot and Kandal provinces over 19 days (10 days in Kampot and 9 in Kandal). None of those interviewed in Kampot were identified as PTSD victims. However, we identified 6 PTSD victims in Kandal, who were then referred to TPO. In June, we conducted 18 interviews in Takeo and Kampot over 13 days (8 in Takeo and 5 in Kampot). We identified 8 PTSD victims in Takeo and 1 woman in Kampot; all 9 were referred to TPO for counseling and treatment.
 

Table 4. Third-Quarter Results: Interviews and PTSD Victims

Fourth Quarter (July to September 2004). We had 6 fieldtrips (2 trips in July to Kandal and Takeo provinces, 2 in August to Kampot and Kandal provinces, and 2 in September in Takeo and Kampot provinces) over 34 days (10 in Kandal, 12 in Takeo and 12 in Kampot). As a result, we interviewed 102 people. All 30 of the men and women so identified were referred to TPO for counseling and treatment.

Table 5. Fourth-Quarter Results: Interviews and PTSD Victims

During this period, TPO staff went to the field on several occasions to support DC-Cam staff in the initial interviews, and worked with DC-Cam on the selection of respondents in need of psychological intervention. In August, our team met to determine the number, location, and types of activities the project would conduct in 2005. While TPO had initially agreed to provide counseling to 15 PTSD sufferers, in light of the number identified (49), it was agreed that TPO would increase the number of people counseled, with support from DC-Cam. Because the PTSD victims are widely dispersed geographically, project staff determined that more information on the expected target areas and outputs, as well as careful planning, were needed in order to accommodate the provision of additional counseling and allow for an efficient allocation of TPO resources. A revised project plan is thus anticipated for the fourth quarter of the project.

As a result of these discussions, TPO decided to visit Koh Sla in order to determine the situation in the area and speak with key members of the community about their experiences during Democratic Kampuchea, the difficulties they are experiencing now, and the area’s resources and activities. TPO identified two areas of conflict in Koh Sla: the ownership of land and tensions between former perpetrators and victims (for example, victims tend to talk a great deal about the past, while perpetrators do not).

The project team decided to defer activities in this area because of the small number of PTSD sufferers identified and the amount of time required to travel to the area from Phnom Penh (3.5 hours one way). However, VOT will continue to look for PTSD victims in this area. TPO proposed instead to target its interventions in Kandal and Takeo provinces; this proposal will be discussed next quarter.
 

1.         Project Staff Training

Training for DC-Cam Staff Members. TPO provided trained DC-Cam staff in four blocks between January and April (roughly January 5-8, February 3-5, and March 29-April 1). Trainees were pre- and post-tested to measure their progress. See the TPO report on training on our homepage: http://www.dccam.org/Projects/VOT/psychological_education_report.pdf. 

Technical Support to VOT Project Staff Members during Interview and Identification. To ensure the reliability of our psychological ratings of victims and to help DC-Cam staff in data collection, TPO counsellors went to the field four times (2 days each time) to provide support and advise DC-Cam staff on issues surrounding psychosocial problems. After an interview was completed, DC-Cam worked with TPO to identify people who were thought to have trauma; they were then referred to TPO counsellors for intervention. This phase was roughly completed at the end of 2004. For more information, see the submission of TPO’s first and second progress reports at http://www.dccam.org/Projects/VOT/TPO_Project.htm.