For expat and local families facing childhood development disorders, Cambodia can be a tough place, with limited services available. One Phnom Penh clinic aims to fill the gap, and help pave the way for improvement. Writing by Joanna Mayhew. Photography by Lucas Veuve.
nly a year after moving with their three young kids to Phnom Penh, Sean and Alice Collier started to notice concerning patterns in their youngest child. Then aged three, their son was restless and uncommunicative. He seemed socially withdrawn, not playing with other children, and was fixated on letters – memorising and repeating them but unable to put them into use. “Something wasn’t right, but we didn’t know what it was,” Sean recalls. “We didn’t have resources here. We were baffled.”
Originally from the States, the couple lived in Japan before moving back to America, and then onto the Kingdom in 2012. This heightened their worry; they feared that experiencing three different cultures in three years might have negatively affected their son. “At first you don’t know as a parent, is it something I’m doing wrong?” he says. “And everybody has an opinion.”
Opinions from friends and strangers ranged from ADHD to autism, but for the Colliers, diagnosis and treatment felt overwhelming in a foreign country, where there was seemingly nowhere to turn. They wondered about quitting their jobs and returning home. “When you’re having trouble communicating with your child, you’re distraught,” adds Sean. “It’s emotionally and physically exhausting.”
For many expats, the lack of clinical services presents a serious challenge, increased dramatically when managing childhood disabilities. These disorders are not uncommon: the Centers for Disease Control estimates almost 14 percent of American children have development disorders (2008). In Cambodia, statistics on these disorders are elusive or out-dated, but professionals believe a similar pattern can be found in the Kingdom.
Located in the capital, Indigo International works to meet these needs. With plants lining the entryway, the three-storey, airy building has comfy session rooms and large playrooms, with chalkboards, short plastic tables and cupboards full of brightly coloured learning games. Offering assessments alongside psychology, speech therapy and occupational therapy services, the clinic currently serves 39 children, about 25 percent of whom are foreigners. It is also the only English-speaking option available for expats.
For the Colliers, it was a lifesaver. Upon hearing about Indigo, they sought assistance. And after their son was found to have sensory processing disorder, hyperlexia and speech delay, they started speech and occupational therapy sessions.
Through these, Indigo works on attention skills and helps kids to grasp that they can impact their environment. “It’s understanding their interactions with people can be something meaningful,” says Indigo speech therapist, Paula Willis. Occupational therapy assists with tasks from participating at school to getting dressed and being able to play. “What we are ultimately aiming for is for children to be participating more in everyday activities,” adds the organisation’s occupational therapist, Heather Miles.
Therapy is provided to children representing a variety of development disorders, including autism – and 69 percent of Indigo’s clients exhibit autistic tendencies. “Autism is one of the most severe, then you have less debilitating forms of disorders, and other pervasive development disorders that are otherwise not specified,” says Magda Goryczko, Indigo psychologist and clinical services manager.
While autism is associated with various social, communication, sensory and behavioural difficulties, diagnosis is not the goal. “It’s not about answering the question, ‘does this child have autism?’ It’s about, how do we now support this child, so they can improve,” says Goryczko.
Indigo’s staff work together to address the complex disabilities, meeting with the child and parents, as well as teachers and principals, to increase understanding and consistency on all sides. Though many downsides exist in managing disabilities in Cambodia, one upside is treatment can be more individually tailored, compared with places such as the UK where waiting lines and therapy limitations may interfere, claims Willis. “It’s one thing to have good professional help, but the heart behind it is really big,” Sean says. “That’s what we appreciate about Indigo – their genuine concern.”
Indigo’s services have also helped Khmer clients, who make up the majority. However, most Cambodians are unable to afford services, and awareness remains low, according to Indigo. “If you don’t know what you’re looking at, you will either ignore or misdiagnose it,” says Goryczko. “And there’s a lot of stigma when it comes to any disability.”
Several Khmer-language NGO services exist across Cambodia, such as the Centre for Child and Adolescent Mental Health at Chey Chumneas Hospital, Komar Pikar Foundation and Rabbit School. But the country has a long way to go in addressing these needs – a priority is training local professionals.
But through what is available, the Colliers have seen improvements. Their son can stay focused longer, interact socially, form long sentences, and engage in learning beyond letters. While it is unclear how long treatment is needed, they remain positive. “It’s opened my eyes to what a lot of other people go through,” says Sean. “It’s been hard, but it’s been good.”