Who would have guessed that a half-eaten apple left in a bedside cabinet drawer 25 years ago could have caused a rumpus and still be remembered 25 years later half- way across the world? Yet it was the subject of quite an incident all those years ago in the United Kingdom; one that should be a lesson today in Cambodia. It illustrates important principles of the rights of individuals; the responsibilities of others to respect those rights; how the social work professions can evolve, and how these can so dramatically affect the lives of vulnerable disabled people.
The late 1970s in the UK saw the transfer of responsibility from health to social service authorities of residential care facilities. “Care in the Community” became the vogue and for good reasons, not just to save money by replacing expensive health professionals with social workers. It was a worthwhile aim to take a less institutionalized approach with vulnerable folks who had no choice but to live in such places. They were to have new homes that more closely resembled normal everyday family living. Many “patients” became “clients” and successfully made the transition. Most professionals supported the move and believed it did serve the best interests of their clients. The social work profession, long regarded as unfashionable and inferior to its health counterparts, was developing.
“Mabel” was one of the new breed of social workers that spotted the apple incident. She reported her colleague “Gladys,” who was a nurse and proud to be of the “old- fashioned” variety, brought up to believe that “cleanliness was next to Godliness” and an important weapon in fighting disease and ill-health. But now, she was a care-worker in a residence for clients with physical and psychiatric problems, not a health facility. Despite that she had no compunction in opening Myrtle’s bedside cabinet drawer and removing the offensive half-eaten apple. Myrtle was far from happy when she wanted to start re-munching it and “threw a paddy,” bringing everyone including the manager to the scene. Gladys stood her ground. “We know what is best for you!” “You cannot look after yourself.” But Gladys was wrong. Her old habits prevailed over the new rules she knew that gave the right of privacy to clients in certain areas and possessions. The bedside drawer was one. She had deliberately violated that right.
Here in Cambodia today, there are far more Gladys’s than Mabels. In fact, I am hard-pressed to find one Mabel even within familiar international NGOs that have development programs, though most would profess otherwise. Sadly, the dearth of Mabels costs the country’s poor disabled people dearly, far more than a half-eaten apple. The “welfare” or “service-provision”, i.e., “we know best” approach is still very much the norm. It is due partly to the fact that Cambodian society is highly status-orientated. The order of seniority is strictly top-down–senior officials, the wealthy, men, women, etc, in strict order. At the bottom, at a similar level to children, are disabled people and other groups living with various vulnerabilities. For example, they may live in extreme poverty; may have many dependents, or are single-women-headed households and often elderly.
So, right at the very bottom are families found living with disability plus several vulnerabilities. Those are the families we work with. Traditional society not only ignores them but shuns them. Their plight is put down to Buddhism (mistakenly) in that such misfortune is due punishment for past sins. A disabled person is not invited to weddings in case he or she brings bad luck on the couple. Despite commitments to UN and domestic legislation promoting disability rights, the education sector does not allow disabled people to pursue careers in teaching. Seldom can they enroll at teacher training school in the belief that children should not to be exposed to disability in their classroom!
It is sad to say, but the truth is there is little or no indigenous spirit to change things. The Ministry of Social Affairs is well-intentioned, but it remains almost at the bottom of all ministries in terms of status and funding. Efforts have been made, including by a body theoretically modeled on and called after the UK’s Disability Action Council. Yet, progress is painfully slow.
In Cambodia, there is virtually no evidence anywhere of special concessions or facilities for physical access for disabled people. Sadly an important opportunity to do this and send a wider signal was lost. The Asia Development Bank, nominally committed to the cause of disabled people, funded the building of many of the 1,629 new commune council offices, but they and the ministry responsible did not include access for disabled people in the design., despite representations. Pictures show that both dry season and wet-season access are impossible in some places.
Therefore, the task falls on external bodies – international donors and NGOs – to instigate change, to instill sensitivity across whole communities, and to enlighten those in authority who are able to sustain change for the better. But are we doing enough? More importantly, are we using our resources; taxpayers’ money allocated to foreign aid and development, in the best way?
The real aim must be for vulnerable groups to be able to improve their own situation; to aspire to equality of opportunity in all walks of life, with our help. Has this not been largely accomplished in the UK and developed world? Higher standards of public sector professionalism in the UK and developed world have meant patients; clients and children now have an automatic right to be consulted in decisions that affect them. The experts admit that they do not always know best. Assertions that a form of disability can affect a person’s capacity to reason are rightly challenged and subjected to close scrutiny.
So, why are we so slow to bring the same standards to Cambodia? Why do we abandon them? Is it due to some kind of local expediency? Our disabled beneficiaries tell us the same story. If they are not put off and can find a clinic; rehabilitation aids centre, vocational training school, etc., when they do get there, they are given little choice. They are expected to be passive and accept whatever is on offer unquestionably even when it may not be an appropriate solution. In areas that do have facilities the only choice in how to acquire a new livelihood is to attend a residential vocational training school. These are very expensive institutions to run where the management sticks to their own beliefs that only a few skills are suitable for disabled people such as clothes-making, mat-weaving, electronic or mechanical repairs, and hair-dressing. So disabled people must “take it or leave it” and even then after their training, only limited support is given to get them started in their new business if by chance, not design, there is scope for it in their community.
One organization, New Horizons Society (NHS), however, has been trying to do things differently. It does try to emulate the best standards of UK and other countries and can point to three major accomplishments. Most importantly it “starts off the way it means to go by.”
Firstly, it does something unique in livelihood improvement projects. It actually allows poor disabled beneficiaries to decide themselves on their own best solution to improve their incomes. They do not have to leave home. NHS’s current 3,035 members have formed or joined 135 self-help groups and have a say along with the other members on their personal or family plan, which then goes on through their federated group network, to approve grants or loans and the conditions to be met. It is not local authority officials, NGO workers, or Microcredit Managers doing the deciding. These disabled people, often deprived of an education, have proven, to the disbelief of many, that they “can do” just as well if not better than the experts. They now have US$ 130,000 in revolving funds and a consistent 90%+ record of success in new ventures; with the ones that fall by the wayside being more than compensated by the higher returns from the most successful ones.
Their success does not end there. If anything their second accomplishment is even more remarkable. They now have newly-acquired confidence and skills in advocacy. At first their aim was just to obtain equality of opportunity, so their children could go to school, or the family would be included in health services. One of their ideas went from one of their then three districts to the national scene for all 184 districts. They persuaded the Ministry of Social Affairs to take action to stop officials acquiring for themselves the small sums of money that are payable as war pensions. After 5 years, in several of their communities, the transition is complete. They have gone from one- time total social exclusion to be leaders today. Some now serve as commune councillors and village chiefs. The “Child Advocacy Group,” consisting of mainly disabled children, has outshone the adults in their newly-found confidence to convey positive images and key messages, especially in their dance troupe.
Their third achievement also defies a trend in Cambodia. Most civil society organizations are started by individuals, usually in response to international donor or NGO initiatives. Such organizations can be artificial and invariably begin in the capital Phnom Penh. They are top-down/center-out in nature. Our members are the opposite. In fact they may well form the single largest genuine active mass membership, grassroots upward movement in the country, and one with an authentic elected leadership.
You would think that these accomplishments would be heralded and replicated. Sadly, despite the fact that the Ministry of Social Affairs and most expert visitors attest to the quality of practice, this is not the case. Their very innovation can be seen as “non-conformity!” It does not go down in some quarters; with some in authority, among some donors and more traditional sister organizations that keep up the old ways. In fact, this is one reason why it finds it hard to compete for funds and remains at constant risk of going out of business.
There is one other reason, though. Post-conflict developing countries usually attract considerable support to rebuild poor infrastructure and human resource capacities. Very large sums are spent on roads and buildings that are visible physical evidence of progress being made from philanthropic awards. Less visible, but still discernible over time, are the efforts to improve services – administrators, lawyers, teachers, health-workers and others all feature prominently in education and training programs. Many are supported to go overseas for best education and training.
In Cambodia, this process has been going on since 1993 when it was admitted back in to the international community. There is though one profession that hardly features – social workers. Why? Given the scale of disaster in Cambodia – the world acknowledges the tragedy of the Khmer Rouge with millions killed through execution, starvation, or hard labour and almost every surviving family traumatized – if ever there is a country that needs the best most highly-skilled social or community workers, surely it is this one? Some 9.8% of the population suffers from one form or more of physical, sensory or psycho-social disability.
And, the absence of social workers shows, because the weak and vulnerable continue to miss out and be left behind. There is no institutionalized profession dedicated purely to working with them on a generic or holistic basis to overcome adversity. Why does social work professional capacity-building seldom appear in international aid programs? Unlike the medical, nursing, teaching, and legal professions, there is no national plan. There is no career entry scheme within services or academic institutions.
The Ministry of Social Affairs does have officials down to district level but their main role is to compile statistics. It does not have social workers. In fact they just do not exist although other occupations do perform social work as a sideline. Mainly it is a responsibility of the commune councils and village chiefs. However, their order of priorities is first loyalty to the ruling party, which has 98% of commune chiefs, followed by law and order. Social work in reality is part of “order.” Given the emphasis on the military and police even today, they receive a much higher share of the national budget than education, health or social services. It means that suppression rather settlement of problems usually occurs.
Money is a factor, too. Officials use their positions to obtain unofficial fees. So, those without money always lose out in disputes.
Credit must be given to some organizations that are trying to do original work in these difficult circumstances but none have the same mass active local membership of New Horizons Society. Two, both modest in size relatively, are worthy of mention. “Social Services of Cambodia” which is an NGO not a public service is pioneering the idea of professional social and community work, but can only do so on a small-scale. Transcultural Psychological Organization (TPO) is the only organization to face up to and tackle the mental scars in the population. It is trying community psychiatric care as well as clinical treatments.
The “New Horizons Society” of ultra-poor mainly disabled people may have proven there is a better way, but with the exception of one big donor, the Australian Aid Agency (AUSAID), they have found it difficult so far to win over others. Even the UK Government’s Aid Agency DfID, which must be given great credit for helping to establish them, has no means to give support to replicate and build on it. Their Civil Society Challenge Fund cannot be used to replicate projects, instead requiring other donors and funds to take on good practice. The same applies to the Diana Princess of Wales Fund. Between them, these two agencies provided vital capital resources and core running costs but once those grants ceased, it has been impossible so far to replace that lost income. AUSAID is keeping things going, for now, but as with so many donors these days, they want most money to go for direct activities for beneficiaries, with only a limited contribution to running costs.
In conclusion, the plea of “New Horizons Society” to governments and other donors is please reconsider your rules. We appreciate the help you give, but we do need core cost support until we can generate internal revenue to cover them and manage all our resources on a sustainable basis. We admit that as disabled people, the usual 1-3 year project timetables are not long enough bearing in mind our very low starting-off points.
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