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Dr. J. Bhoomikumar, Director and Consultant Child Psychiatrist of Caritas’s CCAMH during health check up on a primary school student in Kampong Cham province.
 
Interview Dr. J. Bhoomikumar, Director and Consultant Child Psychiatrist of Caritas’s Center for Child and Adolescent Mental Health Program-CCAMH, on the occasion of the 25th years anniversary of the program.

2016 marks the 25th year’s anniversary of Caritas’s Center for Child and Adolescent Mental Health (Caritas-CCAMH) as a program that has been actively engaged in providing quality service to children with neuro-psychiatric problems, developmental and psychological problems in Cambodia. Caritas-CCAMH plans to have series of events during.
the Silver Jubilee year and the first of the celebrations is to be held on January 20th 2016. Dr. J. Bhoomikumar, who has served as the Director and Consultant Child Psychiatrist of CCAMH program for the last 20 years has given an interview to our communication manager, Ms. Somealea about the background and overview of the program, achievements, challenges, and the future outlook of the program.

Somealea: Please briefly tell about CCAMH and its latest development of the program?
Dr.Bhoomi: Caritas-CCAMH is a public private partnership between the Ministry of Health (MoH), Royal Government of Cambodia and Caritas Cambodia. Caritas-CCAMH team has been providing services for children with neuro-psychiatric problems (mainly epilepsy & tic disorders), developmental (mainly autism & mental retardation) and psychological problems (mainly psychosis & anxiety disorders) since the year 1991. The client population we cater to has changed over the period of years. During the first decade and half, more than 50% of the consultations were for neuro-psychiatric problems followed by developmental (30 to 40%) and psychological problems (10 to 20%). Currently, there has been a shift, as more than 60% of the children seeking help suffer from developmental disorders (mainly autism & language delay), followed by neuro-psychiatric problems (20 to 25%) and psychological problems (10 to 20%). Earlier, providing clinical service was the main focus, whereas currently equal if not more emphasis is given to human resource development, capacity building, out-reach services to remote provinces, research and documentation. For more than three project cycles (9 years), Caritas-CCAMH team has worked in the schools and in close cooperation with the village community but currently as a pilot project, the team has commenced early identification and intervention project in collaboration with the government health sector staff at Lovea Em district in Kandal province. Inspired by the Caritas Cambodia’s prison health program, Caritas-CCAMH team has started to incorporate prison mental health, as an action research program.

Somealea: What are the key achievements CCAMH has reached over the last 25 years?
Dr. Bhoomi: The achievements of CCAMH over the last 25 years are many fold and the key areas are as follows:
  • Infrastructure expansionhas been steady over the years to full-fill the growing need of the children and families. 1991 to 1993 was the first building renovation where Caritas-CCAMH services started its work and this building was formally declared open by late Father King His Majesty Preah Bath Norodom Sihanouk on 17th January, 1995. In the year 2000, the UN volunteers in Cambodia not only jointly raised funds, but also gave three-weeks of labor contribution to renovate one of the dilapidated buildings at Chey Chumneas Referral Hospital (CCRH) to function as a daycare center for children with developmental disabilities. With the help of friends of CCAMH from Switzerland, a training hall, pharmacy, one-way-mirror facility and a family cottage were added to the infrastructure in the year 2002. In the year 2013, a two story building with all specialized services for children with special needs was built with the help of India Brazil South Africa (IBSA) Trust Fund, the only one of its kind in Cambodia.
  • Comprehensive clinical service: Over the years, in response to the growing and diverse needs of the children and their families, assessment protocols and therapeutic strategies have evolved. Psychoeducation and disability counselling, early intervention, occupational therapy, speech therapy, behavior therapy, remedial education, counselling, stress management and relaxation training, art and movement (dance) therapy and pharmacotherapy are offered at Caritas-CCAMH. These multimodal therapies have evolved over a period of time and are at different levels of sophistication and expertise, and some are just at the inception stage.    
  • Human resource developmentgained further prominence from the year 2000. Initially, Caritas-CCAMH team was systematically training its partners in the community. With the growing request from other NGOs, Caritas-CCAMH team offers training to staff and caregivers of other NGOs in various specialized therapies such as speech therapy, occupational therapy, remedial education etc in collaboration with professionals from India, Norway, Singapore, Sweden, Thailand and U.K. As a next level, Caritas-CCAMH team plans to start accredited courses in disability and child and adolescent mental health.
  • Publicationis an ongoing process, as there is no literature in Khmer and therefore Caritas-CCAMH team spends considerable amount on time in translating scientific literature into Khmer and has published in special themes such as autism.
  • Advocacy and lobbying by CCAMH team has resulted in the Royal Government of Cambodia recognizing intellectual disability and autism as one among the disabilities that need support, in a country where only mine-victims and moving disabilities as the only problems.
  • Scaling-up service to other provinces:Due to lack of accessibility and ongoing civil strife, most of the services have been concentrated in and around Phnom Penh to the neglect of northwest and northeast past of Cambodia. Since the year 2000 Caritas-CCAMH has been working in close cooperation with Aruppe center, Catholic Church, Battambang and Caritas Kampong Thom Community Development project to reach out to families and communities in other provinces north of Phnom Penh. Recently, the team has started to extend services to Mondulkiri and Kampong Cham provinces.
      

Somealea: What are the biggest challenges of the program and how to overcome them?
Dr. Bhoomi:
Attitude towards disability, lack of skilled professionals, lukewarm response/ collaboration between government agencies, financial sustainability are the major challenges and Caritas-CCAMH team strives to overcome them through innovative measures.  

  • Attitude towards disability:Though children with disabilities are not actively discriminated against, they may be subjected to neglect due to health illiteracy and hopelessness in the given situation. The CCAMH team has innovative attitude and behavior change strategies such as ‘inclusive play’ and intense awareness raising campaigns through parent associations to change the attitude towards disability. In future, the parent associations of children with disability will conduct awareness raising campaigns in the schools and university campuses.    
  • Lack of skilled professionals:This is of immense concern as there are no training or academic programs available in Cambodia for professionals/ para-professionals working in disability sector. To overcome this challenge, Caritas-CCAMH team has established collaboration with reputed institutions in Egypt, India, Norway, Singapore, Sweden, Thailand and U.K. and the staff get exposure training in these institutions, as well as professionals visit Cambodia to give on the job coaching. Caritas-CCAMH team will commence accredited courses in collaboration with Association for Child and Adolescent Mental Health (ACAMH), UK during the Silver Jubilee year.  
  • Lukewarm response/ collaboration between government agencies:The disability issues are mainly the portfolio of Disability Action Council (DAC) and Ministry of Social, Veteran’s Affair and Youth (MoSAVY) and recently there is an effort to bring in other sectors by Disability Rights Initiative of Cambodia (DRIC) and Caritas-CCAMH took part in the National Strategy Planning Meet.
  • Financial sustainability is a crucial issue, as some of the partners from Europe are phasing out the funding-support after a decade and half, and as Cambodia is emerging as a low to middle-income country, it may receive less of external funding support. Caritas-CCAMH is considering a ‘charity-in-action’ policy though which the rich and middle class Cambodians contribute generously, so that 70% of the clients receive free service with the contribution of 30% of the clients seeking help at Caritas-CCAMH. Besides, it is foreseen that formalized training courses may bring both revenue and human resource.

Somealea: What do you foresee the role of the center in the next 10 years?
Dr. Bhoomi:
The role of the center in the next 10 years is to become a model center for training and research in the field of Child and Adolescent Mental Health, not only within Cambodia, but also in the Indo-china region, viz. CMLV (Cambodia, Myanmar, Laos PDR & Vietnam) countries. 

Somealea: What are the goals of the program over the next 10 years? And what is short-term plan or innovative programs in the coming years?
Dr. Bhoomi: Our goals are:
  • Strengthen the Cambodia Intellectual Disability and Autism Network (CIDAN) by establishing provincial/ regional network
  • Enhanced partnership with Disability Rights Initiative of Cambodia (DRIC) to demonstrate scalable evidenced based intervention
  • Top-up mental health component with the on-going prison health program and
  • Collaborating with Rehabilitation Council of India to start formal/ accredited courses in disability sector
Innovative programs in the coming years:
  • Introducing art therapy programs through collaboration with ‘Red Pencil’, Singapore
  • Parents as volunteers at Caritas-CCAMH (Caritas-SETI, Egypt model)
  • Cambodia Intellectual Disability and Autism Network (CIDAN) led remedial education or special education centers  
  • Scaling-up to institutionalize early identification and intervention program based on the current experience in the Lovea Em Health Operational District, Kandal province.

Somealea: The success of Caritas-CCAMH widely depends on the support and collaboration from donors and partners. Who are the donors and partners of the program? Do you have anything to say for them?
Dr. Bhoomi: Yes, indeed! This is a good question. But for the continuing support and collaboration with our partners, particularly the Caritas family in Europe, the center would not have sustained its steady growth all these years. First of all, our thanks and gratitude go to Dr. Marcel Charles Roy, who raised funds on his own to the tune of $50,000/- USD every year for the project. Our due thanks are to Ms. Maria Luisa Gerig from Switzerland who formed an informal ‘Friends of CCAMH’, group which not only the filled the gap when Dr. Marcel Charles Roy passed way in the year 1998, but continue to offer moral and financial support whenever in need, till this day. In the year 2000, when Mr. Maria Victor took over as the Director of Caritas Cambodia, the CCAMH community and School based inclusive development programs took-off, thanks our European partners, Caritas France, Germany and Spain that continues till today. Over the years, Ecumenical Scholarship program (ESP), Germany supported the capacity building program, which greatly increased the quality of services rendered at the center. The growing need of the children with developmental disabilities and our teams dedication and commitment resulted in the funding support from the India Brazil South Africa (IBSA) Trust Fund, a UNDP unit for south-south collaboration, resulting in a comprehensive one-stop service for children with developmental disabilities in the year 2013, the first ever IBSA support to Cambodia. As Cambodia is poised to get out of low-income status, the challenge of disability issues remains unaddressed. Mr. Kim Rattana, the current Executive Director of Caritas Cambodia plans to appeal to the growing middle and upper-middle class Cambodians seeking help at Caritas-CCAMH to contribute generously, echoing the Caritas principle of ‘Charity-in-Action’ and to create a sense of ownership and participation on the part of parent themselves.

Somealea: From your point of view, what is the biggest change of the program from the inception to the present?
Dr. Bhoomi: The biggest change of the program from the inception to the present is the development of infrastructure to meet the service needs of children with developmental disabilities and the recognition of Caritas-CCAMH by the Disability Action Council (DAC) and Ministry of Social, Veteran’s Affair and Youth (MoSAVY), international agencies such as UNDP & UNICEF and other line ministries and above all by families of children with disabilities themselves as not only a leading service provider but a human resource development organization.

Somealea: The Silver Jubilee Year of Caritas’ CCAMH is coming on January 2016: What does CCAMH plan to do to inaugurate the 25th year anniversary of the program?
Dr. Bhoomi: Caritas-CCAMH will organize series of events, seminars, meetings whole through the year 2016 to highlight the importance of Child and Adolescent Mental Health as a part of Silver Jubilee celebrations. On January 20th during the inaugural event, Caritas CCAMH has invited Dr. Bruno Falissard, President, International Association of Child Psychiatry and Allied Professions (IACAPAP) as guest speaker and senior mental health professionals from Sweden and U.K to highlight the need for Child and Adolescent Mental Health Services (CAMHS), the contribution of Caritas-CCAMH and way forward. We have invited HE Mr. Navin Srivastava, Ambassador, Indian Embassy to underscore the role played by institutions in India in capacity building and the need to continue this on a larger scale. We are also inviting the Dr. Chit Sophal, Director, Department of Mental Health and Substance Abuse (DMHSA) and other government officials to highlight the role played by Caritas-CCAMH in human development through Caritas-CCAMH.

Somealea: Any message?
Dr. Bhoomi: It is time that all the authorities, policy and decision makers of the Royal Government of Cambodia realize promotion of child and adolescent mental health as the key for economic development. The country is poised to become part of ASEAN Economic Community (AEC) and therefore the brain potential of young people of Cambodia needs to be enhanced to keep up the competitive edge among the emerging knowledge-economies.

Background of Caritas-CCAMH:Immediately, in the aftermath of war in the early 90s, many international NGOs, faith-based organizations and individuals (such as Bishop Kike and Marcel Charles Roy) worked in the refugee camps in Thai-border. Dr. Marcel Charles Roy, a good friend of Bishop Emile Destombes, the then Chairman of Caritas Cambodia and late Father King His Majesty Norodom Sihanouk, was deeply affected by the children affected by war and felt the need for mental health services for the children of Cambodia. Dr. Marcel Charles Roy, established the child mental health clinic in the year 1991 at Chey Chumneas Referral Hospital, Takhmau, renovated an old building and commenced the first ever held mental health training in Cambodia. The center was formally inaugurated by late Father King His Majesty Norodom Sihanouk on 17th January, 1995 and since then the center has grown to be a national level referral center, the only one of its kind in Cambodia. During the year 2000, the UN volunteers in Cambodia raised a modest sum to renovate an old building which was inaugurated by Lok Cumtheav Mme. Prime Minster Bun Rany Hun Sen. In the year 2002, a pharmacy, training hall and a family cottage were added with the support of friends of CCAMH in Switzerland. Since then the unit has transformed into a center for human resource development, aptly named as the Center for Child and Adolescent Mental Health (Caritas-CCAMH), thanks to the consistent support from Caritas partners from Europe, -mainly Caritas France, Caritas Germany and Caritas Spain. In recognition of the good services rendered by the team at Caritas-CCAMH, the India Brazil South Africa (IBSA) Trust Fund granted 1.2 million US dollars with which a comprehensive one-stop service for children with developmental disabilities has been established in the year 2013.
 
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About Dr. Bhoomi and his involvement with Caritas-CCAMH

Please briefly tell about yourself

The influence of my parents who were inspired by Gandhi and Vinoba (spiritual guru of Gandhi), early life in Bhoodhan (land-gift) movement, the education at Ramakrishan mission school, the books and people I come across have imbued me with the zeal to travel, engage in creative endeavors, giving unconditionally not expecting no returns, enacting without attachment on the ‘fruits of action’. Influenced by the writings of Carl Jung took to psychiatry after medicine but shifted to social pediatrics while working with NGOs implementing community health in India. The writings of Prof. David Morley took me to public health and working with school teachers on mental health issues got me interested in child psychiatry. Inspired by the lives of Albert Sweitzer, the Swiss physician who spent his life time in Africa providing health care and Dr. Kotnis, the surgeon from India who served in China, I had resolved not to practice medicine for private gains, neither work for governments nor apply for nay job. This resolve took me to many countries, resulting in lifelong learning, as after completing the diploma program in child and adolescent mental health in UK went on to complete the masters in public health and a doctoral program in psychiatry from Umea university in Sweden. The learning and sharing of medical knowledge with the disadvantaged communities continues to this day!

How did you first get involved to the program?

After completing the academic program in child and adolescent mental health at Maudsley hospital in London, UK I went to San Diego State University to audit courses at the department of public health and to work at the county health department in California, USA. On my return, I had called on my professor who mentioned about the assignment in Cambodia as a UN volunteer. In retrospect, I understand that Dr. Marcel Charles Roy the founder of CCAMH had requested through World Health Organization, who had in turn written to my Alma matter in UK. I took the offer from my mentor at Institute of Psychiatry, London, as I was deeply interested in working in diverse cultures. While at the medical school in Chennai I had seen the movie ‘Killing Fields’ couple of times and I was deeply affected by the suffering of Cambodian people and responded to the call. I had thought I will train a team in two years and get back to India, but my mission continues…

What has kept you at CCAMH for over 20 years?

The novelty, the challenge, my interest in sharing knowledge, organization/ institution building capacity, fund raising ability and above all the love for the children of Cambodia had kept me going all these years. Initially, thought of staying just for three years, but when there is civil-strife in the year 1997, many NGOs closed and professionals left the country. I thought it is unfair and cowardice to leave the country at the juncture. In the year 1998, Dr. Marcel Charles Roy the founder of CCAMH passed away and I felt obliged to stay on to make CCAMH a sustainable and viable institution. In the year 2000, Caritas-CCAMH was fully integrated with the systems and procedures of Caritas Cambodia and I was confident the public-private partnership between the Ministry of Health (MoH), Royal Government of Cambodia and Caritas Cambodia will continue for the benefit of children of Cambodia. In recognition of the good services rendered at Caritas-CCAMH and the service need, the India Brazil South Africa (IBSA) Trust Fund offered support for a period of 4 years (2010-13) to establish comprehensive services for children with special needs to the tune of 1.2 million US dollars. The Association of Asian Congress of Psychiatry honored CCAMH with the ‘Center of Excellence Award’ in recognition of the quality of service rendered. In summary, series of challenges, responses, commitments and rewards, particularly the thankful smile of the families seeking help at Caritas-CCAMH continue to inspire me to stay on in the mission.

Any comment?

It is important that the parents of children with disabilities themselves take an active role in management and running of Caritas-CCAMH (Caritas-SETI model), in order to make the center viable ad sustainable.

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One-stop service with specialized services for children with special needs established with the support IBSA Trust Fund, at Caritas-CCAMH, Chey Chumneas Hospital in Kandal province.
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