Paul Andrews is a Family and Systemic Psychotherapist who works in our Children’s Mental Health Services in Barrow and Kendal. But he recently left Lancashire behind on a working sabbatical that benefitted both himself and colleagues and families in Cambodia.
An estimated 2 million people were killed in the Cambodian Genocide between 1975 and 1979.
Under Pol Pot, the Khmer Rouge, a communist regime, committed untold atrocities we can only imagine. Whole families and an entire generation were wiped out, either dying of starvation or the subject of forced disappearances and extrajudicial killings, slaughter and torture.
Those horrors are a far cry from Paul’s work in South Cumbria working in our Children and Young People’s Mental Health Service. As a family and systemic psychotherapist he helps families and young people with mental health in supporting and repairing their strained relationships with each other. Recently Paul spent two weeks passing on knowledge to medical colleagues in Cambodia to help explore issues affected by their families’ history of generational trauma.
Paul explained:
“Growing up as a child I lived in Australia which was directly involved in the Vietnam War in the 1970s. As the war came to an end, the genocide in Cambodia began. Anyone with glasses, or seen as an intellectual, anyone from the government at the time, teachers, medics, were sent to the killing fields and assassinated. I recall many of these news stories coming out from Cambodia at the time. Many of my generation there are now missing and as a result their medical workforce have had to rebuild, like the rest of the country.”
After a chance encounter speaking to a couple of Cambodian doctors in an MDT (multi-disciplinary meeting) at a local hospice where Paul also works part-time in the Bereavement Team, he learnt about the organisation ‘Transform Healthcare Cambodia’ (THC). Travelling with them on ‘sabbatical’ has meant he could help enormously with understanding of generational trauma and the value of family therapy to try and heal past wounds that directly affect today’s generation of young people.
Paul explains:
“Trauma has an impact on anyone and everybody - it’s all about how you try to recover from the experience. I took unpaid leave to visit Cambodia and what I’ve been able to bring back to talk with colleagues about generational trauma, describing what that means for people, is invaluable. Generational trauma impacts people in the UK too - poverty, abuse, discrimination.”
In all of Cambodia there are only three child adolescent psychiatrists to serve a population of 16 million people. Paul’s work at Battambang Provincial Hospital was the first time THC had offered a family therapist to collaborate with Cambodian mental health professionals.
"In Battambang I met Child and Adolescent Psychiatrist Dr Sivleap. She was so enthusiastic to meet me and keen to discuss how to improve family involvement in her clinic.
We arrived in the capital, Phnom Penh, (Puh-nom-pen), I was welcomed into an independent children’s medical centre set up by an Indian Psychiatrist and delivered a presentation about my role as a family therapist in the UK. I felt very welcomed by the team who have been offering trauma based work which commenced shortly after the period of war and famine ceased in the early 90s. I learned much more from this team and offered my own experiences to them.
They were very interested in the whole process of involving the family in understanding a young person’s mental health, and to avoid locating the problem within the child. We discussed the stigma this can place upon the child and how to explore the family as more of a system. I felt my presentation helped support their approaches to family based interventions particularly around issues connected with generational trauma."
It’s the parents and grandparents of today’s generation that were impacted by the Cambodian genocide.
"In Battambang the hospital covers a rural locality as well as the urban population. Some of the overflow wards were located in outdoor temporary shelters within the hospital grounds. Often when children are admitted onto a paediatric ward they are often given a saline drip in order to legitimise their need for treatment, even for a mental health issue. There appears a pervasive fear and a stigma over mental health issues. Parents can be reluctant to refer their children for assessment or treatment.
I attended four family therapy clinics with Dr Sivleap. One family I met included a teenage girl experiencing severe anxiety, she was brought in by her father for an assessment. During the appointment he described his own childhood and explained that at nine-years-old he had been recruited by the Khmer Rouge as a boy soldier and given a gun to kill others including some members of his family. It was a challenging story to hear, he was concerned how his own history may have an effect on his daughter. We spent time to sensitively support them in managing this difficult narrative of generational trauma. His wife had both her parents killed by the regime."
After the session, Dr Sivleap described this as a familiar story told by parents today so her work will be ongoing. Breaking new ground but being culturally sensitive in this largely Buddhist country, Paul also delivered training to paediatric and physical health colleagues about the importance of understanding young people affected by mental health problems.
Paul added:
“As a white European male I was aware how I may be perceived so was mindful in how I positioned myself with Cambodian colleagues and families. My training and experience is to act with curiosity and openness whilst working collaboratively, critical in Cambodia. It was important from the start to ask what they would find helpful. I was able to support the authority of Dr Sivleap in helping break the stigma of mental health and to help build evidence for increased resources as part of the hospital’s commitment to working with children and families.
I’d always wanted to go to Cambodia, and the trip really has had a profound effect on me, I got so much out of it both personally and professionally and learnt so much to pass on about generational trauma. It was a huge lesson in how lucky we are and the importance of gratitude. I hope to visit again next year if funding allows.”
