Disabled people and their communities

a Participatory Rural Appraisal of Prohal, Chong Rok and O Thkov villages, Pursat Province

by

Disability Development Services Pursat (DDSP)

February - March 2003

by: Keo Sophat Steve Harknett Earng Oeurng Tan Tok

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Contents

Executive summary 2 1. Background 3 2. Methodology 5 3. Results:

Prohal village 10

Chong Rok village 15

O Thkov village 19

Summary of results 23 4. Conclusions: towards DDSP's strategy 26 Appendices

Appendix 1: Wealth ranking results 27

Appendix 2: PRA schedule 28

Appendix 3: Maps of Prohal, Chong Rok, O Thkov 29

Appendix 4: Venn diagrams, Prohal 32 Appendix 5: Daily activity chart, O Thkov 34

Cover photo: village mapping in O Thkov village being done by the Village Development Committee. Note: names of all disabled people mentioned in this report have been changed.

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Executive summary

Three participatory rural appraisal (PRA) exercises were carried out in the villages of Prohal, Chong Rok and O Thkov in Pursat Province. The PRA team included staff from Disability Development Services Pursat (DDSP), a new Cambodian NGO, and government social affairs and commune council staff. Through focus-group discussions, a total of 159 disabled people were identified in the three villages, giving an approximate disability prevalence rate of 3%. This figure is approximate as not all the reported cases were verified, and subsequent fieldwork revealed some false positives and false negatives. Disabled people's problems were classified in four groups: basic needs, rehabilitation, social problems and economic problems. Almost all disabled people were found to have a problem in at least one area. The commonest problems were social problems, including lack of vocational training/education, suffering from negative attitudes in the community and inadequate family or community support. About 75% of disabled people did not have their basic needs (eg. food security, access to clean drinking water, health and adequate shelter) met. Wealth ranking exercises confirmed that households with a disabled person were poorer than average households in the three villages. 65.8% of all villagers were ranked as being poor or very poor, but this percentage was 71.8% for households with a disabled person. The percentage was even higher for households with a disabled woman or a disabled child. However households with a mine-disabled person were almost of average level of poverty. A few disabled people were found to be accessing government and non-governmental services. Some disabled people had benefited from services such as vocational training, agricultural training, emergency relief or rehabilitation services. However most people had not received these services, either because of NGOs' limited capacity or because of disabled people's lack of knowledge or resources to enable them to reach the service. There were some areas in which services were not available at all in the village. These were: • home-based rehabilitation services. The only rehabilitation services are extension services from Battambang

which come to Pursat infrequently. They cannot cater for the needs of people with severe disabilities such as paraplegia, cerebral palsy, hemiplegia and mental handicap.

• psycho-social services for disabled people with psychological or behavioural problems such as low esteem or alcoholism.

• support to enable disabled children to go to school, including training and awareness-raising in schools. • support to enable disabled people to access health services, eg. for surgery, leprosy, tuberculosis, etc. Organisations and government departments responsible for service provision and development work in the villages were contacted, eg. in the areas of health, education, agriculture and income generation. Projects which were potential partners to DDSP were identified. The PRA exercises were a useful tool for DDSP and its government co-workers to get to know its future target area, and for the villagers to get to know DDSP. The data from the PRAs is being used to identify disabled people with whom DDSP will work, and to plan strategies and policies.

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1. Background

What is DDSP? Disability Development Services Pursat (DDSP) is a Cambodian NGO set up in January 2003, with the objectives to: • enable disabled people to access services to improve their quality of life • raise community awareness about disabled people • build community structures in social service provision to disabled people. DDSP works in collaboration with the Pursat Department of Social Affairs, Labour, Vocational Training and Youth (DoSALVY). In February 2003, DDSP staff and their government co-workers (at district and commune level) started thinking about the strategy DDSP would use to reach these three objectives. In the team, some people had knowledge about disability, some had knowledge about community development and some had knowledge about Pursat geography and history. The team realised that it needed to learn more in order to plan DDSP's activities. Rather than rushing into the communities and doing something which was not needed or prioritised by the community, or which was overlapping with another service-provider, we wanted to take time to get to know about the communities, and to allow time for the communities to get to know us. Why PRA? To learn about the communities, participatory rural appraisal (PRA) methods were chosen for a number of reasons: 1. they allow all community stakeholders, including disabled people themselves, to participate in the planning of

DDSP activities. Through this participation we hope that the final project design will reflect the true situation in the village, and that project activities address disabled people's problems in the most appropriate way.

2. through PRA, DDSP staff and community members could learn about the village situation together. The DDSP staff were seen more as equals in the learning process which builds trust and relationships between them and the villagers. Successful community development depends on building relationships between project staff and the communities they are serving. There must be trust and mutual understanding between the two sides. PRA methods involve external staff and villagers working closely together. The DDSP team could demonstrate that it valued the villagers' knowledge and opinions about the project design.

3. PRA methods give communities responsibility for the project. This is important as DDSP hopes that the communities will actively participate in project activities in the future. Each PRA exercise concluded with a village meeting in which DDSP presented a summary of the findings, and villagers were free to make suggestions about what they thought the problems of disabled people were and what DDSP should do to address them.

Objectives of the PRA The objectives of the PRA exercise were:

1. to identify all disabled people in the village and to find out about their situation and problems. We wanted to identify all disabled people, including women, children and people with severe disabilities who are sometimes 'invisible' in the community as they always stay at home. We wanted to meet disabled people who had problems and who could receive services from DDSP in future, and also disabled people who didn't have problems, who could maybe become resource people, eg. as trainers or volunteers.

2. to learn about the village and to meet the village authorities. To be accepted by the community, and to provide appropriate services, we wanted to know about the history of the village, the geography, the economy, the resources, the socio-economic problems and the service-providers (governmental and non-governmental) working there. We also wanted to get to know the local authorities and to start building relationships with them, as cooperation with the local authorities will help DDSP's activities in future.

3. for the villagers to meet DDSP staff. Villagers are sometimes cynical about 'outsiders' coming to their village, making promises and then disappearing without helping the village. So we wanted the villagers to start to get to know us, and explain that we were not 'development tourists' but that we would have a long-term commitment to the village.

4. for villagers to learn about the types of disability. It is important for the villagers to understand from the beginning what type of person we will be working with, as villagers sometimes only consider mine-disabled people as disabled and don't think about other types. We wanted to avoid confusion, for example some villagers though that we were healthworkers. One of DDSP's objectives is to raise the community's awareness about disability, and it was useful to begin the process of education about disability right from the start.

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5. for disabled people to express their needs. It was important to listen to all stakeholders' views in the target villages, but above all we wanted to give disabled people the opportunity to tell us about their lives and problems, and to give us their ideas about how DDSP should work in the village in future.

We made it quite clear that the objective of the PRA exercise was not:

• to tell the village what activities DDSP was going to do. We had no pre-designed action plan. We wanted the villagers to tell us what they thought we should do.

• to help disabled people. We made no promises and gave no advice to disabled people during the PRA. However problems and needs expressed by disabled people were noted and will be incorporated in our strategy, and individual cases will be followed up.

Where was the PRA done? The PRA exercise was carried out in DDSP's three target villages:

• Prohal Village, Ta Lou Commune, Bakan District • Chong Rok Village, Phteah Rung Commune, Phnom Kravanh District • O Thkov Village, Roleab Commune ,Sampov Meas District.

These villages were selected after discussion with DoSALVY authorities at provincial and district level, and with Commune Council staff at commune level. DDSP wanted to work in the villages with the highest number of disabled people and so villages affected by mines were selected. Both Prohal and Chong Rok villages are still being demined. They are newly-established villages with settler populations coming from other provinces. O Thkov has now been completely demined but it was a former battleground between the government forces and the Khmer Rouge and it has a large disabled population. Who did the PRA? The PRA team for each target village had six members. Four of these were DDSP staff – the Programme Manager, the Advisor and the two Social Workers. The other two team-members were a district-level DoSALVY Officer and the Commune Council 2nd Deputy, who holds responsibility in the commune for social affairs. In each village, the PRA exercise was supported by the village chief and the Village Development Committee, who provided logistical support.

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2. Methodology Ten tools and activities were selected which met the aims of our PRA exercise. These were as follows. 1. Interviews with key village leaders Objective: To get basic information about the village's socio-economic situation. Participants: The village chief and village development committee (VDC) members. Method: The key village leaders were interviewed with a semi-structured interview frame to get basic socio-economic information about the village, eg: Social:

• population: total population; male/female distribution; number of households and names of heads of households; ethnicity

• village leadership: composition of the VDC and its activities; relations with Commune Council • village organisation: self-help groups, community organisations, cooperatives, etc • service-providers: NGO and government services available in the village • education: primary schools in the village; secondary opportunities outside village • health: health centres, kruu khmers (traditional doctors) and traditional birth attendants (TBAs) available • religion: pagodas, mosques and churches; their role in the village.

Economic: • rice production: area of farmed land and type; use of inputs (tractors, draught animals, wells, pumps, rice

mills, etc) • other agricultural activities: other crops, animal-raising, fishing • forest use • business activity: market, shops, traders, crafts and vocational activities • moneylenders and credit organisations • village infrastructure – roads, bridges, wells, etc.

The village leaders were asked to highlight the main social and economic problems in the village. Results: The PRA team found this one of the most useful PRA methods during the survey for gaining an understanding of the village. However it was sometimes difficult to gather all the information because village authorities didn't have it. In O Thkov village for example, the village chief was not even able to provide a list of households in the village. 2. Story-telling Objective: To find out about the history of the village. Participants: a group of old people who had lived a long time in the village. Method: The PRA team discussed the history of the village with the old people, eg: when was the village founded? What was the village like before and after independence? What happened in the village during and after the war? How has the village changed over time? Results: In Prohal and Chong Rok, story-telling was not very useful because most of the villagers were new settlers and had little local knowledge of the village. 3. Transect walk Objective: To get to know the geography of the village and its features. Participants: three or four villagers, PRA team. Method: The villagers and PRA team walked around the village. The villagers pointed out features, such as water sources, farming area, wells, forest, houses of important people, service-providers, etc., while the PRA team ask questions. Results: This was a useful exercise for the PRA team to get to know the village. The first time the transect walk was done, in Prohal village, the PRA team did the transect walk on their motorbikes, because the village was so big. However this meant that they could not easily ask the villagers questions during the walk. After this the PRA team did transect walks on foot but divided into teams to cover the village more quickly. 4. Village mapping Objective: To get to know the geography of the village and its features. Participants: three or four villagers, DDSP team.

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Method: Villagers and DDSP team work together to draw a map of the village, showing rivers, roads, boundaries, ponds, forests, fields, landmarks, etc. Results: The mapping was found to be not very useful because it duplicated the transect walk activity. The PRA team found walking around the village much more useful than to have the villagers draw a map. Sometimes villagers did not have very clear knowledge about the whole of their village because the area covered was so large. The map-drawing group should have included villagers from all parts of the village. However, after the PRA, the maps have been more useful to DDSP staff, to help find their way to disabled people's homes. 5. Focus group discussion Objectives:

• To inform the villagers about the types of disability • To find out who the disabled people in the village are • To find out about the disabled people's situation.

Participants: key people in the village, eg. VDC, monk, kruu khmer, TBA, school headmaster. Method: 1. A DDSP social worker gave a presentation on the eight main types of disability: moving difficulty, seeing difficulty, hearing difficulty, speaking difficulty, learning difficulty, mental illness, feeling difficulty and multiple disability. The focus group was then asked to list all the disabled people in their village. 2. The focus group was asked open-ended questions about the activities of the disabled people in the village, eg. their work, their behaviour, their education, etc. Distinction was made between disabled men, women and children. 3. The focus group was asked if disabled people had any problems in the village, and if so what they were. The focus group was asked what kind of help disabled people needed and who provided it. Sources of help were drawn as a Venn diagram. A circle representing a disabled person was drawn in the centre of a flipchart paper and circles were drawn around it of varying sizes, with the most important sources of help drawn close to the disabled person and less important sources of support far from the disabled person. Results: The focus group discussions produced a list of all the disabled people the villagers knew about. Subsequent home follow-up is finding that there were some false positives and false negatives, but the exercise was still a useful tool to give DDSP a rough estimate of the prevalence of disability. The drawing of Venn diagrams was a lively activity which the villagers enjoyed and produced some interesting debates about what certain stakeholders do or should do about the problems faced by disabled people. The success of the focus-group discussions depended on the knowledge of the key informants invited. The focus-groups were least successful in Prohal and Chong Rok. In Chong Rok the village teacher came from another village and didn't know about the disabled children in Chong Rok. In Prohal the traditional birth attendant was old and didn't know much about disabled children (or perhaps concealed information, eg. about bad deliveries she had been involved in). In O Thkov, on the other hand, the traditional birth attendant was a young, dynamic woman who provided a large amount of information. Also the village teachers were younger, educated men who could supply accurate information on disabled children in their school. After learning lessons from the first focus group, different key informants were invited to subsequent focus groups, eg. village doctors and krom ('group', a small village administrative unit) leaders, who had more information about disabled people than some other key informants (such as kruu khmers and monks). 6. Wealth ranking exercise Objective: To find out who the poor households in the village are, and to find out about the economic situation of disabled people in the village. Participants: a group of around twenty villagers, including men and women. Method: 1. The names of heads of households are written on separate cards. Households with a disabled person are marked with a cross. 2. Four circles are drawn on a large sheet of paper on the floor, and labelled 'rich', 'medium', 'poor' and 'very poor'. The facilitator discusses with the group of villagers what the characteristics of each category are, eg. in terms of land, housing, animals, etc. 3. The facilitator holds up the cards one by one and asks the villagers which category they belong to. The card is placed in the appropriate circle. If there is disagreement, the facilitator places the card in the intersection between two circles. 4. The number of cards in each circle, and the number of households with disabled people in each category, are counted.

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Results: The wealth ranking exercises were generally successful. One problem was that the villages had a large number of households and so the exercises took a long time. Also the villagers doing the wealth ranking exercise sometimes didn't know some of the heads of the households. However, the end result of the wealth-ranking exercises, charts showing the wealth distribution of households with disabled people, were very informative. 7. Income and expenditure ranking Objective: To obtain information about income sources and expenditures of the villagers and their relative importance. Participants: a group of villagers, including both men and women. Method: The villagers were asked from what products they receive income from day to day throughout the year. After these were listed, the villagers were given a handful of ngiw (a type of seashell) and asked to rank the income sources according to their relative importance, giving many ngiw to the most important income source in the village and a few ngiw to the least important. The same procedure was repeated for the villagers' household expenditure. The types of household expenditure were first listed and then ranked using the ngiw to show how households spent most of their income. Results: This exercise was very lively and villagers enjoyed it. The results were good. One weakness of the methodology was having a mixed group of villagers. Women and men sometimes disagreed (eg. over the importance of expenditure on drinking and gambling!), so in future this exercise should be done in single sex groups. 8. Home interviews with disabled people and their families Objectives:

• To find out about the situation of disabled people and their families • For disabled people and their families to express their needs.

Participants: Disabled people and their families. Method: The PRA team interviewed disabled people and their families. A sample of disabled people was selected purposively so that men, women and children, and different disability groups, were represented. A semi-structured interview frame was used, to collect information in the following areas: 1. Basic data: the disabled person's name, age, sex, type of disability and cause, and household size 2. Basic needs problems in the household, ie. problems in the areas of health, hygiene, housing, food security, access to clean water, and possession of basic items (clothes, cooking utensils, blankets, mosquito nets etc). 3. Rehabilitation problems of the disabled person, ie. disabled people requiring prosthetics, orthotics, physiotherapy or physical exercises, mobility aids, mental development, self-help training, orthopaedic or other surgery, mobility and orientation training, communication development or mental health services. 4. Social problems in the household, ie. lack of education or vocational training, problems in going to school, low self-esteem, low community participation, behavioural problems such as alcoholism, family problems such as separation or child neglect, and poor relations between the disabled person and his/her community. 5. Economic problems. The PRA team considered the combined economic situation of the household, not just of the disabled person. This section covered the household's income generation resources such as land, labour, animals, access to farming inputs, transport, tools, etc. Problems related to debt were also noted 6. The disabled person's main problems in life, to understand disabled people's own perceptions of their priorities. 7. Special skills or special roles in the community that the disabled person might have. The PRA team recognised that as well as having problems, disabled people can also have resources or talents. 8. Services received by disabled people, eg. medical, rehabilitation, education, vocational, agricultural, community development, etc, both from governmental or non-governmental service-providers. Results: The semi-structured interview frame was the tool which was the most unfamiliar to the PRA team. The team initially felt uncomfortable with it because it did not give them a detailed list of precise questions to ask. Some PRA team members weren't used to being guided to making up their own questions. The advantage of the semi-structured interview is its flexibility and ability to capture the unique aspects of individual people's lives. With practice and training, the PRA team became better at using this tool. 9. Interviews with service-providers Objective: To find out what services are provided to the village. Participants: NGO and government workers, DDSP team. Method: Meet with community organisations and NGOs, plus government departments (Health, Agriculture, Women and Veterans, etc) at district level to find out what services they provide, what projects they run, what strategies they use, how often they visit the target village, etc. Semi-structured interview frames were used.

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Results: as above, some interviewers found the semi-structured interviews difficult, and so some information was not gathered. Another difficulty was making appointments with the various service-providers and the logistics of getting there when they were often far from the village where the PRA was taking place.

10. Daily activities Objective: To find out about the daily activities of the villagers, both men and women. Participants: Groups of villagers, both men and women. Method: Charts were drawn on two large sheets of paper on the floor, depicting hours of the day in the rainy season (June to December) and the dry season (January – May). The group of villagers drew pictures under each hour to describe what activity they did at that time. They were asked to differentiate between activities done by men, women, boys and girls. Results: The activity calendars gave the PRA team a good insight into the daily routine of villagers in the target villages. However the exercise was done with 'ordinary' villagers and not with disabled people or other vulnerable groups in the village. This was tried in O Thkov village but it failed due to the difficulty of logistics and poor cooperation from the village authorities. It would have been much more valuable if we had compared the activity calendars of 'ordinary' villagers with the activity calendars of vulnerable villagers. Children's participation in the exercise was low, and their ideas were expressed by adults, which was not what was desired. Training in using PRA methods A basic four-day training was given to the PRA team members, led by the DDSP Programme Manager and Advisor. The training covered:

• DDSP's mission, values and objectives • the main types of disability • the ten PRA methods used in this exercise.

The training included a half-day practical exercise in Roleab village, Roleab commune on wealth ranking and income/expenditure ranking. The four days were not sufficient to make the participants confident in PRA methods. PRA is a practical activity and competence can only come through field practice. Also, some PRA methods were very new for the participants, who found them hard to grasp, eg. the semi-structured interview frames. Evaluation of PRA methodology The PRA team evaluated the usefulness of the various methods employed in the PRA exercises, using a ranking method. The results were as follows. Most useful tools Average Least useful tools • Transect walk • Semi-structured interviews with

disabled people • Semi-structured interviews with

key village leaders • Semi-structured interviews with

service-providers • Presentation of results to village

• Wealth ranking • Expenditure/income ranking • Focus group

• Story-telling • Village mapping • Daily activity

Difficulties The PRA team met together and evaluated its progress periodically, to identify difficulties and to take steps to resolve them. The difficulties faced in doing the PRA exercise were as follows: 1. For most of the team, it was their first experience of PRA, and it took time for them to gain confidence in using

the methods. We noted an improvement in the team's performance from the first PRA exercise (in Prohal) to the third exercise (in O Thkov).

2. The PRA exercises were carried out a few months before Cambodian national elections, at a time when the

political atmosphere was highly charged. In Prohal village, the PRA took place the same week as the voter registration so cooperation from the village authorities was less because they were very busy. In Chong Rok

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village, the PRA team felt that the village chief was inviting only people of a certain political party to PRA exercises. Also in Chong Rok, the PRA team included a commune member who was very politically outspoken which led to some problems with the villagers. This member was warned about his behaviour while working with DDSP.

3. In Chong Rok, the participation of disabled people was low because many of them lived far from the centre of

the village or were busy on their farms. 4. All three villages are relatively new villages with new settlers coming from as far away as Takeo and Kampot.

Also, houses in Prohal village are scattered over a very wide area. This meant that villagers' knowledge about their own village or about other people living in the village was often low.

5. In O Thkov, one day's activities were disrupted by a village wedding in which the entire village leadership

participated. They were absent for the morning activities and a focus group in the afternoon was abandoned because the key informants were drunk! Also in O Thkov, there were no records of the village's inhabitants, which slowed down the wealth-ranking exercises as lists of the villagers had to be made first.

6. DDSP itself faced budget difficulties and the third PRA had to be postponed because of lack of funds. There

were also staffing problems and the third PRA was carried out with inadequate staff, so some activities, especially the interviews with disabled people (a labour intensive activity) were curtailed.

Wealth-ranking exercise: commune council and district DoSALVY staff put training into practice

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Results

1. Prohal village Geography and location Prohal village is 12 km west of Ta Lou commune in Bakan district. It is joined to the commune by a sandy, bumpy road which is almost impassable in the rainy season. Prohal is 50 km from Pursat town, a journey which takes about 1½ hours by motorbike. It is only 5 km from the border with Battambang province. The village covers a very large area, measuring about 7 km from east to west, but the population isn't very dense. There are 319 households and a total population of 1,845. Population is concentrated near the main road, the streams and the ponds. The area of Prohal includes forests, which contain animals such as deer and wild pig, and the Phnom Bak hills. There are four small streams and two ponds in the village but most of these dry up in the dry season. Water availability is therefore a problem in the village. A canal and dam built in the Pol Pot era provide some water but are in a poor state of repair. Many parts of the village are mined, including some areas near villagers' houses and farms. History The name of the village came from a beautiful girl called Mukria. When the villagers came to the village they saw a girl who was similar (prohail in Khmer) to Mukria and the name evolved to Prohal. The area where the village stands now used to be uninhabited forest, containing tiger, elephant and antelopes. A local legend recalls that a king called Preah Bat Chey Cheasda was travelling in the area one day, when he ran out of drinking water. He prayed that if a bird should cry that there was water nearby he would build a pagoda there. In the morning a bird cried and he asked his group to find the place. They found a pond and the king built a pagoda there. In 1992 pieces of stone were found from a 17th century pagoda, supporting this legend. Local elders said that Prohal village was established by around 50 families in around 1930. Their activities were farming, rice growing, hunting and gathering vines and resin. Another business was making coffins to sell to the Chinese. At this time Prohal was on the border with Thailand. However after 1940 there was a border change and the village was cut in two, with one side of the village becoming part of Thailand. By the early 1940s the population had grown to around 150 households. However the population dropped from 1943-6 during the war against the French colonialists, when some people left the village because of insecurity and others left to join the war. Villagers returned in after the war, but in 1952 there was another disaster. A great flood destroyed all the agricultural production. From 1952 until 1970 the population was again up to around 150 families. There was no school yet in the village, so people sent their children to study at the pagoda or in Ta Lou. At this time people began to use modern medicine, whereas before they has relied on traditional medicine. With the beginning of the Lon Nol regime in 1970 came the onset of war. Warring groups were particularly common in the area because of the hills and the forests. In 1972 Prohal came under the control of the Khmer Rouge and communication with areas under Lon Nol was cut. When Pol Pot came to power in 1975, most people in Prohal stayed in the village but new people arrived from the urban areas. People suffered torture and hunger, and many were killed as in the rest of the country. In 1979 the Vietnamese ousted Pol Pot and gained control Cambodia. Many people left Prohal because the Khmer Rouge and the Vietnamese were fighting for control of the land. At this time mines were planted by both sides. The village was almost deserted for 18 years. In 1997 about ten or twenty families returned to Prohal to reclaim their land, but they lived in fear of landmines and they had the added difficulty of clearing the forest which had grown during the years of the village's desertion, to plant rice. In 1998 more people came and they started to build a pagoda and school by themselves. By 2001 there were more than 300 families in Prohal. Some of these were people from different provinces who had never formerly owned the land. Development aid began to arrive in the village for infrastructure and livelihood security. The elders said that the roads in Prohal remain in poor condition. The schools are not enough for all the children and the health services are insufficient. There is a lack of clean water and food shortages are frequent. People are still living in danger of landmines. Economy The main economic activities in Prohal are rice-growing and animal-raising. The forests also play a large part in the village's economy, providing firewood, charcoal, vines and other non-forest timber products. The table below shows

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the relative importance of sources of income in Prohal, based on the income ranking exercises, with six ngiw being the most important sources of income and one ngiw being the least important. Household income: Prohal

****** **** *** ** * • Rice growing • Firewood, charcoal

and vines from the forest

• Animal raising

• Chamkar farming (eg. mango, banana, sugar-cane)

• Thatch from the forest

• Selling agricultural labour

• Cutting wood for housing

• Growing vegetables

• Ox-cart making • Non-forest timber

products

• Rice-milling • Producing sugar

from palm trees • Dog hunting for

forest animals • Gun or catapult

hunting for forest animals

• Fishing

The table below shows the pattern of household expenditure in Prohal, five ngiw being the most important type of expenditure, one ngiw being the least important. Villagers' main outlay is for food, which shows that people cannot produce adequate rice for their families on their own land. Healthcare is another large financial outlay for families. Families frequently sell land and/or animals in order to pay for healthcare, especially healthcare for disabled people. Household expenditure: Prohal

***** *** ** * • Rice • Food items

• Medicine • Weddings and Buddhist

festivals

• Clothes and toiletries • Renting ox, plough • School education

• Contributions to communal development projects

• Household goods • Agricultural tools • Animal health • Vegetable seeds and pesticides • Transport • Leisure • Cigarettes and betel nuts • Beer and soft drinks • Gambling

Local government As in most villages in Cambodia, Prohal has a village development committee. One of its roles is to co-ordinate village planning meetings, and submit village plans to the commune. The village chief participates in commune council meetings. In Prohal, both the village chief and his deputy are mine amputees. Service provision in Prohal Health services - Prohal has 1 private nurse, 3 kruu khmers (traditional healers) and 2 TBAs. The nearest government health centre is at Ta Lou, 10 km away on a bad road. Education - Prohal has 2 schools up to 6th grade, and some classes in the pagoda. One teacher estimated that 15 – 20% of primary-age children don't go to school. Ponloeu Komar, a Khmer NGO, works in the areas of child rights and child welfare. Agriculture - the government agriculture office doesn't work in Prohal. However Ponloeu Komar provides agricultural training and credit. Demining - Mines Advisory Group (MAG) are demining in Prohal and working in partnership with NGOs to develop the land after demining. Disabled people The focus group discussion identified 43 disabled people living in Prohal. The types of disabilities of these people were as follows:

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Total Seeing Hearing Speaking Moving Feeling Mental illness

Learning Others

Male 14 1 0 0 11 0 1 0 1 Female 6 0 0 0 5 0 0 0 1 Boy 15 6 3 0 3 0 0 2 1 Girl 8 1 2 0 4 0 1 0 0 Total 43 8 5 0 23 0 2 2 3 Out of these 43, 17 disabled people (including seven females and six children) were interviewed to assess their situation in depth using a semi-structured interview frame. The types of disability included post-polio paralysis, burns, cerebral palsy, amputation, visual impairment, clubfoot and mental handicap. 16 out of the 17 disabled people and their families interviewed in Prohal had a problem in at least one of the four areas: basic needs, rehabilitation, social and economic. The problems faced by the disabled people interviews are categorised and examples given in the table on the next page. Most common were social problems, including lack of vocational training, negative community attitudes, and lack of family or community support. Economic situation The wealth-ranking exercise in Prohal covered 311 households, including 30 households which had a disabled member. Villagers classified 69% of all households as poor or very poor, but 80% of the households with a disabled person were classified as poor or very poor. The chart below shows the distribution of different categories of 'disabled households'. Although the sample sizes are small and it is not possible to draw firm statistical conclusions, they suggest that families with a disabled child are slightly more likely to be poorer than households with disabled adults. Households with a mine-disabled person were almost the same as households with no disabled person.

Wealth ranking distribution in Prohal

31 20 20 17 30

69 80 80 83 70

0

20

40

60

80

100

All villa

gers

All disa

bled p

eople

Disable

d wom

en

Disable

d child

ren

Mine-dis

abled

% of

hous

ehold

s

Poor or v ery poor

Well off or av erage

Sample sizes All households: 311 Households with: • a disabled person: 30 • a disabled woman: 5 • a disabled child: 12 • a mine-disabled person: 10

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Situation analysis of disabled people in Prohal (sample – 17 disabled people and their households) Problems under each category are ranked starting with the most frequently stated problem. Basic needs situation Rehabilitation Social problems Economic problems 13 households did not have all their basic needs met. Basic needs problems were: 1. food security. Most

households suffered rice shortages during the year, some for a few months a year but some all year-round. When they lack food, families collect firewood or thatch from the forest to sell to buy rice.

2. access to safe drinking water. Most households' main water source is streams and around half the households did not regularly boil water for drinking. Another problem was the distance from the house to the water source (up to 1 km).

3. health and nutrition. Family members having chronic or recurrent health problems and/or nutrition. Two households had a disabled child who was under-nourished and anaemic.

4. housing, ie. house too small for the number of occupants or in a poor condition. One family were living in a house with a roof but without any walls.

5. lack of basic possessions, eg. clothing, cooking pots, blankets and mosquito nets. One family had only one set of clothes each so they couldn't wash their clothes very often.

11 disabled people had a rehabilitation problem: 1. physical exercise

and/or physiotherapy: for weak muscles or paralysis

2. visual impairment interventions: vitamin A, glasses and mobility and orientation training

3. surgery: for clubfoot, eye surgery or plastic surgery for facial burns

4. orthotic device: for a leg paralysed by polio

5. prosthetic arm 6. medical care for a

chronic health problem

7. mental health intervention: for very low self-esteem and possible depression.

16 households had a social problem. These were categorised as follows: 1. lack of vocational training/skills

to enable the disabled person or his family members to earn a living

2. psychosocial or behavioural problems. Many disabled people lacked self-esteem or confidence, or felt they had no hope in their lives. One disabled man drank too much alcohol and didn't care for his wife and children. A disabled child was afraid to go to school because the teacher punished him for failing to learn.

3. negative community attitudes. Disabled people said they were looked down upon by people in their village. Eg. a child with learning difficulty was called 'mad' by other children and he was not encouraged to learn by his parents or his teacher. A person with chronic illness was unable to leave the house and was socially very withdrawn.

4. lack of family support, either material or emotional. Eg. a disabled woman's husband left her a year ago and provided no support to her. The mother of a girl with clubfoot had died, and she stayed with her father who looked down on her and never sent her to school.

5. lack of community support. Eg. a very poor older disabled person and his wife were not receiving any rice from the pagoda, which customarily supports old people. Two disabled children had faced mockery from children at school and punishment from their teacher for failing to learn.

11 households had economic problems. These problems were: 1. no income generation or

irregular income. Many families relied on collecting non-forest timber forests such as thatch and firewood. A disabled woman had a hairdressing business but the income was irregular and sometimes was not enough for her needs.

2. inadequate land and/or low agricultural production, due to a lack of draught animals, lack of water or poor farming methods, eg. no fertilisers

3. debt. Eg. one disabled man had sold his pension, worth 2.5 million riel, for 900,000 riel because his child was sick. He was now 1.2 million riel in debt.

14

Case study from Prohal: Nhip Ly Nhip Ly is a 19 year-old woman who lives with her elderly mother. When she was a young child the family's house burned down and her father was killed. Ly was left with severe burns to her face and arms. Her facial disfigurement does not lead to any physical difficulty like seeing or speaking, but it has led to her having very low self-esteem and depression. The family is also very poor since there are just two people in the house and the mother is too old to work. Ly herself had the idea to start a shop in her house to generate income. However she feels that if she did, no customers would come because they don’t like to look at her face. Recently Ly's mother went to Pursat for Khmer New Year and bought some new clothes. However she bought nothing for Ly, which led to her feeling even more sad. Support for disabled people Venn diagrams were drawn by villagers to show the village's sources of support for disabled people. The results are given in Appendix 4. The main sources of support for a disabled person is his/her family and neighbours, followed by village health services and village leadership. The village chief can mobilise villagers to help a disabled person in case of a disaster such as a death in the family or a house fire. Other less important sources of support are the pagoda, government social services, the Cambodian Red Cross and disability NGOs. Pagoda monks and elders give spiritual and moral advice to disabled people, and also sometimes give food, especially to older people. The Cambodia Red Cross intervenes in times of crisis such as famine or flood. Government social services act mostly as a conduit for international NGOs, eg. helping the International Red Cross to provide rehabilitation aids. Out of the seventeen disabled people interviewed, six had never received any services related to their disability or socio-economic situation. For the others, the services received were: • emergency relief – Cambodia Red Cross • health care – Ta Lou health centre, Boeung Khna Hospital (Bakan), Maung Russey Hospital (Battambang) and

an Asian Eye Care clinic (Pursat) • physical rehabilitation – rehabilitation centres in Pursat (now closed), and Battambang • vocational training – CWARS training centre in Pursat (hairdressing) • economic support – vegetable growing, buffalo loan and tool provision (Ponloeu Komar) • government pension (for army veterans).

A young man in Prohal with upper-limb amputation and eye injury caused by a landmine accident, being interviewed by DDSP social worker

15

2. Chong Rok village

Geography and location Chong Rok is 37 km from Pursat and 4 km from the commune town of Phteah Rung in the district of Phnom Kravanh. The village measures about 4½ km by 3 km. Like Prohal, it is situated at the foot of the Phnom Bak hills, which are heavily forested. The soil is more fertile than Prohal and crops such as groundnuts are grown. There are no laterite roads. Most roads in the village are in the poor condition although the main road to Phteah Rung is OK and can be used at all seasons. Many parts of the village are mined, including some areas near villagers' houses and farms. One pagoda is mined and said to be haunted. There are no streams but two ponds. The same dam and canal as in Prohal provides water to the village although one part of the canal is unfinished. There is no flooding in the village. Population Chong Rok has a population of 1484 people (782 females), in 304 families. 697 people are under 18 years of age, of whom 375 are girls. There are 298 houses and 18 krom (groups). History The name Chong Rok means 'rice store'. Another name for the village is Srah Rumdeing ('spice pond') because of the spice, which grows in the pond of the old pagoda. Before 1948 Chong Rok was covered by forest, and wild animals such as tiger and elephant lived here. In 1948 there were about 100 families in the village, living by rice-growing, farming, hunting and collecting resin from the forest. The people built a pagoda at this time. During the 1950s and 1960s people began to access other villages and markets to sell their products. By 1962 there were 200 families in Chong Rok. People started to clear the forest to sell the timber and to make rice field. As the forest was cleared, the soil in the village became less fertile. The history of Chong Rok from 1970 is the same as Prohal. The population of the village fell during the 1970s and 1980s because of starvation, killings and people fleeing the war. By 1994, the population of Chong Rok had fallen to around 40 families because of insecurity and the presence of landmines. In the late 1990s people began to return and claim their own land as well as land that didn’t belong to them. There was no official demining programme so people demined the land by themselves. They also built a school by themselves and volunteer teachers taught the pupils. In 1998 a pagoda was built. By 1998 the population had increased to 200 families. The population is now more than 300 families, with some people arriving from different provinces because Chong Rok has free land. Economy As in Prohal, agriculture dominates the economy in Chong Rok. However in contrast to Prohal, the dominant farming activity is not rice-growing but chamkar agriculture. The table below shows how Chong Rok villagers ranked their sources of income, from the most important (five ngiw) to the least important (one ngiw). Household income: Chong Rok

****** ***** **** ** * • Chamkar farming

(eg. sugar-cane, groundnuts, beans, fruit)

• Rice-growing

• Selling agricultural labour

• Animal raising • Vegetable

growing • Selling wood for

house-building, fencing, charcoal

• Cutting firewood • Selling thatch • Buying animals to sell • Renting speakers,

cooking food for ceremonies

• Charcoal selling • Motorbike taxi • Brewing alcohol • Selling cakes • House-building • Fishing • Selling traditional

medicine • Battery charging

16

The table below shows household expenditure in Chong Rok. As in Prohal, villagers' main expenditure is on food, again showing that people are not self-sufficient in growing rice and other foodstuffs. Household expenditure: Chong Rok

******** **** *** ** * • Buying rice and

other food materials

• Health-care • Buy fertiliser, pesticide

• Weddings and festivals

• Clothes • Children's

education • Agricultural tools • Entertainment

• Lighting oil • Alcohol, cigarettes

and soft drinks • Seeds • Plough • Kitchen tools • Toiletries,

women's beauty Service provision in Chong Rok Health: there are three private health-workers in the village, three kruu khmers and five TBAs. The nearest government health centre is at Tasas, 7 km from Chong Rok. Education: There is a primary school with three classes and two teachers. However the teachers don't live in the village. After 3rd grade, children have to go to Thlok Daunkau, 4 km away to complete their primary education. The nearest high school is at Bak Chenhchien, 12 km away, so few students from Chong Rok make it to high school. A local NGO Anakut Komar works in Chong Rok, supporting school-building and working in child rights and child health and welfare. Anakut Komar also provides vocational training in Phnom Kravanh district. Agriculture: the government department of agriculture provides training and materials to families for animal raising. Anakut Komar also provides agricultural training in Chong Rok. Disabled people The focus group meeting in Chong Rok identified 41 disabled people. This represents about 2.8% of the village's population. The disabilities of these 41 people were as follows: Total Seeing Hearing Speaking Moving Feeling Mental

illness Learning Others

Male 23 0 1 0 13 1 1 0 7 Female 9 1 0 0 4 0 2 0 2 Boy 6 0 0 1 2 0 0 1 2 Girl 3 0 0 0 0 0 0 1 2 Total 41 1 1 1 19 1 3 2 13 Out of the 41 disabled people, twelve were interviewed, including two women and five children. Their disabilities included post-polio paralysis, burns, leprosy, amputation, mental handicap, fracture and shrapnel wounds. All of the twelve disabled people and their families interviewed had a problem in at least one of the four areas of basic needs, rehabilitation, social situation and economic situation. As in Prohal, the commonest type of problem was social problems. Examples of problems faced by disabled people in Chong Rok are given in the table on page 18. Distribution of disabled people in Chong Rok according to wealth ranking The village wealth-ranking exercise showed the wealth distribution of 323 households, including 41 households with a disabled person. 76% of disabled people were found to be in poor or very poor households, compared to 68% of villagers in general. The chart below suggests that households with a disabled woman or a disabled child are more likely to be poorer than the average household in Chong Rok. Households with a mine-disabled person were almost the same as households with no disabled person.

17

Case study from Chong Rok: Ing Pisith Pisith is an eight year-old boy with mentally handicap. His speech and walking are like a much younger child and he often falls over. His mother said that he has poor eyesight and poor coordination. Pisith's fine motor skills (for example holding a pen) are clumsy. His mother said that he could hear but he would not reply and seemed to be 'in a world of his own'. Pisith also has behavioural problems. He would often cry or laugh incessantly for no apparent reason, and he had an obsession with knives. He is not able to play normally with other children – he would fight with them or threaten them with a knife. He has a short attention span and cannot concentrate on one activity for long. Because of his behavioural problems he needs close supervision from his mother. Pisith's disabilities came from birth (maybe complications at delivery) and also a severe fever when he was young. His family sought medical treatment from the local health centre to try to cure his disability. They sold a cow to pay for this treatment. The treatment did not help much although the mother said his eyesight improved. Pisith has never been to school because of his mental handicap and behavioural problems. Other children with learning difficulties in the local school were reportedly beaten by teachers if they didn't learn.

Wealth ranking distribution in Chong Rok

34 24 10 1333

66 7690 87

67

0

20

40

60

80

100

Allvillagers

Alldisabledpeople

Disabledwomen

Disabledchildren

Mine-disabled

%ag

e of h

ouse

holds

Poor or very poorWell off or average

Sample sizes All households: 323 Households with: • a disabled person: 41 • a disabled woman: 10 • a disabled child: 8 • a mine-disabled person: 12

18

Situation analysis of disabled people in Chong Rok (sample – 12 disabled people and their families) Problems under each category are ranked starting with the most frequently stated problem.

Basic needs problems Rehabilitation problems Social problems Economic problems 9 households did not have their basic needs met. Problems were:

1. serious or recurrent health problems in the family, including tuberculosis, fever or ill health due to shrapnel wounds.

2. lack of food security, ie. rice shortages during at least part of the year. Two families reported year-long lack of rice.

3. poor housing: house in poor condition or of inadequate size for the family

4. lack of basic possessions such as adequate clothes, mosquito nets, cooking pots and blankets

5. lack of clean water.

9 disabled people had a rehabilitation problem. These were:

1. play/stimulation for mental development

2. speech therapy 3. medical treatment,

eg. for chronic disease or wounds

4. physiotherapy 5. prosthesis or crutch 6. protective

shoes/gloves for a man with wounds caused by leprosy

10 households had a social problem. These were:

1. lack of vocational training or skills

2. psychosocial or behavioural problems. Eg. a disabled man was an alcoholic and beat his wife. An amputee didn't participate in village festivals, weddings, etc, maybe because of low self-esteem or because of poor relations with other villagers.

3. negative community attitudes. Eg. a man with wounds caused by leprosy said that villagers were afraid of him because of his appearance and they were afraid they would catch it from him. Because of this, he preferred to live far away from other villagers (although his family were very supportive and allowed him to stay with them).

5 families had economic problems. These were:

1. no income generation or irregular income. Most families had no sources of income other than agriculture. Army veterans receive a monthly pension, but one veteran was forced to sell it for three years to pay for healthcare.

2. inadequate land and/or low agricultural production. Eg. the family of a girl with facial burns sold all their farmland and cows to pay for healthcare for her and other family members.

3. debt: usually incurred to pay for healthcare for family members.

4. unsuitable income generation. The man with leprosy-related disabilities was involved in clearing the forest to make farmland, which gave him very bad wounds. Moreover this activity was damaging to the environment.

19

3. O Thkov village Geography and location O Thkov is in Roleab commune, Sampov Meas district, Pursat province, and situated about 7 km from Pursat town. It is a long, narrow village, stretching 7 km from one end to another, nut only about 1 km wide. Population O Thkov village has a population of 2,005. There are 390 families. The whole population of the village is of Khmer nationality, although there is a large Muslim community in the neighbouring commune of Roleab. History O Thkov is a relatively new village which used to be part of Roleab village until it was created as a separate village in 1995. The area now occupied by O Thkov village used to be covered by forests and contained many wild animals. Few people lived there although some people went there to hunt antelope, wild rabbits and wild pigs. From 1979 – 1984 people were afraid to go there because of the Khmer Rouge. As security improved, especially since 1990, people started moving into the area and clearing the forest. The first pagoda in the village was established in 2000 and the first school in 2001. In contrast to Prohal and Chong Rok villages, O Thkov was never mined. Economy The main economic activity in the village is rice farming. There are 10 rice mills in the village. The income ranking exercise showed the importance of agriculture and also the forests to the economy of the village. In the table below, five ngiw represents households' most important sources of income and one ngiw represents the least important. Household income: O Thkov

***** **** *** ** * • Collecting firewood

and wood for fencing

• Growing vegetables

• Growing rice

• Selling labour for agriculture

• Collecting non-forest timber products (eg. mushrooms, bamboo, leaves)

• Raising animals • Rice milling

machines

• Collecting thatch • Selling labour for

cutting forest • Home grocery

shops • Buying and selling

vegetables • Selling labour

outside the village (eg. at Poi Pet)

• Motorbike taxi • Making charcoal • Breaking stones • Brewing beer • Carpentry (making

windows, doors, ox-carts)

The expenditure ranking found that by far the most important type of household expenditure was on food. Villagers showed how important it is by ranking it with six ngiw while other important types of expenditure, such as health care and school fees, only scored three ngiw. The table below shows how villagers ranked their types of expenditure (six ngiw being the most important types and one ngiw being the least important). Household expenditure: O Thkov

****** *** ** * • Buy food • Health care

• Buy fertiliser, seeds and animals (eg. piglets, chicks)

• School fees and materials for children

• Agricultural tools • Contributions to weddings

and Buddhist festivals

• Clothes • Tobacco and alcohol • Entertainment, visiting

other people/places • Household materials • Paying interest on loans

• Agricultural labour • Contribution to communal

development projects (eg. road-building)

• Women's beauty • House repair • Animal health • Gambling

20

Local government O Thkov has a VDC but it only has two functioning members. The VDC members participate every three months in the Commune Council's planning meetings. Service provision in O Thkov O Thkov is relatively close to Pursat town, so it is relatively well serviced by government and non-government service-providers. Health: There is a private doctor in O Thkov, whose services are probably not available to the poor because of the high cost. There are also 5 kruu khmer and 4 TBAs in the village. The nearest government health centre is in Pursat Town about 10 km away. The village chief cited the great distance to health facilities as being one of the village's greatest problems. Health NGOs working in O Thkov include TPO (mental health) and Cambodian Health and Human Rights Alliance (health and human rights education). Education: O Thkov has two primary schools offering education up to 6th grade. About 897 children in total are enrolled in the two schools. After 6th grade, children can go to Prey Sday secondary school, 6 km away. Agriculture: a co-operative association has been set up by Oxfam Quebec which lends money for pig-raising and crop-growing, and provides agricultural training. A philanthropic barang (Westerner) called 'Robin' bought land in O Thkov for 74 poor families to settle on. Credit: the government Women's Department runs a credit programme in O Thkov. Some villagers have also accessed credit from private credit operators (ACLEDA, Seilanithih), but they have a bad reputation with some villagers because of their high interest and confiscation of property of loan defaulters. Disabled people in O Thkov 75 disabled people were identified by the focus-group discussion. Their disabilities were as follows: Total Seeing Hearing Speaking Moving Feeling Mental

illness Learning Fits Others

Male 33 9 4 2 11 2 1 4 Female 22 4 3 1 9 3 2 Boy 14 1 2 3 5 1 1 1 Girl 6 1 3 1 1 Total 75 15 12 6 26 5 3 1 1 6 Out of these 75 disabled people, 8 were interviewed. They included two amputees (one of them a double amputee), two paraplegics (one with additional mental handicap), one child with cerebral palsy, one child with visual impairment and two people with upper limb paralysis. All eight had problems in at least one of the four areas of basic needs, rehabilitation, social and economic. The table on page 22 gives more details of these problems. Economic situation of disabled people A wealth ranking was carried out for 108 households in three krom. These households included 46 with a disabled person. This very high figure probably included people with mild impairments and chronic diseases. The wealth ranking classified 54% of all households as poor or very poor. However the percentage of households with a disabled person which were poor or very poor was higher (63%). The percentage of households with a disabled woman or child, which were poor or very poor, was even higher (67% for disabled women, 64% for disabled children). However care must be taken with these statistics because the sample sizes are small. The table below shows the percentages of households ranked according to the four wealth categories. Distribution of disabled people in O Thkov according to wealth ranking Well off Average Poor Very poor Total All villagers 18 (17%) 31 (29%) 38 (35%) 21 (19%) 108 (100%) All disabled people 5 (11%) 12 (26%) 19 (41%) 10 (22%) 46 (100%) Disabled women 0.5 (4%) 3.5 (29%) 7.5 (63%) 0.5 (4%) 12 (100%) Disabled children 1.5 (11%) 3.5 (25%) 3 (21%) 6 (43%) 14 (100%)

21

Support for disabled people Venn diagrams were drawn by villagers to show the village's sources of support for disabled people. The results were similar to the results in Prohal, with the family, neighbours and village leadership being the most important sources of support for disabled people. The monks and achars from the pagoda were judged to be a more important source of support for disabled people than in Prohal, perhaps because O Thkov has more pagodas. The Venn diagrams for O Thkov are shown in Appendix 4. Out of eight disabled people interviewed, six had received services from various service-providers. These were: • health-care - the commune health centre and the Russian Hospital in Phnom Penh • physical rehabilitation (wheelchairs) – from rehabilitation centres in Pursat (now closed) and Battambang • economic support - Church World Service (providing cows to self-help groups). Case study from O Thkov: Chuon Chun Chuon Chun is a 35 year-old woman whose legs are both paralysed. She also has a mental handicap. She lives with her old parents, but they are both old and her mother has mental health problems and is an alcoholic. When she is drunk she becomes drunk and has been known to beat her husband. Chun also has a younger sister whose husband is also an alcoholic. He does not work because of numbness in his legs, which the family attribute to his alcoholism. Chun has been disabled since childhood and she has never been taught self-help skills, so she does not help in the house with the cooking, washing, etc, although she has quite strong arms and fairly good co-ordination. Her communication is poor and she talks like a young girl. Chun has an old wheelchair which is completely broken. The father is the main income earner in the household. He gathers and sells thatch from the forest but this gives a very small income. Chun begs by the side the road, and since this is a main road it gives quite a good income. However it exposes her to the sun and the dust all day and is not good for her health. The family is not respected in the village because they make little contribution to village life.

Wealth ranking distribution in O Thkov

46 37 33 36

54 63 67 64

0

20

40

60

80

100

Allv illagers

Alldisabledpeople

Disabledwomen

Disabledchildren

%ag

e og h

ouse

holds

Poor or v ery poor

Well off or av erage

Sample sizes All households: 108 Households with: • a disabled person: 46 • a disabled woman: 12 • a disabled child: 14

Boy with cerebral palsy in OThkov meets DDSP staff

22

Situation analysis of disabled people in O Thkov (sample – 8 disabled people and their families) Problems under each category are ranked starting with the most frequently stated problem. Basic needs problems Rehabilitation problems Social problems Economic problems 6 households did not have their basic needs met. Problems were: • food shortages at

certain times of the year

• house too small, or in poor condition

• lack of adequate clothing

• chronic health problems

• lack of access to safe drinking water

• lack of land (the disabled person was living on public land).

All 8 of the disabled people had a rehabilitation problem. These were: • broken wheelchairs • need for

physiotherapy/physical exercises

• broken prosthetic • treatment for an eye

problem • mental development.

7 households had a social problem. These were: • lack of vocational skills • lack of social participation

because of broken wheelchair

• poor family care and non-attendance at school

• low confidence, and additional burden of a child with mental handicap

• unhappiness, bad relations with other villagers and low position in the village (a beggar)

• a disabled child neglected by stepmother.

7 families had economic problems. These were: • Inadequate or lack of

land for farming • Lack of draught animals,

pigs, chickens, etc • Environmentally

damaging economic activity – forest clearing

• Income generating activity which did not give regular income.

23

Summary of results Disabled people in the three villages Focus groups held in the three villages identified a total of 159 disabled people. Information about these people's type of disability was not completely accurate because of participants' lack of knowledge about disability. Subsequent fieldwork has shown that some of these people are not disabled and has found other disabled people not identified by the focus groups. Another problem with the focus group discussions was that disabled people were only classified according to their most obvious disability, and some people have two or more types of disability. Despite these problems, the information gives a rough picture of the prevalence of different types of disability. The commonest type of disability was moving difficulties. See the bar chart below.

A total of 26 (16%) of the 159 disabled people identified had mine-related disabilities (amputations, eye injuries and shrapnel wounds). However in Chong Rok and Prohal, which are more mine-affected than O Thkov, about a quarter of disabled people were mine-disabled. O Thkov also had the lowest percentage of people with moving difficulties because of the lower number of mine-related disabilities.

Types of disability of 159 disabled people in 3 villages

68

24 2218

8 7 6 51

0

10

20

30

40

50

60

70

80

Moving

Seeing

Others

Hearin

g

Mental

illne

ss

Speak

ing

Feelin

g

Learn

ing Fits

Type of disability

No.

of p

eopl

e

Gender/age breakdow n of 159 disabled people in 3 villages

44%

23%

22%

11%

MaleFemaleBoyGirl

The greatest proportion (44%) of the disabled people identified were adult men. A total of 33% of those identified were children. See the pie chart on the left.

24

Disabled people's problems 37 disabled people from the three villages were interviewed in depth and 36 of these were found to have a problem in the areas of basic needs, rehabilitation, social situation or economic situation. The graph below shows that the commonest problems faced by disabled people are social problems. These problems included lack of skills or education for employment, low self-esteem or behavioural problems, negative attitudes in the community, and inadequate family or community support. A surprisingly high number of disabled people did not have their basic needs met. Basic needs includes year-round food security, regular access to clean drinking water, good health, adequate housing and adequate household possessions such as clothing, blankets, mosquito nets, etc.

Wealth ranking The wealth ranking for each of the three villages showed that households with a disabled person are likely to be poorer than households without a disabled person. This supports the idea that disability is both a cause and an effect of poverty. Disability can be the cause of poverty, for example it can prevent a person working productively. Disability can also be the effect of poverty; for example people who cannot afford health care may suffer health problems which lead to disability. The graph below is a composite of the data of the three villages, based on a wealth ranking of 488 households of which 84 were households with disabled people. The graph gives some evidence (although sample sizes are small) to suggest that households with a disabled child or a disabled woman are the most likely of all to be poor. This could be because disabled women have less income generating possibilities than men. They also often find it difficult to find a husband and therefore have children, and children provide labour and can earn income for the family. Also, many disabled men (ex-soldiers) receive government pensions but disabled women who were almost all civilians during the war do not. Households with disabled children may be poorer than average because of the great sums of money many families pay to try to treat their disabled child. The PRA exercise found several cases of families who had sold animals or land in order to pay for their child's treatment. Also, severely disabled children take up time for care, and mothers (who are usually the child's primary carer) have less time for income generating activities. The greater likelihood of households with a disabled child to be among the poor could also be because these families were too poor to provide the medical care to prevent the onset of the disability in the first place. People disabled by landmines were found to be almost at the same level of poverty as non-disabled households. This could be because most mine-disabled people are single amputees, which may not be a severe handicap to employment and work as some other disabilities. Moreover most mine-disabled people are men, who may have opportunities to work. Also many mine-disabled people are ex-soldiers who receive pensions or other financial support from the government or NGOs.

Problems faced by a sample of 37 disabled people

28 28

33

23

0

5

10

15

20

25

30

35

Basic needsproblems

Rehabilitationproblems

Social problems Economicproblems

Problem

No. o

f disa

bled

peo

ple

25

Support for disabled people The primary source of support for disabled people is the family, relatives and close neighbours. Outside of the family, the VDC, the pagoda and the Cambodian Red Cross can help in times of crisis. For rehabilitation, there is a lack of services in the target villages. The rehabilitation centre in Pursat town closed down in 2001. Now the only services for prosthetics, orthopaedic surgery, etc are in Battambang, which disabled people can travel to if they have the time and the money. Fieldworkers from the Battambang rehabilitation centre come to communes near the three target villages maybe once a year to repair prosthetics and orthotics, and distribute wheelchairs and crutches. Gaps in the services available in the three villages were: 1. community-based rehabilitation services, especially for people with severe disabilities like paraplegia, cerebral

palsy and hemiplegia. 2. psycho-social services for disabled people with psychological or behavioural problems such as low esteem or

alcoholism. 3. support to enable disabled children to go to school, including training and awareness-raising in schools. 4. support to enable disabled people to access health services, eg. for surgery, leprosy, tuberculosis, etc.

Sample sizes: • Total households - 488 Households with a: • disabled person - 84 • disabled woman - 21 • disabled child - 26 • mine-disabled person *- 15 * no data for O Thkov

Wealth distribution of disabled people in three villages

34.2% 28.2% 22.2% 23.5% 31.8%

65.8% 71.8% 77.8% 76.4% 68.2%

0%

20%

40%

60%

80%

100%

Allvillagers

Alldisabledpeople

Disabledwomen

Disabledchildren

Mine-disabled

poor+very poor

welloff+average

Expenditure-ranking exercise in O Thkov

26

4. Conclusions: towards DDSP's strategy Priorities for action The PRA helped the DDSP team and its government co-workers to identify priorities for action. These priorities are being formulated into a strategy. Policies and approaches used to address these priorities are being developed using information gathered from other service-providers and development actors during the PRA. This will ensure that DDSP's strategy is coherent with other development initiatives taking place in the province. Basic needs - many disabled people, in common with other very poor people, need help to obtain the basic materials for a minimum quality of life, such as adequate housing, adequate rice, clothing, cooking utensils, water jars, blankets and mats. Many disabled people also need help to access government health services, which they don’t use because of the distance. They often use private health staff in their villages, who are expensive and have little medical knowledge. Disabled people sell animals and land to benefit from the questionable service of such village 'doctors'. Rehabilitation - disabled people need information and help to access specialised rehabilitation services such as surgery and prosthetics/orthotics in Battambang. People with severe disabilities such as cerebral palsy, learning difficulties and paraplegia need home-based rehabilitation support, eg. physiotherapy and rehabilitation aids for walking and sitting. Social problems - awareness-raising needs to be carried out for communities in general and for specific groups, such as school-teachers, to create a more inclusive environment for disabled people. For disabled children who cannot attend school, home-based education needs to be provided. Disabled adults need to access vocational training. Counselling and psychosocial support needs to be provided to those disabled people with problems such as low self-esteem, anxiety and alcoholism. Economic problems - disabled people need to access capital for income generating projects (eg. tailoring, radio repair) or for agricultural inputs (seeds, fertiliser, irrigation, etc). Disabled women - DDSP should specifically focus on disabled women because of the particular problems they have, such as low chance of marriage, lower education and higher likelihood of being poor. Disabled children - DDSP should also focus on disabled children because of the neglect they often face in their families and their lack of education. Such a situation should be dealt with while the disabled child is still young, otherwise the outlook for the child when he/she grows up is even more bleak. Partnerships One of DDSP's organisational values is to identify and use community resources (skills, services, materials, money) before using DDSP resources. This is to avoid duplication and to use scarce resources effectively. The PRA identified a number of potential partners, with whom DDSP will discuss collaboration. These are: Health services – DDSP can refer disabled people to the Ta Lou, Tasas and Sampov Meas health centres, which serve the three villages for medical treatment, eg. for tuberculosis, leprosy, etc. Rehabilitation – fieldworkers from the ICRC rehabilitation centre and the Spinal Cord Injury Centre in Battambang occasionally visit Pursat and DDSP can work with them to help disabled people in the target villages to receive their services. Agricultural support – World Vision, Anakut Komar, Ponloeu Komar and CCRD are all providing agricultural support in the target villages. Mental health services – Transcultural Psychosocial Organisation (TPO) provides mental health services in one of the target villages. Management – Commune Councils have a mandate to implement development projects and one official in each commune is nominated as responsible for social affairs. The Commune Council could be helped to provide commune-level social services for disabled and other vulnerable people.

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Appendix 1: Wealth ranking results

1. Prohal (305 households)

2. Chong Rok (323 households)

19 (3 disabled) 62

(7 disabled)

63 (12 disabled)

101 (19 disabled)

Above average Average

Poor

Very poor

10

36

32

Above average

Very poor

Average

Poor

74 (4 disabled)

14 (2 disabled)

81 (7 disabled)

98 (12 disabled)

5

33 (5

disa

bled)

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3. O Thkov (108 households)

Appendix 2: PRA schedule Day 1 Day 2 Day 3 Day 4 Morning Group interview with

village chief and Village Development Committee (VDC) Story-telling about the history of the village, with village elders

Village transect walk and mapping

Semi-structured interviews with disabled people – home visits

Presentation of findings to village meeting, and discussion on DDSP's strategy

Afternoon Focus group discussion on disability with key village stakeholders

Group work on: - Wealth ranking - Income ranking - Expenditure ranking

Semi-structured interviews with disabled people – home visits Group work on villagers' daily activities

Interviews with service-providers at commune and district level

Bakan District: Prohal Village, Ta Lou Commune - 11th – 13th February 2003 Phnom Kravanh District: Chong Rok Village, Phteah Rung Commune - 18th – 21st February 2003 Sampov Meas District: O Thkov Village, Roleab Commune - 11th – 14th March 2003

Above average Average

Very poor Poor

21 (10 disabled)

38 (19 disabled)

18 (5 disabled)

31 (12 disabled)