My report as a member of the People-to-People Ambassador organization sponsored delegation of Psychiatrists, members of the Am. Psychiatric Association visit to Cambodia and Viet Nam
TO: My friends new and long standing whom I had the pleasure to be with at various points during the APA convention in 2008.
I received feedback from my original mailing from several people they couldn't open the attachment. So, I decided to copy and paste the report. There are people with special interest in services to women and children. The thumbnail sketches of the Cambodian Women's' Crisis center and the Mary Knoll programs are most inspiring, heart warming and heartbreaking at the same time as are the other sections of the report. I have worked with these organizations and SSF which does great work in some of the poorest areas of Cambodia.
I would be honored to receive your feedback, suggestions, and recommendations. I am distributing this widely based on the experiences of Mr. Greg Mortensen who wrote a wonderful consciousness expanding book entitled three cups of Tea. It is worth reading if you haven't. He wrote hundreds of letters before launching on his mission to help the people who rescued him and made him a member of their family (post third cup of tea). I have been in communication with Dr. James Gordon also Director Center for Mind Body Medicine CMBM in Washington DC to suggest ways of collaborating between us, Mr. Mortensen, Dr. Gordon, and my colleagues in the USA and in Viet Nam and Cambodia to develop creative solutions to complex and extremely daunting challenges.
Neither of these is new to Mr. Mortensen nor Dr. Gordon. Dr. Gordon is the Author of “Unstuck” a groundbreaking work on treating depression. He has done research in very dangerous locales in the world to test his theories.
Please suggest ways of helping the brave and creative, dedicated and extremely hardworking(stretched thin) people in the various programs we visited during our memorable and emotionally depleting in some ways and in other ways inspiring and invigorating trip.
Velandy Manohar, MD
Velandy Manohar, MD,
Distinguished Life Fellow Am. Psychiatric Association
President, Asian – American Caucus of the APA
ABPN B/C: ADULT PSYCHIATRY
ABPN B/C: ADDED QUALIFICATIONS ADDICTION PSYCHIATRY (RECERTIFIED 2003)
ABMS: BOARD ELIGIBLE-PAIN SUBSPECIALTY CERTIFICATION 2004
ABPN: BOARD CERTIFIED-PSYCHOSOMATIC MEDICINE 2005
CERTIFIED BY SAMHSA/CSAT TO USE SCHED III, IV, and V OPIOID DRUGS.
ABPN: EXAMINER, PART II ORAL EXAMINATION, ADULT PSYCHIATRY.
NATIONAL BOARD MEDICAL EXAMINERS: CONSULTANT: USMLE II (STEP 2).
AM. PSYCHIATRIC ASSOC: CERTIFIED IN ADMINISTRATIVE PSYCHIATRY,
CT MEDICAL EXAMINING BOARD: MEMBER, UNTIL DECEMBER 07
CT.MEDICAL EXAMINING BOARD-NON-BOARD HEARING PANEL MEMBER SINCE JAN 2008
CT.DEPT OF MOTOR VEHICLES COMMISSIONER'S MEDICAL ADVISORY BOARD-MEMBER
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04 30 08
EYE -WITNESS ACCOUNT OF THE UNDER FUNDED MENTAL SERVICES
AVAILABLE TO THE UNDERSERVED PEOPLE OF CAMBODIA AND VIET NAM
I would like to bring to the attention of the MUR and our colleagues in the APA as a whole the urgent needs of the people of Cambodia and Viet Nam. A group of about 40 toured VN and Cambodia. This delegation under the leadership of Dr. Pedro Ruiz, MD was organized by the People-to-People Ambassador Program. We had notable APA members in our delegation among them: Dr. Nada Stotland and Carolyn Nadelson. We wear able to meet and exchange our observations and discuss our mutual interests with members of the staff and administrators of key institutions, NGO’s, and MH professionals in the community in both Nations. We left on March 24th and returned on April 3 to LAX. At the very first meeting with the Psychiatrists from the mental health Center of Ho Chi Minh City and of the Khmer Soviet Friendship Hospital we realized with trepidation that there more psychiatrists in our one bus than there were in all of Cambodia or Viet Nam.
I wish to share with all of you what I learned from the dedicated, creative, and hard-working staff members and the directors of the programs we visited. I will also attach correspondence I have had with some of the key people we met to give you an idea of how individual members can assist the core MH staff in educational and health care institutions as well as the staff of what we would call social services providers to help them offer the types of assistance to build resilience and optimism into the minds and hearts of the people of both nations who were ravaged by decades of war and genocide. I would like to provide a framework to help you visualize the needs of the people and appreciate the challenges confronting these redoubtable front-line professionals who are bringing comfort, respite, solace, relief, and caring medical psycho-social services in these two countries.
A decade or two hence interested observers will no doubt recall to life the tribute paid by Sir Winston Churchill in the house of Commons after the heroic victory of the British Air Force over the much-vaunted Luftwaffe " Never in the field of human conflict have so many owed so much to few." In a sense the dedicated NGO's, volunteers and staff of various government agencies engaged in a nation-wide effort to help their fellow country men and women while they are themselves trying hold their body and soul together while surviving their own sojourn in hell and enduring their own pain while trying to ease the pain of their patients and clients as the case may be waging a war of survival against the machinations of Pol Pot and his allies. One NGO group is trying to assist aging and scared victims of Pol Pots genocidal machine to testify in the Tribunal that will attempt to convict and punish the few remaining perpetrators of the Killing Fields. If I may paraphrase Sir Winston Churchill who asked and answered this rhetorical question, "What is our policy ?...to wage war against a monstrous tyranny, never surpassed in the dark lamentable catalogue of human crime."
In addition to the large-scale war that had drawn in the major powers, during four fateful years 1975 to 1979 the people of Cambodia were subjected to severe fragmentation of their families and total relocation of their communities and forced to witness and endure a massive genocide campaign that caused the deaths of 1.7 million and disappearance of 1.3 million people out of their total population of 7 million. This is tragically highlighted not only by the remains of the victims in the memorial Pagoda/Stupa at the Killing fields of Choeung EK, the notorious Tuol Seng Museum, the heartbreaking pictures and horrifying torture devices of S-21(Security Prison) but also by the photo taken of an innocent little girl Loung Ung age 5 holding a small school slate with the number 590, 023. With Gods grace Loung Ung escaped but that number indicated the Pol Pot Regime was just getting their genocidal machine in high gear because 1.2 million more ( twice as many as those who were killed before little Loung Ung picture was taken) were murdered after that picture was taken. Besides these horrors the tragically cruel business of human trafficking is a major international and socio-cultural problem. With increasing pressure from outside South East Asia some changes are evident. Much more has to be done. The Cambodian Women’s crisis center I will be introducing to you is addressing this problem as well as domestic violence. About 1500 girls are returned from Thailand every month.
The people of Viet Nam also have to bear the staggering loss of an astronomical number of people: 3 million of their children, brothers, sisters, and parents during the American War. People of both countries have to endure the loss of their family members as well as assist the millions burned by napalm, poisoned by Agent Orange and other chemicals, and maimed by cluster bombs and other munitions. Some of these bombs are huge but the biggest bombs were twice my height and could destroy everything in sight around the impact point. Referring to the massive bombing runs of the B-52's the following chilling statement was made. I don't recall who made it but there is horrible prophetic truth in it, “darkness will settle on the people of Cambodia. There will be houses but no people in the dwellings. There will roads but no travelers on the road. The land will be ruled by barbarians."
The War museum was quite useful to put many facets of the impact of the American war in perspective. I would recommend the impact on the people who dropped the bombs and the people who ordered the bombs to be dropped to place on record their thoughts and feeling then and now. An open sharing of the warriors, civilians at all levels of society of all sides of the conflicts could benefit from a truth and reconciliation process similar to one organized in South Africa but only after the Pol Pot henchmen and women are found and charged and convicted of crimes against humanity.
Bob Dylan a seer and poet of our times presciently gave voice to the doubts, concerns, and fears of a generation when he released “Blowin’ in the wind" in Free-wheeling Dylan in 1963 and later in 1967 in Bob Dylan's greatest hits. It is worth recalling his words because of the eloquent presentation of the bewildered minds, tortured psyches, and perturbed hearts of an entire generation.
"How many roads must a man walk down
Before you call him a man?
Yes, 'n' how many seas must a white dove sail
Before she sleeps in the sand?
Yes, 'n' how many times must the cannon balls fly
Before they're forever banned?
The answer, my friend, is blowin' in the wind;
The answer is blowin' in the wind.
How many times must a man look up
Before he can see the sky?
Yes, 'n' how many ears must one man have
Before he can hear people cry?
Yes, 'n' how many deaths will it take till he knows
That too many people have died?
The answer, my friend, is blowin' in the wind,
The answer is blowin' in the wind.
How many years can a mountain exist
Before it's washed to the sea?
Yes, 'n' how many years can some people exist
Before they're allowed to be free?
Yes, 'n' how many times can a man turn his head,
Pretending he just doesn't see?
The answer, my friend, is blowin' in the wind,
The answer is blowin' in the wind."
Based on the observations of the areas of the two nations our delegation visited namely Siem Reap( North)and Phnom Penh (South east) in Cambodia, Ho Chi Minh City ( Saigon) and its hinterland(parts of the Mekong delta) the people of both countries appear to farming successfully in the countryside ( Viet Nam is major Rice Producer in the world) and in the city limits local folks are bustling here and there on millions of scooters and motorbikes with as many a four people if not five on one two wheeler. In Cambodia we saw hundreds of children in their smart White shirts and blue shorts of skirts or pinafores as the case may be rushing to school or playing after school. We also saw many schools, institutions of higher learning along the road. In Viet Nam sadly the children didn't seem to have the support of the communities in which they lived to share their lives with other children in schools and playing fields. They seemed to be engaged in the hard work of raising the tender shoots of rice to maturity in the muddy paddy fields. They take care of the rice seedling but who is the steward of human seedlings that striving to endure and prevail. I will return to this seedling metaphor later when I describe the Mary Knoll programs.
Alas! nary a soul at the local community, state or national level appeared to be around to raise the capacity, prepare these children and provide the opportunities for these children to succeed in the competition with the best and brightest in the countries all around them. Instead, their current status in their society seems to destine their childhood of dreams to evaporate in the hot sun and youthful aspirations to be washed away in the next monsoons rains. Although the urban areas are chock full of people especially of younger men and women and children, the countryside in the delta for instance most of the people I saw working and walking around were women. Very few of their male peers were about their business. An occasional fishing boat with men in it would pass by. In addition, both in the city and in the urban areas I didn't walk by or drive by older people in their 60's or 70's men or women. Where are these invisible men in their 40's and 50'sand the seniors who are needed to connect the generations and help in the transition from the turbulent past and frenetic present to the future we can all live with - cohesive, peaceful yet dynamic, literate, prosperous and healthy. " Yes, 'n' how many times can a man turn his head, Pretending he just doesn't see? The answer , my friend is blowin' in the wind, The answer is blowin' in the wind" Dylan
On many occasions while traveling by bus through the countryside in Viet Nam and Cambodia or in a boat though the Mekong delta I recalled the haunting words of the Elegy written in a country church yard by Thomas Gary. " Let not ambition mock their useful toil, Their homely joys, and destiny obscure; Nor Grandeur hear with a disdainful smile, The short and simple annals of the poor." " For thee, who mindful of the un-honored dead, Dost in these lines their artless tale relate; If chance, by lonely contemplation led, Some kindred spirit shall inquire thy fate." Here rests his head upon the lap of earth, A youth to fortune and to fame unknown. Fair science frowned not on his humble birth, and Melancholy marked him for her won.' " Finally," no farther seek his merits to disclose, or draw his frailties' from their dread abode,-There they alike in trembling hope repose, The bosom of his father and his God." Thomas Gray. To add to their misery Viet Nam has announced today that it will suspend all adoptions of Viet Namese children by US parents- to -be based on the findings of study completed by the US embassy. The nine-page study reported by the Associated Press said Adoption fraud was extremely prevalent.
With all the hustle and bustle in the cities pedestrians in Viet Nam must have current life insurance policies because crossing the road requires you to step off the curb at the right time and just walk across. How do you know it is the right time because you got to the other side and was in time for lunch ? You could get old and gray if you don't step off the curb. But a friend pointed out that may be better than being quick and dead. With the luck of beginners all of the delegation who ventured out was all accounted for at the last count before we left town. The Viet Namese and the Cambodians know so many ways to stimulate the millions of cells in the nose and palate and the stomach lining that it was a most wonderful gastronomic experience to enjoy their warm and cheerful hospitality and sample their culinary creations presented in extremely esthetic ways.
The People-to-People Ambassador Program staff and Our delegation Leader Dr. Pedro Ruiz and Ms. Angela Ruiz worked out a very well-rounded professional program which gave great access to the professional staff, leaders of the field volunteer and NGO staff of a variety of agencies and hospital and teaching institutions in both countries. We were very warmly welcomed by our hosts and no effort was spared to make us feel comfortable and well hydrated and nourished. We are deeply grateful to all of them especially because of the circumstances that I have outlined that appears as a giant amoeba with pseudopodia attempting to engulf everything in its neighborhood. The guides were extremely well-prepared fort eh discharge of their duties which they did expertly and greatly enhanced our knowledge and understanding of the Viet Namese and Khmer culture architecture and traditions.
1. The staff of the MH Center of Ho Chi Minh City(Saigon) and some psychiatrists in Private Practice met with us in the Hotel and we had extensive discussion. During the formal presentations it became clear that there was no funding for specific programs for their patients with PTSD, or for their Veterans and to conduct epidemiological studies. They however served large numbers of patient with very limited trained psychiatric staff. The two commonest disorders were Schizophrenia and Epilepsy. They reported the presentation of some disorders were not strictly per DSM-IV descriptions e.g., MDD, PTSD. The incidence of Alcohol use disorder was 1.73%, Depression 9.4%, Anxiety 6.1%, Dementia above 65years is 7.8% They treated 400 to 500 people a year with a couple of psychiatrists.
I was not very clear about the details of their psychiatric training. The top people were trained in other countries in Europe and in Australia. Dr. J. Bennet, MD, Director of the University of Southern Illinois medical school residency program made a very detailed presentation. This presentation is available. We had language-based barriers as well as tensions because the staff of the MH Center couldn't meet our expectations about the depth and openness that professional colleagues should be able to share about matters of mutual interest. It is not clear if living under Communist Govt.s for decades may have a real impact on how far they are able to go when they describe the conditions on the ground.
2. The Le Minh Xuan MH Center had very nicely designed IP units in beautiful large plot of land.. It had 400 beds. The length of sty could be 3-4 months. There were a number of activities for the patients. The design of the buildings on the perimeter and a nice courtyard in the middle that allowed a variety of interventions and socialization seemed to suiting the patients.. There is follow-up arranged prior to Discharge. Medications are provided for the patients perhaps based on a sliding scale.
3. Substance Use disorders are managed by a separate agency in Ho Chi Minh City.
The discussion points were as follows:
a. The role of Religion and Spirituality vis - a - vis the system of MH care
b. The system of MH care for Adolescents and children.
c. Understand the psychosocial approaches used in MH Care.
d. Review the factors associated with the management of the HIV/Aids epidemic.
e. The role of social and cultural factors in diagnosis and treatment.
4. Royal University of Phnom Penh ( RUPP)- Dept. Of Psychology. The students and the staff conveyed robustness and dynamism. The Bachelor of Arts Degree Program appears to meeting the needs of the energetic students who wish to get into the trenches and work with volunteers and NGOs and other personnel available on the ground to alleviate the serious MH problems being experienced by the people of Cambodia. From 1980 the Dept was a combined psychology and teacher training unit called the Dept of Psycho pedagogy. From 1993 onwards, the 4-year course was revamped to focus only on Psychology and to meet international Standards. The RUPP has developed many community-based links to organizations that offer practicums and work placements.
5. The Trans-cultural Psychology Organization (TPO)
This organization is the lead agency in providing psychological supports to the victims of Genocide. It has 5 offices in 5 regions. They focus their efforts to prepare potential witnesses to testify before the Tribunal to be set up and run from 2007 to 2009. There have been delays in bringing the perpetrators to justice. The TPO staff also helps to alleviate the suffering of the villagers caused by the destruction of the social fabric of the country that existed for hundreds of years before 1975. They help manage PTSD, Mood and Anxiety disorders, Domestic violence, Alcohol and Substance use disorders. Exploitation of boys and girls and Trafficking. Economic privation and break down of infra-structures of communities. Mental health and behavioral problems. Vocational training and educational programs.
6. Cambodia Women’s Crisis Center. It was created by a group of women who were motivated by a shared vision of eliminating Trafficking, rape, domestic violence in order that their clients will achieve personal growth, peace of mind and happiness. There is a HQ site in Phnom Penh and three regional offices. They have emergency shelters, Vocational training, educational opportunities, medical, counseling, and legal services are also provided. One in five Cambodian women is victims of Domestic Violence. Rape of younger adolescents is reported every day in the media. Their tireless and well-trained staff participates in public media campaigns and plays a leadership role community organizations and advocacy. They also offer training to potential workers who wish to do this kind of work in the trenches. There about 50,000 known prostitutes in the country and about 64 % are victims of trafficking. And being sold into slavery. About 1500 women are returned every month from Thailand.
7. The Mary Knoll HIV-AIDS program.
The goal of the Seedlings of hope family is to serve our brothers and sisters with HIV/AIDS. Our Main Concern is for those who are alone, those who are homeless, those who have no food, and their children. The following are a record of their accomplishments in January 2008
a. AIDS awareness education: 1352 people were reached in the greater Phnom Penh area, the villages along the Mekong and Bassac rivers and through the 39 regional centers in the Southern Kandal district.
b. Medical consultation office Chey Chumneas: Office has served 64 clients, Chey Chumneas has served 712 clients.
c. Home care : 468 patients provided palliative acre in their homes, hospital, or office several times a week. No deaths occurred at Home.
d. Hospice- 24-hour care. 16 people on average, 29 served.
e. Little sprouts Prevention of transmission from mother to Child. Medications provided to mothers, follow-up and homecare also provided. 50 pregnant women, 149 mothers and 151 infants were served. The rate of HIV/AIDS in children dropped from 35 % to 5 % since they began this program.
f. Little sprouts program for children with AIDS and are orphaned. 24/7 care is provided, and psychosocial development is worked on . 273 children and 11 adults were served. !68 children live with their parents, 105 live in group homes
g. Total adults and dependents served 1120, Total little folks served are 607, total little sprouts are 284, Total in Prevention of transmission program is 350. Grand total served by Mary Knoll program is awe inspiring, breath stopping 2436 souls.
8. The Khmer-Soviet Friendship hospital is in Phnom Penh. It was established in 1950. The Khmer Rouge took over the administration and did little to improve or support the mission. It was closed from 1979 to 80 when the war between Viet Nam and Khmer Rouge was in full throttle. The hospital has been able to fulfill its mission as best as it can to the public. It is very busy place with active out-patient services and in patient units. It has 18 medical departments including psychiatry, medicine, infectious disease including AIDS/HIV Pulmonary including TB, ENT, Ophthalmology, Neurology, surgery, oncology, Urology, etc. It is the largest hospital in Cambodia. It serves as teaching institution-a University on its own. It serves over One Hundred Thousand Cambodian people annually. Impoverished folks are served without regard to their ability to pay. There are a number hard working talented nurses, physicians, and other staff to care for the patients. The nurse's stations of the units we visited were sadly threadbare in terms medications available to the patients. They had only five drugs, namely Amitryptline, Doxepin, Haldol, Mellaril and Carbamazepine available to their patients. The teaching faculty is paid $40 -50 a month. They are expected to finish their work in the hospital and find other avenues to earn the money to support their family.
The talented staff could do so much more if they had an integrated electronic health record or a Computer system for ordering, tracking, and reporting results of tests, procedures, Tracking patient flow, patient demand and staffing patterns, quality, safety, and financial indicators. The staff could enhance their educational and training programs if they internet access and were able to tap into EBM content on the web and developed appropriate data bases that would cue safety and effectiveness enhancing innovations through the use of laptops. They cell phones to communicate but I didn't see Blackberries or other PDA type devices. These barriers have precluded any opportunity to link up with clinics and clinicians in the various regions from where their country men and women trudge their dreary path to the doors of this prestigious institution. They don't have the ability to train more people in the regional centers through Broad band and Skype technology.
The hospital patient care units were sparse but clean without a hospital smell. They were airy and well ventilated. Although completely open and not air-conditioned there were no flying insects or mosquitoes around. It is possible the dry season had something to do with it.
I have the names and e-mail addresses of the contact people in these fine programs and have been in communication with them trying to find ways of helping them build and strengthen and expand their reach by seeding the whole country with agencies built on successful models and staffed by people trained by the leaders in the field, the veterans of the original agencies and college programs.
The World Heritage site at Angkor Wat Temple with the five towers and several grand temples that bear eloquent testimony to the creativity and power of ancient Khmer people and their cultural and religious interactions with India from the first century of the Christian Era. Hinduism and Buddhism are intermixed in the sculpture and designs of the temples in the Siem Reap. The teachings are as old as the hills and emphasize the key precepts of Sakya Muni Buddha( the enlightened sage from the Sakya clan) and from Hinduism. French ( is the most recently acquired) , whilst Khmer, Pali ( Buddhist Canon) and Sanskrit are ancient languages. the Pali canon and the Sanskrit scriptures came to Thailand, Cambodia, Malaysia, Sri Lanka and Viet Nam and Bali from India. These scriptures embrace all creatures and calls service without expecting rewards. Key virtues such as humility, courage of one’s convictions wisdom, generosity of spirit, selfless service and renunciation are hallmarks of the exemplars of both faiths.
This great Hindu hymn in Sanskrit has captured the essence of both faiths. Since the Devanagari script is not known to many I am offering this transliteration and translation generously prepared at short notice by my friend Dr. T. Seshan who is a teacher of Sanskrit at the Sree SatyaNarayana Temple in Middletown, CT.
"VISMRUTA BHEDAS SANTO! NIRMALA BHAAVA AAPANNAH
EKII BHAAVAM HRUDAYAROODAM SATTAMKURVANTU.
BHOH BHOH SATATAM KURVANTU! (VISMRUTA....) (1)
PORVAJA MUNIJANA KAVI JANA VAANCHA SARVESAAM EIKYAM
SUKHINAS SARVE SANTVITI GAANAM TESAM BAHU HRUDYAM
BHAASHA DHANA MATA JAATI VIBEDAH HRUDAYE MAA BHAVATU
DUHKITA DEENA JANAAN UNNETUM HASTAH PRASARANTU
BHOH BHOH HASTAH PRASARANTU! (VISMRUTA.....) (2)
GANGA TUNGA KAVERI JALAM ASMAAKAM MATVA
KRUTA SANKALPAH KAARYAM KARTUM AALASYAM HITVA
SUVARNA PUSHPAAM PRUTHIVEEMETAM KRASHTUM AAYANTU
PRAVAHATU KAMAM SVEDAS SROTAHDHAIRYAM MAA JAHATU
BHOH BHOH DHAIRAYM MAA JAHATU! (VISMRUTA...) (3)
GHARSHANA LUNTANA VANCHANA HANANAM PRALAYAM SAMYAATU
SNEHASSROTAHPRAVAHATU BHRAATUR BHAVO HRUDI LASATU
ANIALASSALILAM ANALASSARVAM SARVESHAM EKAM
PRAVAHATI RAKHTAM ABHAKTAM MAATUH BHEDO MAA BHAVATU
BHOH BHOH BHEDO MAA BHAVATU (VISMRUTA....) (4)
Paraphrasing the overall idea (Gist of it)
1) Forget the external differences; with a pure heart cultivate the feeling of oneness, i.e., we are all members of one family.
2) The ancient seers and poets (of Bharat that is India) belong to all of us. The thought that all mankind be happy was dear to their hearts. So do not entertain in your heart thoughts about differences in language, wealth (status), religion or caste or ethnic groups among us. Rather stretch out your hand to uplift the downtrodden and the oppressed.
3) Understand that the waters of Ganga, Tungabhadra, and Kaaveri ( Rivers in India) belong to all of us, Indians, not to any particular state or region. Let's make up our mind to cast aside laziness and get down working hard and cultivating this earth into a garden of golden flowers. Let the sweat glands flow as freely as our heart felt desires. Don't ever abandon your courage and lose heart!
4) May the desire to kill evil tendencies like hitting (or pounding), plundering and trickery rise to the level of opening the flood-gates! Let the idea of friendliness flow freely and let the feeling of brotherhood sound resoundingly in your heart!
Nature's forces of air, water and fire treat us all equal; mother's blood flows undivided through the baby(in the womb); why then entertain differences?
" Common be your prayer; common be your ends in life; common be your purpose; common be your deliberation; common be your desires; unified be your hearts; Unified be your intentions and perfect be the union amongst you. RK Veda,X,191-3,4. May all humanity be blessed with comfort and joy. May peace pervade the three domains of existence.
I hope you will consider writing to me and offering your suggestions including what you my patient reader is willing to do personally to help the various programs I have brought to your attention in this letter and how the APA ( we working in unison as a whole) could collaborate with our colleagues in these two ancient and resurging nations to build on their extraordinary work and make it possible for them to replicate the models that work and expand their reach in to each and every village of Cambodia and Viet Nam and alleviate the terrible suffering caused by separation and loss, terror and chaos, anomie and loss of the sense of oneself and fear about what is to come.
What can we do individually and collectively to strengthen the willing hands, the resolute hearts and the keen minds of the resilient people who are already doing some of the essential work to assist their fellow country man and women and especially the children to answer these challenges in a self affirming manner? How do we play honorable roles to provide for an enduring framework that will firmly secure individuality liberty, foster communal harmony and protect the sovereignty of both Viet Nam and Cambodia?
Besides offering prayers for the souls of the martyred victims of Pol Pot and the Khmer Rouge at the Pagoda/Stupa and the killing fields I meditated on this prayer (Transliterated Sanskrit words) which applies to all those who have committed their lives to make common cause with their less fortunate brothers and sisters in order that they may collectively transcend their monumental losses and go on achieve real tangible personal freedom, communal harmony and live in nations whose sovereignty is respected by its neighbors and the great powers and such crimes against humanity as human trafficking and exploitation of children will end in our lifetime.
"Durjana Sajjana Bhuyath, Sajjanaha Shantimaapnuyat. Shanto muchyeth bandebhyo, Muktaschanyaan vimochyeth. Om Shanti, Shanti, Shantihi"
May those who are consumed by self-will and ill-will be transformed into people who are resolved to act cooperatively to establish comity and amity. May those who are engaged in this pursuit attain to peace. May those who have been blessed with tranquility and Peace attain to freedom from the bondage of material existence (the Soul is seen as being enveloped by five sheaths) May those who are thus liberated be dedicated to empowers others to attain freedom from bondage. May peace prevail in the three domains of existence.
Velandy Manohar, MD.