Horrors Causing Blindness

My mother-in-law, Srai Sim, lived through the horrors of the Khmer Rouge in Cambodia. I wrote her story here. When she told me her story, she mentioned how she began to lose her eyesight while toiling in the rice fields. She’s had trouble with her eyes ever since those days. I thought it strange and assumed it was/is due to the malnutrition and hard labor she endured under the Khmer Rouge soldiers.

I recently discovered the following article from the LA Times, titled Blinding Horrors: Cambodian Women’s Vision Loss Linked to Sights of Slaughter. I will share it in its entirety below…


Eang Long cried for many days after the Khmer Rouge soldier beat her brother and his three children to death. She vividly recalls how the soldier threw the youngest child, a 3-month-old, against a tree until the baby died.

“My eyesight started to get terrible after I saw the tragedy,” Long said. “Because I was crying so hard and long, my eyes were red and started to swell up. Then I started to have problems with my eyesight.”

A decade later, Long, 65, who now lives in Long Beach, still has days when shadows–like silent phantoms of the past–obscure her vision. She says her bifocals do not always help and she fears her eyesight will get worse.

Long and dozens of other middle-aged Cambodian women are coping with a condition that some researchers have called “functional blindness”–blindness or visual problems caused by psychological factors.

Two researchers who have studied the condition say it is linked to post-war trauma stemming from the genocide by Communist leader Pol Pot and the Khmer Rouge in the late 1970s.

Gretchen Van Boemel, associate director of clinical electro-physiology at the Doheny Eye Institute in Los Angeles, says it was 1984 when she started to notice a disproportionate number of Cambodian women in the 40 to 60 age group who had the disorder.

“I talked about this with a friend who was involved in Southeast Asian affairs,” Van Boemel said, “and she described all the atrocities and killing fields in Cambodia.”

Armed with this information, Van Boemel contacted her friend and former college classmate Patricia Rozee-Koker, now a psychology professor at Cal State Long Beach. By 1985 the two researchers had located a group of 30 Cambodian women, ages 40 to 69, who volunteered to be in a study. All of the women had lived in Cambodia during the Pol Pot regime and later spent one to six years in a Thai refugee camp before being relocated to the United States.

Van Boemel said the purpose of the survey was to show that “a psychological overlay was causing the women’s eye problems, even if the brain was functioning normally.”

Each woman was interviewed and given an eye exam and a test to determine whether the visual system in the brain is functioning normally. Van Boemel said the test monitors brain waves as subjects look at checked patterns on a video monitor.

In each case, the test revealed normal visual acuity, often at the 20/20 or 20/40 level. These same women, however, when looking at an eye chart could barely see the top line of 20/200–the point of legal blindness. Other women had no light perception and could not detect light or dark shadows.

Rozee-Koker said most of the women’s functional blindness surfaced during the Pol Pot years. Personal interviews brought out repeated stories of forced labor, the murder of family and friends–often in their presence–beating and torture, starvation, a treacherous escape to Thailand and separation from family. She said the findings indicated that the longer a woman was bound to Khmer Rouge servitude or life in a refugee camp, the more her vision was impaired.

Reports Received Attention

Results of the study were presented at the 1986 American Psychological Assn. annual meeting in Washington. There was only one other paper about Cambodian refugee women and both reports received considerable attention. The paper, “The Psychological Effects of War Trauma and Abuse on Older Cambodian Refugee Women” is scheduled to appear in a coming issue of the journal, “Women and Therapy.”

The researchers found that the Cambodians do not always understand their condition and that many optometrists and ophthalmologists dismiss the vision loss as a case of “faking” or “malingering,” Van Boemel said.

As an example, Rozee-Koker pointed to a 1985 piece in the journal Ophthalmology. It described new immigrants who might be milking the welfare system with complaints of functional blindness. “That article was racist,” Rozee-Koker said. “But people believe it. It was very insensitive.”

Dr. Eric Nelson, a third-year resident at the UCLA School of Medicine, recently completed a preliminary study of Cambodians with functional blindness. “We found some patients who had been considered malingerers,” he said. “But our research proved this to be wrong.”

Unexplainable Problems

His findings were confirmed by Long Beach ophthalmologist Hector Sulit, who in the last five years has noticed a significant number of Cambodian women with unexplainable visual problems.

“I don’t think it has anything to do with their age, but because they lost family or children,” he said.

As more data about functional blindness in the Cambodian community became available, Rozee-Koker and Van Boemel decided to continue their study.

This fall they completed a 10-week study of 15 Long Beach Cambodian women. Each Saturday the women participated in a therapy or skills group for 90 minutes. The therapy group uncovered deep post-war trauma.

The most dramatic improvement took place in the skills group. As the women mastered such basic skills as taking a bus downtown, using a telephone and shopping, they felt a growing sense of empowerment over their lives.

Or as one Cambodian woman told Rozee-Koker: “When I am happy I see better.”

Improvement in Vision

“It was amazing to see the difference,” Rozee-Koker said. “From having to be guided by our arms into the elevator to the psychology building or holding themselves in a fetal position–to the last week when they were standing up straight. Many could smile and with some, their vision improved.”

For Chhou Chreng, 64, the sessions were an opportunity to learn how to dial 911 and to brush up on writing.

“I lost my vision in an accident in 1979,” she said. “Something fell on my head and then things were not clear.” Under Pol Pot she was forced to work in the rice fields for four years. Her husband, brother and many cousins died of starvation.

“Sometimes I will get a headache if I think about my sister in Cambodia,” she said. “Then I will get pain all over my body and my eyes will hurt.”

Both researchers, who are compiling their data, acknowledge that 10 weeks is not enough time to deal with these bouts of depression. Next year they hope to start a student intern program at Cal State Long Beach that will assist local Cambodian women.

Another agency, the nonprofit Community Rehabilitation Industries, also works with Cambodian women. Konthea Kang, a program coordinator at CRI, estimates that up to 20% to 30% of the dozens of Cambodian women she sees have had visual loss symptoms.

Older women, she said, have a more difficult time assimilating into American life styles. In Cambodia, most young people take care of their elderly relatives and parents. In rural areas, she said, women stay at home and raise families and many urban husbands also frown upon wives who work. When these women reach the United States, they are strongly encouraged by federal and state agencies to find a job. But in the workplace, they encounter yet another problem.

“When they can’t speak English, they don’t know what to do and get laid off,” Kang said. “After this they feel lost for several months.”

Tormented by Nightmares

As a counselor at the Asian Pacific Mental Health Center in Long Beach, the Rev. Kong Chhean said he tries to help his patients become more secure. The counselor and Buddhist monk has a caseload of about eight women with visual dysfunction symptoms. They are tormented by frequent nightmares about the Khmer Rouge and are afraid of attacks, even though they are half a globe away from the soldiers.

Although light is being shed on functional blindness, experts say that successful treatment is often tied to mental health care and that poses a problem in the Cambodian community.

Kung Chap, a vocational rehabilitation counselor at the Long Beach office of the California Department of Rehabilitation, said the concept of mental health care in Cambodia is negative. A mental health facility in Phnom Penh called Takhmao Hospital “looks like a jail,” he said. “The people there are labeled as crazy people. They would have been beaten and electric shock used on them.”

Cambodians, Chap said, would rather seek help from the family, a temple or a shaman with magic cures. They are slow to accept the American-style of counseling and therapy.

Rozee-Koker and Van Boemel have also found Cambodians to be afraid of agencies, hospitals and the university. On one occasion they made an appointment to interview a woman and her family. When they got to the house, the entire family had picked up and moved.

“We had evoked memories of the Khmer Rouge,” Rozee-Koker said. “To them it was a voice of authority. To their minds it sounded like Pol Pot.”

The refugees, Rozee-Koker said, will carry the scars of their experiences throughout their lives. “They do not want to see any more violence, any more pain. They have essentially closed their eyes to it.”

Or, as Chhou Chreng put, it, “When I feel happy my eyes are normal. When I think about Cambodia and my family I see flashes of light and dark.”


Srai Sim’s Story

On April 17, 1975, the Khmer Rouge army marched into Phnom Penh. Over the next few frantic days, journalists covered what they saw before they were forced to leave. They watched, astounded, as Khmer Rouge soldiers, young peasants from the provinces, mostly uneducated teenage boys who had never been in a city before, swept through town. For them, Phnom Penh offered many mysteries. The boys didn’t know what to make of telephones, or toilets. But they set to their job right away, evacuating Phnom Penh, forcing all its residents, at gunpoint, to leave behind everything they owned and march toward the countryside. Hospital patients still in their white gowns stumbled along carrying their IV bottles. Screaming children ran in desperate search for their parents.
~Joel Brinkley, “Cambodia’s Curse”, pg. 40


I wrote up this article a while back, but this is a story worth reposting…

Srai (sister) Sim is my wife Makara’s mother. Here is her story of survival from the Khmer Rouge…

Srai Sim was born in 1954 in Phnom Penh, Cambodia’s capital city. She grew up as the only daughter in a family of five children. Her father was a government worker and her mother was a home maker.

At the age of sixteen Srai Sim got married. Her husband, a sergeant in the army, was a good hard working man. Soon after the marriage this young couple had their first daughter, Srai Dtop. A hopeful future lay before them.

It was during this time (1975) that the United States was in its last days of war with Vietnam. Cambodia was a nation in turmoil, partly as a result of that war, but also because of a politically unstable history. In April 1975 the Khmer Rouge (the Cambodian communist party) sent its soldiers into Phnom Penh in order to evacuate the city. The residents of Phnom Penh were told that the evacuation was for their own safety as American planes were going to bomb the city. They were also told that they would be able to return in 3 days. But the truth was that the Khmer Rouge (KR) saw all cities as a capitalist threat to their communism. It was the mission of the KR to turn Cambodia into a total agrarian society completely under KR rule. Emptying the cities was their way of ending any non-agricultural lifestyles.

At that time Srai Sim was 7 months pregnant with their second daughter and their oldest was 3 years. Srai Sim’s family was forced out of Phnom Penh, and along with many others, they were driven like cattle to the province of Kampong Speu (see map below). They were made to walk the entire distance. In Kampong Speu their second child, Srai Owne, was born and one month after the birth they were relocated to the village of Moung Roussei in the Battambang province. Here the family was given one week to rest. Afterwards they were sent to work in a village called Phnom Thippadei, near Moung Roussei. They were told to cut down some trees and make a home for themselves. Work was difficult. The family had to depend entirely on the KR soldiers for food. All the people were given such small amounts of food that there was not enough to keep their families healthy.

About two months after completing their home KR soldiers began asking the people who had had a government job in Phnom Penh before the evacuation. Srai Sim’s husband was a soldier for the previous government, so he was included as being a former government worker. All those who had had a government job were being allowed to return to Phnom Penh. Srai Sim was happy that their family would be able to return home, but they were told that for now only the men would be going back. Her husband was taken away.

One month after Srai Sim’s husband went home their oldest daughter became very sick and was unable to recover due to the lack of food and medicine. Srai Dtop died never seeing her fourth birthday. Srai Sim was being given so little food to eat herself that she was no longer able to produce breast milk for baby Srai Owne, and 3 weeks after Srai Dtop died so did little Srai Owne. Soon after Srai Owne’s death one of the KR soldiers came to visit his mother in Moung Roussei. The soldier told his mother that all the men who were taken back to Phnom Penh were actually taken out to the forest and executed. The mother told Srai Sim, and so Srai Sim then knew that her husband was dead also.

Soon the KR soldiers noticed that Srai Sim no longer had any children to care for, so they assigned her to hard labor in the rice fields. Srai Sim would begin work at 6am and work until 10pm each day, with 3 hours’ worth of break time in between. During her breaks she was given only rice soup to eat. She was given a quota of how much work she needed to do each day, and was threatened death if she didn’t meet her quota. The KR followed through on these death threats with workers who could not keep up. Often Srai Sim had difficulty just to keep standing. As a result of the relentless labor, and the lack of food, Srai Sim began to lose her eye sight. Her friend needed to guide her around as she worked. Srai Sim was afraid that if the soldiers saw how blind she was becoming they would shoot her because she could no longer work.

When the rice season was over she was then assigned to driving a cart pulled by cows to haul wood and other building materials. The people were being forced to build new homes for the KR soldiers. The work was easier for Srai Sim, and she recovered her eye sight. She hauled the wood from the forest to the construction site each day.

One of the home builders was a man named Heang. Heang was a farmer before the KR took control of the country. He too was a forced laborer. The KR foreman of the construction site noticed that Srai Sim and Heang were both single and he decided that the two of them should marry. It was the plan of the KR to force farmers and city dwellers to inter-marry. When Srai Sim was told this she refused. When asked why she refused she said she had a husband waiting for her in Phnom Penh (she knew he was dead). The soldier told her that her husband would already be remarried himself. She still refused. The soldier said he would kill her if she continued to refuse. She told him to kill her and that she’d rather die than remarry. Thankfully Srai Sim’s friend stepped in and spoke some reason to her by saying that someday the KR would be gone and she would be free to do what she wanted and wouldn’t have to stay married. Srai Sim agreed to the marriage. So, along with 22 other couples, they were all forced married on the same day.

Although Srai Sim was dead set against the marriage, Heang was very happy to have a wife. He was afraid of Srai Sim leaving her. He would hold onto to her very tightly at night so that she wouldn’t sneak away. Soon Srai Sim was back in the rice field again, and Heang was sent into the forest to cut trees 40 km away. Whenever Heang was given some days off he would walk the 40 km, night and day, to visit his wife, and then walk the 40 km back again.

Towards the end of 1978 Vietnam invaded Cambodia in order to topple the KR government. The fighting made its way to the Moung Roussei area. KR soldiers began killing many Cambodians rather than letting them escape during the chaos of the fighting. The KR soldiers rounded up Srai Sim and all the other workers and took them into the forest where Heang was working. They sent everyone up a small mountain to create a stronghold against the Vietnamese soldiers. It was extremely hot up the mountain, and they began to run out of drinking water.

Some of the Cambodians couldn’t take the heat and thirst anymore and ran down the hill to escape. They were killed in Vietnamese/KR crossfire. If the KR soldiers saw Vietnamese soldiers taking Cambodians to safety they would open fire. Srai Sim and Heang realized that they were going to die on that mountain. They decided to make a run for safety. As they ran the KR soldiers began to fire at them. Thankfully they were not hit. The Vietnamese soldiers saw them and yelled to them to keep running. Srai Sim and Heang made it to the Vietnamese and were taken to safety. The Vietnamese defeated the KR and by early 1979 the Vietnamese took control of the country. The town of Moung Roussei was now relatively safe from the KR so Srai Sim and Heang settled there together.

sim n kids sm
In 1980 Srai Sim and Heang had their first son, Sarin. Later they had more children: a daughter, Makara; two more sons, Petra and Seyha; and then two more daughters, Gunya and Dtolla. When Sarin was 17 years old he began attending a Christian church in the area. Sarin became very involved in the church and began to invite others his age to attend.

Srai Sim herself was not interested in Christianity but she didn’t mind that her son was involved. At this time Srai Sim was a financially successful saleswoman. She was also a strong Buddhist and she would give offerings regularly at the local temple. Sarin would often encourage his mom to come to church but she would always refuse. Soon hard times fell on Srai Sim again as she fell into serious financial problems. Heang himself was only able to do small jobs here and there and could not raise enough money to support the family alone. Srai Sim began to question her Buddhist faith. Sarin again invited her to come to church and this time she accepted. At the church service Srai Sim felt the touch of God and she cried throughout the entire service. She didn’t know why she cried, but she knew she was encountering God. She began to follow Christ.
sim school

In 2002 the entire family decided to move to Poipet. They knew that Sarin could get himself a job at one of the casinos. He could then make good money to help the family. Sarin did get a job at a casino and soon Srai Sim’s other children were able to get jobs as well. Srai Sim was now totally trusting God for all her needs. She knew that God was with her. She started a small house church out of her home and began to teach her neighbors about Christ.

Today Srai Sim is still serving God and is the director of our school in Poipet. She is strong in her Christian faith, and works hard to lead others to the truth she has found in Christ.