Soap-Opera Message Offers Help to Cambodian Viewers : Immigrants: Husband-and-wife doctor team uses video to help viewers deal with horrors suffered in war-torn Cambodia.

It’ll never win an Emmy for best daytime soap opera.

But in the public health field, “Yesterday’s Music-Tomorrow’s Flowers” could someday become a classic, having paired with the concept of the barefoot doctor with the age of video.

The four-part, made-for-video drama is probably the first American-made soap ever produced in the Cambodian (Khmer) language with Cambodian actors.

On one level, the fictional story of Chan Kolab, a petite Cambodian woman plucked from the misery of a Thailand refugee camp to live with her uncle and his family in San Diego, contains the usual melodrama common to any soap, in any language.

There’s the love angle between Chan Kolab and a boyfriend, Sok Kom; the crescendo of music as each episode comes to a climax; and the scenes of East San Diego life common to Cambodians--the English-for-adult classrooms, the ubiquitous doughnut shops they love to frequent, and the TV-video systems that form centerpieces in their homes and apartments.

But for the soap’s producers, David and Jennifer White-Baughan, a husband-and-wife doctor team at UC San Diego, the experimental drama has a role much deeper than that of mere entertainment.

It’s a unique attempt to combine popular video and refugee counseling to relate medical information and treatment for mental health to a group of people living apart from the nation’s middle-class medical world.

Their interest in refugee health is longstanding. David Baughan has treated hundreds of Cambodians in his family medical practice at UCSD and the experience of psychologist Jennifer White-Baughan goes back to work she did in Seattle with Hmong refugees while a registered nurse.

In tackling mental health issues, the Baughans found that almost every refugee family, no matter how poor, has a television and a VCR, and the machines are in almost constant use by Cambodians hooked, day-and-night, on Chinese-produced popular melodramas dubbed in Khmer.

As Chan Kolab tries to adapt to her new country, she’s plagued by headaches, insomnia, stomach pain and flashbacks about the “killing fields” of Khmer Rouge rule in Cambodia--physical ailments she doesn’t understand and her UCSD clinic doctors like David Baughan can’t cure. She starts to think she’s “crazy” and worries her uncle will dislike her for all the trouble.

In reality, however, her aches and pains are symptoms of stress and depression resulting from the trauma of witnessing horrible years of terror and death under the Khmer Rouge. Only gradually do both traditional Khmer healers and western doctors come to understand her situation and arrange proper mental health treatment.

For too many Cambodians in San Diego and elsewhere in the United States, the symptoms of Post Traumatic Stress Disorder--once known as battle fatigue and common among Holocaust survivors as well--are poorly understood and often go untreated.

To make these immigrants aware that their “craziness” is neither crazy nor uncommon, the Baughans used the video “hook” that any Cambodian could stick into their VCR.

By getting the refugees to identify with Chan Kolab and learn about their problem, the UCSD team then opened the door for refugees, many dubious before seeing the video, to consider accepting mental health aid.

As part of their research, the Baughans trained five Cambodians as field workers to work with residents in their homes--the “barefoot doctor” part of the project--and follow up the soap drama with nine weeks of counseling about how to minimize the traumatic disorder and bring more joy into their new lives.

“The video was a great icebreaker, no doubt,” Jennifer White-Baughan, a psychologist, said. “But the therapeutic improvements we found in traumatic stress and depression with our patients resulted as much from the follow-up counseling sessions.

“I don’t want to give the impression that by just watching the video alone, people will get better” although she said the drama itself proved a good educational tool.

The entire project, including filming, was done on a shoestring, with $50,000 from the county’s Department of Social Services, $7,000 from the UCSD School of Medicine, and $13,000 out of the Baughans’ own pockets.

David Baughan wrote the script with the help of friends made among the 8,000 members of San Diego’s Cambodian community. He corralled a group of eager actors who often spent their weekends over a period of months patiently filming amid simultaneous direction in English and Khmer.

The video department at the UCSD School of Medicine handled the technical chores.

The Baughans now would like to find a few thousand dollars for a follow-up study on whether the health boost that the Cambodians got after the video and counseling has lasted beyond the project’s end.

“The Baughans targeted one of the most disadvantaged groups with an intervention that was both culturally sensitive and innovative,” said Bob Moser, director of refugee services for Catholic Charities in San Diego.

“Their work in going out into the community and using people from the community got right to the heart of the problem, by showing a simple solution can sometimes work, that you don’t need the complex levels of clinical diagnosis all of the time.”

John Robbins, who formerly coordinated San Diego County government refugee services, called the use of video “a stroke of genius, a great prototype for how to reach people in their homes.” UCSD nursing administrators already are planning an entertainment-type video on nutrition for refugees.

Even administrators at the office of the United Nations High Commissioner on Refugees in Bangkok, Thailand, were impressed with the video when the Baughans screened it while on a trip to Southeast Asia last summer.

“I was both pleased with their use of (Cambodian) talent and ideas, as well as their innovation in a field (mental health) that often discourages that,” said Ken Bush, a UN social services and education officer. “And the idea of a video is applicable anywhere.”

The video rang true with Cambodian residents in San Diego because the Baughans captured the spirit of their lives, said several refugees who worked on the project.

“It’s very, very realistic,” said Ratry Som, a county social services worker who helped direct the soap’s filming. “Their interest in the Cambodian community is genuine and they made a lot of friends.

“I even learned to (understand) my own experiences, where I still have a dream or nightmare, that I’m going back to Cambodia and have lost my passport, when suddenly the Khmer Rouge appear and demand it and I am intimidated . . . and then I wake up suddenly and realize it’s still just a dream.”

“It was interesting to watch the families with the video,” said Leng Lao, a UCSD graduate in engineering who helped with translation and family outreach.

“The important thing was that some of our people discovered the nature of their problems. The video made it easier for them to discuss what happened in Cambodia.

“I am young and so perhaps not affected as much. But I see the women who just stay home, watch TV, care for the baby, and after a while they start to think about the past, and it gets to them day-after-day without anyone to talk to, and so they think it is only their problem.”

Heng Sok is one of those women, living with her husband and two young daughters in a well-kept apartment where the children’s school artwork decorates the walls.

She still has occasional headaches and other symptoms of traumatic syndrome even after watching the video and receiving counseling last year.

“The (drama) was true to life and I think even mild compared to cases such as mine,” she said through translator Sopha Lanier.

Lanier teaches at Jackson Elementary in East San Diego and in her spare time still visits those families she helped counsel after training from the Baughans.

“Even now, 10 years after the Khmer Rouge, I still get fresh memories, I still do not feel safe at times, I still think I’m back in Cambodia,” Heng Sok said. “My children tell me simply not to think about it.”

She credits the project with helping her understand why she feels the way she does, and for giving her some ways to deal with it, if only to simply go for a walk.

“It’s not easy to get rid of these feelings,” Heng Sok said, viewing a video of the latest political events in Cambodia as a result of a shaky U.N.-brokered settlement among warring civil war combatants.

A UCSD professor of psychiatry who supervised the Baughans’ work called the project seminal in providing mental health treatment in home settings.

“That’s a novel concept not just in San Diego but everywhere,” Dr. Perry Nicassio said. “In the case of post traumatic stress disorder, these refugees have great difficulties. Furthermore, most are divorced from the traditional mental health system, which assumes you can identify appropriate referral agencies and drive to a mental health center, and then get the traditional one-on-one treatment model that is very expensive.”

Nicassio would like to see more community agencies use video and home visits by field workers trained to help their peers, whether refugees or members of other under-served groups.

“What I’m saying is that there are some (treatments) here through video and counseling that might be all that some people need,” he said. “Others will still need medication and other interventions, but at least they could be identified through this public health outreach.”