But the belt is steadily tightening on this diet just weeks after one of the worst cyclones in decades hit the camps and killed hundreds of people in neighbouring Myanmar, from where most of the estimated 1 million camp residents fled military atrocities in 2017.

In March, the United Nations World Food Programme (WFP), the agency responsible for providing food aid to the camps, sparked mass anxiety there when it cut its monthly, per-person food vouchers from $12 to $10. Just days ago, WFP announced another reduction in Cox’s Bazar, taking the monthly ration down to $8 starting 1 June.

Whether this amount will be enough to ensure survival is yet to be seen. According to the WFP, even before the March ration cut, 12% of children in the camps were acutely malnourished and 41% chronically malnourished. 

“It’s a shameful action of the United Nations. It showed that their leadership has failed,” said Khin Maung, a civil society leader in the camps and executive director of the Rohingya Youth Association, of the latest cut. “If they continue to reduce the ration, Rohingya people will die of hunger.”

The agency didn’t reply to Globe’s multiple requests for comment but has attributed the ration cuts in Cox’s Bazar to budget shortages. 

“We are appealing for urgent support so that we can restore rations to the full amount as soon as possible,” stated WFP’s Bangladesh country director Dom Scalpelli in a press release. “Anything less than $12 has dire consequences not only on nutrition for women and children, but also protection, safety and security for everyone in the camps.” 

According to Scalpelli, WFP would need an additional $56 million to restore the full food rations and “keep this lifeline intact until the end of the year”.

The shortages come as the agency has expanded operations worldwide, including in active war zones Ukraine and South Sudan, as well as those with recent ceasefires such as Ethiopia and Yemen.

More broadly, the agency has reported that 2022 was a record year for fundraising, which comes mostly from governments. Last year, donors gave $14.1 billion for WFP programmes around the world, which reportedly extended aid to a “historic high” of about 158 million people. 

But the funding is not enough to cover the ongoing humanitarian crisis facing the Rohingya, according to the UN, which is urging states to support an all-encompassing aid platform with $876 million for the refugees and Bangladeshi host communities. 

To date, only 20% of that total required has been funded.

According to Nay San Lwin, co-founder of the advocacy group Free Rohingya Coalition, the most recent reduction will likely prompt riskier decisions from the refugees stuck in Bangladesh. This includes possibly returning to Myanmar through a controversial pilot project of repatriation without citizenship to areas still affected by armed conflict. 

“When the refugees have no food, they will take a step of ‘do or die’,” Lwin said. “WFP’s move is absolutely encouraging the refugees to take part in this repatriation.”

The mostly Muslim Rohingya are originally from the Rakhine State in western Myanmar, where the Buddhist-majority state has discriminated against them due to cultural and religious differences. The Myanmar government has never recognised the Rohingya as an official ethnic group and had for decades denied them citizenship before the military brutally expelled them in 2017.

When the refugees have no food, they will take a step of ‘do or die’”

Nay San Lwin, co-founder, Free Rohingya Coalition

During this campaign, hundreds of thousands of people fled to neighbouring Bangladesh after the national military slaughtered civilians and burnt entire villages.

For this, much of the international community accused Myanmar of genocide. The Gambia made these allegations official by filing a genocide case with the International Court of Justice in November 2019, but this has been complicated by Myanmar’s 2021 military coup and spiralling armed conflict.

In the meantime, the country’s Rohingya refugees remain in limbo and uncertainty, whether exiled in Cox’s Bazar and further abroad, or confined to poorly managed detention camps in Myanmar  

“We, the persecuted minority Rohingya people, are expressing our plight and troubles at WFP’s decision to cut food ratio yet again amid such hyper-inflation,” Rohingya refugee freelance writer and photographer Aung Myint said of the situation in Bangladesh. “We tried to complain to the UN but there is no one who can stand with Rohingya and support us with this issue.”

The Rohingya in Cox’s Bazar are prohibited from leaving the camps to find work in Bangladesh, leaving the camps entirely reliant on humanitarian aid. According to the WFP and Rohingya community sources, when food becomes scarce, youths take the risk of being exploited after illegally escaping the refugee settlements and falling into the hand of traffickers or being forced into child marriages.

In the camps, some now fear that deeper cuts to food allowance will be fatal.

“This isn’t the first time the WFP has cut monthly allowances. Rohingya survivors of the Myanmar genocide have suffered enough, yet the reduction has been carried out,” Lwin said.

The post Food rations cut again for Rohingya refugees to just $8 per month appeared first on Southeast Asia Globe.

New cases of Covid-19 have spiked in the weeks after the Eid al-Fitr holiday, filling hospitals in the two Muslim-majority nations. In Malaysia, nearly 75% of hospital beds are currently being used and hospital admissions have increased 33.5%. Cases in the country are also up 65%.

Meanwhile, five major hospitals in Indonesia have had a 50% increase in patients, according to a Ministry of Health spokesperson. Just last week the country had one of the highest daily reports of cases in the past five months.

The coronavirus has continued to mutate across Southeast Asia. New variants that are dominating the region are easier to transmit, even for those who have been vaccinated and boosted. Recent data from India on the Omicron subvariant referred to as Arcturus shows a higher-than-average fatality rate, according to infectious disease epidemiologist Dicky Budiman.

“That should send us a very serious message. It should raise our awareness to improve our mitigation and prevention,” said the researcher at Griffith University in Queensland.

Travel for Eid al-Fitr is one of the largest annual migrations in the world, but this year was especially massive in Southeast Asia with “revenge” travellers returning home in full force to visit families. The Indonesian Ministry of Transportation predicted a 47% increase in the number of travellers from last year, for a total of 123 million people. 

The sudden exodus is particularly pronounced with residents leaving urban areas like Jakarta. Almost 10 times as many police were deployed to manage the city’s security and traffic than when it hosted last year’s G20 summit. 

After years of government restrictions and fear of infection, people were eager to finally enjoy themselves. 

“It’s like you want to not only travel but you don’t want to comply with any restrictions, any requirements, wearing masks, everything. I saw during this mudik,” said Budiman, using the Indonesian term for the surge in travel that happens before the holiday.

Besides travel, researchers believe some of the latest Omicron subvariants, Arcturus and its sibling Kraken, have contributed to the increase in cases. 

Indonesia detected its first Arcturus cases in late March and early April. The same subvariant was also found in Malaysia in March. 

Omicron’s subvariants are more contagious and more likely to infect even those with immunity than some earlier Covid variants. While these subvariants don’t generally make people as sick as other Covid variants, vulnerable populations such as the elderly, immunocompromised and unvaccinated are still at greater risk of experiencing severe illness.

“Mobility can spread the disease, but the increase in cases is primarily caused by virus mutations in the form of new variants of concern and its subvariants,” said Masdalina Pane, epidemiologist and senior researcher at Indonesia’s National Research and Innovation Agency.

She said government officials in the past have overemphasised travel as a factor in the spread of the virus, and that strict mobility restrictions have resulted in public mistrust of health measures. Indonesia’s Ministry of Transportation restricted travel home for a period around the holiday in 2020 and 2021. Malaysia also tightened travel restrictions ahead of the holiday in those years.

This year’s Eid al-Fitr is just one example of the challenges ahead for the region in mitigating the pandemic among people ready to return to pre-pandemic socialisation.

Looking to the future, as the WHO has lifted the international public health emergency status for Covid, public health officials face an uphill battle in encouraging people to continue to stay vigilant. 

Ilham Akhsanu Ridlo, professor of health policy at Airlangga University in the city of Surabaya, said that’s especially true in Indonesia, where he says repressive approaches made the spread of the pandemic worse.

“I see the challenge now as restoring some level of trust in authority. For many reasons, especially in the early phase of the pandemic, the level of trust tended to be low because some policies were not based on scientific evidence,” he said in an email. “Until now, that sentiment has not completely disappeared.”

The post Covid-19 cases soar after Eid al-Fitr celebrations in Malaysia and Indonesia appeared first on Southeast Asia Globe.

As she felt increasingly disconnected from her peers, lonely and misunderstood in her rural hometown in northern Laos, she ventured on a quest to save herself from her own terrifying thoughts. 

“I started asking myself what was wrong with me,” she said. “I had no friends I could talk to. I was scared of being with myself.”

Mee, now a senior student of health science in the capital Vientiane, soon realised she needed help, but with no support system, she had no choice but to teach herself coping mechanisms that she learned from the Internet.  

“It was then that I realised I wanted to help those who are mentally suffering and cannot find a way out,” she said. “I wanted to become a psychologist.”

But Mee soon learned that graduating in psychology isn’t an easy option for students in Laos, as such degrees simply aren’t available there. 

The country’s medical infrastructure is generally limited, with that for mental health especially so. Laos has just one licensed psychiatrist for a scattered population of 7 million and no specific psychology faculty at any of its three national universities – the closest students can find is educational psychology, which is more related to teaching. 

Development agencies, civil society and youth-led counselling advocacy groups such as Gamlang Chai and WeCare took strides to improve basic services during the isolation of the Covid-19 pandemic. Even still, a broader lack of data or understanding about mental health conditions often makes it difficult for those in distress to find help before it’s too late.

Though Mee thinks mental health support in Laos is still weak overall, she believes the pandemic was at least a turning point for awareness. For now, more concrete solutions feel far away.

“I quickly found out that becoming a psychologist was not easy here,” she said. “My only choice was to start studying medicine and then apply for a scholarship to study abroad.”

Where are the experts?

Over the past three years, the United Nations Population Fund (UNFPA) has helped foster a more robust set of hotlines for those seeking help.

Working with the Health Ministry, UNFPA collaborated with the Vientiane Youth Center, Lao Youth Union and the Women’s Union to ensure longer hours and quality counselling through existing hotlines, as well as establishing new ones to meet demand during the pandemic.

“Whenever there is distress, whether physical or emotional or economic, there is an increase in the burden of mental well-being,” said UNFPA Laos country representative Mariam Khan. “What we aim to achieve is to create a safe support team that is trained to provide comfort and confidentiality to local communities so they can feel comfortable reaching out.”

But the biggest challenge was finding enough licensed and trained people across Laos who specialised in this field, Khan said, adding the lack of expertise became “very apparent” when UNFPA began seeking national counselling trainers.

Today, Dr Kongsy Chounlamany is one of only two people in the country – the other being retired – with a master’s degree in guidance psychology, from Thailand. She’s also the only one with a PhD in educational psychology, obtained with Umeå University in Sweden. With her background, Chounlamany is the vice dean of the Faculty of Education at the National University of Laos in Vientiane, and the country’s sole professor of general psychology.

“The biggest problem is that even at the hospital, doctors treating mental illnesses are not psychologists or psychiatrists,” Chounlamany said. “They have no professional training in mental health.”

According to her experience, mental health studies have never been popular among Lao students. She said mental health disorders have mostly been considered through the lens of superstition or folk medicine, which views such conditions as the result of a mother’s stressful pregnancy, or disregarded altogether.  

The topic also remains strongly taboo across Laos. According to those who spoke with Globe, the result is that mental health problems are normally ignored until they become too severe or result in suicide, an act that would bring great shame to the person’s family.

Although the National University opened an Education and Psychology Department in the early 1970s, it soon closed for lack of teachers and students. Only in 2017 did the department reopen its doors but, once again, the same problem emerged. 

This year, the faculty counts only seven students, Chounlamany told the Globe.

Lao youth stepping up for support

Still, she thinks the field may now be starting to change. 

With the loneliness of pandemic lockdowns, members of the public began creating support groups and mental health advocacy pages on social media. Meanwhile, national social services, working with international organisations such as UNFPA, enhanced their efforts in providing counselling training to medical staff and emergency response volunteers across the country. 

Khan also noticed a visible improvement in mental health support since 2021. 

But “as in many other cultures, in Laos talking about self-harm all the way to suicide is still considered a bad omen,” she said. Medical emergency response to such cases is limited or nonexistent in most places, but she balanced that by pointing out the role of traditional support systems in steering the vulnerable away from harm.

“What is very special here is the strong sense of community,” Khan said. “While the official service system might not be as well developed for crises and emergencies, there is a tendency to respond at a community level.”

This approach was what inspired Valy Phommachak, a speaker for Lao Youth Radio, to co-found a community support network on social media called Gamlang Chai, roughly translated as “cheering and supporting you”.

As a public radio speaker during the hardships of the pandemic, Valy felt increasingly targeted by vicious comments on social media from embittered people.

“I couldn’t take more hate comments in and I couldn’t deal with it alone anymore,” she said. “I just wanted to shut down. I knew I needed help”

As she managed to find help through a now-dismantled volunteer organisation, Valy wanted to create a safe space for her fellow citizens struggling with mental well-being. The result was Gamlang Chai, which she and her team launched in late 2020.

Since then, they’ve hosted a series of Wellness Festivals, panel discussions and other events in Vientiane. They’re also now looking for funds to create a free mobile app to gather all the available tools and information about mental health in Laos, including hotline numbers, breathing exercises and a list of health service providers.

“We wanted to educate people about mental health and to destigmatise it,” Valy said. “I’m no expert, but one thing I know is that the smallest help can really make the difference.”

The post Laos opens up about mental health amid poor professional support appeared first on Southeast Asia Globe.

His partner suggested he get checked for HIV. Ork was surprised and dismayed at the request, but took the advice and went to Phnom Penh to run the test. He was positive. 

“I couldn’t believe my eyes when I saw the results.” Siek Ork said. “I had never been with any other man. How could this happen?”

Siek Ork found out that his partner had been cheating on him for almost two years, and, although he refused to be tested for HIV, his boyfriend admitted there was a high chance that he had been positive for a while. 

The couple broke up and Siek Ork moved to Phnom Penh from his home province to start a new life. He hoped to find more support and understanding from the community in the capital.

“If I stayed there, I knew people would judge me a lot. In remote areas, the community does not yet understand HIV yet,” Siek Ork said. “I already had problems with my family when they found out I was gay. They couldn’t take this.”

He’s now one of approximately 74,000 people living with HIV in Cambodia – a number now growing at a quickening rate, alarming public health officials. The official yearly count of newly found infections doubled between 2018 and 2021, according to the National AIDS Authority (NAA), rising from about 500 to more than 1,100.

The recent spike in recorded infections has confounded more than a decade of successes in curbing the spread of HIV in the kingdom. But leaders of the NAA say lingering complications from the Covid-19 pandemic, plus a top-down approach to health governance and systemic failures to include input from those most at-risk are undermining their efforts to control the virus.

NAA vice-chairman Dr Tia Phalla said men who have sex with men, transgender people, and sex workers and their partners are rarely invited to participate in policy-making directly impacting their own lives in Cambodia.

“Their participation in drafting effective mechanisms is essential,” said Phalla.

Need for inclusive participation

In 2016, the Ministry of Health – which oversees the NAA – announced a new programme with support from United Nations programme UNAIDS to encourage collaborative policy-making between the government, service providers and at-risk groups. 

But Phalla said these efforts, known as the Dynamic of Stakeholders System, have shown no visible progress due to the lack of inclusion of key populations. 

“If we don’t change our mindset and start valuing the participation of HIV patients in the policy-making procedure, nothing will ever change. Infections will just keep increasing instead,” he said. 

In Cambodia, the absence of affected groups stems from a broader, top-down approach to governance in which high-ranking entities make decisions for others in society, Phalla explained. His 30 years of experience taught him that target individuals are often uncomfortable sharing their needs before government authorities or health system representatives because of the power imbalance between them.

“A body cannot stand with just one leg,” Phalla said. “Both are equally important and necessary for the balance of a person. And so is the government and affected population.”

Even the NAA is subject to this top-down hierarchy. Phalla said the authority is often left out of decision-making about HIV, and is left to observe the Health Ministry and service providers mostly act on their own.

Cambodia is aiming to reach zero new HIV infections by 2025 while trying to become fully independent from external financial sources or foreign non-governmental organisations such as USAID. International funds allocated to HIV prevention in Cambodia have been steadily decreasing according to Dr Tep Navuth, the NAA director of planning, monitoring, evaluation and reporting.

“We have very little funding for HIV prevention programs right now,” Navuth said. “With little international support and limited domestic financial availability, it is not a surprise that more than a thousand people still get infected every year.” 

Recent data collected by UNAIDS in cooperation with the NAA shows a great disparity between infection rates and the national allocation of funding to HIV prevention and response. 

Statistics collected by the authority revealed that 15% of the national HIV-related budget is allocated to HIV prevention. But with 72% of new yearly infections found among at-risk groups, only 7% of that total HIV budget is used for treatment and prevention among these groups.

Boosting that last number is one of NAA’s top priorities, according to Navuth. 

Not enough

According to a historical study published in 2006, only three of 12,414 people living with HIV across the country in 1999 were receiving antiretroviral treatment (ART). 

In 2003 the Global Fund started funding the inclusion of ART in the national healthcare system, enhancing the government’s HIV response.

Today, according to some of the most recent data collected by UNAIDS, of the estimated 84% of people living with HIV in Cambodia who know their status, 99% are on treatment and 97% are considered virally suppressed. That means the amount of viral particles in their blood has become undetectable. 

Despite that progress, UNAIDS country director Patricia Ongpin warns that challenges still remain, and feelings of shame and fear often prevent those with HIV from receiving proper treatment.

“People might have not heard about [the spread of HIV], but that doesn’t mean that we should stop paying attention to it,” said Ongpin, who also oversees the agency’s work in Laos and Malaysia. 

Ongpin lauded Cambodia’s successes in controlling HIV as “a great achievement” that was made possible through a highly targeted response. But at the same time, she said generalised information is not easily accessible to the public, meaning that especially the youngest generations lack basic knowledge on disease prevention. 

More than a thousand children under the age of 15 in Cambodia are living with HIV, according to Ongpin, and of these only a slim majority are currently receiving treatment.

“If people start getting to know better how and where to get HIV testing, as well as how to prevent and respond to HIV, Cambodia will be on a good way towards ending AIDS,” Ongpin said.

Cambodian youths lack awareness

But the recent increase in infections is not entirely to blame on high-ranking institutions or policymakers, said Phalla. A multitude of other social factors had a crucial impact on this issue, including the Covid pandemic, new cultural norms for the youths, increased intravenous drug use, and less awareness. 

Covid has contributed to increasing poverty levels across the country, which hit almost 18% of the population, according to national statistics shared by the NAA. The economic challenges forced the HIV-vulnerable community to avoid the costs of STD/HIV tests or treatment as well as causing an alarming decrease in the use of condoms. 

“Those kinds of protections seemed to have become an unaffordable luxury for many,” Phalla said. 

As Covid restrictions urged limited social interaction, people had to stay home with their partners or families and avoid clinics or hospitals. Outreach programs were also interrupted during the pandemic, moving most of awareness-building activities online – causing a further decline in access to information for the general public. 

The NAA employs people from at-risk groups to work as professional community outreach organisers, paying $250 monthly to educate their peers about HIV on a full-time basis. But Phalla says the NAA is looking to restructure this program to attract more participants, as the money isn’t enough to interest those with better-paid jobs. 

Phalla said men who have sex with men are generally more reluctant to be involved in any HIV-related programs because of the stigma attached to the virus and discrimination against them, which is still strong in Cambodia. Families or employers often reject them, especially in remote areas and if the individual lives with HIV. 

“If you pull one leaf out from a plant, it would dry up quickly,” said Phalla of the vulnerability of men who have sex with men or those living with HIV who are shunned by their families. 

“While the plant (family) remains green and healthy, the separated leaf dries up. Which one of them would you use to set a fire? The dry leaf of course.”

Siek Ork is a living example of the hardships such people face when they lack family support. 

“I couldn’t stay there one more day,” he said. “It was unbearable seeing my family’s suffering, knowing about my condition.”

Because of a lack of family acceptance of their sexuality, Phalla said, men such as Siek Ork may feel forced to avoid seeking external support or information.

“The more we listen, the more we have people involved. That way awareness increases, and stigma decreases, thus we will have fewer infections,” he said. 

The post Cambodia’s HIV surge: high-risk groups essential for better policy appeared first on Southeast Asia Globe.

Bringing together government officials, academics and economic experts from around the world, CDRI’s 2022 Cambodia Outlook Conference will provide key stakeholders a platform to address the most pressing issues facing Cambodia in the coming years. This auspicious event will be held on the 6th of October 2022 at Sokha Phnom Penh Hotel and Residence. Returning to deliver his 14th Cambodia Outlook Conference keynote address, Samdech Akka Moha Sena Padei Techo HUN SEN, prime minister of the Kingdom of Cambodia, will set the stage for a full day of panel discussions and audience participation.

Up first is “Sustaining Development in a Fractious Post-COVID World,” an examination of the big picture changes in global and regional economies post-pandemic and what they mean for Cambodia. Looking at digital transformation, globalisation and environmental pressures, geopolitics and the “new normal” will be at the centre of discussions. Led by moderator and panellist Minister Delegate Attached to the Prime Minister in Charge of Foreign Affairs and ASEAN, Dr. Kao Kim Hourn, this session will feature the University of Notre Dame’s Dr. Caroline Hughes, the National University of Singapore’s Professor Bert Hofman and Professor Wing Thye Woo from the University of California, among others.

The second session, “How Can Cambodia Continue to Succeed After COVID-19?” dives into the details of Cambodia’s economic success pre- and  post-COVID-19. An examination of the weaknesses and strengths of development will guide discussions focused on identifying promising strategies for cooperation between government, business, and civil society to navigate ongoing uncertainty. Featuring CDRI’s Executive Director, Dr Eng Netra as well as experts from leading educational institutions, key insights will be shared and promising strategies discussed. 

“Priorities for Revitalising Cambodia’s Development Model” is the theme for the third session where discussions will centre around the future of the nation with a special focus on a shift towards higher quality development. By identifying immediate actions as well as long-term strategies in public health, human resources, sustainable agriculture, and digital and technological innovation, discussions will focus on modernising Cambodia’s economy. Moderated by Okhna Sok Piseth, CEO & Co-founder of G Gear co. Ltd., and featuring H.E. Dr. Phan Phalla, Secretary of State for the Ministry of Economy and Finance and H.E. Sok Chenda Sophea, Minister Delegate attached to the Prime Minister and Secretary General of the Council for the Development of Cambodia (CDC), among others, this session will shed light on Cambodia’s path forward. 

With CDRI’s Chairman of the Board of Directors, H.E. Dr Mey Kalyan, providing a summary of the day’s events, “The Way Forward: Key Messages for Reform and Action,” will provide the audience and participants time to reflect on the conference’s central points and most profound insights. Deputy Prime Minister and Minister of Economy and Finance, H.E. Dr Aun Pornmoniroth will provide closing remarks and conclude the event.

With the 2022 Cambodia Outlook Conference, CDRI continues to bring together the most dynamic and influential stakeholders from Cambodia, Southeast Asia and beyond to address our post-COVID world. We look forward to seeing you there and hearing your thoughts and insights on Cambodia’s promising future!

Media representatives are welcome to attend and report on the conference at Keynote Opening Address only. See the attached program for details. Please direct any questions about conference arrangements to Ms. Bun Phoury at phoury.bun@cdri.org.kh. 

The post 2022 Cambodia Outlook Conference: Revitalising Cambodia:  Sustaining Development After COVID-19 appeared first on Southeast Asia Globe.

To combat this concerning trend, a new social behaviour change (SBC) campaign has been developed to educate and motivate women to take their health into their own hands. Importantly, Bloom brings together key stakeholders in government, civil society and the healthcare sector to provide important information about the risks these conditions pose and specific actions women and families can take to live healthier lives. 

“Reducing the burden of NCDs is a key priority of the Royal Government of Cambodia,” explained Dr. Kol Hero, director of the Preventative Medical Department for the Ministry of Health. “This campaign contributes to the fight against hypertension and type 2 diabetes, which is not only a health challenge but also a development challenge.”

Jim Maister kicked off the campaign launch, held September 21st at Phnom Penh’s Raintree event space. As chief of party for Preventative Health Behaviours (PHB), the USAID funded wing of PSI, Maister highlighted the dire consequences that arise when personal health is neglected. In 2018, 64% of all deaths in Cambodia – some 60,000 people – were due to NCDs and it is estimated that one in four Cambodians die prematurely, before the age of 70.

Reducing the burden of NCDs is a key priority of the Royal Government of Cambodia”

Dr. Kol Hero, director of the Preventative Medical Department, Ministry of Health

Joined by Dr. Kol Hero and Dr. John Eyres, director of USAID’s Office of Public Health and Education, Bloom’s “Priority Behaviours” were laid out for the audience. With strategies developed through primary research and surveys conducted by PSI and research firm 17 Triggers, limiting salt intake, opting for healthier cooking methods and eating more fruits and vegetables are key messages. Motivating people to exercise throughout the week and conduct regular health screenings for hypertension, type 2 diabetes and cancer round out these priority activities. 

Motivating women to embrace personal agency and take control of their health is at the heart of the campaign. Given the primary role that women play in setting the precedent for family behaviours, Bloom is targeting women between the ages of 30-44 in the urban and peri-urban areas of Phnom Penh, Battambang and Kampong Cham with the goal of empowering women to be the catalyst for broader changes. 

Charged with designing, branding, and activating the campaign, Phnom Penh’s Brains Communication brought its creative vision and established track record as a 360 digital marketing firm to develop a comprehensive outreach strategy. Through ongoing and in depth collaboration with PSI and other key stakeholders, a coordinated approach was developed with social media taking centre stage.

With the tagline “Live wise, Healthy life,” social media posts and behavioural nudges will play a key role in shifting attitudes and changing habits. Videos depicting the benefits associated with lifestyle changes alongside messages from Cambodia’s most recognised online influencers will drive engagement and paint a picture of how living a healthy life not only helps women, but entire families. 

Cambodia’s progress over the past 30 years is impressive, however, achievements lead to new challenges and cooperation is essential in the face of these obstacles. Rolling out in the coming weeks, Bloom will be found on social media and smartphones around the Kingdom, a unified effort across government and civil society that can empower women, help families, and change lives.

The post New challenges, new solutions: sowing the seeds of healthy lifestyles with Bloom appeared first on Southeast Asia Globe.

She and her partner grew so fond of the toy they even named it Johnny. Yet after graduation, as she worked in a high-rise office tower along Singapore’s main shopping street, Lim walked past a sex toy shop nearby every day for four years and never went inside.

“If I were to walk in and if I were to look at toys, I might be seen as very promiscuous or very slutty in some way,” Lim, 29, said of her feelings at the time. “I don’t tell people I’m using toys. It’s a hidden secret that I feel a lot of people have.”

As the co-founder of sex toy company Genvie, Lim is among a growing group of Southeast Asia entrepreneurs trying to coax conversations about sex toys into the open. 

By branding themselves as sex educators as well as retailers, the companies host female empowerment workshops, publish intimacy tips and even teach basic anatomy, reaching young women and queer people through palatable Instagram carousels and soft, welcoming websites.

Countries in Southeast Asia, especially Singapore but also the Philippines and Malaysia, have seen a rapid rise in homegrown sex toy companies in the past five years.

“We really noticed the problem here in the Philippines is the stigma, the taboo, the lack of sex education about pleasure and the health benefits of pleasure,” said Renz Rollorata, who co-founded toy retailer Lauvette in 2019. “We know that the opposite of that is education.”

The sexual wellness business is part of an overall rise in Southeast Asian “femtech,” a catch-all term for technology focusing on women’s health and experiences. Although there’s little region-wide data tracking the industry, Southeast Asia accounted for at least 41 of the world’s 318 femtech companies last year, according to Fermata, a femtech retailer and platform.

More than half of the region’s femtech companies are located in Singapore, followed by a handful in Thailand and a few each in the Philippines, Malaysia, Vietnam and Indonesia. Roughly one-third are sexual wellness companies.

The uptick has made some sex therapists question whether for-profit companies are equipped to provide sex education, while founders argue they’re filling an information vacuum for young people looking to explore and learn about their bodies.

“They’re trying to answer questions, and there are a lot of questions,” said Francesca Geary, marketing director at Fermata. “And it’s just the start.”

The sex toy industry has been well-established in the U.S. and Europe for the past quarter-century, with around half of heterosexual Americans and even more LGBTQ+ people reporting use of a sex toy as of 2013.

A lack of local companies has left Southeast Asia consumers with fewer options than their Western counterparts. Longstanding cultural and religious taboos around sex, which underlie legal issues, have made some entrepreneurs question whether there would be enough customer demand. 

In 2018, a handful of young Cambodians were arrested and forced to stand in front of dozens of dildos at a press conference after selling sex toys on Facebook. In Malaysia and Thailand, potential entrepreneurs have been scared off by “obscenity laws” pushing the import and sale of toys into murky territory.

Instead, customers navigated thousands of toys from major online retailers like Lazada or Shopee with little information about how to use them, let alone public forums to discuss sex. 

“When we were talking to our communities and close networks, we’d be met with, ‘But this is an American problem, it’s not really a big thing in Asia,’” Geary said. “‘We don’t see companies like this here. Is this not too niche for Asia?’”

In terms of finding help, there’s a lack of awareness – where do I find help and how do I seek it?”

Andrea Koh, sexologist

That mindset has started to shift. E-commerce dramatically increased throughout the region in recent years, with Indonesia, Vietnam, Malaysia, Singapore, Thailand and the Philippines experiencing a growth in internet users by about 75% since 2015, according to a recent Bain & Company report. About eight out of 10 consumers have purchased items online.

The internet also has changed how millennials and Gen Z think and talk about sex, whether bingeing the Netflix show “Sex Education” or connecting over a shared vocabulary of sex positivity and enjoyment, according to Malaysia-based sexologist Andrea Koh. 

“Because of all this media that’s empowering people to be more open about sex, it creates more awareness in the public to say, ‘Okay, let’s look at my own sexual relationships and how I can improve that,’” Koh said. “It’s just that in terms of finding help, there’s a lack of awareness – where do I find help and how do I seek it?”

Sex toy companies see themselves as a first step toward answering that question.

Lith Ng, the 26-year-old co-founder of Malaysia-based retailer Erosu, received a bare-bones, abstinence-heavy introduction to sex at her conservative high school outside Kuala Lumpur. 

But she dug deep into discussions on the social media site Tumblr, sharing articles and books with strangers about feminism and discovering the much-studied orgasm or pleasure gap, which refers to the disparity in orgasms between men and women during heterosexual sex.

Although she started incorporating sexual themes into her work as a visual artist, she felt she couldn’t make much impact beyond the local art bubble. After years of internal debate, she and her partner launched Erosu at the start of 2020 with the idea that other people in Malaysia would be interested in sex toys if they had an approachable place to find them.

“I want to advocate for pleasure, and what’s a better way to do it than selling this stuff and also educating and empowering other people?” Ng said. “A lot of people are dying to talk about it, but they don’t know who to talk about it with, without being shamed.”

On a Saturday morning in March, a group of about 70 university students logged onto a videoconference called, “Into the Thick of It: A Vulva Affair.” Hosted by a Singapore-based platform promoting vaginal and vulval hygiene, the students’ questions ranged from asking about whether you should use lubricant with sex toys to how to start masturbating for the first time.

“That’s very typical,” said Lim of Genvie, whose cofounder spoke on the panel. “It’s very early on sexual wellness discovery phase, which is why we try to cater according to who we’re speaking to.”

That can include anyone from teens to new parents. Advertised in soft pastels and pinks on social media, recent events by Southeast Asia’s sex toy startups included titles like “Female Orgasms,” “From Painful Sex to Pleasure Warriors,” “Queer Sex 101” and “Don’t Let Men(struation) Keep You From Pleasure.” Bite-sized Instagram content ranged from the fun (“Things to Know About Being in a Throuple”) to the serious (“Men are also victims of sexual harassment”).

The goal is to welcome people, especially women, who are curious about exploring their sexuality but have been scared off by garish or outdated marketing, explained  Rollorata of Philippines-based Lauvette. The company hosts weekly Instagram Live webinars with experts and produces a long-form blog, regular social media content and in-person events, some in partnership with an HIV awareness group.

“We provide it to the public regardless whether we get sales out of it or customers out of it,” Rollarotta said. “Education and our business of selling sex toys are not separate, it just goes hand-in-hand.”

At the launch of a recent sex toy pop-up event in Singapore, British dating and sex podcaster Nixalina Watson, who revamped her U.K. blog ‘Sex and London City’ for a Singapore podcast audience in 2019, was rapt with attention during a discussion of aphrodisiac scents, the room decked out with a full-sized vagina diagram and toys galore for men and women.

In the four years she’s lived in Singapore, Watson said she has felt stigmas surrounding female sexuality start to crack – similar to the changes she witnessed in the U.K. when she lived there.

“Growing up, I never had any of this,” Watson said. “So to have these workshops where people can go, and you’re giggling, messing around with sex toys, but it’s also really informative – I was just sitting there like, ‘I didn’t know that, I didn’t know that.’ It’s wonderful.”

That purported mission has drawn scepticism from some experts. Martha Lee, a Singapore sexologist who has a Ph.D. in human sexuality, said sexual wellness has become conflated with sex toys in part because of pandemic-born influencers and companies’ tendency to oversimplify information into clickable answers. 

“Whatever they’re putting out is really just things that they have Googled,” Lee said. “Because they’re not trained, they don’t know what they don’t know or are missing out on, they don’t have the full picture, and can potentially do a lot of harm.”

“It’s much more acceptable to educate people than to shove toys down their throats,” she added.

Jingjin Liu, the founder of sexual wellness education company ZaZaZu, agreed that companies “can be full of shit” and said ZaZaZu has moved away from selling toys to focus solely on sex education and empowerment. But the industry has established a starting point for people to vocalise their needs and desires, she said.

“The point is to get more conversations ongoing, and this is what we tried to do at the beginning with products,” Liu said. “At the end of the day, if you want to empower women to own their sexuality, you need to start with sexual exploration.”

Customers may also decide where to turn to for sex education. Raymond Tang, a 31-year-old personal assistant in Kuala Lumpur, has been encouraged watching friends talk more openly about sex and pleasure in the past few years.

As a gay teenager, Tang’s sex education was so lacking that he first learned about sexually transmitted infections such as HIV as a university student. Now he firmly believes any conversation about sexual health is better than none.

“In school, you should be exposed to these things,” he said. “Unfortunately, that’s not going to happen anytime soon.”

The post How Southeast Asia’s sex toy companies are reimagining sex ed appeared first on Southeast Asia Globe.

The meditative motion reminded her of how she stroked her late husband’s hair in hospital during his last days of fighting leukaemia .

Her husband, who loved the outdoors and camping, passed away a month ago and Tan’s grief is still raw. The blind horse leaned its body gently against her.

“I don’t understand why it keeps coming near me, maybe it wants a cuddle? It must be so comfortable to want to lean against me,” Tan mused. 

Tan stepped aside to let her daughter Sarah enter the space. With the younger woman, Stardom lowered his head and nuzzled his face against her leg affectionately. 

On cool Sunday morning at the horse stables, the rain drizzling softly outside, amongst around 60 retired racehorses and aged ponies, Tan and her daughter were  participating in an equine interaction session organised by HERD Singapore, a  social enterprise founded in December 2021.

Initiatives such as HERD, which believe in the healing power of horses and aspire to give more people a chance to have meaningful interactions with these animals, are gaining popularity in Singapore.

Fuelled by the pressures of the pandemic, the demand for new avenues and practices for mental welfare are rising in the city-state and equine therapy practices such are emerging as a critical resource and provide a rare pocket of serenity carved out in one of the most high-stress and urbanised cities in Asia.

Healing horses

Equine assisted therapy is an experiential mental health treatment method that uses the connection between people and horses to enhance physical or emotional healing. Research has indicated that it is effective for treating people experiencing depression, anxiety, and/or trauma-related symptoms, as well as ADHD, autism, dissociative disorders, and other mental health conditions. 

Although it has been on the radar of health professionals and patients for over half a century, the recognition of therapeutic riding stretches back to Greece in the 5^th century BCE.

While it is established in places such as Europe, United States and Australia, equine-assisted intervention remains somewhat of a niche in land-scarce Singapore, only gaining traction over the last couple of years.

Long-standing stigmas around topics of mental health have hindered the ascent of practices outside traditional talking therapies. 

A 2017 survey of Singaporean young people cited by global health services company Cigna, found that around 44.5% of respondents associated mental illnesses with negative, derogatory terms like “stupid”, “dangerous”, “crazy” and “weird” and  46.2% of them said they would be “very embarrassed” if they were diagnosed with a mental illness. 

The pandemic and its lockdowns further exacerbated the urgency for increased mental health awareness. Samaritans of Singapore, a suicide prevention organisation, received over 39,000 calls for help in 2020, during the height of the city-state’s covid restrctions, an 18% increase from the year before.

HERD founders, Chan Li Wen, Jamie Lee, Pearlyn Yap and Sharifah Faizah first met while developing and running equine assisted learning programmes at an animal-assisted intervention centre in Singapore. The current team also includes their equine consultant and mentor, Mr Tommy Wong, who has more than 30 years of experience in the equine industry.

Their experience at the centre fuelled their belief in the therapeutic potential of animals, especially horses. 

They have worked with a variety of beneficiaries such as schools, orphanages, family service centres and nursing homes and have combined experience in social work, counselling, special needs, stable operations, natural horsemanship, programme development and equine-assisted learning facilitation.

The team hold full -time jobs and spend their after-work hours doing curriculum planning and administrative work for HERD. On the weekends, it’s dedicated to sessions with the horses and clients. The programmes are supported by the Gallop Stable (a riding centre that rescues and supports retired racehorses).

Their first session at the end of February catered to a family with members aged from 7 years to 77 years.

“We’ve seen our clients present their most vulnerable side with horses, and what they share with the horses can be unique and different (than other forms of therapy),” explained Liwen. 

You don’t choose the horse, but the horses choose to work with you”

Jamie Lee, HERD co-founder

For now, they are targeting to work with families looking for bonding activities.

Through these exploratory “horse-led activities” like grooming and interaction, it  opens up conversations about family dynamics, love language, communication styles, self-awareness, according to co-founder Lee.  

Horses are prey animals and are extremely sensitive to the environment. They are acutely attuned to the smallest changes like tone of voice, body language, behaviours, and emotions. 

The horses in the programme need to have the right temperament and willingness to work with clients. But most importantly, the team subscribes to a unique philosophy – “you don’t choose the horse, but the horses choose to work with you in a mutually beneficial relationship,” Lee said.

On board is Stardom, a visually impaired horse, Big Ben, a massive thoroughbred who retired from his racing career, Dawn Don, a senior horse, Disney and Snowy, all of whom “seemed to want to connect and were interested in human interactions,” said Chan.

She recalled how Snowy appeared initially reluctant to interact with visitors, turning away whenever they approached her.

She added, “But we took her out, spent some time with her and gave her a good groom. She was enjoying the attention so much until her legs almost gave way because it was too shiok (a Singlish word to express a good feeling or extreme satisfaction).”

While it’s early days yet, the team hope to make their programmes more accessible to the general public and to change the perception that it is restricted to an exclusive or wealthy group.

They also hope to train up a pool of volunteers to learn about animal assisted intervention, and to plan programmes centred on respite care, practising mindfulness and reducing anxiety.  

“There are so many more people who need this but can’t reach it, like stressed out caregivers or special needs individuals… a caring society is one surrounded by nature and animals,” said Yap.  

Helping young and old

In a densely populated urban city-state such as Singapore, exposure to green spaces is paramount to mental health.

With intervention methods like art therapy or counselling, a lot happens indoors, mostly in a closed space.

For someone who may be cooped up at home in front of a computer experiencing stress, this gives them the option of being in a simple country-like space where they can experience animal-assisted programmes and find healing and balance,” explained Sandra Leong, chief executive of charity Equal-Ark Singapore, who joined the organisation in January. 

For the last seven years, Equal has been running equine-assisted intervention programmes for hundreds of youths, people with special needs, caregivers and seniors with debilitating conditions like clinical depression or dementia.

The place is home to 10 retired horses (including polo horses, racehorses and school horses) and six playful Argentinian falabellas or miniature horses.

The team believes that interacting with horses offers the elderly a different type of psycho-social care, many of whom have never had a chance to see a real horse up close.

One in ten people aged 60 and above in Singapore has dementia, according  to a nationwide study.

Zherwin Acosta, Equal’s head of animal welfare and operations, recounted how many frail and wheelchair-bound elderly clients were reluctant to go near the horse at first, but ended up warming to these gentle giants and wanting to groom and feed them. Some patients with dementia can vividly remember the horse’s name even after a visit.  

They’ve also brought the miniature horses out to the community too like nursing homes and schools for special needs children – they are so tiny that they can easily fit into building lifts and be transported four at a time in the horse trailer. 

For the youths, such programmes also build their self-esteem, social awareness and confidence and values like perseverance. In Equal’s signature “Cross the River” horseplay game, students have to work as a team to guide a horse across a make-believe river.

Acosta recalls how one boy refused to engage in the first session, preferring to linger in the corner by himself. But when they brought one miniature horse beside him, they witnessed a transformation.

“He started to lead the horse by himself. By the second session, he asked if he could have two. Seeing him progress from this quiet boy to someone confident… It really brings youths like him out of their shell,” said Acosta.

While they had to organise smaller breakout groups and scale down sessions at the height of Covid-19, things are looking to get back on track this year.

As Leong led the horse Ribena out to the pasture to graze, she talked passionately about their upcoming plans to make their services more accessible to the community and to ramp up their outreach.

2022 will see them reaching out to more groups of beneficiaries, collaborating with other social service agencies, and bringing on more minded partners to bring its animal-assisted programmes to more people.

“While we ride out the tail-end of Covid-19, we are seeing deeper social issues that may need a multi-intervention approach. We are also seeing pent-up demand by individuals and families seeking help and meaningful experiences,” said Leong.

“What’s really amazing about horses is that they can have a beautiful connection and interact in a gentle yet transformational way with those we serve.” 

The post The Singaporean mental health initiatives riding on horses’ healing power appeared first on Southeast Asia Globe.

“Reparations were never even a consideration,” explained Michael Karnavas, international co-lawyer for Khmer Rouge leaders Meas Muth and Ieng Sary during their cases in the Extraordinary Chambers in the Courts of Cambodia (ECCC). “That’s why when the judges started writing the internal rules, the best they could do was some sort of show, to encourage the government to build a monument. But that’s not really reparations.”

Established in 2007 with the latest appeals coming in 2021, the tribunals designed to hold accountable the architects of the 1975-1979 genocide were deadlocked by layers of bureaucracy and left many victims and survivors unsatisfied. Now ageing and with limited access to healthcare, there is a renewed urgency to collect this generation’s stories and offer some form of tangible recompense.

Securing funding from the United States Agency for International Development (USAID), the Documentation Center of Cambodia (DC-Cam) is conducting a grassroots campaign that has reached more than 24,000 Khmer Rouge survivors across the country. 

Launched in 2021, Advancing the Rights and Improving the Conditions of the Health of Khmer Rouge Survivors links youth volunteers with survivors – many isolated in remote communities – to record their stories, take health surveys and provide access to medical checkups at 48 clinics nationwide. Though DC-Cam is unable to use funding for direct care or prescription medication, trained medical professionals at these clinics treat minor ailments and afflictions and can provide guidance to survivors for additional care.

Made up of 700 youth volunteers known as the CamboCorps, including many whose own family members were victims, the project operates in every province and is building a database of the demographics, health status and oral histories of Khmer Rouge survivors. Volunteers also provide care packages and facilitate the establishment of informal associations through which survivors can come together to share stories, discuss community concerns and organise memorial activities such as building stupas. 

The project highlights the scale of the tragedy – in many ways the whole country was the scene of a crime that devastated an entire generation – but it also demonstrates how grassroots work can fill gaps in institutional efforts. 

More than 10,000 audio recordings have already been uploaded to DC-Cam’s database and preliminary findings are set to be released this year, representing a concrete step to ensure these stories are never forgotten. 

“‘Reparations’ is a tricky word. If you look at genocide in other countries – Bosnia, Rwanda – there is always difficulty with the legal framework for reparations,” DC-Cam Director Youk Chhang explained. “But from my position, in Cambodia, our question is ‘Can we give something to the victims?’”

Difficulty accessing healthcare is an issue impacting people across the country, though it is amplified in remote, rural communities. With the trauma of starvation, forced labour and physical abuse leaving lasting effects on survivors, Chhang and his team saw health checkups and medical consultations as something tangible to improve their quality of life. However, inspiration for the project was also rooted in the ECCC proceedings.

“Many of the accused had serious health issues that postponed the trial process,” said Kim Sovanndany, a project coordinator who has worked with DC-Cam for 16 years. “The reaction of the survivors that attended the tribunals when they were told the delays were because the accused were getting treatment; they were concerned. ‘Why do they get very good treatment when we don’t get any care?’” 

DC-Cam’s early healthcare work setting the trajectory for Advancing the Rights began in 2014 and focused on common ailments among eldery survivors, especially those living in far-flung villages.

A 2021 study conducted by HelpAge International, with support from the Ministry of Social Affairs, Veterans and Youth Rehabilitation, included surveys among people between the ages of 60 and 90 and found hypertension, diabetes and arthritis are all typical ailments among the ageing population. The study also identified long distances between clinics and communities as an obstacle to accessing quality treatment.

They believe bad health is an unavoidable part of being old.”

Findings from a HelpAge study

Understanding that scheduling appointments does little if patients are unable to reach a doctor, DC-Cam organises transportation for survivors, either with private cars or through community rideshares. However, there are other challenges beyond rough terrain and long distances.

“There were cases where some people were not comfortable speaking with strangers,” said David Ly, a 20-year-old volunteer who works in Kampong Cham province. “They thought maybe we were running a scam but after their neighbours got the health checkup and spread the good news, they changed their minds and participated with us.”

The HelpAge study also found many elderly Cambodians “did not wish to seek help… despite being in pain, because they believe bad health is an unavoidable part of being old.”

This reality was confirmed during DC-Cam visits. However, 21-year-old volunteer Sothea Srun, who also works in Kampong Cham province and heard about the program through her university, saw how interactions with survivors could help change attitudes about healthcare.  

“Our work builds good relationships with communities,” she said. “When we go to do interviews and surveys we also raise awareness and give explanations about the benefits of getting health checkups regularly and not delaying until they get really sick.”

These types of attitudes and a general lack of understanding about the importance of healthcare highlight the importance of the work that DC-Cam is doing. With hundreds of medical checkups completed, the tangible benefits of the campaign are promising for survivors like Chantol Boun, who toiled as a labourer under the Khmer Rouge.

“Our work builds good relationships with communities”

Sothea Srun, DC-Cam volunteer

“I still have digestive problems from before, because there was no food and no clean water to drink; I just had to drink whatever water I could find,” she said. “Before I didn’t realise the problems I had but after the help from the volunteers, I know to go to get my health checked regularly and try to do some exercise.”

As is often the case with trauma, physical scars only tell part of the story. For survivors, even those who served as witnesses in the trials, any hopes that the ECCC would bring closure were soon abandoned, as proceedings dragged on and bureaucracy won out over action. 

“From the perspectives of those victims that testified, they had an expectation of coming in and wanting to tell their entire story,” Karnavas explained. “Essentially, the court is not interested in hearing the entire story, they just want snippets. So those that came to testify left unsatisfied.”

Tasked with compiling civil party complaints in preparation for the trial, providing an outlet for victims to share their experiences has been at the heart of DC-Cam’s work since its inception. The stories that volunteers collect is a continuation of the group’s efforts to help this generation gain some form of closure while ensuring their history isn’t lost to time.

I wanted to tell people what I went through: the fear, the hard work, the starvation”

Minea Sem, Khmer Rouge survivor

For Minea Sem, who was just 13 years old during the Khmer Rouge regime, speaking with volunteers allowed her to process the events in a way she had never been able to do before.

“I feel relief now, but I was angry at [Khmer Rouge leader] Pol Pot and I wanted to tell people what I went through: the fear, the hard work, the starvation,” she said, sitting in front of her home in rural Mondulkiri. “I wanted to tell [my story] so the younger generation will remember what we went through.”

Still carrying shrapnel in her leg from a landmine and living alone as a caretaker on another family’s land, the opportunity to share her experiences also gave Sem a sense of connection with the younger generation, a feeling that volunteers see in many of the people they meet. 

Sinai Khean, a 23-year-old volunteer in Mondulkiri province, has no doubt about the impacts this interaction has on survivors. 

“The process helps survivors to feel cared for. It gives them some hope and relief because some survivors don’t believe that people want to talk to them,” he explained. “They are happy and feel better because there is someone that wants to hear their stories.”

For Sovanndany and her team, the realities of the trauma that survivors experienced is daunting. However, she believes the project can provide hope to a generation that has waited decades for closure. 

“If you think about reparations for these people – they lost their property, they lost their families, they lost everything – nothing can replace this,” she said. “But this project contributes directly to the victims, even if we just give a small contribution I think it can make them happier and healthier.”

Additional Reporting by Chanmakara Vorn.

The production of this article was funded by Documentation Center of Cambodia

The post A long time coming: oral history and healthcare with Khmer Rouge survivors appeared first on Southeast Asia Globe.

Like many Malaysian youth, he lit up a cigarette at 17 thinking he wouldn’t get hooked. He even disliked the taste. But before he knew it, cigarettes became the antagonist in his life. 

Bazil initially was in denial about his nicotine dependence. “Looking back now, I realise I was addicted. I smoked a pack a day around [ages] 19 through 22. I’m pretty sure my lungs are the colour of charcoal,” he said. 

The spectacled and tanned young man with an active lifestyle found he was quick to start panting and had trouble keeping up with his teammates during football and basketball training. Eight years since his first puff, Bazil was more than ready to quit smoking. 

The Malaysian government may soon offer him help, along with others who might be forced to wean themselves off the habit through new legislation. 

Following New Zealand’s announcement of a plan to progressively raise the legal smoking age each year, accompanied by a ban on tobacco sales to people born after 2008, Malaysia came out with its own version of the initiative to take on tobacco addiction, known as the Generational End Game.

Current tobacco control legislation was approved by the Malaysia Parliament under the Food Act 1983. The updated proposal would prevent anyone aged 17 and younger from legally buying smoking and tobacco products.

During the January executive board session of the World Health Organization (WHO), Malaysian Health Minister Khairy Jamaluddin announced plans for new legislation outlawing anyone born after 2005 from buying tobacco and smoking products, including e-cigarettes, vapes and heated tobacco.

E-cigarettes and vapes produce an aerosol or vapour by heating liquid usually containing nicotine and flavouring. Heated tobacco is designed not to burn or produce smoke.

The harmful effects of nicotine and smoking isn’t groundbreaking news, but Malaysia’s smoking rates are barely declining, only a 1.5% reduction in four years. The Malaysian government estimates the country has 4.9 million smokers, with one in five people over 15 years old consuming tobacco products. 

The Malaysian government’s National Health and Morbidity Survey for 2019 found approximately 323,110 of the nation’s smokers were ages 15 to 19. The same survey in 2015 determined 80% of adult smokers began before the age of 21.

Ultimately, the goal is to “reduce the number of new smokers until we reach a time when there are no longer smokers in Malaysia,” Khairy said during his speech for World Cancer Day on 17 February.

A February online poll by health information service CodeBlue, part of the Galen Centre for Health and Social Policy organisation, found 95% of 676 Malaysian respondents supported the age-based purchase ban.

Jennifer Tan, a smoking cessation provider and a member of the Malaysian Pharmacist Society, whose position includes engagement with smokers, said the ban is long overdue and the next step in the nation’s tobacco control policies.

“We have been quite lenient for quite some time. When certain measures [to reduce smoking] are voluntary, we don’t get the results that we want,” Tan said. “Knowledge and awareness doesn’t mean action. Our last option is enforcement and that’s through things like bans.”

But 5% of Malaysians who were polled opposed the legislation, with some saying they were sceptical of the government’s poor track record in smoking ban enforcement. 

When certain measures [to reduce smoking] are voluntary, we don’t get the results that we want”

Jennifer Tan, smoking cessation provider and member of the Malaysian Pharmacist Society

Member of Parliament Ong Kian Ming said tobacco regulation needs to have a holistic approach. Policies cannot overlook the presence of illicit cigarettes and current harm reduction strategies like nicotine replacement therapy.

“A much more rigorous debate is needed before it is tabled in parliament,” he told Code Blue.

Destiny Sze, a non-smoker, said the proposed law would serve as only a minor deterrent.

“What’s to stop those born after 2005 to get someone older to buy it for them? This is a problem happening even now with underaged smokers,” Sze said, adding that the oversight method is also problematic. 

“This will be infinitely harder to regulate unless the government plans to mandate ID-ing every young person making a tobacco [or] cigarette purchase, and even that has flaws of its own,” Sze said.

Previous government efforts to curb public smoking include the Control of Tobacco Products Regulation 1993, which banned smoking in air-conditioned restaurants and the Control of Tobacco Products Regulation 2004, which was amended in 2018 to ban smoking in all eateries, indoors or outdoors. 

Not long after the 2018 ban, diners continued to puff away in restaurants.

Carmelo Ferlito, an economist and CEO of Center for Market Education, an academic and economic think tank in Kuala Lumpur, said the main causes for poor enforcement are restaurant owners’ complacency and the subsequent liberty to smoke.

“The customers are their butter and bread so why [would they] punish them?” he said. “By defending the non-smoker, we are harming the smoker by depriving [their] pleasure from nicotine.”

Tobacco use is the most preventable cause of morbidity and mortality in Malaysia. 

The 2012-2016 National Cancer Registry revealed cancer deaths are increasing. There were 64,275 recorded deaths from 2007 to 2011 and 82,601 deaths from 2012 to 2016. Annually, the country has an estimated 27,000 smoking-related deaths.

“The generational ban is aimed at decreasing the uptake of smoking,” said Dr. Helmy Haja Mydin, a respiratory medicine specialist. “Over time, this will decrease the overall prevalence, with corresponding decrease in healthcare costs.”

Malaysia’s government is expected to spend $1.7 billion (MYR7.4 billion) treating major illnesses caused by smoking by 2025. That is more than double the cost of tobacco taxes, which have not increased since 2015, he said.

The tobacco industry in Malaysia has remained profitable… while the government and ordinary families have been left to bear the cost”

Dr. Mary Assunta, senior policy advisor, Southeast Asia Tobacco Control Alliance

Mah Suit Wan, who has provided smoking cessation services for 11 years, believes tobacco industry revenue is unjustifiable. 

“Malaysia is spending huge amounts of money in treating smoking-related diseases and possibly e-cigarette or vaping use-associated lung injury cases,” Mah said. “How can we continue to turn a blind eye towards money spent on smoking related diseases as opposed to the economic aspect?”

Dr. Mary Assunta, senior policy advisor at Southeast Asia Tobacco Control Alliance, said the tobacco industry has refused to phase out its product over six decades despite deaths, a lack of compensation for patients and government efforts to protect public health.

“The tobacco industry in Malaysia has remained profitable and made money for its shareholders while the government and ordinary families have been left to bear the cost of treating the sick and burying the dead,” she said. 

Questions sent by the Globe to tobacco distributors in Malaysia went unanswered.

The health ministry launched a 2004 anti-smoking media campaign, Tak Nak, aimed at youth that did not yield results. Beginning in 2009, cigarette packaging was required to carry graphic health warnings in a bid to deter non-smokers and encourage smokers to quit.

But the accessibility of smoking products prevented any serious reduction of youth smoking. Cigarettes are available over the counter in convenience stores and restaurants. 

Malaysia’s bold Generational End Game will encourage its ASEAN neighbours to follow suit in arresting tobacco’s grip, Assunta said. 

But Helmy thinks more than an age-based ban is required to significantly cut smoking rates.

The Malaysia ban would need to be complemented by the WHO Framework Convention on Tobacco Control, known as MPOWER, he said. The WHO initiative includes efforts to monitor tobacco use, provide information about the dangers of tobacco, identify ways to protect people from smoke, raise taxes and encourage methods for quitting. 

“Tobacco control policies work in tandem,” Helmy said. “There isn’t one specific policy that will work for everyone or every time.”

Mah agrees, noting that only when easily accessible and affordable smoking cessation efforts and the awareness of harmful effects of e-cigarettes are championed can the government’s Generational End Game initiative succeed.

“We must not let go of any opportunity to help the existing smokers quit,” Mah said.

When e-cigarettes and vapes became mainstream, many smokers became convinced they were a healthy alternative to cigarettes. But the appeal of e-cigarettes as a healthier option and different flavours of vapes have opened a new gateway to nicotine addiction. 

“Heated tobacco is not as safe as companies portray it to be,” Tan of the pharmacist society said. “They claim that everything is food grade. But food grade is for your stomach, not your lungs.”

The solution is not switching from one addictive product to another, Assunta said. “This plan to ban sale of tobacco to those born after 2005 is visionary with the clear focus to eventually phase out tobacco in society.”

“The fight is over Malaysia’s minors,” she said. “The tobacco industry wants to continue addicting young people to replace the 27,000 who die annually and secure a lifetime of new smokers.”

When Bazil used cigarettes exclusively, there were clear boundaries of acceptable places to smoke. But after he began vaping, the lines blurred: “I was vaping everywhere. In my room, my toilet, the kitchen, my car.”

“In my opinion, vaping is twice as bad as cigarettes,” said Bazil, who is now 25 and limits himself to two cigarettes per day. 

“It’s a good thing they are doing this for the generations to come,” he said of the proposed law. “I personally don’t want my kids to get into smoking in the future.”

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