Author’s Note: In June 1988, I joined an American non-governmental organization (NGO) and the Royal Thai Government Ministry of Public Health to manage a 5-year cooperative health and development project to provide comprehensive health services to highland residents of an isolated, politically sensitive and culturally unspoiled region in the extreme north of Thailand along the Burmese border.
The Project included a 10-bed hospital, with outpatient and laboratory services, simple administrative offices, kitchen and staff housing, as well as community-based primary health care, health education and community development in the surrounding villages. Electricity arrived during my second year there, and we used a radio – powered by the truck battery – to contact the District Hospital in the lowland.
The Project developed a locally appropriate model for preventive and clinical health care delivery by training and facilitating the entrance of hill tribe health workers into the Thai National Health System, together with innovative community-based health and development strategies such as gravity-fed village water systems, household gardening, opium detoxification, and vector-borne disease control.
Remote and politically unstable, our district was the last one in the country to be developed for primary health care — and for other basics such as piped water, electricity and sealed roads.
Many of the area residents are spirit worshipers with little or no understanding of Western medicine or the linkages of proper hygiene and nutrition with good health, and water is scarce in the hilltop villages.
For example, mothers typically keep a child’s head covered with a warm, colorfully woven cap. But due to cultural beliefs and scarce water, they rarely if ever bathed the child’s head. So, it was not uncommon to find a raw, infected and bleeding scalp under a child’s cap.
It was also a challenge to encourage the local people to use pit latrines, and to sleep under mosquito nets. Sometimes, a supportive village headman would try to set an example for the community by using a pit latrine at his home. But this was a hard sell to locals who were used to relieving themselves in the bush, and complained that the pit latrines smelled badly. In addition to providing bed nets to the villagers for malaria control, we conducted studies on their use – as they often ended up being used for fishing.
Working with the District Health Department, the Project helped villagers build gravity-fed water systems — hacking through the dense bush and rugged mountain terrain to lay the pipeline and pouring cement tanks for water storage in the village.
A particularly grand sight was joyful kids frolicking under the water taps flowing with fresh water into their hilltop villages for the first time ever. These community-based water projects were jointly financed by the Project and the communities themselves – who took out loans against their projected rice harvest. Access to clean water is one of the most basic of needs, and was highly valued by our communities.
The Project also facilitated village-based opium detoxification to gradually move addicts off opium and onto the government’s liquid methadone treatment program – an alternative which seeks to reduce the risk related to injecting drugs. Recovering addicts were put to work building a village fish pond while reducing the methadone dosage day by day.
All the addicts in the village were required to participate or they would be forced to leave the village – and this was not easy, especially since some addicts had been smoking or eating opium for 30 years more and had no desire to stop.
Ongoing immunization campaigns were of particular importance, as it was not uncommon to see kids dying of immunizable diseases like Diphtheria. So, whenever we were in the field, we made it a priority to immunize every woman of child-bearing age against Tetanus. Our nursing staff even trained me how to give injections to support these busy campaigns.
Interestingly, the local women typically lined up to get their shots from me – the tall, foreign ‘doctor’ – despite my admonitions that they were more likely to receive a painless shot from our more experienced local nurses.
Our Project staff also joined government health teams for week-long treks to outlying health stations along the border — flying in by helicopter and then walking out through villages, mountains, dense jungle, rushing streams, and fields of ripe rice — escorted throughout by the Thai Border Police in full combat gear for our security.
Regular skirmishes between the local narcotics traffickers were ongoing, and several years earlier, two Russian doctors were kidnapped from the area and held as ransom for an opium warlord’s release from Burmese government captivity.
As Project Director, my time was divided between a mountain of administrative tasks at the Highland Health Center, and a full schedule of planning and logistical work with our Thai Government counterparts in the lowland.
Thirteen kilometers of our road (and most bridges) washed away each rainy season, so four-hour walks (barefoot for better traction) and moving supplies and medicines by horseback to the nearest road was an on-going adventure from June to October.
Staggering out of the office dazed and bleary-eyed after full and exhausting days — but always in time for a swim in the local reservoir before dinner at our village’s only restaurant. A warm beer and BBQ’d chicken feet on a stick smothered in hot chili sauce to cover the toe nails and crunchy cartilage topped off the quiet nights in the village — before returning to the charming glow of oil lamp light illuminating the health center windows.
Whenever possible, brief holiday trips by overnight VIP bus to quiet islands in the Gulf of Siam provided much-needed breaks in the sun, the sea, and coconuts.
Stay tuned for more stories – coming soon!