Thailand: Assisting marginalized groups

Thailand's HIV-prevention campaign is regarded by some members of the country's large Islamic community as insensitive to its religious and cultural beliefs. Therefore MSF is working with Islamic representatives to develop a culturally appropriate training curriculum on HIV/AIDS.

In 2001, the Thai Ministry of Public Health committed itself to providing life-extending antiretroviral (ARV) medicines to 50,000 people living with HIV/AIDS by 2005. Treatment is being provided through more than 800 hospitals across the country.

Working in tandem with government efforts to expand treatment, MSF is collaborating with patient groups and other nongovernmental organizations to provide people with adequate knowledge to make informed decisions regarding treatment, to become partners in their own care and to help their peers adhere to treatment.

MSF treats patients directly with ARVs in the capital, Bangkok, and in the provinces of Surin, Rayong, Nonthaburi, Petchburi and Kalacin. Depending on the location of the project, MSF offers home- and clinic-based care, treatment of opportunistic infections and technical support to district and provincial hospitals.

In June 2005, MSF was able to turn over to the national AIDS program a project that, by the end of 2004, was providing ARV treatment to 965 people, of whom 10 percent were children. Operating from two provincial hospitals and four district hospitals in the provinces of Surin and Mahasarakham, the project gradually turned its attention to training Thai health care providers to offer their HIV/AIDS patients high-quality care, including adherence counseling and tracing of those who discontinue treatment.

Although MSF has successfully transferred all of its patients to the new national program, the organization will continue to provide drugs to the program in Surin until December 2006 if needed, as part of the handover.

Unmet needs

Thailand's HIV-prevention campaign is regarded by some members of the country's large Islamic community as insensitive to its religious and cultural beliefs. Therefore MSF is working with Islamic representatives to develop a culturally appropriate training curriculum on HIV/AIDS. Together with another organization, MSF has opened an office in Hat Yai, in southern Thailand, to look at the particular issues facing Muslim women with HIV/AIDS.

In spite of the government's commitment many groups such as HIV-positive prisoners continue to have limited access to treatment and care. During 2004, MSF started to provide ARVs in one small prison in Bangkok. A team now also visits Thailand's largest prison to give technical support for both HIV prevention and ARV treatment, with medicines provided by the government. The prison programs are carried out in partnership with two community-based organizations.

HIV-positive undocumented migrants and unregistered ethnic minority groups cannot obtain comprehensive care in Thailand. In Chiang Rai province, MSF gives technical support to two district hospitals, one of which treats 30 patients actually living in Myanmar who cross the border to receive treatment. MSF has begun to develop a support group for people living with HIV/AIDS in the town on the Myanmar side of the border.

Twenty years into the HIV/AIDS epidemic, HIV-prevalence rates among men who have sex with men in Thailand are now approximately 17 percent, and few prevention interventions that are effective for this population have emerged. MSF is working with others near Bangkok to develop a model combining HIV prevention and care for this population.

MSF is currently giving medical aid to 7,000 people of the Mon minority group who live near Sangklaburi on the Thailand-Myanmar border.

 

Helping refugees and migrants

Every year, thousands of migrant workers enter the country illegally to work in the agricultural, fishery or textile industries. They usually work for low wages, live in dire conditions and are excluded from social-welfare or health programs.

In Maesod, a town in Tak province near the border with Myanmar, MSF has expanded its tuberculosis (TB) program for undocumented migrants. Patients needing to be hospitalized are brought to a "TB village," but most continue to work in agriculture or factories, and some cross the border daily from Myanmar.

They are seen daily by MSF's TB treatment supervisors. By October 2004, more than 500 patients were taking part in the program. Seventy-five percent of the 500 patients admitted to the program in 2004 successfully completed their treatment. To help patients adhere to treatment, the team has boosted its counseling and patient-education program.

Until June 2005, MSF teams in Mae La refugee camp, near Maesod, provided basic health care for almost 40,000 refugees, mostly members of the Karen ethnic minority. Of the 300 people admitted to MSF's inpatient department each month, some 15 to 20 percent came from outside the camp. MSF also operated two outpatient health facilities in which staff conducted about 12,000 medical consultations a month, of which 10 percent came from outside the camp. The team also managed the camp's water supply.

MSF also handed its activities in Tham Hin camp in Ratchaburi province to another group in June 2005. MSF had provided health care, water and sanitation for 9,000 Karen refugees from Myanmar. The team conducted more than 2,000 health consultations per month at the outpatient clinic and admitted some 130 people to its inpatient ward each month. MSF also treated those with chronic diseases including TB, obstetrical problems and HIV/AIDS.

MSF is currently giving medical aid to 7,000 people of the Mon minority group who live near Sangklaburi on the Thailand-Myanmar border. MSF supports health structures in Myanmar's New Mon state by providing medical care and supplies. During 2004, the team supported activities in 10 clinics in Myanmar's districts of Halochanee, Beeree and Tavoy.

However, MSF has had to withdraw the international staff who supervised these activities, due to increasing insecurity and communication problems. Malaria is the most common disease in all of these projects, although acute respiratory infections and diarrhea are significant threats.

Assistance to migrant workers

The labor provided by migrant workers, especially those from Myanmar, has been essential for redevelopment of the tourist and fishing industries in coastal provinces affected by the 2004 tsunami. MSF has established a project in Phang Nga province to help migrant workers receive health care and other needed services.

The tourist resort of Khao Lak, in Phang Nga province, was severely damaged by the tsunami, and tens of thousands of migrant workers are expected to help reconstruct it. MSF plans to assist the public health system in providing health care to migrant workers, to provide health education to migrant-worker communities, to set up a community-based system of mental and psychological support and to advocate for equitable access to health care for all migrant workers. Partners in this project include government district health departments and local nongovernmental organizations.

Maternal health in Yala province

Maternal mortality and the death rate of children under five in the three southern provinces of Yala, Pattani and Narathiwat are reported to be significantly higher than in other comparably poor provinces elsewhere in Thailand. This is a longstanding problem, but the situation is becoming more critical with growing civil unrest in the area.

People face increasing difficulty accessing services, particularly at the primary health care level, because both patients and staff fear the insecurity. There has been a reduction in the availability and quality of services, and many health center staff now work only during daylight hours and implement fewer community-outreach activities. In response, MSF recently established an office in Yala province to manage a project alongside local partners to increase women's and children's access to health care.

MSF has worked in Thailand since 1983.

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