A San Francisco Bay Area native, Praveena loves slam poetry and cold cliffy beaches. Her belief in the power of storytelling feeds her daily practice. She is a maker of higgledy-piggledy to-do lists, vegan cuisine, and the occasional scrapbook.
Diao lives five minutes away from Suwannakhuha District Hospital. At 36 years old, his protruding bones and withering skin serve as a disappearing vestige of a strong man's body. In 2009 Diao was diagnosed with Chronic Kidney Disease (CKD). Just an hour away in Udon Thani, lies a hemodialysis center that will restore his health and livelihood. However, this drive is too far and too expensive, making Diao's condition that much more excruciating. Diao, who's name translates to solitary, is ironically not alone in his plight. He and many others have slipped through the cracks of Thailand's revered universal healthcare.
A team of two students, myself, and a journalist set out with the loose goal of learning more about the true nature of Northeast Thailand's Healthcare system. Peera (they/them/theirs), a journalist for Isaan Record, served as our translator and acted as our first link to the healthcare system. Beyond being fluent in the local Thai dialect, their parents are also healthcare providers. We first met with Peera's friend, Dr. Potsawat Wetpanich. At 27, he was one of six young and passionate doctors who worked at the hospital. Overburdened with patients, their devotion to providing healthcare to local villagers was undying. My vested interest in the way social determinants of health impact wellbeing led me to inquire more about the ways in which key players and practitioners in the system are incentivized. I took note of the way in which privilege permits some doctors to focus more on improving population health while others live in social circumstances that understandably facilitate a capitalist climate.
With no time to linger, the afternoon soon met us with a sultry breeze. After hearing from doctors and administrators, witnessing a bloody ER incident, and talking with patients attending the weekly CKD clinic, we finally had a minute to breathe. I hung on to my beating heart, overflowing with intrigue, follow up questions, and messy notes. In this country's revolutionary free healthcare system, the issue of lack of access to services quickly became apparent in CKD patients. Out of 200 people with CKD in this village, only about 10% of people get treatment. Though a majority of current chronic kidney disease interventions focus on individual behavioral factors (symptoms, diet, physical activity, etc.), it is equally important to address the influence of underlying non-medical social and environmental contributors to chronic conditions.
Next, we followed a team of doctors making afternoon rounds to visit three patients in palliative care. Diao was the second patient we met. His humble testimony and strength moved everyone in the room. Diao's credo of acceptance of his imminent death left me incredulous and filled with emotion. We decided to visit him again the next morning. We asked Diao if we could center our article around his narrative to depict, "universal inaccessibility." At the end of this second exchange, Diao was no longer a symbol of lachrymosity. As our rapport grew, so did our shared humanity. Though his hobbies are harder to perform with withering flesh, he smiled a wide grin while revealing his favorite pastimes; he enjoys weaving nets and reading religious texts. Diao is an ordinary being who embodies both simple profundities and profound simplicities. I am honored to help share his story.
Supreme Court, Sakon Nakhon Province-The back of my neck is pressed against a cool wall and I stare at my dusty ankles, the only sliver of skin to be seen. I am draped in unfamiliar formal clothes, undoubtedly uncomfortable in this edifice of law and order. Escaping this 97 degree Fahrenheit weather, I find my breathe in this overly air conditioned room. Come to think of it, this room feels filled with people who breathe one of two kinds of air. Upstairs, there are villagers who inhale humidity in farmland and bear a darker, sun-kissed complexion to corroborate the fruits of their labor. The other bodies in this government building possess respiratory tracts filled with artificial air and apathy. Three minutes later, an older Meh (mother) decked in black attire saunters down the stairs. Behind her are forlorn faces of family and community members. The hairs on my arm stand up straight and a chill crawls through my blood. In just a handful of seconds, we find out she has been sentenced to three years in prison. For what? Trespassing on her own land.
This seemingly oxymoronic judgement is one that many villagers here have endured, including her husband. The same day, we visit him in jail as his daughter tells him the devastating news through bars, opaque glass, and a telephone. As an outsider, I am overwhelmed with despair and hopelessness. The same week, 10 students and I traveled to Jad-RA-Beab village in Sakon Nakhon Province. Here, we were able to witness the effects of Thailand's Forestry Management from villagers, government officials, lawyers, and NGOs. Within our exchanges, local leaders of peoples movements shared their hope, successes, and challenges in bringing justice for marginalized groups forced to relocate to accommodate large scale state projects. Their resistance is rooted in resilience and strength.
First, we heard perspectives surrounding the incredulous "Master Plan," which also led to Orders 64 and 66. Order 64 is Thailand's national goal of reaching 40% of forest area. To achieve it, indigenous people must be removed from the land. Currently, the country is at 33%. Order 66 states that people who are classified as poor should not have to relocate, but classified investors are vulnerable to being sanctioned to relocate. Failure to comply can result in villagers being sued or even arrested for trespassing onto the reserved land.
Confusion arises in how government officials are classifying people as either poor or investors. For example, a villager who technically owns 25 rais of land but only uses 5 is classified as an investor and is punished based on the number 25 rather than 5. The 1998 Cabinet resolution, which has been used to determine the land rights of people living in forests, has caused many problems between people and authorities. Officials use old aerial photographs and satellite images to refer back to original land ownership. This is the sole method of determining how much land someone owns; officials do not take into account other form of paperwork proof. Villagers claim these photos are misrepresentative. Another issue is that villagers feel tricked into giving away their signature and land titles; in exchange for random incentives, officials used villagers signatures and list of family members to persecute them as investors.
Government officials are incentivized by an oppressive system. Each department (police, military, etc.) has to reach a certain quota of arrests per day to prove they are doing their job. Additionally industries such as PTT (gas station) make deals with the Royal Forestry Department to plant trees, which in turn is yet another way that the government and industry work together. Worse, villagers are left out of any conversations.
The national government seems to lack coordination with the local system. For example, the Prime Minister's office assured villagers who don't have anywhere else to go can be labeled as, "on probation" and are allowed to temporarily work on their land. However, the local government doesn't recognize this policy and still places people under arrest. Even if someone is proven to be not guilty in a court case, they are still subject to civil fines starting upwards of 80,000 baht. Villagers often spend time in jail as wrongly accused and when released, it is difficult to seek compensation from the government.
Meanwhile, the population's mental health suffers. Families are torn apart, children are left parentless, and sometimes family members leave home in the face of fear. Stress and lack of advocacy takes a toll on everyone. The only support lies within the community, and often times it is limited. On the inside of prison, people are left completely in the dark, unable to stay in the loop of recent events. These families have used this land for generations, which amplifies the burden and pain endured by those who are evicted.
Interestingly enough, this oppression is cloaked in positive environmentalism; the plan to increase Thailand's forest area is rooted in an attempt to reduce the effects of global warming. Forest maintenance executed by the government flops in comparison to the expertise of villagers who have proven their mastery in tending to the forest. It is in their blood to do this work and do it well.
The soft-spoken man brushes the ground, and underneath disheveled brown forsaken leaves, lies the faint outline of a rectangle. He bends down solemnly and steadily lifts what now appears to be the entrance to a tunnel.
Other foreigners around me join me in this strange scene of tourism- families and couples are each accompanied by their own local guide. Everyone, as if in a synchronized act, fawns over this magic trick and whips out their camera. The guides demonstrate how to enter the tunnel and tells us to follow.
Besides the claustrophobia accompanied by crawling through the tunnels, it was an awe-inspiring experience for my dad and me.
During the Vietnam War, the U.S. relied heavily on aerial bombing, while local troops went underground in order to survive and continue their "guerrilla" tactics against the much better-supplied enemy. The tunnels of Củ Chi are small, but nonetheless a historical part of an immense network underlying much of the country.
I flash back to the highlighted term in a high school world history class: guerrilla warfare. We empathized with American soldiers who wrote letters home about great loss and wartime struggles, yet we could barely comprehend the reality of war on one's own soil.
Even for a progressive California public high school, history was taught to us with bias. Terms were firmly highlighted and bolded with a complementary appendix, listing definitions in alphabetical order as if they were facts. The Trail of Tears was only referred to as an act of genocide if the teacher felt especially obliged to - see Manifest Destiny. Our eurocentric curriculum downplayed the role that conquest played in the spread of Christianity- see Father Junipero Serra. Most of the Indian history I learned dwelled on customs rarely observed today, like sati- widows sacrificing themselves in the flames of their deceased husbands' funeral pyres.
Like all stories, history reflects its teller. And it permeates our books, brains, and bodies.
Monday, February 27th
9am: Leave from CIEE
10am-12pm: Introduction to the area and the committee within the Wetlands Preservation Group
Noon: Lunch together
Afternoon: Observe villagers' way of life around the wetland (weaving, animal raising, farming, community forest, etc.)
Evening: Meet with homestay family (Kaying, Beth, and I were paired with Kooky Meh)
My Yai in Kang Lawa was sweet, smiley, and sassy in the best way. I was touched by her happy go lucky spirit and sugary love she shared with us. Pictured here, she wandered off with me and found a friendly dog to cuddle. Typical Yai.
Tuesday, February 28th
7:30am: Give alms to the temple
10am-12pm: Visit potential industrial area
Noon: Lunch together
Afternoon: Tour of the lake
3pm-5pm: Exchange with community
After giving alms to the temple monks, we indulged in an early traditional Isaan breakfast. Then, we heard from village leaders of local activist group fighting against a large industry. The same day, we were also fed a feast for lunch. I was particularly enchanted by the ~forest soup~ made from handpicked veggies and herbs from the local woods. Also enamored was I by the walls of this nearby temple. Beautifully illustrated with a story recalling the different forms that the Buddha has taken.
Wednesday, March 1st
8:45am Leave from Kaeng Lawa
10am-12pm: Exchange with Provincial Industry Office
Noon: Lunch together
2pm: Walking tour of the area
Evening: Meet with homestay family
8pm-10pm: Exchange with the community
After hearing from the government representative, it was disturbing to witness the fragmentation of different departments in Thailand. This misalignment of incentives, or lack of coordination, spawns inefficient allocation of resources. By definition, fragmentation adversely impacts quality, cost, and outcomes. In this case, however, it can also result in a human rights crisis. Throughout the exchange, the industry representative couldn’t clearly answer questions regarding villager’s wellbeing, land use, and future industrial plans. Worse, indigenous villagers are left completely out of the conversation. After digesting his laughable remarks, I left wondering if this man honestly believed that “90% of villagers are satisfied with the industry development.” Is the foggy supply chain so long and muddled, that he can't hear the cries and complaints echoing from the other end?
Thursday, March 2nd
Morning: Boat tour of the area
Noon: Lunch together
Afternoon: Nature walk
Friday, February 3rd
10am-12pm: Exchange with Pob and Dao Din
Noon: Lunch together at Vegetarian Restaurant in Khon Kaen
1:30pm: Molly and I left for Udon Thani
Every evening at dusk 1,000 buffalo come back to this plot of land on their own. This week has been sweaty and dreamy, filled with sunsets and moments of calm just like this.
Beating the sunrise, two friends and I woke up at 5 am to start our Saturday morning with an otherworldy attraction. Groggy eyed, we made our way to Nong Han Kumphawapi Lake in Udon Thani. After a fourty minute bus ride from our hostel in Udon Thani, a 7 km tuk tuk ride quickly whipped us awake. I managed to hunt down a couple to share a boat with us; where my broken Thai lacks, my plucky American spirit makes up for it.
Soon enough, we embarked on a two hour pontoon ride. The well-traveled boat routes paved the water and a soft breeze grazed the blooming pink beauties. In a hazy dream, we glided through the floating flora as elegant egrets simultaneously soared alongside. The late morning sun kissed my skin and naked head. I fantasized about jumping in the cool murky water and bobbing in a slow dance with the blushing bulbs.
Talay Bua Daeng showcases its beauty during Thailand’s cool season, but the peak blooms occur from beginning of December to the end of February. The best time of day to see the lotus blossoms is between 6:00am until 11:00am or 12:00pm.
Pictured includes the views from that glorious morning, the hostel we fell in love with, and a classic sunset no-hands cartwheel by Molly.