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.