Sawasdeeka again from the beautiful (and for once, somewhat dry - get outta here rainy season!) country of Thailand!
Though I've been spending the last few days trying to figure out how in the world my program is halfway over and I'm less than 50 days away from my return to the states, the last few weeks have been filled with research and community engagement driven homestays. As I've mentioned in previous posts, we're getting into the meat of our course, where we take all of the research and data collection tools that we've acquired thus far and actually get to put them to use in the field! Over the last three weeks, we spent two days and two nights each in a rural, semi-urban, and urban slum community in Khon Kaen Province.
The first homestay was in a larger than expected community situated in the middle of acres and acres of rice fields - the main source of income for most of the villagers. After arriving, we split off into three groups and began the process of collecting as much information about the health status of the community as possible in the short span of time that we had to do it. For day one, that meant attempting to figure out the dynamics of the community and beginning to set up interviews with village health volunteers. (VHV: a concept fairly unique to Southeast Asia in which each community or village has members that are trained to provide basic healthcare and respond in health emergencies. In Thailand, they receive 600 baht ($18USD) per month in compensation and are typically responsible for 10 households.) After talking with a few people, it became clear that Dengue Fever - a disease spread by mosquitoes - was a major concern in the community. We spent the next day and a half learning about the prevention mechanisms that have been implemented and how successful they've been. After a larger than usual number of cases last year, the community has been encouraging the use of mosquito nets, frequently changing their water, putting chemicals and small fish in water tanks to prevent mosquito larvae, and encouraging people to make efforts to prevent standing water from accumulating. So far, it's been successful and there haven't been any cases of Dengue this year!
The following week, we set off for what I would say was the most interesting and thought provoking homestay. We stayed in a community about 20 minutes from campus that is situated near a fishing net factory and a Burmese worker camp. My group was in charge of leading this visit, which meant we spent time compiling the results from demographic and quality of life surveys and putting together a geo-social map of the community - a geographic map that also highlights the social construction. From the demographic surveys, we were able to determine the changes that have taken place in the community, what improvements still need to be made, and what health concerns are most prominent. Of the health concerns, Diabetes was a main culprit, understandable from the high number of small convenience stores selling processed goods in and near the community. There were numerous shops selling candy, ice cream, sugary drinks, and snacks scattered throughout the community, a Tesco Lotus Express up the street, and a market that sold pizza, donuts, and pre-made meals next to the village health promoting hospital. When compiling the quality of life, or "Thai happiness", surveys, we discovered that surprisingly, men and women were equally "happy," while teens and kids were significantly "unhappy." We theorized about possible causes for the low scores amongst the young people in the community and concluded that there might have been a discrepancy in how the questions were interpreted by different age groups.
Our final community had us re-visiting an urban slum that we'd done a "dry run" homestay in shortly after arriving in Thailand. This community, home to about 200 households, is situated along a set of railroad tracks and along its outer boundary, runs into the city center and the big mall in Khon Kaen. An interesting urban development meets urban slum conundrum that we often grappled with during our time there. This was the most difficult community to get an accurate picture of the health status for a number of reasons. The community is close knit both geographically (homes are very close together) and socially, and they are incredibly loyal to their headman, making it difficult to get anyone to really talk about the improvements that they think need to be made. The community itself is also facing eviction in the next year or two as a high speed rail system is planned to be built on their land, leading to an attitude of "we're leaving soon anyway, so it doesn't really matter." We also had a hard time tracking down health volunteers to talk to, making it hard to get a good sense of what the health problems are. One thing we did notice was a massive amount of trash that was littered throughout the community. In one section, there houses were built of stilts over a swamp land, and all of the garbage was disposed of by throwing it under the homes and into the murky water. Cleanliness was a major concern for the community, as was healthy eating and Diabetes.
With all of the information we've gathered, we're now into the research analysis phase where we'll begin to pose research questions for each community and eventually turn those research questions into intervention proposals. We'll spend the next month collecting additional data, planning, and then implementing one or two interventions in the communities that we visited.
Our program also requires each student to select a topic of interest and complete their own research paper about a health issue and how it exists in Thailand. Having been involved in tobacco control in the states for over six years, I'm incredibly interested in the tobacco control and prevention programs in place in Thailand. More to come on that front!
For now, I need to get back to studying and preparing for an intense week of assignments and exams before we get our much anticipated "semester break" -- five more days and then it's off to Seoul and then a beach in the south of Thailand!
Peace, love and smiles!