Thailand - Volunteers Forge Better Care in Thailand’s Villages

BAAN MAE PING, Thailand — The ailments that bedeviled past generations in this mountainside hamlet are fading away. The parasite that causes malaria has been vanquished from the surrounding jungles, and villagers say it has been years since a baby died before turning 1 year old, once a common heartbreak.

“So many children died and we didn’t know why,” said Phasom Yuranatbongkot, 54, a homemaker.

As in many other parts of Asia, decades of economic growth and development have helped end the isolation and medical neglect of places like Baan Mae Ping. But that is only part of the story. The country has also built a vast network of volunteers who have brought basic health care to the most remote corners of the kingdom and at very low cost.

Thailand’s Village Health Volunteers, as they are known, have been a source of reliable caretakers in a country perpetually beset by military coups and changing governments. Health care has marched forward in Thailand even as its politics have been mired in conflict.

The volunteer system has helped even out inequalities in a society where wealth — and medical resources — are heavily concentrated in the sprawling metropolis of Bangkok. Volunteers, who number more than one million in a country of 65 million people, spread awareness of disease and screen for chronic illnesses. They have also helped bring down the infant mortality rate to one of the lowest levels in Asia by assisting pregnant women.

Eight times as many children died in infancy when the system of volunteers was established five decades ago by a Thai civil servant returning from a stint at Harvard. Thailand has about 12 deaths per 1,000 births, considerably below most of its neighbors. Cambodia has 68 deaths per 1,000 births, China 17, Indonesia 30 and Vietnam 19, according to the World Health Organization.

No one ascribes all of Thailand’s progress to the volunteers. Better roads, more hospitals and greater prosperity have played a big part.

But last year the World Health Organization reported that there is “convincing evidence” that the volunteer corps, which it called the backbone of one of the world’s most successful public health systems, has helped curb a slew of infectious diseases, including H.I.V., dengue and malaria.

The system costs the government about $120 million, or $2.70 a year for each person living in a rural area, a modest sum by Western standards.

Volunteers get a few perks, including discounts on hospital rooms and subsidized education for their children who go into nursing. The government only last year began paying volunteers a monthly stipend of about $20. This was initially described as a salary until the program’s founder, Amorn Nondasuta, now 83, objected.

Mr. Amorn insisted that paying volunteers a salary would damage the very thing that had made the system so successful — the spirit of community service and self-reliance in a society with a strong tradition of caring for family and neighbors. “It’s in the culture,” he said. “We take care of one another.”

The government relented and instead called the small payment an honorarium.

Volunteers typically receive a few weeks of training, and each of them looks after 15 to 20 households. They do not aim to replace doctors or nurses, but offer caring support that Mr. Amorn compared with that provided by an aunt who tended him when he was young.

“She would put me on her lap, give me medicine and stroke my head,” he said. “That gave me warmth that I didn’t experience in any hospital.”

In a country where power radiates from Bangkok, the volunteer system is a rare example of a relatively autonomous community-based program. Although the program is financed by the national government, its volunteers are not centrally supervised and have wide leeway to carry out health campaigns.

Volunteers are a mix of sentinel and town crier. They watch for outbreaks of diseases and spread warnings about those that are detected. In campaigns against SARS and bird flu, they are credited with making Thailand one of the region’s least affected countries.

“Our role is to control and prevent disease,” said Sangad Kasaem, 42, a volunteer in Baan Mae Ping who, like most people in the hamlet, belongs to the Karen Hill Tribe minority group. “We’re not in charge of curing it.”

Volunteers here display an esprit de corps common in Thai rural areas. They greeted a recent visitor in traditional attire and put on what they described as their first PowerPoint presentation, projected inside a bamboo shelter.

But first they played the anthem of the Village Health Volunteers, which is known by its Thai acronym, ASM:

We are the ASM

We are not afraid to fight disease.

The ASM put our hearts into helping Thais nationwide so that the nation can flourish.

In the long run, a flourishing Thailand, paradoxically, may be one of the greatest challenges to the volunteer system, experts say.

It works in villages where neighbors traditionally shared an ethos of mutual assistance, building one another’s houses and helping to harvest one another’s crops.

But it does not work nearly so well in Thailand’s swelling cities, where residents are lucky if they know the person living down the hall of their apartment building.

Komatra Chuengsatiansup, a medical doctor who heads the Society and Health Institute at Thailand’s Ministry of Public Health, said the program would need to adapt to a changing Thailand.

“We don’t want to lose the opportunity to make it better,” Dr. Komatra said. Village life itself has already changed radically. Many households own a motorcycle or car. The old scourges leprosy and goiter have been replaced by the ailments of more affluent societies: diabetes and high blood pressure.

Volunteers in Baan Mae Ping urge villagers to avoid smoking and alcohol and recommend regular exercise, a notion that would have seemed absurd in decades past for people who foraged in jungles and waded through rice paddies.

Life expectancy in Thailand was just 55 years when the volunteer system began in 1962. It is now 70.

Sao Siri, a resident of Baan Mae Ping, is an emblem of the progress. She turned 100 in August and received a certificate of congratulations from King Bhumibol Adulyadej.

Her secret to longevity? She credits cheap store-bought whiskey boiled with herbs harvested from the jungle.

“One glass of whiskey in the morning and one glass of whiskey in the evening,” she advised.

THOMAS FULLER

Poypiti Amatatham contributed reporting from Bangkok.

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