24 March 2010

Doctor Visits

After an overnight visit in the private hospital due to a nasty spell of food poisoning I went to the second homestay of our Urban unit in the landfill. Ignoring the warning of my parents and ajaans, I approached the trip with apprehension. I had a small shopping bag full of medicine, and I couldn’t really eat anything substantial without feeling nauseous.

On the second night of the homestay as I was finishing my antibiotic, Amy, my roommate for the trip who happens to be fluent in Thai, explained that I had been hospitalized days earlier to our Meh (homestay mother). I showed her what I thought was a hefty share of drugs. She remarked, “You can’t beat me,” and pulled out a much larger, heavier bag of pills.

Meh told us that she suffers from a rare liver disease that she’s had for most of her life. The medicine needed to treat the disease costs 6,000 Bt a month and the booster shot needed once a year costs 50,000 Bt. Because the disease is rare and expensive to treat, it is not covered under Thailand’s 30Bt (a little less than one US dollar) per visit health plan that has delivered affordable healthcare to so many. She cannot afford such high prices for treatment so she must take vitamin supplements instead, which she admits do very little. Meh has 3 children, 2 of whom have an early form of the disease, and a husband. She works 7 days a week scavenging in the landfill for 11 hours a day. She visited the doctor 2 weeks before we stayed with her and he informed her she would die in 5 years if she doesn’t treat the disease.

Our 3 pairs of eyes welled up with tears as we talked about her situation. Though I couldn’t understand most of her words, her fear was audible in her voice. I resisted the urge to cry on the spot because I didn’t feel as if I had the right; I received treatment in the nicest hospital in Khon Kaen for a stomach bug without concern for payment. My parent’s insurance plan covers our fancy treatment and overnight stays.

I suppose the most striking element of the conversation was that there is a treatment for Meh’s disease that could mitigate most of her symptoms and allow her to lead a normal life. The problem is not one of biology; it is political and economic. Meh will die in 5 years because she cannot afford the cost of living.

I have had many debates about the economic feasibility of universal health care state-side long before coming to Thailand. Though I’ve never really wavered on my position that health care is a human right, it was not until that moment that I really understood the magnitude of that concept. If we allow health to be treated as a commodity, meaning some may purchase and others can’t afford, then the economic arguments against universal coverage will continue to hold strong. I didn’t deserve treatment days before because of my parent’s job, but because I was a sick human being and the technology existed to make me well. The logic breaks down if framed in any other way. Meh is a person therefore she deserves treatment.

On an emotional level, I think the situation was even more difficult. I realize that human rights are often eclipsed by economics. Those who work in the informal sector face these challenges every day across the world, especially in my home country. Meh’s experience is not uncommon. It troubles me further knowing the amount she works and the labor conditions she experiences. What is she to do in order to fight? When one works 11 hours a day there is no time to find other means to pay one’s medical bills. There is not time to lobby to expand healthcare coverage. Unfortunately, I left the homestay feeling as if my Meh’s life was to be determined by her circumstances.

As students we are asked to develop collaborative projects with these communities that enhance our learning process and benefit the community’s efforts. The issues faced by the landfill are complex and multidimensional. When I reflect on my visit, the issue of an unjust health care system comes to mind, among the other challenges they face. I cannot even understand the intricacies of my own system and the idea of understanding the Thai health care system is daunting. It is difficult as a student not to feel overwhelmed by these complexities. I think possessing an unwavering moral vision is the easy part. The challenge is to place that vision of human rights into policy terms.

Becky Goncharoff
Transylvania University


Alvin Sangsuwangul said...

Thanks for sharing your powerful experience. I know if can be overwhelming, but if you focus on what you can do now then y'all can make a difference in forwarding the work of past and future ciee students. I'm excited to hear about the final projects! Is anyone thinking about doing a human rights report in the landfill community?

-Alvin ciee fall 08'

Callan said...

Insightful post, Becky. As a premed student hoping to attend medical school in the near future, I am very interested in the current universal health care debates that have been occurring in the United States and abroad. I agree that health care is a human right that all global citizens despite ethnicity and socioeconomic status, and I also find it challenging to “place that vision of human rights into policy terms” when stories like Meh’s are so heart wrenching and seem so unjust. Similar to Thailand, Mexico’s health care system is unaffordable or inaccessible to many particularly those in rural and indigenous communities. Countless people rely on chain pharmacies like Farmacias Similares which provide consultations and medications. Although the medicine sold in these stores are cheap, they are not approved or regulated by national or international food and drug organizations. Also, partially due to their economic constraints, many Mexicans particularly women and those of a lower socioeconomic status have turned to traditional medicine for common illnesses and injuries. In my internship, I have spent several weeks shadowing a woman who practices alternative medicine, and I have learned that using this holistic type of medicine is a way for practitioners and patients alike to reclaim their indigenous culture and heritage.

Anonymous said...

I really enjoyed this post and after hearing your Mae speak in our exchange, I was also deeply troubled by the unfairness of healthcare and accessibility. It's frustrating that all these systems, economics, healthcare, environment, consumption, etc. are all so intertwined, that fixing one means having to fix all of them. It's a tough change to make and one that seems daunting. Every time I go into a homestay, I am constantly reminded of my privilege and the accessibility to things that I have in my life. I am still a student but compared to the work that these wonderful people are doing, I am not working hard enough. They work so hard yet are denied basic rights because of how societies and politics have been built up. What I try to keep in mind is that we and the next generations are the future and if our minds continue to shift in the direction of equality and accessibility for all, hopefully we can recreate this world before its too late.

Megan said...

Becky, I think you really touch on a number of critical issues in regards to universal healthcare reform but more importantly, the basic human right of access to care and treatment. I think the most frustrating component of the whole system of inadequate access to treatment centers on the idea that treatment does exist, and is available to the select few who are privileged enough to received treatment. For example, 5 million children go blind in Sub-Saharan Africa every year due to a lack of vitamin A. This simple nutrient, accessible in foods like eggs, milk or spinach is readily available to so many people and yet people literally lose one of their senses due to a lack of proper nutrition. The same analogy can be drawn for access to medical treatment. In your post, you discuss that your Meh takes vitamin supplements as a natural remedy for her health issues but in reality, she really does need medical treatment. While some people may chose to go the holistic or more natural route, given her socioeconomic circumstances, she does not even possess the option to access adequate medical treatment. Thus, she is forced to slowly suffer as the result of a treatable illness. The politics of circumstance and how your environment shapes your opportunities in life is a difficult concept to grapple with; however, I think your insights and your internal struggle is a beautiful and powerful tool you can use to seek out new information and work to better understand the very systems which have given you so much good health care treatment.


Michelle Nguyen said...


This was a heart wrenching post. When I read, "The problem is not one of biology; it is political and economic. Meh will die in 5 years because she cannot afford the cost of living," my heart stopped. I have also been insanely frustrated with the world and its sickening commodification fetish. Why do we assign a price for everything? Why do we feel like we need to quantify everything into cold hard cash? I have always believed that basic things such as food, water and health are basic human rights that every single person inherently deserves. Sometimes, I wonder:

If these rights had been honored throughout history, would some of the serious issues we face today still exist?

For example, if we had ensured that everyone had the right to life and the concrete things required for that (food, water, healthcare), would we fall into the same capitalistic frenzy? Or would we develop a different, more sustainable economic/political system, in which everyone could at least live?

And what does money ultimately mean any way? Why are we so obsessed with profit and commodification? Why do we ascribe ourselves to this system?

I mean, we created this system that values pieces of paper more than human life. We chose to live this way. But my question to the world, is WHY???