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