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Migrants' health to be given more priority
Concern over spread of Aids, huge number of workers not undergoing check-ups
The Public Health Ministry plans to make migrant healthcare a bigger priority in a bid to prevent the spread of diseases, including Aids and tuberculosis.
Currently, more than a million migrants live in Thailand but do not undergo formal or regular health checks, mainly because they have not registered with relevant authorities.
The number of registered foreign workers stands at 668,576. Of those, 419,428 have had health check-ups.
The ministry's permanent secretary Dr Prat Boonyawongwirot said yesterday he was concerned about the unregistered foreign workers who did not have healthcare coverage.
"There are a large number of them," he said at a seminar on how migrants could prevent the spread of Aids in the country.
Prat said 17,117 registered foreign workers sought treatment from hospitals over the past 10 months.
The most common diseases were acute diarrhoea, sexually transmitted diseases and tuberculosis (TB). And between 17 and 55 per cent of those with TB also had HIV.
"If foreign workers are covered in the healthcare scheme, they will receive treatment and will not pass on diseases to Thais," he said.
Promboon Panitchpakdi, secretary general of the Raks Thai Foundation, said his foundation and nine other non-government organisations had worked together to prevent Aids among foreign workers.
Their project, the Prevention of HIV/Aids Among Migrant Workers in Thailand Project (Phamit), had received funding from the Global Fund to Fight Aids, TB and Malaria (GFATM).
Thongphit Pinyosinwat, chief of Raks Thai Foundation's development monitoring and evaluation division, said the HIV prevention project Phamit began in 2003 but had found an increasing number of foreign workers with HIV or Aids each year.
"It's possible that more infected migrants will come forward because they trust our project," he said.
Thongphit said the Phamit
project offered migrant workers voluntary testing program and confidential counselling, should they need it.
Between 1989 and 2005, the confirmed number of migrant workers with HIV in Thailand's coastal provinces, Tak and Kanchanaburi stood at 5,015. Of those, 58 per cent were Burmese.
Most of the infected workers were fishermen, because they usually bought sex from prostitutes when their boats reached shore.
Burmese national Panya, 36, sought training to help protect himself, his family and other Burmese workers from disease.
"I have worked here for 13 years with a permit. Throughout my volunteering services, I have found that foreign workers hardly enjoy any access to healthcare services, even though they are registered. They can't read Thai and they find it a huge trouble when seeking treatment at hospitals," he said.
Panya said unaccompanied HIV-positive migrants rarely received treatment at Thai hospitals.
"If they go to the hospitals with non-government organisations' staff, they are more likely to receive treatment," he said.
Another Burmese worker, Narong, 44, said Burmese workers did not want to cause any burden to Thailand.
"Some people said that we were too negligent to take care of our health. But the fact is, some of us are required to work up to 20 hours a day - so how could they remain healthy?" Narong asked.
Duangkamon Sajirawattanakul,
Ninnete Surarat
The Nation
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SAVING LIVES
With a little help, migrant workers are now getting access to basic health care
The girl with the perfect smile and ebony locks sits on her stool, a chewing gum poster of glowing youth. Beside her sits her husband, his face split by a goofy grin of pride. They are newlyweds, full of the hopes and dreams universal to young couples. They are also new arrivals: Burmese migrants who only today touched Thai soil for the first time.
Even their beaming smiles can't disguise their evident bewilderment and fear. They have arrived in a land where they don't understand a single word, can't read a sign and if they fall sick or have an accident, have absolutely no idea who to turn to.
In Phangnga, a province bordering the famous tourist island of Phuket, tens of thousands of Burmese have trekked overland or come by boat to reach Thai shores. They come to work on construction sites, rubber plantations or fishing boats, and whether they are fleeing persecution or destitution in their native land they have the same goal in mind: to make a better life.
But a shot at a better life comes with risks. Although the Burmese migrants form the backbone of the low-paid labour force, many can't get the legal documents that entitle them to health care and education.
They remain illegally and their precarious status means lives led in constant fear of arrest and intimidation by Thai authorities. This, in turn, makes them insular and wary of outsiders, thereby preventing their integration and leaving them isolated and vulnerable.
The young couple explain why they would leave behind their families for such an uncertain and potentially dangerous future:
''Back in Burma we lived as part of a big family, but we were the only ones who could find work. The political situation in the country makes life very unstable. We made just a dollar a day and this was barely enough to feed us all. So, we decided to leave our homes and come here in the hope we could earn more and send some money home.''
To get here they endured two days cowering in the bottom of a tiny, crowded boat, as waves kicked up by a storm dwarfed the leaky hull. The wife thought she was going to die. Waiting for them at the end of their journey was their new home: a single mattress on the floor of a toilet-sized shack not even tall enough to stand in and hastily erected in the shadow of the multi-storey luxury resort they are constructing.
In Thailand, Phangnga was the region worst affected by the December 2004 tsunami. Prior to this there were over 30,000 registered Burmese migrants in Phangnga alone, with the same number here illegally. Many were victims of the tsunami.
While no official figure has been provided, local grassroots organisations reported more than 1,000 missing Burmese.
When Medecins Sans Frontieres Belgium (Thailand) (MSF) came to the area to offer emergency relief, it found tens of thousands of Burmese workers, traumatised and destitute. Medical relief for Thai nationals and Western victims was well organised, but Burmese migrants could not always benefit and in desperation many returned home.
But the ongoing violence in their country and the promise of jobs in Thailand, particularly with the rush to rebuild hotels, has brought many back. And whether legal or illegal, lack of information, fear of persecution and cost mean most are excluded from even basic health care.
''To get to a hospital some migrants in the area have to pass check points that could lead to their arrest and when they arrive at the hospital they have no means of deciphering the signs or directions, or communicating with the medical staff,'' explains MSF Medical Coordinator Dr David Wilson. ''And at the end of it all, they receive a huge bill that is more than they can afford. Even those migrants who are legally entitled to health care and can receive treatment for free have no idea of their rights. So they don't go.''
The inaccessibility of health care is having a clear impact with health indicators for Burmese migran
ts plummeting below those of their Thai neighbours. Mother-child health is particularly poor and every month another Burmese baby dies out of an average of just 25 births. Most deliveries are at home, in poor conditions, often under the supervision of a traditional birth attendant and very few women use any form of contraception, even if they do not want to become pregnant.
Sexually transmitted infections (STIs) and HIV are another growing problem, due to poor health education, the predominance of lone men and the higher levels of STIs in Burma. MSF has identified at least 90 HIV-positive patients, who are sick enough to require anti-retroviral treatment. But, because they are classified as mobile groups, even those with health cards are not provided with the treatment. Tuberculosis (TB) poses another problem with sick workers having no place to stay, and poor, cramped living conditions making the risk of transmission high.
To address these problems MSF has set up a number of initiatives to improve migrant workers' knowledge and understanding of health, and increase their access to care. This is achieved through a combination of mobile clinics, home visits, activities in health centres, hospital support and education in the community.
Outreach teams identify migrant worker communities and pave the way for health educators and mobile clinics to inform workers about family planning, STIs and what to do in case of health emergencies. MSF doctors and nurses treat the ailments they can on the spot and refer more serious cases to the hospital, covering the costs, if necessary.
The organisation also runs two health clinics and a primary care unit specifically targeting migrants, with signs, information and services in Burmese.
In two hospitals, MSF bilingual volunteers offer translation services, pre- and post-HIV test counselling and health information sessions.
One of the problems faced by some migrants with infectious diseases, such as TB, is that when they are too sick to work, they have nowhere to stay and no means to live. As well as securing their medical treatment, the organisation has provided a safe house for TB and HIV/Aids patients who would otherwise be out on the street.
One of these patients is Yang, a 42-year- old fisherman.
For weeks Yang lay inert in the stinking bowels of a commercial boat, too sick to move, but unable to get off until the vessel returned to port. He was soon hospitalised and diagnosed with TB and HIV, but although the TB was treated, he could not access the HIV/Aids treatment available to Thais.
When help finally reached him, Yang weighed just 45kg. He could not walk, had gone blind in one eye and lost all feeling in his legs. He was relying on the charity of neighbours to stay alive.
Yang now lives in a safe house where all costs are covered and residents take turns in caring for each other, with medical staff visiting every week. But, what distinguishes this from palliative care and hopefully will save Yang's life, are the drugs he is receiving. Yang is now taking triple anti-retroviral therapy. He is the very first Burmese migrant in the province to receive such anti-retroviral treatment and MSF is determined that he won't be the last.
Back at the construction site, the young husband is in deep conversation with the MSF doctor from the mobile clinic. He would like to start a family soon and enthusiastically asks the price of a hospital birth. But his face drops the moment he hears the sum: It's more than two months wages. This is an issue the organisation is looking into, but for now the newlyweds agree that family planning is, perhaps, the best solution. Their attention swiftly refocuses on the reproductive health information session going on beside them.
Phangnga is a tourist destination dotted with luxury spas and dive boats. But for these young workers, crowded into make-shift camps with poor hygiene and no facilities, life is never going to be easy. At least by arming them with health education, helping them understand their rights and offering them health care, either directly or through the health system, MSF is ensuring they don't suffer avoidable health risks as well.
''These people have exchanged political persecution and poverty for exploitation. They work all day, every day of the year, doing the jobs Thais refuse, for a pittance. But many have nowhere else to go. The very least they deserve is their health,'' says Dr Wilson.
http://www.bangkokpost.com/Outlook/28Nov2006_out39.php
