DVB Multimedia Group

Staring at a medical black hole

Joseph Allchin
Jan 11, 2010 (DVB), Not far from the white sand of Thailand's Andaman Sea coast, tucked away from the luxury resorts, sits some very different accommodation for 'foreigners'.

This shelter is not ordinary; the collection of tin huts house around 17 HIV patients. Many have been in Thailand for decades, all invariably to work. Here they are looked after and taken to get donor funded antiretroviral (ARV) drugs, without which they would not survive.

In July last year however, the donor agency Medicins Sans Frontieres (MSF) Belgium pulled out its staff and announced that funding for ARV drugs would cease as of December 2009. In Phang Nga state there are over 100 such Burmese migrants dependent on this aid. "We do not know why they withdrew;" says Htoo Chit, head of Grassroots Human Rights Education (GHRE) group, "we didn't have clear information why they have withdrawn." Phang Nga is home to around 150,000 Burmese migrants who form an essential pillar of labour in most of the least desirable jobs from construction to fishing.

An NGO presence was established in the relatively affluent region after the Asian tsunami, in December 2004 which inundated Thailand's west coast. "Before the Tsunami we had no information, but after the tsunami many NGOs were working on these issues," explains Naing Moe, an HIV patient living in a GHRE shelter.

"It's very painful, I really don't know how to communicate my anguish," Naing Moe confides as he looks at the prospects that the year hold, his eyes steady, yet pained. He was diagnosed with HIV in 2008 when he was taken to Taukapa hospital by MSF. He had no idea about the medicine. "I asked when I could stop taking them, and they said it's alright but you will need to take them for the rest of your life."

Naing Moe was a survivor of Asia's worst natural disaster and he helped the tourist town of Khao Lak recover; his labour going into reconstructing the resorts, chalets and hotels that draw westerners and their dollars to Thailand. He left Burma in fear as a 17-year-old; he was part of the tumultuous protests that erupted in Burma in 1988. He proudly tells of his part in protests and how his adolescence involved burning down a prison to free incarcerated protesters in 1988. He fled to Thailand through Ranong and has been working on fishing boats, in construction and brick kilns ever since. As a youngster he knew little about HIV. He worked the notorious conditions at sea, where he was introduced to drugs by fishing boat owners pushing for more from their work force. "When you are young you just do these things" he adds.

When MSF pulled out another NGO, World Vision, took on the mantle of providing the ARVs, but only till June 2010. This was simply paying for the treatment not the transport, nutrition and counselling that MSF had provided. Po Po of GHRE explains that many of the Burmese migrants work in remote areas, out at sea or on rubber plantations. Most are in Thailand illegally, and accessing basic services is therefore very difficult, not only because of language barriers and transport but the ever-present fear of arrest. "They are scared to go to the hospital because many have been arrested," said Htoo Chit.

MSF would previously take the patients to hospital but since this stopped the GHRE shelter has seen four patients die already. "In the beginning they [MSF] brought the patient with their car to the hospital; it was very safe for [the patirent] and after MSF withdrew we didn't have enough cars and we are working the whole area and we are working for children and women as well, not just the HIV patients".

So four patients died because they did not receive the treatment on a regular enough basis, one leaving children behind. "We have had four to five die in the last six months. It's not just the facilities but, because they are feeling so depressed, some don't want to take the pills," confirms Htoo Chit.

The head of MSF Thailand, Remi Carrier, claimed however that MSF ", will cover the needs of all the migrant patients in the cohort we handed over and currently under treatment,until June 2010, after which they will receive treatment through the national health scheme." A strange gap exists between Bangkok and Phang Nga,, however; no one was under this impression in Phang Nga.

The problem of funding for migrants health is a large one and one that Carrier agrees is "complicated". The tsunami drew aid agencies to the region, but it is actually far from impoverished. For a month and half of a Burmese migrant's wages, divers can go for day trips to the Similan islands, while shiny new cars cruise between restaurants and resorts. Here foreigners exist at either poles of the economic strata. On the one hand westerners on beach holidays and on the other Burmese, seeking a better life and fuelling the 'Thai dream'; keeping Thailand 'affordable', as the 'Amazing Thailand' adverts boast. The two groups exist simultaneously juxtaposed and worlds apart. They both however form indispensible pillars of the Thai economy.

Win Soe was a farmer back in Burma, and also lives in the shelter provided by GHRE. He came to the shelter when he was so sick he couldn't work. With the ARV treatment that MSF were providing he was able to go back to work, earning 250 Thai baht ($US7.50) a day, but could only usually get about 20 days work a month. "I don't earn enough to save, enough to eat and that's it," he says. Po Po from GHRE estimates it costs between 15,000 to 20,000 baht ($US455 to $US605) a month to pay for the ARV treatment, three or four times more than his salary.

Win Soe now has a 'residents' permit for Thailand. This however still does not qualify him for what MSF term Thailand's 'universal' ARV programme. Whilst Naing Moe has been here for over two decades the notion that his labour and lengthy residence should entitle him to a piece of the pie is not even considered.

It's a question that Andrew Dircks of World Vision says is a "good one" but reservedly states that World Vision need to maintain good relations with the government of Thailand. The issue of labour rights is thus a bridge too far in the 'land of smiles'. Htoo Chit however says that under Thai policy migrant workers are afforded equal rights with Thais but that "most of the migrant workers are undocumented".

Carrier further claimed to DVB however that "MSF tried to help bridge the gap for patients who could not yet receive treatment through the national health scheme. We believe we have bridged this gap for our patients in Phang Nga, since the Ministry of Health has guaranteed they will receive free treatment."

So just after the fifth anniversary of the Asian tsunami that is scarred into the memory of this coast, the town of Khao Lak, once 10 metres under the waves and rebuilt by cheap Burmese hands, had an inaugural parade to 'celebrate' the passing of this anniversary. Flyers advertising the parade were in English and German; it seems that one group of foreigners were again forgotten.