In this two part blog series, Bronwen Griffiths, a Clinical Nurse Specialist in NSW, tells us about her recent trip with the MOSAIC programme (Medical Outreach and Social Aid in Communities) to Northern Thailand. She tells us about the programme and her experiences in the village of Ban Khunsuay.
It’s only 12 kms off the district highway to the village of Ban Khunsuay, but it takes nearly an hour of grinding low gears over the precipitous, rutted track that passes for a road before we get there. Bad as the road is, however, it’s the least of what divides the subsistence farmers of the Doi Wawee area from the comforts of modern Thailand.
Separated by language, culture, and the lack of a legal Thai identity, the mostly Akha, Lahu and Yao people who work this steep hill country are 30 years behind their lowland Thai neighbours in terms of basic services. They are not allowed to own land, their children seldom progress beyond primary school, and there is no provision for even basic healthcare services in the local area.
The MOSAIC program is part of a wider engagement with the local communities to address the endemic trafficking of children in this area for labour and sex work.
Our brief is to identify the core health and social needs of the community and then see what can be done to provide some solutions, while working on a next to nothing budget and the goodwill of volunteers.
We have a good range of basic equipment, including a donated ex ambulance cardiac monitor. Unfortunately, however, we have a very limited capacity to purchase medication for ongoing treatment. Our team theoretically includes support from the Chiang Rai District Health Service, but they prove unable to make an appearance, so we are left with only one clinician (me) and an enthusiastic crew of COSA volunteers.
We spend the first evening doing health checks on a group of kids recently removed from a trafficking network who are now boarding with families in the village and attending school. Most of the girls were shuffled through the brothel system for up to a year before being passed through this area on their way down South, so we need to arrange sexual health follow up (a five hour round trip with significant logistic hurdles.)
The general community clinic is scheduled to run from the local meeting hall on our first full day in the village. We’ve given great thought to how we can create an area of privacy for assessment, but the community clearly feels this would rob them of excellent entertainment. As the first elderly Akha woman in traditional silver headdress cheerfully bears her entire breast for the stethoscope, I realise that our curtains will remain a purely decorative backdrop.
The atmosphere is festive – people have dressed up for the occasion and wait patiently for hours, sewing, catching up on local gossip and showing a keen collective interest in every single presentation.
On the first day we register 60 people and get through 35. We ask the others to come back for the catch-up clinic in 2 days when we have finished with the village school. The cardiac monitor (AKA ‘Keith’) is definitely the hit of the occasion, and as the day goes on a trend for adding some vague chest problem in the hope of being hooked up clearly emerges.
Keith earns his keep though – we have a case of rapid AF in the first half hour and later on a symptomatic 39 year old with marked ischaemic changes and left ventricular hypertrophy.
All I can do is put both men on daily aspirin and give them a printout of their rhythm strip to take to Mae Suai hospital, this ensures that regardless of the language barrier their need for urgent treatment will not go unnoticed.
Read part two of Bronwen’s blog tomorrow!
Have you heard of the MOSAIC project? Have you been on any medical outreach trips or would you like too?
Image credit: Bronwyn Griffiths.
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