MAE HONG SON – For hill tribes people in the far-flung villages of northernmost Mae Hong Son, getting even basic medical help can be a hard struggle.

Medical staff in a ‘caravan’ set out on foot on one of their regular visits to a remote village in Mae Hong Son where they deliver medical help and educate local residents about basic health and sanitation.

However, the district public health team has decided that if the highlanders find it tough coming to town for assistance, they will go to them.

Behind the postcard natural beauty for which the province is renowned lies hardship faced by the locals living deep in the high mountains that stand as barriers to the necessities of life.

People of various ethnic groups co-exist in the villages tucked away on the high elevations. Residents suffering from minor ailments prefer treatments with home-brewed traditional medicines to modern cures which may necessitate a long trek to town to obtain.

In some cases, the brew fails not only to stem the residents’ illnesses but exacerbates the conditions.

At the Pang Ma Pha Public Health Office supported by Pang Ma Pha Hospital, local staff operate the mobile unit they call a “medical caravan” full of medics and public health workers. The unit is deployed to remote areas of the district to get treatment to sick residents.

For six years, the caravan, officially named the Primary Care Unit@Home or the PCU@Home, has navigated through the dense forests to reach mountain villages and the result has been improved standards of public health and medical care.

One village in the Pai Wildlife Sanctuary stands as a clear testament to the success.

Ban Bo Sa Pae in tambon Sop Pong, Pang Ma Pha district, is a community of 916 Lisu ethnic highlanders, only 10% of whom hold Thai citizenship.

The majority of the population cannot speak or write Thai. Originally, they migrated from Myanmar to escape the often fierce fighting between ethnic rebels and Myanmar government troops. They tend to make a living mainly from farming.

The long distance from the village to the nearest hospital involves an arduous journey to town. The overall health standard of residents was poor. Only those critically ill are taken to the hospital.

“In one case, at least four strong men had to carry the sick (on a home-made stretcher) on foot to hospital. The walk covering 17km took four hours,” said Siwarach Kaenkaew, 37, the village chief.

“Some died on the way to hospital. Others were pronounced dead soon after arriving.

“But that’s no longer the case now. Access to medical service is much better than in the past,” said Mr Siwarach.

Every two months, residents meet the medical caravan which offers free medical services to those in need, vaccinations to children, and follow-up on cases in which patients suffer from non-communicable illnesses such as heart disease, diabetes and asthma.

He explained that a village medical staff member is hired by Pang Ma Pha Hospital to provide fundamental medical care to the locals and communicate with the hospital in case residents require urgent medical attention and referrals are needed.

Auttasit Sangjan, chief of Pang Ma Pha Public Health Office, said the Primary Care Unit @ Home (PCU@Home) was developed in 2012 to get medical assistance to remote communities. Delivering help regularly to the villages ensures the sick are assessed accurately by medical experts and the right treatments are administered.

The medical caravan also reduces overcrowding at hospitals.

He added the medical team does not only provide treatment to highlander residents, but also educates them on how to care for their well-being and about family planning, personal hygiene and sanitation.

The caravan, at the same time, passes on knowledge about preventing disease outbreaks along the border, especially tuberculosis.

The medical team forms the front-line defence against a resurgence of diseases, some of which have been eradicated from Thailand previously, but which are brought into the country again as people cross the border.

Mr Auttasit said the programme has led to a significant drop in people suffering from diarrhoea because the sanitary system in the villages which the mobile unit has visited has been overhauled.

Children are vaccinated against life-threatening diseases in all villages which the caravan visits. However, some residents have been diagnosed with respiratory diseases and complain of muscle pain. The residents spend many hours a day toiling the fields.

The medical caravan receives an annual budget of around 600,000 baht from the government. It makes regular visits to 32 villages high up in the mountains, many just a stone’s throw from the border with Myanmar. Ethnic minority people from Myanmar are therefore also among the caravan’s patients.

The local hospitals, particularly those near the border, treat sick people from the other side of the border. However, only 20% can afford to pay the bills and that has seen the financial burden on the state-run healthcare and medical facilities increase over the years.

Pang Ma Pha Hospital is one such facility. Saddled with four million baht of debt a year and counting, its finances are in poor shape. More bills are left unpaid by poor patients who include those from the neighbouring country.

“We don’t have that many patients from across the border. But when they arrive on our doorstep, they are usually in a critical condition, which requires expensive treatment,” said Niwat Yingyodtrakoon, the hospital deputy director. He has been with the hospital for more than a decade.

“In some complicated and expensive treatments, what we can do is collect 2,000 baht in advance, which is very low compared with the actual cost.

“Some can absorb the payment, while others find it out of their reach. At the end of the day, we have a duty to help them whether they have the money or not,” said Dr Niwat.

The hospital, which caters to around 15,000 mostly poor patients a year, must manage within the 30 million baht annual budget it is granted.

Meanwhile, more foreign patients are coming knocking on the hospital’s door. Last year, the hospital treated 1,426 foreign patients, up from 494 in 2014. From January to August this year, it treated 1,197 foreign patients.

Diseases which are chronic are usually more costly to treat, such as tuberculosis and HIV/Aids. The hospital has had to fork out a large budget to buy medicines.

According to Pang Ma Pha Hospital, sometimes it has to make do with inferior-quality drugs due to budget constraints. It has asked authorities to deal with the problem urgently.

The remoteness of the hospital is also taking its toll on medical staff. A nurse who has been living here for 10 years said that looking after patients in an ambulance as it negotiates many bends on the route is exhausting. Sometimes, it takes more than eight hours to transfer one patient.

She also has compelling stories to tell about the foreign patients but they do not always have a happy ending. A Myanmar boy with brain cancer was referred from Pang Ma Pha Hospital to Mae Hong Son Hospital and then to the hospital in Chiang Mai, which is readily equipped to handle complicated procedures.

The boy was a rare case study as the kind of brain cancer he suffered from, which hampered his sight, had never been encountered previously in Thailand. The treatment went well because he was able to see again.

However, one year later, he did not show up for a follow-up appointment and the hospital learned later that the boy had gone missing.

During treatment, the boy made frequent journeys between the two provinces. The boy’s family had no money to pay for the procedures. All expenses were borne by the hospital.

Statistics show the Public Health Ministry allocates 400 million baht a year to support medical services provided by state-run facilities along the country’s border.

However, the budget is insufficient given the magnitude of responsibilities and workload which the facilities endure. To fully cover the costs, at least 1.1 billion baht a year is needed.

By Apinya Wipatayotin
Bangkok Post