Estimates place the number of Burmese migrant workers in Thailand at more than two million. Many of this number are in Thailand illegally and migrant families are often required to live on factory or farm grounds, where living conditions are substandard. Poverty, poor sanitation, injury and disease caused by working conditions, and sexual abuse, are widespread. Migrant workers are only given one day off per month, which makes it extremely difficult for migrant families to access medical services. Moreover, only registered migrants are eligible for Thai government-assisted health and social services. While some small non-government clinics have opened, lack of adequate funding and medicine limit the effectiveness of such services. Migrants with health problems often use medication administered intravenously, bought from a local shop. Since the medicine is not prescribed, the dosage and type may be wrong, which may lead to further complications.
In response to this ongoing health crisis within the migrant community, SAW has developed three main responses, all of which are interdependent and support one another. The first is the Mobile Medical Team, which provides services to migrants in their villages and/or places of work. The second is a Health Education program that promotes awareness and peer learning on reproductive health issues. Finally, SAW operates Health Care House in Mae Sot, a safe house for women who have contracted HIV/AIDS. Most of the health projects are carried out in rural areas around Mae Sot and in slum communities within the city. In addition to these main projects, SAW also has a Mental Health project and runs an Evening Clinic in Mae Sot five nights a week.
In summary, SAW frequently treats patients for a wide range of ailments including: seasonal influenza; respiratory infection; diarrhea and dysentery; skin infections; malaria; chronic diseases such as hypertension and diabetes; various traumas and injuries; infected wounds; and, worm infestations among many others.
Factors Contributing to Poor Health Standards
Lack of Access
Migrants in the areas served by SAW face several obstacles to prevention and treatment of health problems. Their rural location makes it difficult to access local hospitals and clinics because of distance and cost. Even if transportation is secured, Thai security checkpoints are a deterrent. Most migrants are undocumented and a stop at one of these checkpoints on the way to the hospital could result in deportation or paying a bribe of up to 500 THB to authorities in order to be allowed to stay in Thailand. At the hospital, migrants with work permits have access to low-cost treatment through the Thai healthcare system. However, most migrant workers do not have work permits. The cost and security risk of traveling, the cost of treatment, and isolated location prevent migrants from getting tests and treatment from licensed physicians, thus resulting in the spread of Sexually Transmitted Infections (STIs) and exacerbating other existing health issues.
Access to health care and medication inside the communities is poor. Locally trained nurses move frequently, as they are also migrants, and while NGO-funded clinics have been established in the communities, they are only able to reach a limited number of people. The need exceeds the capacity of these stationary clinics. Local midwives are sought when reproductive health issues or pregnancy arise, but not all are formally trained, nor do they always use properly cleaned instruments. Local pharmacies stock some medication, but the cost can be prohibitive and many of the medicines are expired. Since migrants have not consulted with a physician about their illness, they seek advice on medication from the shop owner or self-medicate, which can lead to further complications and does not usually solve the original problem. Preventative measures including family planning and mosquito nets are also not accessible to the migrant community because of cost.
Lack of Knowledge
General lack of knowledge is another impediment to obtaining proper treatment. Health education in Burma is extremely poor, so migrants lack knowledge about health practices when they arrive in Thailand. In Thailand, the isolation of migrants in rural areas, on factory grounds, or in slums, prevents them from having access to workshops and information that are more accessible to urban dwellers in Mae Sot. Lack of knowledge is a cause of both poor hygiene and the use of traditional measures to prevent or cure ailments, often with detrimental results. A lack of understanding about family planning and awareness of HIV has led to many cases of unsafe abortion and the spread of HIV.
In addition to lack of health access and lack of knowledge, there are several health risks that exacerbate an already difficult situation. Migrants who work in agriculture with pesticides and other chemicals are not provided the proper protective masks and gloves. These chemicals trickle into ponds and streams that the migrants use to bathe, cook, and drink because there is no sanitation system or running water. The dry season (February – April) brings little rain, thus migrants are completely dependent on contaminated sources of water to meet their needs. Ingesting chemicals or allowing them to touch bare skin is a cause of respiratory illness, hair loss, stomach issues, and skin or eye infections, lung problems, and dizziness and vomiting among the migrant population.
Poor Reproductive Health Awareness & Access
Family planning and awareness of HIV/STI prevention are among the most pressing issues for many migrant communities. There is a high incidence of teenage and other unplanned pregnancies, which has contributed to a high number of unsafe abortions performed by untrained midwives. Child delivery can also be risky because of a lack of access to local hospitals for both geographical and financial reasons; people make do with local midwives.
As cultural norms prohibit premarital relations, young people are often overlooked by health education projects including family planning and HIV-prevention. Without proper family planning and access to contraceptives, high numbers of unwanted pregnancies occur. Lack of access to hospitals and clinics combined with a predisposition towards traditional practices has kept the number of practicing Traditional Birth Attendants (TBAs) high. These traditional midwives rarely use gloves and are unaware of the best practices in terms of sterilization during medical procedures. In addition to aiding in births, some TBAs also perform unsafe abortions, which can result in excessive bleeding and death.
Pregnant migrant workers are at a high risk of losing their jobs as a result of their pregnancy. When women are dismissed, it is very difficult to find temporary shelter until they can find a new job. Women in this situation become more vulnerable to the sex trade, human rights abuses, trafficking, rape and murder. Another unfortunate consequence of the inhospitable environment for women and families has been a clear trend in child abandonment within the migrant worker community.