MAP Foundation: More Than Support
It’s 9:00AM and climbing past 90 degrees in Chiang Mai, Thailand. The air is warm and wet as we walk out into morning and across the street to MAP Foundation. I hop into the bed of a waiting pickup truck and lean back next to Hok Meung, our partner with MAP’s Community Health Empowerment (CHE) team. Divya and Alex climb into the cab, and no sooner have we sat than our truck lurches from the gravel driveway down towards the thoroughfare. Soon, we’re speeding down Chiang Mai’s highways, past hotels, markets, and new skyscrapers reaching up between them. The looming Doi Suthep dwarfs our small talk and the city behind us.
Before long, we veer into a forest of family homes patched with corrugated aluminum and advertisement-painted plastic sheets. As we pass a skeletal and scaffold-wrapped highrise, Hok Meung taps me on the shoulder and gestures towards its upper floors. “Migrants work in places like that.”
“Not very safe?” I ask. He laughs and shakes his head.
“Not very safe.”
We roll to a stop before a weather-worn two-story house, and disembark. We’ve arrived at our morning’s destination: a local support group for Burmese migrants living with HIV/AIDS. Stepping under the awning and indoors, we find ourselves amidst a circle of people, buzzing with conversation and laughter. Their sudden attention is all the more surprising for the momentary silence it brings.
“Sawadii ka!” the women nearest us shout. “Welcome to our home!”
Before we know it we’ve been seated, handed cups of 3-in-1 and incorporated into what feels like a family gathering, seated in a cozy living room—albeit one adorned with public-school-style posters detailing “anal sex,” “dental dams,” and “female condom use” and stacked with boxes of condoms. The room is air-conditioned not well enough for the forty people - men, women, boys, girls - packed in, speaking their own shared kind of Thai. They hail from any of Burma's numerous ethnic groups and speak different mother tongues. They cannot read Thai - not even the expiration dates on their government ID cards. One by one, they welcome us and introduce themselves; we smile, nod, and try to look not-hopelessly-lost. Hok Meung sits next to us, leaning over to Alex and I to translate intermittently.
A short, well-dressed woman seats herself, smiling, at the center of the circle, and launches it into a conversation. I feel out of place in my ripped jeans and unfortunately-timed "US-freakin'-A" shirt. I don't feel like I've earned this attention or appreciation. I don't feel worthy of the respect of these people, given my easy life back home. White guilt?
They tell us to feel free to take pictures, and we do, fighting the feeling that we’re zoo gawkers filming from behind the safety glass. I make sure my flash is off, and then I make sure again.
I drink my coffee greedily. I am crushingly tired. An adorable girl lazes amidst the circle. She is maybe 8, maybe 10. She plays with a ball and a bag of toys. Her adjacent mother fans herself with a balled shirt. Her other hand cradles her infant son. She takes her turn describing her struggle with ARV medication and daily life as a mother, a worker, and a person with HIV. I cannot understand her, but the frustration leaps from her voice, etches itself in familiar wrinkles on her face. It doesn't stop her from cracking a few jokes - she's deadpan but the circle laughs assentingly.
I get the impression of a "preach."
Hok Meung translates roughly. She says her family, even her closest sister, did not understand why she had to begin taking medications and refused to accompany her to the hospital or pay for it. Left to her own devices, she went alone and began a course of ARVs, only to run out of money for them, forcing her to discontinue her treatment. She took up work to help save up for more medications, but by the time she'd saved up enough her disease had progressed, necessitating heavier and pricier drug cocktails. She bristles with defiant humor.
Thailand also offers free HIV treatment to registered migrants, by a ten-migrant-per-hospital quota, but only to those whose CD4 cell counts fall beneath a certain mandated cutoff. Last year, Hok Meung tells us, it was 350 cells/mm3; this year, he says, it has been lowered to 250. One woman in the circle has yet to meet the cutoff; she needs to monitor it consistently to determine when she’ll qualify. This is typically done every six months. The annual expense—1000THB, or roughly $30—is steep for migrants constantly seeking work, food, and lodging, often paid far below the 300THB/day minimum wage.
One man, denim-clad, short-haired and smiling, begins to detail his experiences. Our guide tells us he suffers from both HIV and TB, and that he's just returned from a one-month hospital stay to medicate his tuberculosis.
Someone across the circle quips in Burmese, "we all used to live at the hospital, right?"
I can't stop looking at his eyes. They're deep brown and radiant. He looks happy. He looks, despite the dust and wear, at home.
Hok Meung tells us the Thai government requires migrant workers to pay 1,900 baht per year for health insurance, on top of a 5% social security income tax.
Once registered as persons with HIV receiving treatment, migrants cannot transfer to a new hospital and must always follow up for more medication - which they will need for their entire lives - at this hospital. Migrant workers move often and risk of unemployment, arrest or deportation. This means they could easily be taken hundreds of miles away from their medication source, with no warning or recourse.
The man with HIV and TB, our guide tells us, registered for medication at a hospital elsewhere in Thailand and had to move to find work. He wants to change hospitals, but due to government policy, the group's coordinator tells him, he will be unable to and must commute to the other hospital - perhaps hours away by road, though we don't know where - to obtain his medications. MAP's CHE branch will be accompanying him to the new hospital to speak with the doctors on his behalf and see if something can be arranged.
This, I am realizing, is why I’m here. MAP doesn’t, and can’t, pay for everyone’s treatment and travel costs—and while I’m sure that help would be appreciated, even life-changing, I think they offer something more powerful.
These people, men and women, have come to Thailand looking for a better life—for shelter, work, food, medicine, and a future for their families—and find so little sympathy and often no recourse when their basic rights to healthcare and a living wage are disregarded. The MAP team does what so few others do: looks past their circumstances to see the human beings underneath. They see people, like any others, struggling through disease, through dislocation, through unemployment, through delegitimization—and they stand up for their rights when they can’t defend themselves.
The conversation turns to plans moving forward from this meeting. The woman who spoke first chimes in and, translating, Hok Meung tells me she wants to start a community fund for healthcare: "She wants to start a fund, so if someone in the group needs medicine and cannot pay, they can all help one another." I don’t think to ask her name.
The group breaks for lunch, and MAP staff begins loading boxes of free condoms into waiting pickups out front. We’re ushered onto the driveway, where smiling support group members hand us boxes of chicken and fried rice. Divya and I sit down with the woman, and Divya plays with her infant son while we eat. The four of us sit together for probably thirty minutes, wordless and smiling, watching the little boy’s curious gaze, tiny hands, and excited shouts.
I’m still digesting the morning’s healthcare figures, still forming a bigger picture of the people that we’re trying to help. I’m so very far from expertise. But all at once, I am proud to be here and to know these people—and I am proud to say I’m helping MAP in some small way.
Before long, we say our goodbyes, hop back into the pickup, and roll off towards MAP. Divya rides in the bed with Hok Meung and I this time. Entering the highway, I catch our guide’s eye.
“Can I ask you a big question, Hok Meung?” He nods. “What's your favorite part of the work you do? What's the best part, in your opinion?”
“I came here as a migrant worker,” he replies. “When we came here from Burma, we knew nothing. I understand what these people go through, and I can share my experiences with them.
I’m happy I can do that.”
- Nick