07/31/15: The Final Presentation
Finally, today was our final presentation day! We gathered at a big classroom to present and my group, being Group 1, decided to go first! We presented our Merry Mobile Mamas (MMM) project but before we did, we summarized our findings as follow:
Before carrying out our idea of using pregnant women as a gateway to improve access to healthcare, we needed to review all the barriers we found in the field, to make sure that we were not missing any important aspect that we could focus on. Thus, we categorized the barriers faced by displaced Burmese into three distinct themes and came up with some of the insights that we felt were most important to consider before we could finalize our solution.
As we learned from BMA, the ongoing conflict in Myanmar between the government and ethnic groups is one of the major issues that prevent equal access to healthcare along the Thailand-Myanmar border, because most of the people living there belong to one of the ethnic groups. Their conflict prevents the process of convergence in healthcare, both between the ethnic groups and the government and also between Myanmar and Thailand. This conflict hinders the opportunity of improving healthcare access along the border. As San Nay Htoo from BMA said, the first and most important step that should be done is for them to sincerely stop fighting. However, we acknowledged that this conflict has been going on for a long time and has a very deep root that we, alone, can’t possibly tackle.
The lack of documentation in Thailand and Myanmar also plays a big role in preventing displaced Burmeses from accessing government services in both countries. As we learned from a lot of the patients we interviewed, many displaced Burmeses with no proper documentation are prevented from getting the healthcare they need because they are afraid of getting caught at checkpoints along the way to receive health services. When caught, they face certain amount of fees or possibly get locked up in jail and deport back to Myanmar. In addition, it seems that some Thai health providers prefer not to treat undocumented Burmese because they only get enough funding for Thai citizens and documented migrants. As we noticed, it might also be due to the discriminations towards the Burmese. These problems can only decrease the already low access to healthcare for undocumented Burmese.
Furthermore, low wages, high costs of government services and lack of funding add more difficulties to their access. As we learned from going into the communities, many displaced Burmese have to borrow money from their friends or take out loans when they are in dire need to use health services. Even simple services cost them a lot of money as compared to their earnings so many of them wait until their sickness or symptoms are very serious before they decide to actually seek health services. Even though they can have an easier time accessing MTC with its free services, when the cases are serious, they have to be referred to big hospitals like Mae Sot Hospital. As we learned from many health facilities such as MTC and SMRU, the cost of referral is huge and with limited funding that they get, only a few cases actually get referred. The rest of the patients faces the option of going to big hospitals and paying out of their own pockets.
Language and cultural barriers make it difficult for displaced Burmese to communicate their needs and ask for assistances from Thai health providers. As we learned from people like Mung Lah Por who couldn’t communicate with the sub-district hospital, most displaced Burmese only speak Burmese or one of the ethnic languages but most Thai health providers only speak Thai. As a result, displaced Burmese feel very uncomfortable using Thai health services even though those services are sometimes easier for them to access. Although some hospitals like Mae Sot Hospital do provide interpreters, some of the patients we interviewed felt that there are not enough interpreters to make patients feel comfortable.
Another problem is the communication between health systems, not only the ones in Thailand, but the ones in Myanmar as well. The process of Health Convergence is one of the first steps that is being taken to tackle this problem. However, as mentioned, the conflicts in Myanmar still presents as a hinder to this process.
Another vital problem with communication is the inconsistency of health records and services. Since many displaced Burmese are mobile, it’s very easy for them to lose track of all their health records. This is a big problem in the case of immunization, especially for children whose parents can’t recall which vaccines the children were already given, like in the case of Pyee Pyo Aung. Since there are limited communications between health systems and the fact that each one of them keep their own separated health records of patients, it is very difficult for patients to have consistent health records. In addition, as we learned from the sub-district hospital, the process of translating Burmese names into Thai can also be a problem. All these problems regarding health records encouraged us to think that there should be a more centralized and easier to access system for health records. We think that in the future, fingerprint system like the one utilized by SMRU should be used more wildly. As for the inconsistency of health services, the health post we visited was a great example. The irregular schedule of when the health post opens and the lack of communication of opening hours to the community prevent many people from using the services there. A lot of people stopped going there because they cannot rely on it to be opened. This is just an example of how inconsistency make it difficult for people to utilize health services.
The lack of education is one of the most important factors that can prevent displaced Burmese from accessing healthcare. Without the awareness of what health services are available to them and how they can access those services, it is very difficult for them to utilize the right services. We found that some displaced Burmese, especially the ones that live in isolated communities far away from the main cities, do not know about the health services that are available to them. Even if they do, they do not know the specific details of those services, for example, they did not know about the availability of Burmese interpreters at Mae Sot Hospital. Some Burmese simply refuse to consider all Thai health services because they cannot understand Thai. They really don’t know that interpreters are available at all. In addition, some Burmese are also uncertain if their undocumented status will limit their access to some health services. They are not sure if they will have to pay a large amount of money to be able to use the services. As a result, they prevent the risk of having to pay a lot of money by avoiding all Thai health services. Therefore, an education on health services and access is definitely a necessity for displaced Burmese to understand the services available to them.
In addition to education on health service access, it is unquestionable that education on personal wellness and prevention is also necessary. If proper measures are being taken in the first place, such as the prevention of sickness and injury, there will be less cases that are severe to the point that they have to be sent to a hospital or a clinic. Personal wellness and prevention education also includes the knowledge on immunization and health checkups. As we found that some Burmese do not understand the importance of vaccinations and think that it’s only necessary for children, it is clear that education on health is needed for them.
Lastly, we learned that an important aspect of working towards improving healthcare for displaced Burmese is by providing them the resources they need in order to serve their own community and develop a sustainable health system in their community. During our time in Mae Sot, we learned about a lot of programs already in place that are working towards this goal, for example PLE’s SHIELD program that is working towards creating an integrated community health volunteer system between Thai and Burmese so that they will be able to work with the dynamic border population that exists in Mae Sot and other border areas. In addition, we learned that there are already training programs at MTC that are working with Ethnic Health Organizations to train health workers from different ethnic states to be able to learn essential provider skills so that they can go back to their communities and be able to use those skills to serve their people. After learning about all these programs, we were assured that programs that actually empower and educate the communities to be able to sustain themselves are one of the best ways to tackle a lot of barriers faced by displaced Burmese, or at least, it should be where we focus on.
After we were done with our presentations, the school provided us with a lunch buffet! The food was really good and was a nice way to end our last day here. It was definitely an intense course, however, I wouldn’t trade this experience for anything else. I’m really glad to be a part of this program and would encourage anyone to take part in it!
