Thailand’s health services are among the best in the region.  This improvement over the past 50 years is astounding.  Any medical procedure that is standard elsewhere is available in this country, including the most advanced.  Thailand is trying to become a “medical hub” and for 15 years has been striving to promote “medical tourism” where travelers come to Thailand for elective surgery as well as advanced treatment.  These developments have promoted Thailand as a top-level retirement location as well.

In this essay I would like to ruminate on a lesser known aspect of health services development in Thailand, namely the spread of health care into the “hinterland.”  My comments are personal observations, subject to review.
 
1.Primary medical care is now available to 80% of the population  from where they live.
2.Every one of Thailand’s 77 provinces has (or will soon have) a general hospital and most of the 900 districts () have a hospital open 24 hours with in-patient facilities and a doctor on site round the clock.  Specialists come on rotation.
3.There are international-class medical centers in every region of the country.
4.The development of clinics with scheduled emergency health services in populated sub-districts is proceeding with extensive local support.
5.Preventive health care and education about health risks are expanding to the point that average village residents are conversant about these topics.
 
VILLAGE HEALTH VOLUNTEERS (referred to by the initials อสม) are organized by the staffs of village clinics.  The work of each volunteer organization receives directives from the district health department and financial support from the central government to give the volunteers a small monthly stipend.  A local organization might have about 20 volunteers.

The volunteers meet monthly for strategy planning and health training.  They are called on to assist in health campaigns such as the current, annual “deadly mosquito crusade” (my translation of the phrase).  If an epidemic breaks out the volunteers’ first duty is to collect data and to spread the word about measures to be taken.  If the epidemic is severe, as was the case with dengue fever in our village last year, the volunteers help provide back-up services for medical teams to descend.  Any rise in health risks is probably first noted by volunteers.  Diabetes, cancer, and heart disease are the 3 leading medical health issues in our village.  The volunteers keep track of persons with elevated risk factors.

Over all, the health level of village residents has risen dramatically.  Life expectancy has risen from 50 to 75 years in the last 50 years.  Infant and early childhood mortality rates have dropped almost to zero.

I would argue that the most important contribution made by Village Health Volunteers is health awareness and neighborly concern.  It would be hard to measure the effect of having 20 people in most every village know that blood sugar levels over 120 are dangerous, that blood pressure for older people ought to be about 130 over 90, and that stagnant water is where mosquitoes proliferate.  Nutrition is the leading contributor to poor health for people in our village now that public sanitation is vastly improved.  
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Village Health Volunteers are on the front line helping to expand health services to every village.

I attended an event the other night that reminded me how complicated gender is, and yet how simply it can be handled.  As I looked around I saw every point on the gender spectrum represented by people at this village gathering to celebrate a fellow’s graduation from university.  There would be no way to accurately place anybody on the continua without listening to their stories over time.  But it is tempting to jump to conclusions at a glance.  “Here is a farmer and his wife,” we might think.  “That singer is a kathoey, for sure.”  “Obviously, she is a Trans.”  But, if we become acquainted with these people (as Pramote and I have done) it becomes clear all is not always as it first appears, and maybe nothing is.
 
That raised the question for me, “Knowing as little as we tend to do, and much of what we know being wrong, how can society function?”  Some societies become dysfunctional, as a matter of fact, when they become overloaded with mystery or ambiguity as when new people move in.  But our village commencement party went along and village life in that village functions placidly by applying the simple principle of “mai pen rai.”  (“Never mind” is the standard translation.  “Let it go” is often what it really means.  “Never mind” is dismissive.  “Let it go” is a more plaintive exhortation or instruction.)
 
“Never mind” works most of the time.  But in writing things take on sharper shapes.  A lot of writing is being done these days, perhaps more than ever in the history of humankind.  Several billion people write every day and post it on the Internet.  After being aggravated for a while yesterday by seeing still another announcement on-line about “ladyboys” I decided it is still important to try to straighten out our gay discourse so we can be careful about applying it to ourselves and others. 
 
My contribution this weekend is a simplified word list:
 
Gender  behavioral and psychological aspects of one’s identity
Gender identity  a person’s perception of their gender as male or female or something else
Sex  biological aspects of one’s identity
Sex assignment  an infant’s sex noted at birth by medical professionals on official records
Cisgender conforming to one’s sex assignment, also “cis” versus “trans”
Transgender  not conforming to one’s sex assignment, also one who is using medical intervention to change gender identity, including reassignment surgery to alter physical organs  
Intersex  one with confusing or ambiguous biological sex indicators at birth
Binary  the concept that there are 2 distinct sexes but also that one is either gay or straight
Non-binary  gender identity outside the 2 binary categories; also “gender-fluid”
Gender Dysphoria  anxiety over one’s gender; distress or unhappiness caused when a person’s gender identity does not map their physical attributes
 
THAI TERMS IN ENGLISH
 
Gay  a male who prefers sex and romance with males
Kathoey a male who exhibits feminine characteristics
Third sex a female personality born in a male body as karmic punishment, a subset of kathoey
Tom a female who exhibits male characteristics
Trans short for transgender but exclusively one who is transitioning from male to female
Ladyboy a pejorative, insulting term for a “trans”
 
 
For previous blog-essays on similar themes see:
www.kendobson.asia/blog/lady-boys
www.kendobson.asia/blog/village-trans-wedding
www.kendobson.asia/blog/real-men
www.kendobson.asia/blog/spectrum

                                                 Taking Over from a Failed Generation

News this morning is that a trial date has been set for October 29 in Eugene, Oregon for a suit brought by a group of young people against the US government for its efforts to stop strategies to address climate change and global warming.  The suit, in brief, says these efforts are going to have a disastrous impact on coming generations.  The Trump administration, of course, has tried to block the court case.

Following the Parkland, Florida high school shooting that left 17 persons dead and 16 injured, surviving students launched a campaign to bring about a few measures of gun control, including a ban on public sales of the type of automatic, rapid-fire guns used in several of the recent mass shootings.  The first rally by students at the Florida state capitol was followed by a nationwide day of rallies at 800 locations including nearly a million gathered in Washington DC.  The students are now working toward voter registration to get new voters to elect legislators to bring the changes in the law that the current law-makers are afraid to make.  Even though the National Rifle Association has apparently backed a smear campaign against the students, including an Internet challenge that certain student leaders be shot dead and the Trump administration has been utterly silent about this form of terrorist intimidation, the students are making amazing progress and getting results.
            
Across the Atlantic young adults are also becoming aroused at the actions of their elders.  It seems that the younger generation is not as happy with Brexit as the older generation who voted for Great Britain to exit the European Union.  It remains to be seen whether they will become a voting block to replace enough of those sitting on the green benches of power (i.e. in the House of Commons) to reverse some of the trends toward isolationism and protectionism if not the whole neo-liberal game plan.

In Spain, Italy, Greece, Israel and Turkey as well as in France, Switzerland, Germany and Austria it is not the oldest who are being contested by the youngest, but those in the middle age bracket.  My generation, 75 and above in age, has already largely shifted out of power.  World leaders are in their upper 50s and 60s on average. (Of course there’s Trump and the Pope pushing the average up.)  The voters who have won battles recently are 45 to 75.  These are the ones hanging onto conservative outrage at things which cost money and might change the way the world has run to their benefit.

Meanwhile, here in Thailand and South East Asia, the young adult generation is also not as docile as the power-wielders would like.  There is little evidence that the generation aged 18-38 (to pick an arbitrary spread) is as enthusiastic to raise challenges as are those in Hong Kong and Taiwan, but whenever a choice target comes they are the ones to make waves.  Despite threats of imprisonment and worse (far worse), it is this generation that uses graffiti, Internet, and sneakers to let the world know their elders are plundering the planet and expect to get away with it.

​Two examples have drawn world attention.  When a rich and powerful mogul was caught poaching in a national forest, the hunter was protected from prosecution by colleagues in the government.  All over the city of Bangkok graffiti of the black cat began to call attention to this crime and the injustice that is following.  Shortly afterward, pictures began to appear on-line of a posh housing development for retired judges that has encroached on the slopes of Doi Sutape, a mountain with semi-sacred resonance that overshadows the city of Chiang Mai.  A young adult protest has succeeded in (temporarily) stopping the construction and has embarrassed the military and District 5 of the Judicial Department who colluded to bend the law so these houses could be built.  “They are legal,” the officials insist.  “They are wrong,” the young people responded, and set out on a 700 kilometer march from Chiang Mai to Bangkok to protest the housing development, and coincidentally to protest the law and those who made the law.

These timid voices here and bolder ones around the world are thinking in terms of regime change. It is hard to believe they will pull it off, and peripheral consequences are even harder to imagine, but what is inevitable is that the young generation is finding its voice and that voice is going to be heard.  Those in power in this generation are not going to last, not only because getting old is inevitable, but because what they are doing is devastating and they are failures.  

Songkran is the traditional Thai New Year also known as locally as ปี๋ใหม่เมือง (bpii mai mueang).  It is the only traditional holiday set according to the solar rather than the lunar calendar.  It is always April 13, and recently also commemorated on April 14 and 15.  Many institutions and some businesses extent the time into a full week of vacation.

For reflections on the meaning of this New Year’s festival (the last of at least 4 commemorated annually in Thailand) see previous blog-essays:
www.kendobson.asia/blog/songkram-songkran
www.kendobson.asia/blog/two-songkrans
www.kendobson.asia/blog/the-other-songkran 
 
This year I would like to reflect on how Christians handle this.  It is illustrative, I think, of how Christians handle several other cultural traditions in Thailand.

Since Songkran is a combination of cultural, religious and social traditions it is not surprising that Christians have little to do with the religious observances.  Trips to the temple, washing Buddha images, paying attention to spirits of ancestors which are the point of most religious aspects of Songkran are simply ignored.  There are no Christianized church services (that I know of) about Songkran.  Songkran often overlaps with Easter, but even when it does not, as is the case this year, churches will not devote a part of their Sunday services to remembering Songkran. It should be remembered in passing, that this is not how Christians handle some other traditions.
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But Songkran is too big to ignore entirely.  It is a major holiday.  At the heart of Songkran is respect for elders.  Young adults are expected to demonstrate their appreciation for elders of their parents’ generation and older.  Here in the north young people come to homes of their oldest relatives and present them gifts, for which, in return, they are given blessings.  Scented water is used and strings tied around wrists of the young people express wishes for long life and prosperity.  Slowly, over the past fifty years, the Christian taboo on this has been relaxed.  In fact, some churches have blessing ceremonies around this time of year at the end of church services.  Some even dare to do it during the Songkran weekend.  If a village or organization has a blessing ceremony, Christians now tend to join.  More conservative churches have declared these things forbidden since they smack of the occult, and they are done by Buddhists. 
  
This, in a nutshell, is how Christians in Thailand handle most cultural traditions.  Starting a hundred and fifty or more years ago with aversion and loathing of the tradition, engendered by popular or suspected connections with supernaturalism and the occult, Christians have cautiously moved to accept aspects of the tradition and to shorten the gap between Christian sub-culture and the culture of the world around them.   

Nawt was ordained into the Thai Sangha on March 19.  It is a traditional rite of passage for him.  The idea is that it will prepare him for the rigors of adult life, which will become more difficult grueling on Monday April 9 when he is inducted into the Thai Army as a volunteer.  That is a second traditional rite of passage.  There are no plans at present for the third rite, which is a wedding ceremony.

This is a photographic essay documenting Nawt’s ordination ceremony.
 
1.The ordination began with a noisy procession into the precincts of Wat Ba Fang where Nawt was to be ordained by the “bishop” (head of the abbots of the district).  The parade was led by elders from Nawt’s village bringing money trees and offerings.

2.Nawt was dressed in white in the role of a prince, reiterating the steps taken by Gautama, the Buddha, from his secular role as prince into the renunciation of those privileges into the higher role as a mendicant monk seeking Dharma-truth.

3.The bishop and most of the congregation were waiting in the assembly hall for the ordinands to arrive.  Two boys were to be ordained, Nawt who would be fully ordained into the priesthood and a younger boy who would become a novice.

4.Nawt presented himself to the bishop.  He was formally called a “Nag” which is short for Naga, a serpent divinity that protected the Buddha and sought to become a monk according to legend.  Only men can be monks, but the Naga was told how to be reincarnated as a man and given honor by having all applicants thereafter called Nagas.

5.A solemn part of the ceremony was when the ordinands took leave of their parents.

6.After presenting saffron colored robes to the bishop, he invested them with the first piece and then gave them instructions about what the roles of an ordinand will entail.

7.Then they retired to be robed.  The first of 9 articles was like a sarong.

8.When Nawt was fully robed he and the abbot of Wat Hang Dong where he spent his 15 days as a monk returned to the main part of the assembly hall.

9. The ordinands reaffirmed taking refuge in the Buddha, the Dharma, and the Sangha.  This is the basic vow of all Thai Buddhists. 

10.The younger novice presented gifts to the bishop.  His ordination was finished.

11.Village and family elders accompanied Nawt to an ordination hall for his solemn vows.  Nawt then formally asked to be ordained. The ordination hall is called a “bot” (pronounced like boat). 

12.Nawt was told to wait outside for the chapter of 9 priests to decide to accept him.

13.Two priests barred the door with a traditional bound volume of sacred text while they asked him standard questions about his fitness to be ordained.

14.When his answers were acceptable he was formally accepted into the Sangha and he joined the chapter of monks in affirming their vows, which all monks do every fortnight.

15.Nawt’s ordination was over.  He was a monk.  His first ordained act was to carry his bowl as he left the bot, so that his closest family and elders could make merit by presenting him with rice.

16.On his way back to the assembly hall for the final worship to end the ceremonies, the new priest accepted rice from his grandmothers and elder aunts.
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17.The mood lightened as they neared the assembly.  Nawt threw hands-full of colorfully wrapped coins to the crowd (and to me).  These were collected as sacred souvenirs. 
 
Nawt stayed in the temple in our village for two weeks.  He could possibly have stayed for the rest of his life, provided he was not drafted into the army on recruitment day after his 21st birthday.  But he was not planning on a religious career as a refuge.  He has his life ahead of him.