Bussing It!

So, I realize it's been a while since I posted. Thanks for the implicit reminders (Shawn and Leah :). The reason being is of course, that I have been entirely too busy, so let's rewind back to Malaysia.

On the way back from my artsy, farsty adventure at Central Market. I took the bus back home. I proved that my experience of taking the bus in many countries is consistant. It ALWAYS takes me two times the fare. This time, it was an amusing little attempt.

My friend ensured I was on the right bus and told me to make sure the bus driver knows you need to go to hospital Ampang. Easy enough. I told the hyperactive ticket taker this information and she assured me she would let me know. So, about half way through the journey, I notice she gets off to have dinner and the bus continues on. So, I wait and wait and finally walk to the front of the bus and say "Hospital Ampang". Well the bus driver starts yelling something at me in Malay and pointing out the window. He stops the bus in the middle of a 4 lane busy road, yells something to the driver of the bus going in the opposite direction, and tells me to get off and take the other bus.

So, frogger style, I dart through traffic while people are honking at the bus to continue and hop on the other bus. After a few minutes, a lady comes to collect my fare and I say "Hospital Ampang". This time the whole bus starts yelling something to me in Malay trying to convey that I should have been on the other bus. So, he continues with me and drops me off in the middle of nowhere and tells me to wait there until the bus comes and make sure it goes to Hospital Ampang. I recognize the place as where the 1st ticket taker stopped for dinner.

I wait about 20 minutes, until the correct bus comes. I hop on, insist the lady confirms that this bus is going to the correct destination and continue. Things start looking familiar and I see my block. I tell the driver, this is where I need to be and ask to get let off. He refuses since it isnt the Hospital once again. Then I see my apartment, once again I ask. He refuses and tells me we are almost there. SO, the bus continues, loops around and then just stops. Everyone gets off. The driver and ticket lady turn the bus off and leave and I ask, what am I supposed to do? Apparently, it was the end of the route. In about an hour (mind you its almost 11pm at this point) they will load a shift of hospital workers on and continue taking me to the place i need to go. So, I asked them to point me in the direction of the apartment and I set off on foot. Twenty minutes later, I was home.

I guess moral of the story, don't listen to the bus drivers and maybe a taxi is worth it!

Artsy Fartsy-World Music Festival Penang Island

So, Thursday was May Day and most parts of the world had the day off to celebrate the 8 hour work day. Of course, this is a little too close to communism for the good old red, white and blue, so I decided to celebrate my own way by taking a little time off and having my first art lesson with my little Bohemian Artists at Central Market in Kuala Lumpur.Here is a pic of my first lesson on how to draw on eye. My teacher is an incredible pastelist; I felt like karate kid. He made me draw 100 circles and shade them while he chain smoked cherry hand rolled cigarettes and watched and told me I needed to "become one with the graphite and the paper". Apparently I was lucky to have him as a teacher because he was just coming out of a vow of silence for 5 years.

Then this weekend I took off to the island of Penang for the World Music Festival which was a great experience. Penang is an early 16th century port where traders from Portugal coming from Goa used to come. It became a place for all traders following the Spice Trails to come together and I guess a perfect place for pirate raids. So, it is a historic town opening to the straits of Malacca in Northern Malaysia. I finally found my beer and then decided that its too hot to drink beer because I had a headache all day.

The festival was a wonderful time (http://www.penangworldmusicfestival.com/). Great production, great performers. I met some fun musicians from Kenya (Lake Victoria) called KENGE KENGE and spent time with them. Their performance was amazing and the music incredible. Overall the festival was great.

On Sunday, I headed to the butterfly garden. I forgot how amazing it is to feel the gentle touch of a butterfly on your skin. That was amazing combining my 2 favorite things: butterflies and orchids. Then I went and pampered myself at the beach. Sang show tunes with some gay manicurist from Singapore...all in all a good trip.

For more photos you can go to http://www.facebook.com/photo.php?pid=406924&l=2d2d6&id=508474203

Cutest Rock Star Ever!!!!!!

Melting Away in the Asian Melting Pot

So, I have almost been in Malaysia for one week. I haven't had too much time to explore and have been working too much. I have found a fruit called a rambutan (a relative of the lychee) that is sweet and just fun to hold. I've been trying not to embarass myself with chopsticks, but I think I am getting the hang of them.

On Saturday we had a huge patient group workshop of about 110 plus people. It was very successful and I had the opportunity to meet many patients that I only knew as names. That was very rewarding. I designed a map for patients to come and sign and put a sticker where they are from. Patients liked it and we plan on taking it when we go to do some rural meetings to show them where the other patients are in the country.

Malaysia is a melting pot of many cultures--Malay, Indian and Chinese. As a British colony , the Chinese came to build the railroad and the Indian to do the rubber tapping. Because they have natural resources, I think Malaysia is much better off than a lot of the other nearby countries. It is very modern and clean in Kuala Lumpur.

I wondered how 3 very different races live in such harmony, given other parts of the world have tensions amongst "their own" people. It appears the rascism here is not within these 3 groups-but to the outsiders wanting a better life. They are mostly Bangladeshi and Indonesian with a sparse group of Africans (Nigerians and Somali). Everyone tells me that crime has increased once they arrived, especially the Indonesians) and there is now some ethnic tension.

I can't gauge how safe it is here. I know there is a warning against travelling to Eastern Malaysia because of terrorist activities and kidnappings. Everyone says a woman should never walk alone, its very dangerous. Being double the size of the average man here, I feel I have a little advantage :)

So, when I first arrived I was in the mood for an ice cold beer. Then I realized, all the shopkeepers are muslims and it is against their religion to carry, sell, and consume alcohol. So, I want a beer-just one. My mission to find one continues. I hear there is a Chinese shop somewhere that may have one :) I'll let you know how that goes.

I spent an evening touring around an art market and that was wonderful. One of our patients is an artist there and he introduced me to some amazing pastelists and painters. I will return tomorrow and some of them have agreed to give me some lessons. I'm really excited. I saw a Malaysian kite stall which was incredible. Many colors and each kite hand cut and painted.

I decided to stop working so much so this weekend I am taking a short flight to Penang province for their 2nd annual World Music Festival. Should be fun!

If you smile at me, I will understand

Here I am, in the warm tropical heat of Bangkok. I don't have too many first impressions so far because I have done nothing but work essentially. Thai people are very friendly and always smiling...I see why its called the "Land of Smiles"

I stayed in our office near Victory Monument for the first few nights and spent many hours playing with developing country internet where my work takes 3 times as long to do. I have a hard time figuring out the boundaries of the Thai people because they are so friendly and accomadating, I don't know what is too much to ask. Hopefully that will come with time.

Saturday, we had a wonderful patient group meeting. It was great to see a project that I have been nuturing since infancy becoming fruitful. Watching patients laugh and smile and interact with each other--you would never guess they had a disease. I crossed the language barrier with many smiles, gestures and laughs. It makes me believe that attitude is everything and I found the patients so inspiring.

They had a thai blessing and welcoming ceremony for me with jasmine and rose flowers. People pour water on your flowers and hands while giving you a blessing. Also, since I came a little late for the thai new year (Thai: สงกรานต์ Songkran, from Sanskrit sankrānti "astrological passage"), they gave me a taste of the celebration by putting clay on my face and arms along with well wishes. It was an amazing experience!

I moved into what will be my apartment last night. After carrying all my bags with some help up 5 flights of stairs, I arrived at a beautiful terrace with blooming flowers and the night breeze flowing by. My roomate Alice is absolutely wonderful and we had so much to talk about and connected wonderfully. There is an amazing pool at the apartment that I am sure I will love.

On Thursday I leave for Malaysia for an all-Malaysia patient group meeting and a few rural visits. I'll be there 3 weeks. Ok, more later.

Misses to all! Muah!

One more trip.........

So far I haven't shared this blog with many people nor have I posted very often on it. Seeing as I will soon be leaving on another extended trip, I thought it would be a great way to communicate my thoughts and experiences with those I love.

So, check here in the upcoming months

Political Instability: A Roadblock for Equity to Universal Health Coverage in Thailand

Thailand is under the world's scrutinizing eye in the next democratic election slated to be December 2007. Contrary to intuitive logic, candidate preference has little impact on access to healthcare for Thailand’s poor. Whether the government can return to political stability will determine the population's health future. If the health system remains the government's priority amidst a perceived increased need for defense spending, a decreasing Gross Domestic Product (GDP), and a lessening interest by foreign investors, the successes of its Universal Coverage (UC) health scheme may prevail in providing equitable universal coverage.

Thailand has been called one of South-east Asia’s most stable democracies. This title was tarnished after a military coup ousted Prime Minister Shinawatra in September 2006 validated by accusations of wide-spread corruption and abuses of power1. This political instability was unappealing to foreign investors and is thought to influence future economic development inThailand. Many investors are eagarly awaiting the outcome of the election for reassurance that democracy will again be restored2.



Thailand’s free-enterprise economy with pro-investment policies has been doing well2. The Thai economy grew 6.9% in 2003, 6.1% in 2004 and it is predicted that real GDP growth will slow to an annual average of 4.5% a year in 2008-12, down from 5.5% in 2003-07. This shift is mainly due to higher crude oil prices and lower anticipated foreign investment 3.
During the periods of economic growth, Thailand devoted a larger portion of the National Budget towards the Ministry of Public Health (MoPH) budget which enabled them to incrementally launch a successful UC scheme. For example, in 1990 of the 335, 000 million baht national budget, 4.8% (or 16, 225.1 million baht) was designated to the MoPH. In 2004, 8.1 % (or 77, 720.7 million baht) of the 1,028,000 million baht national budget was given to the MoPH 4. By 2004, the percentage of the budget spent on security versus health was 13.5% and 8.1% respectively 5.



However, with political instability and military spending on the rise, many worry that additional spending on national security, coupled with reduced foreign investment, will divert funds from the health sector. Thailand's military leaders recently awarded themselves pay increases totaling $9 million and increased the defense budget by over 30 percent. This is a $1.1 billion hike, reportedly at the cost of its health sector6. In a budget requested December of this year, the allocation for defense spending will increase to 115 billion baht (3,639,008,201 USD) or 33.8%, in comparison to the 86 billion in 20067. In December 2006, the Thai Board of Investment reported the value of investment applications from January to November had declined by 27% year-on-year2. This increased military spending has the potential to greatly impact the successes of UC in Thailand.






Thailand has been moving toward a tax-based UC scheme for all Thai citizens. The population covered by public health insurance schemes increased from 71% in 2001 to 95% in 20038. The UC scheme is funded by progressive direct taxes in which wealthier people contribute more to the system. Additional funds are to be raised from a sin tax on alcohol and tobacco9 . However, with less funding available to the national budget, making health accessible to Thailand’s population may be negatively impacted.

Although this scheme has proven to be innovative and unprecedented, many reports state a lack of health equity in under-served populations as well as a major stress on human and material resources within hospitals. Many regional hospitals have been accruing increasing debt 10. In fact, Siriaj Hospital, Thailand's oldest medical school, faces debts of approximately $13.5 million- due to earlier phases of the UC scheme 11. Under-served populations (i.e. those with Thai as a second language) have shown dramatic disparities. Nationally, 90 per cent of children are immunized against the six major preventable childhood diseases by the age of two. However, the rate drops to 81 per cent for children in these households 12. These examples demonstrate opportunity for further health sector spending to improve access to healthcare across the Thai population.



In order for Thailand to continue on a path of improved health for all, as is the goal for the Universal Coverage scheme, a continued emphasis must be placed on allocating sufficient national budget to public health expenditure. If the elections on December 23, 2007 are able to restore democracy and political stability, the stage is created for foreign investors to continue to be attracted to Thailand, the GDP will eventually begin to rise and the health sector can continue to receive the attention it needs. International and national forces should join together to ensure the upcoming election is fruitful in restoring political stability, if not for the economy, then for the health of those on the margins of Thai’s society.







WORKS CITIED

1. The Nation, "What Thaksin had done wrong", 22 November 2006


2. https://www.cia.gov/library/publications/the-world-factbook/geos/th.html


3. http://www.economist.com/countries/Thailand/profile.cfm?folder=Profile-Economic%20Data


4. Wibulpolprasert, Suwit, Thailand MDG’s and Universal Coverage of Essential Health Services. Available at http://www.wpro.who.int/NR/rdonlyres/5DB24877-DD7E-499D-A2D2-473E32AE0F10/0/15ThailandMDGsanduniversalcoverageofessentialhealthservicesSWibulpolprasert


5. Wibulpolprasert, Innovations in the Health Financing: The Thai’s Experience, presented April 20th, 2004


6. USA for Innovation website: Available at: http://www.aei.org/publications/pubID.25890/pub_detail.asp


7. Asia Defense News. Available at: http://www.asiandefense.com/news/update/12-06-2006.html


8. PRAKONGSAI, PHUSIT, et al. Assessing the Impact of the Universal Coverage Policy on Financial Risk Protection, Health Care Finance, and Benefit Incidence of Thai Households, Journal of Health Science, 2007


9. Mills, Anne, Strategies to achieve universal coverage: are there lessons from middle income countries? 30 March 2007


10. Hughes and Leethongdee. “Universal Coverage In The Land Of Smiles: Lessons From Thailand’s 30 Baht Health Reforms”. Health Affairs, 26, no. 4 (2007): 999-1008


11. Corbe, Ron. “Thailand’s Health Plan Creates Challenges for Hospitals” Available at http://www.voanews.com/english/archive/2006-05/2006-05-03-voa33.cfm


12. UNICEF-Thailand. Available at: http://www.unicef.org/thailand/reallives_3888.html