#07.13.15

The first day of our fieldwork finally started today! The design challenge that my group, the Mae Tao Clinic (MTC) health services group (also known as Group 1), focused on was the question of “how might we improve healthcare access for displaced Burmese living along the Thai-Myanmar border?” We started the day off with a visit to MTC. We met with our MTC facilitator, Khun Chan, who briefed us with our schedule for this and the next weeks. He also gave us a tour around MTC and let us visit most of the departments there. I learned that MTC provides many different kinds of services, including general care, acupuncture, dentistry, optometry, reproductive health, surgery and trauma. As we toured MTC, I learned that the department that they mostly focus on is the labor and delivery department, because a lot of their patients are mothers. While touring, my group was amazed at all the services they provide to their patients, all free of charge! However, we also began to observe some of the problems in the clinic. The entire clinic seemed very busy and chaotic. We saw a lot of patients sitting outside in hallways, breast feeding and changing diapers. There seemed to be no sort of patient isolation. In addition, all the patients also used the same squatting toilets, which seemed dark and unsanitary. We saw all of these as huge risk factors for these patients, especially in terms of disease outbreaks in the clinic. The large number of patients waiting to be seen also worried us because it seemed like MTC was over run and could not keep up with the constant flow of patients. With these ideas in mind, we began to consider if there were alternative ways or places that these people may be able to go to receive the care they need so that they could be seen sooner and help to decongest the system at MTC, to make it an overall more sanitary and healthier environment.

The next place we visited during our fieldwork was the new MTC that was still under construction. The clinic has to be relocated due to the costs to maintain the old clinic on rented land. One thing we began to consider even before getting to the new clinic was how much farther it was from the main town and road. This immediately made us wonder if this would be a disadvantage to the displaced Burmese in terms of transportation to the new clinic. The farther location could mean more checkpoints that these patients need to cross, higher costs, and overall greater difficulty to reach the clinic. Could these factors ultimately prevent some of the Burmese from reaching the clinic, or make the journey too dangerous and difficult in times of emergency? Once we arrived at the clinic, we did notice that the new clinic seemed much more organized and up to date. It had much higher quality rooms and equipment which we all agreed would provide the patients with better overall services. One of the biggest improvements we saw was with the isolation of rooms. We were very happy to see this as it would help to decrease the chance of diseases spreading throughout the clinic. A possible problem we did see, however, was with the decreased number of beds. When we asked why that was the case, Dr. Nyunt Naing Thein told us this was because MTC hoped to increase relations with Thai health services and begin to refer more patients to Mae Sot Hospital. We initially thought of this as an improvement because Mae Sot Hospital has better services and more resources available for its patients. However, we still question whether more referrals was the right answer to improve displaced Burmese access to healthcare.

In the afternoon, we drove through and visited some of the communities where some of the displaced Burmese lived. We quickly noticed how remote and rural the great majority of these communities where. Most of the shelters were simple homemade huts with little to no electricity or running water, which displayed to us that these people were living with a very basic standard of living. We also noticed during the day that the communities were almost empty and even the Learning Centers had decreasing students in higher grades because almost everyone has to work to support their families. We saw this as a possible risk to community members’ health because they have to work so much that they do not have time to spend on their health and education. They may also risk losing their jobs if they miss a day of work to go to a clinic. This made us wonder how we could help these people overcome this barrier so they could have more time to focus and educate themselves on their health. When we drove through one set of communities in particular, we noticed that the conditions were especially unsanitary. We discovered that these communities were in charge of sorting the trash for Mae Sot and we observed huge piles of garbage right next to people’s huts and lots of random trash scattered around the communities. The communities in general had a bad smell lingering around them and there were flies everywhere. All these factors made us think about all the health issues and diseases that could arise in these communities because of them. We began to wonder how we could improve the sanitation of these communities so that these people could live in a healthier environment. Would the best way to do this be through educating the community on proper sanitation? Or could a general community clean up service that could be run by volunteers in the community?

After we were done with today’s fieldwork, I went to the vegetarian place again for my dinner. I got a sukiyaki dish; it was delicious as expected. Right after dinner, my group had a meeting to go over what we learned today. We made a poster to write down notes and summarize our experiences so far.