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Bangkok’s Forgotten Children

The New Physician April 2000
The problems of Klong Toey’s
poorest residents are largely ignored
by the local medical community.

Morning is peaceful in the portside district of Klong Toey, one of the most depressed regions of Bangkok. I wake up every day to the sounds and smells of people cooking breakfast. I pass shopkeepers and merchants preparing for the day’s business on my short walk to my office. It is still early, when the traffic is light and the smog absent, so I enjoy the fresh air as I prepare for another day at the Duang Prateep Foundation, a charity group dedicated to helping Thailand’s urban poor.

The residents of Klong Toey do not own their land; they have moved to the area in search of work at the nearby seafood factory or at the Port Authority of Thailand. The Port Authority owns the thousand acres of Klong Toey, and evicts people from time to time, though it uses only a quarter of the space.

I have taken a leave between my second and third year of medical school to spend seven months working as a public health officer here. One of my tasks has been to study the rate of height growth and weight gain in children in area kindergartens to check for malnourishment. Most of the children show no significant difference in height and weight compared to Thailand’s national standards, but this doesn’t mean they are healthy. The guidelines were devised 15 years ago, when Thailand’s economy and standard of living were very different than they are today. Now many malnourished children gain weight from a diet of junk food, making it harder for me to spot their poor nutrition.

I have also helped to identify an infestation of bed mites as the likely culprit in numerous appearances of a rash in children from an inland village, and I am conducting a survey to evaluate the general health of older Thais.

I prize these accomplishments, because each day brings me dozens of reminders of my many limitations. I only speak a little bit of Thai. With my blond hair and blue eyes, I am immediately recognizable as a farang, a foreigner.

Despite these obstacles, my work here is meaningful because the problems of Klong Toey’s poorest residents are largely ignored by the local medical community. I have seen volumes of research devoted to the health of higher-income Thais and Thais from rural regions, but almost none about the urban poor. This disparity is also evident in the distribution of physicians. Thai medical students serve an obligatory three years after graduation as payment for their free medical education, but they are seldom sent to practice medicine in the depressed regions of the cities.

Although violent crime is rare here, the presence of a major industrial seaport makes Klong Toey a natural gateway through which methamphetamines and heroin are smuggled and distributed throughout Thailand. Drug abuse seems to touch everyone here. Many mornings on my way to work, I see a boy of perhaps seven sniffing glue from a paper bag. I have seen other children throughout the community suffer permanent brain damage from the effects of inhalants. When I return home at night, a group of young men are often hanging around the courtyard next to my building injecting themselves with amphetamines. They are sometimes aggressive, and the sight of them usually causes me to take a detour back to my apartment.

Widespread IV drug use in Klong Toey contributes to a high occurrence of HIV. No one knows how much of the region’s population is infected, although the percentage is believed to be higher than that of Thailand overall, which is approximately 15 percent. The lack of easily available HIV testing is not viewed as a problem here, because there is no money to treat those infected. At the Mercy Home, an AIDS hospice around the corner from my office, an average of one patient dies every day. The 30 patients living at the Mercy Home at any given time are among the small number of HIV-positive people who receive AZT, but it is usually too late for these people by the time they are allowed to move into the home.

The foundation I work for runs a program that sends drug-addicted children to detox and then to live in drug-free environments in rural Thailand. I once asked the founder and secretary-general of the foundation why the children who had used IV drugs were not tested for HIV and Hepatitis B. She replied that even if the children tested positive for the disease, there was no money to treat them. Drug cocktails to combat HIV cost large sums of money even by American standards, which makes them unaffordable to all but the richest people in Thailand. The Thai government provides free health care to all its citizens, but only gives AZT to pregnant mothers to minimize the risk of transmission to their unborn. All these children would receive with these test results would be the knowledge that they have a disease that their health-care system is unwilling to treat.

Hearing impairment is another common malady among children in Klong Toey. Some lose their hearing from congenital rubella; others from the overuse of aminoglycosides as infants. Within the foundation, a school that provides free hearing aids and speech therapy to these children. While the students in this special school are lucky enough to have had their hearing impairments detected at a young age, many more Thai children go undiagnosed, missing the crucial years when they need their hearing to develop speech and social skills.

I recall the case of a young Cambodian girl who came to the foundation unable to speak Thai. A Bangkok police officer asked the foundation to take her in—even though she was not addicted to drugs—simply because she had no other place to go. The signs of abuse by the parents who had abandoned her were unmistakable. Cigarette burns covered her body, and her nose had been fractured so badly she appeared not to have a nose; just two nostrils that stuck out with below a flat surface between her eyes. We made a few calls, and found a surgeon who would do the reconstructive surgery for next to nothing. Several months later, I saw the girl again, her nose having reappeared as if by magic.

Before I came to Bangkok, I never realized how much a medical education empowers us to help others, not only with our own skills, but also with the association that we have with colleagues around the world.

This was the lesson of seven months in Klong Toey, Bangkok, geographically and culturally the opposite side of the world from my life in the United States—in a place where even “free” health care is out of the reach of many, and where an education in medicine is valuable currency in the economics of helping those in need.
Dan Handel is a third-year student at Northwestern University Medical School in Chicago.