Mae Tao Clinic (MTC) is a health service provider and training center that offers affordable quality health care for transient workers and other displaced persons along the Thailand–Burma border. Since its beginnings in a dilapidated building with bare dirt floors, the clinic has expanded over the past 24 years to currently employ a staff of about 700 doctors, medics, medical students, and other health workers, who serve 400 to 500 clients per day and handle a total of 115,000 cases per year.
Among the key lessons that I took away from her story, two related points might especially resonate with urban planners: (1) urban and social problems are historically and locally contingent, complex, and transient, such that (2) local knowledge and existing forms of social organization are critical to formulating effective planning responses.
To elaborate, the town of Mae Sot (in which Dr. Muang’s clinic is located) is on the Thai side of the border, but has a majority Burmese population, including Kachin, Shan, Mon, Arakan, Karen, Karenni, Palau and Chin ethnic minorities. Many of these patients are undocumented and without health insurance. Migrants arrive in Mae Sot for various reasons: involuntarily as victims of human trafficking; to flee civil war and poverty in Myanmar; to work in the plethora of low wage manufacturing operations along the Thai-Myanmar border; or to pass through to Thailand in search of greater economic opportunities. They come to the clinic with health issues related to dangerous work conditions in the factories and overcrowded living conditions at home as well as for reproductive care.
The five most prevalent health issues in Mae Sot are:
(1) communicable diseases such as malaria and diarrhea;
(2) reproductive health issues, including sexually transmitted illnesses, family planning services, maternal and child health, and birth registration;
(3) workplace or traffic injury;
(4) poor nutrition; and
(5) mental health issues such as psychosis, schizophrenia, depression, anxiety, and post-traumatic stress disorder.
As each of these carries an environmental dimension, they can also be prevented through community outreach, education, and mobilization. MTC partners with local NGOs, schools, public agencies, and companies to train health volunteers of diverse age, skill, and ethnicity to identify cases, provide referrals, and disburse health information, whether in the context of families and households, workplaces, or neighborhoods.
In Mae Sot, as in many other towns and cities around the world, scientific or medical expertise enable but a narrow sliver of understanding and recourse amidst ever complex and changing societal conditions. Likewise national citizenship or “formal” health care systems are insufficient guarantors of quality and affordable health coverage for much of the global populace. On the other hand, most places have residents and other local stakeholders who traverse diverse daily routines and urban spaces, possess extensive skills and capacities to learn, and interact with countless others in myriad ways. The question is how to translate their place embeddedness, investment in the locality’s future, direct insight into policy and governance systems, including their gaps and dysfunctions, and attunement to the fluidity and emergence of social life into better policy and planning.
Post by Lily K. Song.