Bad sight” our guide prompts us, leading us through the door an unknown house, unannounced yet unhesitant. Her role as a Village Health Volunteer gives her a unique visibility in the community. For 13 households in the village, she is the personal health resource, modelling years of debate on the role of primary health care around the world. Throughout Thailand, each trained volunteer disseminates health information to and monitors the health status of around 15 families in his or her community. Supporting these volunteers, the Health Promoting Hospitals construct the first tier of public medical care. Located in each sub-district, or tambon, these hospitals are the first stop in the national insurance referral system and provide basic allopathic and traditional care close to the home of each Thai citizen.
During a study visit to the Health Promoting Hospital, an English man named Martin came to act as translator. As a 20 year resident of the area, however, his insights into Thai culture and Thai views on health proved even more valuable than his language skills. The low level of dependence on physicians provided a way for the resource-strained Thai health care system to expand access in the population, but I did not sense that the community focus of the system represented an intervention from above. Individuals volunteering for public health? Communal priorities over individual privacy? Thailand, it seemed, could be a public health dream.
Martin confirmed many observations, pointing to the parallel influences of collectivist culture and Buddhist values as essential sources of support. Before Western studies of public health ever reached Thailand, citizens sought care and advice at local Buddhist temples and continued to do so as urban expansion created severe disparities in access among the population. Martin further attributed the ability to communally seek solutions to the gentle temperament praised in the Buddhist religion. In general, a Thai will avoid confrontation—not from a fear of individual repercussion, but from a concern for overall harmony, he shared.