PHAMIT Site Profiles

   
Raks Thai Foundation
    
    Raks Thai Foundation (RTF), the Principal Recipient, has been working on HIV/AIDS prevention, and care and support programming for over ten years. RTF has been providing HIV prevention and reproductive health programming for migrants in the seafood industry for over five years, and has recently expanded the number of provinces reached through PHAMIT.
 
As of October, 2005
 
Samut Sakhon (Mahachai)

Samut Sakorn Province just southwest of Bangkok is quite small but densely industrialized. The majority of industry is in seafood processing concentrated in Mahachai District. Much of the seafood processed here comes directly from boats docking at the numerous deep-sea ports in the area, and is processed mainly by female laborers. Although not adjacent a border, migrant workers have a considerable presence in this province.

In 2004, over 103,000 migrants, including family members and dependents, registered under the state registry. Estimates by government officials, however, put the actual number of migrants working and living in the province, including family members and dependents, as possibly reaching up to 200,000. Although more migrants obtained work permits in 2005 (73,896 total with 69,455 from Burma) than the previous year (just over 63,000 total), it is reported that the number of those without any form of registration in the area also appears to be increasing.

    
     
Target Groups

The vast majority of migrants in Mahachai (around 94 percent) come from Burma. The majority are Mon, with Burmese, Karen, Tavoy, and other ethnic groups present to varying degrees. Most have crossed the border at Kanchanaburi, even though there are those who have crossed at Ranong and even at northern borders. The Mon group has a long-standing, historical presence in the area, and there are a number of Buddhist temples with Mon-Thai monks. A number of villages in Mon State in Burma directly rely on migrants working in Mahachai for income, and many people from the same village can be found living and working together.

The fishing industry in Samut Sakorn is large and diverse. The biggest boats, or “mother” boats, go with a crew of fifty into deep international seas in Indonesia, the Andaman Sea, and even southern parts of the Indian Ocean for years at a time. Most laborers on these boats are Thais, although it is believed that migrants are also present to some degree. Recently, one boat returned to Mahachai with a large number of the crew suffering cardiovascular Beri-Beri; a couple even died. They had been at sea for seven months without any fresh vegetables, eating only fish and rice the whole time.

Numerous transport boats and medium sized trawlers come and go on a regular basis, docking along the river to unload their catch and then staying long enough to refresh supplies. Transport boats have crews of 30-40 men and return to shore every fifteen days, while trawlers of various types and sizes have crews of 5-25 men and return either daily or every four to seven days, depending on the type of boat. Some trawlers will “hop” along the coast, docking at ports to unload their catch and replenish supplies going along the coast in one direction, and then come back.

It seems that at least a couple of fishermen on each boat may be infected with an STI, most commonly cancroids, herpes or syphilis. Also of concern is a perceived increase in the number of boats that have fishermen injecting oil or inserting beads under the foreskin of their penises. In some cases, 10 to 20 percent of the crew has “enhanced” their penises in this way, with a growing number suffering from complications that require surgery.

Karaoke and brothels in Mahachai are located away from the docks, but migrant fishermen and factory workers are the main customers. There are over fifteen commercial sex shops in Mahachai, many of which are located on one small street in the center of town. Shops have ten to forty women present, many of whom are single mothers from Issan. Condom use is reportedly mandatory in the shops and the women are able to refuse customers who don’t want to use a condom, of whom, most are Mon men. Although there may be regular condom use with sex workers in Mahachai, there is negligible condom use between spouses and intimate couples. Many of the migrant workers in Mahachai’s factories are young, some still in their teens. Without their families present and feeling lonely, some may experiment with sex for the first time, often without knowing about or using any form of contraception.

Women are the primary laborers in seafood processing, sorting and cleaning fish and shellfish, while the men mostly do the heavy labor of lifting and carrying. Due to the large seafood processing industry, the number of migrant women registered with work permits in Samut Sakorn is approximately equal to the number of men (this varies by year, but recently the number of women registered has exceeded the number of men) - the only coastal province where this is the case. There are many stages of production in the seafood industry, often done in various locations. Preparation and cleaning is done in informal settings or small factories, with the later stages of production including processing, freezing and packaging done in large factories that hire up to 800 people. Labor and sanitation standards often vary according to the type and size of factory, with smaller factories and informal settings having the weaker standards.

Seafood processors may work over ten hour days, often starting at 3 a.m. and working until the shipment is finished, which may take up to twelve hours or more with large shipments. Seafood processors are paid by volume; those who are more adept at peeling shrimp get a higher wage, with daily wages ranging from 100 Baht to over 400 Baht. During off-season, migrants make considerably less money and may not have work for a couple of days at a time, quickly eating up any money they may have saved.

 
Common work-related health problems among seafood processors include: respiratory infections from working in cold storage units, muscle aches and other types of discomfort associated with bending over or standing for extended periods of time, and skin problems such as eczema caused by wearing rubber gloves or keeping hands in cold and briny water.
Migrants live in cramped dormitories with up to ten people staying in a small, poorly ventilated room, which they share by rotating between day and night shifts. In “Talad Koong,” an open-air shrimp-peeling factory with an integrated migrant community, it is estimated that there may be 3,000 migrants or more present, including children. In addition to Talad Koong, there are over 60 communities of varying sizes with numerous children present scattered around Mahachai. Sanitation in these communities is noticeably poorer than most Thai communities, often strewn with trash or immediately adjacent marshy areas.

Health services in general are difficult for migrants to access due to location, language barriers, and fear of harassment /arrest. Rates of unplanned pregnancy, as indicated by high birth rates and the frequency of complications from unsafe abortion, are increased by women's limited access to family planning information and services. People living with HIV/AIDS (PLHA) are periodically found in the community, suffering alone, without anyone to take care of them.

Many families have two to four children and regularly have their children transported back and forth between Burma and Mahachai at certain ages. Although public education is supposedly available to all children in Thailand, it is impracticable for many children of migrants to enroll due to language differences, fees and mobility. With low rates of enrolment in Thai schools and the scattered and reclusive nature of migrant communities, children of migrants rarely receive regular preventative health, and their mobility may potentially disrupt immunization schedules as well.

Health Problems    
 
  • Unplanned pregnancy is common with high birth rates and reports of unsafe abortion and related complications.
  • Work-related health conditions include respiratory-tract infections, fatigue, skin problems, and muscle aches.
  • Cramped living conditions leads to transmission of communicable diseases such as TB, while poor sanitation contributes to gastrointestinal problems and mosquito borne-diseases.
  • Individuals suffering from advanced stages of HIV/AIDS are periodically found alone and uncared for in the community.
   
Activities and Strategies

Raks Thai Foundation (RTF) has been working with migrants promoting reproductive health and family planning in Mahachai since 1999, providing a strong base for which to expand activities under the PHAMIT Project. Current activities are separated by zones with four drop-in centers as a focal point. RTF’s centers all serve a similar purpose by providing a place for core activities, such as small group activities, training and coordination of volunteers, and health referral. Additionally, each center provides a specific service according to the needs of the immediate target community including: a health center with a focus on reproductive health, a legal clinic, child development centers, and even a safe house.

RTF’s migrant and Thai field officers cover over sixty communities with populations that range in size from 50 to 3,000 people. Activities also reach four piers and over ten large factories. Many communities reached are adjacent factories, with most people living in dormitories owned by the factories. In some of these areas, there are disproportionate numbers of women to men, with children present to varying degrees except in factory compounds.

   

Small group activities, organized and assisted by volunteers and led by Burmese field officers, are usually held in the community. Activities often start with a discussion on individuals’ immediate health concerns, leading into reproductive health, family planning, with an emphasis on condom use, and then to HIV/AIDS. Materials used in activities, such as flip charts, posters, and photo-copied brochures, are in the Burmese language. By orienting activities to health rather than specifically to HIV, Raks Thai Foundation is also able to gain access to factories and sex workers.

 

Raks Thai Foundation has developed a network of volunteers throughout the migrant community and in factories. These volunteers notify RTF about opportunities for outreach, and are part of the health referral system. They receive on-going training and refresher courses each month, and, according to their availability, willingness and level of knowledge, over time may eventually become a health assistant. There are at least seventeen volunteers currently active in five of the larger target communities, of which, six are able to provide small group activities independently.

There is a condom box at each of RTF’s four centers. Volunteers also help distribute condoms directly and by maintaining condom distribution boxes located in dormitories at four large factories. Sex worker volunteers also assist in distributing condoms provided by RTF, and condom boxes have been placed in 2 snooker halls and at a small shop where migrant fishermen sit and drink alcohol. Condom boxes are refilled three times each month.

RTF has assisted over thirty migrant PLHA in the past two years. PLHA have been referred to RTF by local hospitals, by members of the community and volunteers. RTF has assisted these people by providing home-based care, including providing emergency shelter at one of the drop-in centers, and by assisting them in returning to Burma, to a safe house at the border or to a hospices.
 
Raks Thai Foundation has strong relationships with local government, especially in the health department, which has resulted in regular partnerships. The Talad Koong health center, for example, works with the Provincial Hospital to provide a mobile clinic to ten different communities on a rotating basis. The mobile clinic is given three or four times a month depending on the hospital staff’s availability. A private hospital also partners with the health center at Talad Koong to provide mother and child health services once a month, and the Provincial Health Office provides vaccines. The Provincial Health Office has also been providing trainings to a set of migrant health volunteers, many of whom are RTF volunteers, three to four times a year. In all, around 400 volunteers pass through these trainings in a year. Some of these volunteers will assist with follow-up on 50 migrants receiving TB treatment (over 300 migrants requesting work permits tested positive for TB in 2004).
Child development centers at three of RTF centers teach Thai, Burmese and Mon languages, and have art and math activities for over one-hundred children. Vaccinations and other preventative health care for migrant children are provided through RTF centers and mobile clinics. In addition to direct preventative health services for children, RTF is developing a curriculum on Life Skills with a hygiene component for children of migrants through assistance from the Non-Formal Education Office.

Community clean-ups in migrant communities are organized a couple of times a year, and RTF provides support for cultural and community activities, such as celebration of Burmese and Mon festivals. In some cases, the PHO and local hospitals have provided support for HIV/AIDS prevention campaigns on national holidays.

RTF also assists migrants in accessing their legal rights. Twice a week an RTF team goes into the communities and surveys rights-oriented problems migrants are experiencing. The team also gives rights trainings in the community to inform migrants of their rights entitled to them as migrants and laborers. This is supported by a legal clinic twice a week where a lawyer is available to provide advice, and pursue legal cases as necessary. Only a few legal cases have been processed, however, mainly concerning rape or physical abuse. For labor issues, direct negotiation with employers is usually the first recourse, with only the hardest cases being referred to the government’s Labor Management Committee or Social and Labor Security Office.
 

Activities
Description
  
Outreach  

Small group activities on health that lead into family planning and HIV prevention are led by Burmese field officers and organized and assisted by volunteers.

Volunteers

A network of volunteers throughout the migrant community, in factories and among sex workers informs RTF about opportunities for outreach, and assists with health referral. Those who receive extensive training become health assistants.

Condom distribution

Condoms are distributed directly through volunteers and condom boxes located at each of RTF's four centers, in four dormitories at large factories, 2 snooker halls and a small shop. Sex worker volunteers also assist in distributing condoms provided by RTF.

IEC materials

Materials used in activities and distributed are in the Burmese language, including flip charts, posters, and photo-copied brochures. Materials come from various sources, including some produced by RTF.
Referral and counseling

Health referral is provided as necessary, and is supplemented by treatment of basic ailments at RTF centers. Emphasis of health services is on reproductive health, including family planning, and mother and child health. Health volunteers are involved in health referral, and follow-up.

Community activities

Community clean-ups are organized, and support is provided for cultural and community activities. PLHA have been given care and referred to hospices or the border. Three of the RTF centers have child development centers, with around 120 children of migrants in attendance.

Rights and advocacy Rights trainings are given in the community, supported by a legal clinic with a lawyer from the Thai Lawyers Association. Some cases have even been pursued in a court of law. RTF also assists negotiate labor disputes with employers.