Raks Thai Foundation works in two areas in Trad Province. The more recent of the two sites is in the capital district of Trad where there are 5 piers along the river and two more piers at the ocean thirty kilometers away at Laem Ngop. These piers receive fishing boats but not cargo boats. Most fishermen are Cambodian, but some boats have groups from Burma, including, notably Karen. The three main types of boats located at these piers are Dtai, Laak and Oun. These boats will have a crew of 10-20 and will stay out at sea from one week to one month. There are around twenty or so Cambodian direct sex workers in the area.

There are a small number of Cambodian families living in this area, but they do not have their own community. They mostly integrate into the Thai community and live in small groups near the docks. Most families have two or three children, and there are families that have been here ten years. Children are born and raised here, and some only speak Thai. Most of the Cambodian children in this area go to Thai schools. These children often have no documents though, and this, it is feared, will raise problems in the future.

Cambodian women are coming in for ANC at the Provincial Hospital, and although the numbers are low, there is a significant percentange that have HIV. These women are included under the PMTCT program with powdered milk. There is also now the ECAT Project that just started, which will supply ART to the mother and the husband after the woman has given birth according to their CD4 count.

Overall, this community has few health problems, partly because health services are easily accessible. The greatest health threat facing this community is violence amongst Cambodians triggered by alcohol and gambling. In Chonburi, jealousy has been noted as what has caused violence, but in Trad, because there are more families present, this isn’t the issue. Gambling and related debts has led to individuals spending all their money on the Thai side, creating frustration and ending in violence, often fueled by alcohol.

Activities & Strategies

HIV prevention is still a core element of PHAMIT activities. Accordingly, there are fifteen condom distribution boxes placed at snooker halls, stores and at piers. Although there is a network of volunteers in the community to assist in activities, since they are working migrants, they are hard to reach on a continuous basis. The PHAMIT team thus has on-going recruitment and provides regular trainings with around twenty volunteers at a time. There are currently around five long standing volunteers assisting Raks Thai’s team in this community.

The outreach team, comprised of a Thai field officer, a migrant field officer and occasionally a volunteer, teaches about HIV and general health including STIs and family planning. There are also discussions on accessing health services and health rights. Outreach focuses on “hot issues” which has recently included dengue fever. Generally, employers are helpful and assist in arranging activities.

There is a drop-in center at one of the piers that has a female volunteer attendant. Trainings are conducted for volunteers and there are other activities; there is a reading library, video and karaoke as well as condoms available. There is generally no need for referral services from the center as migrants feel secure going on their own. The center is open Monday to Friday from 9am to 5pm. On Saturdays and Sundays there are activities for children. There are 19 children ages 5-15 years attending; younger kids are taught in the morning and the older ones in the afternoon. Lessons teach Khmer literacy, “manners” and hygiene. Officers from the Hospital and Raks Thai Field officers teach on alternating days

The Provincial Hospital has one translator, a woman, who has been working for over three months and is receiving “on the job training.” The translator works in the ANC clinic on a regular basis and can help out with other translation. This is considered a trial period. She is currently hired through PHAMIT, although this is not one of the pilot project provinces.

The main target area of Klong Soun and Baan Makaam, one of the last communities before reaching the Cambodian border, houses fifteen communities of migrants from Cambodia. The migrant community is estimated at around 8,000 including children, and 10,000 if including fishermen.

Fishing boats either go out less or for longer periods due to the economy, but most boats that originate from the area don’t leave the Gulf of Thailand. “Dtai Chaw” boats have 5-8 crew members and go out for two or three days. Migrant crew members tend to stay with the owners of these boats longer than other types of boats. Oun Dam and Oun Keaw are boats with 25-35 crew members, and go out for about four and a half days. These boats provide no financial security and so the crew change boats regularly. Some boats go to the South for the Monsoon season May-Oct, while in Oct–May boats from the South come here. There is a disturbing trend in the age of migrant men working on boats. It appears that around five percent or one out of every twenty fishermen from Cambodia is around the age of fifteen.

There are also lots of children, some born and raised here. There is currently an average of around two children per family. If born in Thailand, they will receive the “pink book,” which is a health record and informal recognition of birth, but does not equate a birth certificate, while children born in Cambodia usually come to Thailand with their parents but without any documents. Around 100 Cambodian children have applied for school, but enrollment is still generally very low. The problem is that they would overwhelm the Thai system, which is already straining to accommodate the Thai population (border areas are typically resource-poor and have trouble accommodating the local Thai nationals). Moreover, although the local population is composed of around 60% Cambodians and 40% Thais, the government only collects taxes from the Thai population. This results in a lack of funding to support the Cambodian community, most notably provision of education.

When children aren’t in school, it is highly likely that they will “help” their mothers. Those who are eight years old and up are known to assist in peeling shrimp. This is prominent as most of the work is informal and done in the place of residence – not in factories. As mentioned, more young people, mostly in their early teens, are being encouraged by their families to work. Domestic workers in this area are not known to have specific problems with their employers such as violence, but they do not receive a very high wage. (Historically this area does not have any animosity based on culture or nationality, like the border with Burma, and the Cambodian population is more or less accepted.)

There has been a continuous and long standing presence of sex workers from Cambodia in one area near the piers. There are fifteen shops with sex workers, each shop with around three to nine women. Currently there are around seventy or more sex workers present in this area. Some of the women have children with them here or else back in Cambodia. An average time for staying in this area is about eight months to a year, some stay longer.  When they get sick, the employer will go to the pharmacy, describe the symptoms and buy medicine for the women.

With increased awareness and decreased stigma, more migrant PLHA are approaching Raks Thai for assistance. At least one person is now receiving ART in Koh Kong while working on the Thai side of the border. In the last twelve months (2006), there WERE around ten HIV cases reported from the ANC clinic in the Klong Yai Hospital. There is no support group for PLHIV in this area, mainly because those who are taking ART on the Koh Kong side in Cambodia attend the support group linked to the hospital there.

Reporting of STI is low in the area. Additionally, there is high awareness from Raks Thai’s interventions and most people are willing and feel comfortable to go to the hospital or a clinic on their own. Additionally, the health clinic in the area has a weekly STI clinic specifically for sex workers, who are encouraged by their employers to attend. However, the women simply get tested – there is no explanation or counseling. If they test positive, then they will receive information and treatment. There is no mandatory blood testing.

HIV counseling is provided in Khmer language in three locations where migrants seek health services in the area – the Klong Yai Hospital and two health centers. Counseling services are provided regularly at the antenatal clinic and for general health issues when needed. The translators are a small group of resident Cambodians who are also PLHA. These people were once refugees and have a specific residence status that will allow them to get Thai citizenship. They were recruited from the local PLHA group and trained by the hospital on HIV counseling, TB, antenatal care, vaccinations and women’s health.

To reach fishermen in the area, Raks Thai sets up activities at local coffee shops where the men go to relax. There are currently around eight shops where activities are held, reaching around thirty to sixty people at a time. The outreach team, which includes a Thai field officer, a Cambodian Field Assistant and two migrant project officers, will also go and give brief outreach sessions on the docks to fishermen.

Except for activities with fishermen, the outreach strategy for the community in this location has shifted over the years. As Raks Thai has had a significant presence at this site for around nine years, a considerable section of this community has had a continuous presence in the area and Cambodians are generally well aware of HIV, there are less activities focusing on HIV in the community. The majority of activities at this time concentrate on general and reproductive health and communicable diseases, as well as providing updates on changes in registration policies. Nowadays, Raks Thai asks migrants what they want to know.

Another shift is that for activities with the community, Raks Thai field staff provides less of the activities directly. The migrant community is now taking on more of the burden of outreach activities with Raks Thai providing technical support. As part of this strategy, there are twenty-five volunteers in the community, mostly all women. They meet once a month with the Raks Thai staff. In the monthly meeting, issues are discussed in depth so that volunteers have a strong understanding and can relate correct information to the community. Some issues addressed include: what it means to be registered with a work permit, what the requirements are for migrant children entering Thai schools, HIV prevention care and support, and other health topics.

Some of the volunteers may assist in distributing condoms if they feel comfortable, usually by placing a distribution box in front of their residence. Besides the boxes that are maintained directly by volunteers, there are also condom boxes placed at various locations around town such as at snooker shops, barber shops and moto-taxi points. In all, there are twenty-five boxes throughout the community.

The main criterion for recruiting volunteers is that they are identified as a leader in their community. These volunteers then assist in arranging activities with groups of men or women. They help distribute IEC materials, especially focusing on “hot” issues, such as polio vaccines campaign for children that took place in 2006 and dengue fever more recently.

As part of capacity building of volunteers, the Provincial Health Office gave a two-day training for “migrant health volunteers,” many of whom also have a role as community volunteers mentioned above. Around forty-five people attended the training, only five of them were men. The volunteers cover two districts that are highly populated by Cambodian migrants. Doctors from the Koh Kong Hospital, the border province in Cambodia adjacent Trad, helped give the training in Khmer language, which improved understanding. A range of health topics were covered including HIV, TB, Dengue fever, Malaria and vaccinations.

Raks Thai provided financial support for migrant community leaders to organize a Songkran (water festival) event for 200 people last year, which included Khmer games, dancing and merit making with monks from Koh Kong. A youth group of fifteen young women is also being formed to help these young adults organize social activities if they want.

Trash is still a major problem in the community. Although there have been education campaigns, this has not yet translated into behavior change. The Tambon Administrative Organization has requested to set up an event with 25 volunteers to do a community clean up and campaign.

Seeing that there are numerous children in the area without access to education, Raks Thai has recruited a couple of “informal teachers” to provide basic language and other basic activities at the office. Approximately forty children are enrolled, with the group separated into two classes. The parents must enroll the children and are required to pay a small fee that assists the volunteer teachers. They must also purchase uniforms. The intention of these requirements is to have parents understand the hidden costs of education (although the price they pay is cheaper than the Thai schools) and to establish the parent’s commitment to their children’s education. The uniforms make the children feel that they are in school, and gets them (and the parents) ready to attend school, which includes washing the uniform regularly. Raks Thai has been working to sensitize parents to understand the importance of education for their children in these ways, but it is still a struggle when they see their children as a financial resource.

Activities

To reach fishermen, teams go to docks and coffee shops. Community members are more settled, so topics focus less on HIV and more on other health topics, with discussions extending into rights and children’s issues.

Volunteers have an increasing role in provision of information depending on the community. Near the border, there are a significant number of volunteers who can provide health information and referral if necessary, and have received training by both Thai and Cambodian health officers.

Condoms are distributed directly at activities and through numerous condom boxes placed throughout the community. Sex workers receive condoms directly from Raks Thai, and condoms are available at the drop-in center and the office.

There are numerous materials available in Cambodian language that have been developed and produced by PHAMIT partners. Due to the proximity of the border and good relations with the Cambodia side, there are also materials from Cambodia available.

The hospitals and health centers in these target areas have translators available to provide counseling, which is especially important for the antenatal clinic. Migrants in these areas do not need referral generally. Cross-border referral is provided when needed, especially for those with HIV who are in need of ART.

Assistance has been provided for cultural events organized by the community. A main concern is ensuring that children receive education, as very few are able to access Thai schools.