Thailand

Free access to healthcare in Thailand is available only to registered Thai nationals or to persons with a specific registration status. Vulnerable groups such as ethnic minorities and migrant workers are often excluded from the health system, causing them to do without treatment for serious medical conditions including HIV. MSF has responded by providing healthcare to marginalised groups throughout the country.

Establishing non-discriminatory care for HIV/AIDS

MSF began its first-ever antiretroviral program in Bang Kruai district hospital in 2000 using generic antiretroviral (ARV) drugs. Since then, MSF has worked closely with the Access to Essential Medicines campaign, local partners and the Thai government to establish localised HIV/AIDS programs and MSF continues to advocate for large-scale generic production of ARVs in the country.

In Chiang Rai province, MSF is supporting two public hospitals that offer HIV/AIDS care to unregistered migrants from Laos and Myanmar. At the Mai Sai hospital, MSF provides free ARVs to unregistered minorities who lack access to healthcare. An MSF doctor works alongside hospital staff and MSF ensures drug supply, pays for lab tests and hospital referrals. At Chiang Saen district hospital, MSF offers HIV treatment and care to unregistered minorities and to people who cross into Thailand seeking care specifically for HIV/AIDS.

In Kuchinarai, Kalasin province, the district hospital in 2005 assumed responsibility for 160 MSF patients receiving firstline antiretrovirals. MSF is now focusing on a pilot program to introduce secondline treatment, an alternative drug regimen for people who are not responding to the drugs they were initially prescribed. This involves understanding why initial drug regimens failed and ensuring that hospitals and hospital staff have the correct training, access to facilities and drug supply necessary to offer effective secondline treatment.

Treating patients in Bangkok prisons

MSF provides clinical support for HIV in two prisons in Bangkok: the medium security Minburi Remand Prison, and Bangkwang, a maximum security male prison where inmates are incarcerated for life. MSF provides medicines, training, covers lab costs and sends medical staff to work in the clinics several times a month. As of July 2006, 44 patients were taking ARVs.

Providing basic medical care to undocumented migrant workers

There are thought to be over two million migrant workers in Thailand, with more recent arrivals contributing to the post-tsunami reconstruction of hotels and tourist resorts in areas such as Phuket. Many of these workers remain undocumented and lack access to healthcare. MSF is using mobile clinics and a newly opened health center in Phang Nha to provide basic medical care focusing on mother and child health, treatment of sexually transmitted infections and ensuring clean water and sanitation.

In 2005/2006, MSF also added 518 patients to its tuberculosis program treating undocumented migrants in Mae Sot, Itak province. HIV testing and treatment is now systematically offered to tuberculosis patients because of high rates of HIV/TB co-infection, and treatment is now also available for persons with multi-drugresistant tuberculosis.

Assisting Laotian refugees

In July 2005, with sanitation activities addressed by other actors, MSF began providing healthcare and a water supply to 6000 Laotian Hmong people who had taken refuge in Phetchabun in northern Thailand. The Hmong are an ethnic minority who largely aligned with the Americans during the Vietnam War, and cite marginalisation and persecution as reasons for fleeing their country even today. By October, 6094 medical consultations had been conducted in the camp, mostly for respiratory infections and diarrhoea. Other nongovernmental organizations (NGOs) departed in October and MSF was the only remaining NGO, left in complete charge of the camp. MSF lobbied the United Nations High Commissioner for Refugees, NGOs and the Ministry of the Interior to take responsibility for this refugee population, with no results. As of July 2006, MSF continued to carry out 500 medical consultations weekly.

Handover of projects to the Thai government

In December 2005 MSF closed an HIV/AIDS project in Surin province, where 752 patients were receiving ARVs. All patients on firstline treatment were integrated into the national HIV/AIDS program and MSF will provide drugs to the 33 patients on secondline treatment until December 2006.

In Phetburi, central Thailand, MSF has supported an HIV treatment program by providing drugs, medical staff, technical support and training at Ban Laem District Hospital and the paediatric department of the Phetburi Provincial Hospital. Now the responsibility for approximately 120 adults and 70 children on ARVs has been handed over to the Ministry of Health and the project will close in 2006.

MSF has worked in Thailand since 1983.

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