The Refugee Relief International, Inc. team to the Thai-Burma border in April, 1999 consisted of Team Leader John Padgett, MMS,PA-C, who also served as tropical and general medicine consultant; David Mohler, MD, orthopedic and general surgeon; Jeff Gieseke, RN, nurse educator and clinical instructor; Paul Edwards, engineer and building design consultant, and Andy Hamilton, paramedic and clinical instructor.

The purpose of the mission was to establish a clinical facility, or "jungle hospital" on the Thai-Burma border to provide humanitarian assistance to the Shan, Lahu, Karen, and other ethnic minorities being forced from Burma (Myanmar) by the Burmese military government's policy of ethnic cleansing and forced relocation of Burma's mountain dwelling minorities.

The team's intent was also to provide direct medical and surgical assistance to the indigenous people, when appropriate, and to provide medical supplies such as vitamins, de-worming medication, antibiotics, anti-malarials, and fever medications. A further purpose was to provide basic medical instructions to Shan medical workers, who intend to take their skills back into Burma to assist their people.

The mission was successful on a number of fronts, but, due to Thai government objections as to location, we have not as yet begun construction of the jungle dispensary. The sequence of events is as follows:

Deployment
The team deployed to the Chiang Mai area on 15 April, awaiting transportation and link-up with the indigenous medical personnel from the Shan refugee community. There was delay because of the Thai Songkarn (Water Festival) holiday, but the team used the time to purchase medical supplies to increase its clinical capability, and to purchase personal items such as field gear and mosquito nets.

On 17 April, the team traveled overland to Fang, Thailand, on the Thai-Burma border area. We were pleased to see that what we had started the year before with a cash contribution and medical and surgical supplies had grown into a legitimate medical training center and clinic. This clinic served the refugees in the vicinity, and trained village medical workers to return to their homes on the other side of the border with clinical skills to help their people.

As the need was greatest in the border town of Muang Nga, the team proceeded there the next day, the 18th of April, and met with the local Thai Public Health worker, Mr. Prasit, who was leading the effort to train, teach, and treat the Shan refugees. His Shan assistant, Miss Moo Han Oo, a medical assistant, is also a primary clinician for delivery of medical care to the refugees. There is no physician present.

Also involved in training the village health workers was an American, Richard, who represented no NGO or other organization. A former public health nurse in California, he decided to spend time assisting the refugees in a worthy cause. He did the best he could to help with limited medical knowledge.

Operations
The site where the training was conducted contained a small building of bamboo and thatch construction, which served as classroom and clinic, and female living quarters in the rear of the building. A similar, longer building with a dirt floor was the sleeping quarters for the men, and cooking and eating area. When patients were seen in the clinic structure, classes moved in to the living quarters.

The small group of huts where the students were living and training was on land owned by a local Lahu village chief, now a Thai citizen. The land was for sale, and the refugees who had moved there for their education as health workers, and the small clinic itself, were in jeopardy of being expelled when the land was sold.

The initial plan for our team was to purchase the land whereon the clinic and dorm buildings stood, then build our dispensary next to them. The land was purchased for Thai Baht 38,000, but before construction could begin, the Thai Ampur (District) authorities informed us that it would be an illegal operation without permits, which would not be forthcoming in that location.

The Thais had concerns about the border location, in that they feared it would attract too much attention from the Burmese government, with increased traffic, and training programs for a resistance movement the Thai government does not admit to having on its soil.

It was therefore determined that the dispensary would be put up on Thai Public Health Service land, and the Thais have encouraged this. This way, even if there is increased traffic to the facility, it is functioning as a legitimate Thai public health facility, treating patients from the district. There is also, incidentally, a nice classroom facility on the site, to train whomever the local public health official decides to train.

Our focus now is to work with the Thai local authorities to build the facility, then to staff it on a rotating basis with Refugee Relief medical volunteers, and support it with medication and equipment, as funds allow.

Mr. Edwards has, in conjunction with Dr. Mohler and myself, come up with a very functional, cost effective design. The low bid from local contractors was approximately Baht 111,000 when the dispensary was to be built on our land. As the new facility may need minimal upgrading to pass the local Thai authorities, we may need to budget as high as Baht 120,000, but we have determined not to let costs exceed a reasonable limit. This will not be an open-ended project.

During the mission, clinical instruction was provided to the students in fluid replacement and IVs (they started them on each other), management of trauma, and basic nursing skills. Dr. Mohler attended a surgical case, and Mr. Padgett saw tropical and general medical cases and assisted in clinical instruction, but the primary purpose of the mission, and the purpose which took up most of our time, was to plan and begin construction of the dispensary.

In the limited time available, while plans were begun, students trained, and patients assisted, the dispensary construction was not started, due to objections by the Thai bureaucracy. We are now working with the Thais to obtain permission to go ahead, and they have sounded encouraging.

The team also took a short side trip to Cambodia, where we delivered some US $5,000 worth of medicine and surgical supplies to the Government Hospital in Phnom Penh. We were quite disappointed, however, to see considerable deterioration in the hospital conditions. Our team had, during previous visits, strongly stressed sanitation, and had seen progress in the cleanup of garbage and medical waste, and viewed with pride the construction of latrines and water points for patient use.

This trip, however, we saw that sanitary conditions had fallen back to 1995 levels, that is: standing piles of garbage and medical waste, human excrement in unused rooms, no functional toilets, and large areas of standing stagnant water (one was outside the tropical disease ward).Clouds of flies were everywhere, and one can only speculate on the wound infection and fly-borne disease now occurring in that hospital. It will take a resident team of military medical advisors with authority to make drastic change, before the hospital can expect to discharge a patient in healthier condition than when he was admitted.

Mission Goals Accomplished:

• Land purchased for clinic/dispensary construction. While not now used for construction, refugees and students now have secure housing;
  
• Medical and surgical supplies and infant formula delivered to the Shan and Cambodian health authorities;
• Medical training given to Shan village health workers; - Jungle hospital/dispensary plans drawn up, construction drawings complete
• Direct medical humanitarian assistance rendered to Shan and Lahu refugees in the form of medical and surgical treatment and consultations
• Refugee Relief International, Inc., is now 1/3 owner of property on the Thai-Burma border, used to house refugees and Shan village health worker students.

Lessons learned:

• Do not attempt to get anything done during Thai holidays when in Thailand. Do not, if possible, schedule any mission days during Thai holidays
• Even though our plans were to avoid official contacts, the site where we had hoped to build was accessible to Thai bureaucrats, and thus Thai oversight. Once the bureaucrats entered the picture, the plans had to change
• When bureaucratic oversight is possible, go armed with letters, permits, and approvals prior to attempting to break ground

Respectfully submitted,

John E. Padgett, MMS, PA-C
Director of Operations
May 5th, 1999      

Click here to view the Financial Report for this Mission.