Nine years ago, public health officer Khanongsilpa Daengthong was "shocked" when told he would be sent to work on Pha Luay Island, one of the 40 islands that comprise Surat Thani's Ang Thong Archipelago in the Gulf of Thailand.

Khanongsilpa's task was to oversee healthcare for the island's population of about 630 people. He was only 24 at the time, and was reduced to tears when he thought about the potential hardships and gruelling work on the remote island about 20km east of Koh Samui and 18km from Don Sak port at Surat Thani on the mainland.

"I had lived on the mainland all my life, and I was dreading taking a boat," he recalled.

But his tears were not caused by fear of the sea so much as his overwhelming reluctance to live and work on this 5 square kilometre island that did not have electricity or running water. He was distraught at the prospect of the living conditions and being far removed from his family.

The majority of Pha Luay's population makes a living by fishing. They are used to hardship and go to sea even when they are sick. The most common health problems include respiratory conditions associated with the local weather, and chronic diseases such as diabetes and high blood pressure, mainly in the elder inhabitants.

Their access to health services has always been limited and expensive. In emergencies or cases of serious illness, a four-hour round-trip to the nearest hospital on Koh Samui costs between Bt1,000 and Bt2,000. In the rainy season it is even more expensive because only bigger boats can navigate the rough seas.

A few months ago the islanders finally began producing their own electricity when solar panels were installed under a government project to help the villagers reduce the cost of fuel oil used to run generators.

During his nine years on Pha Luay, Khanongsilpa has seen other health officers come and go. Most, like him, were reluctant to work on the island. Some found the assignment too stressful and stayed only for a few years at most. Khanongsilpa's current and only colleague, Ekarat Riyaphan, has worked on the island for two years.

After years of experience with the Pha Luay people, Khanongsilpa last year came up with the idea of portable medical kits for all families.

Apart from basic first-aid necessities, the kits include drugs for common ailments like diarrhoea and fevers. Some kits are customised for the needs of individuals - for example, diabetic patients are supplied with the necessary medication.

Normally the villagers get their kits refilled every two months at the health centre on the island. For those with a particular condition, a signed prescription allows them to replenish their kit either at the health centre or the Koh Samui Hospital.

Having lived on Pha Luay for nine years, the health officer - who is lucky to see his wife of six years more than once a month - has come to love the island he was so reluctant to go to.

As an honorary member of the "Pha Luay family" he never needs to cook for himself. At least four families take care of his meals every day.

"It is even harder for me to leave compared to how awful it was when I first came here," Khanongsilpa said.

"I've found another home here ... we're family. A very warm and kind-hearted family. I remember the day I got married six years ago. It was very impressive. Almost a hundred families [from Pha Luay] came to the wedding on the mainland," he said with a smile.

In another year or so it will be time for Khanongsilpa to move on - to further his career and raise a family of his own on the mainland.

But he says he will miss such things as going down to the beach on Pha Luay to catch a mobile phone signal (spilled over from Koh Samui) to chat with his wife and parents.

"Of course, my wife and my family will be glad to see me in the flesh. But there will always be another family, a very big one, for me to miss here when I really go back to the mainland," he said.

Arthit Khwankhom

The Nation

Kho Pha Luay