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Published on June 13, 2005 - They came from every province; leaders of the nationwide network of village health volunteers. Summoned by the Public Health Ministry to Bangkok for urgent instructions on how to respond to what may be a record outbreak of dengue fever this year, they left frustrated, dreading the burden ahead and complaining about a lack of government support. “The officials said we must get serious [in the fight against dengue], but I don’t how much more serious we can get,” said Chamlong Srisawad, chief of volunteers from Chachoengsao province. “We campaign against dengue fever every year with limited success. Perhaps it’s time the officials revised some strategies.” Many rural health volunteers say they don’t have the time, resources or training to carry out their duties and the complaints are increasing. But the government continues to assign them more work on disease surveillance, especially now that the country is preparing for an influenza pandemic that could infect as many as 26 million Thais. On the surface, the emphasis on the role of the volunteers makes sense because of their sheer numbers – more than 800,000 people across the country with strong roots in each community. The system is even promoted internationally as a model for early detection of an expected pandemic evolving from the deadly H5N1 bird flu virus. “Thailand was able to successfully control Sars and bird flu because we used these volunteers,” said Dr Rewat Wisarutwet, director general of the Medical Services Support Department, which oversees the volunteers for Public Health Ministry. “They are at every village corner working at the grassroots level. No other [disease control] strategy could match this strength that we have.” But the volunteers, as well as provincial health officials, say the expectations could be too high. A health officer from Kalasin province estimated that only 60 per cent of the volunteers actually did the community work expected of them. A volunteer from Suphan Buri agreed. She said only half of her 15-member team showed up when duties called. “Some just applied to be volunteers because they expected small benefits such as medical treatment without paying Bt30 like other villagers,” she said. Many others drop out because of distress, exhaustion and lack of morale. Kamphong Triras, who coordinates more than 40,000 volunteers from Nakhon Ratchasima, said the volunteers were now given far more work than they could possibly handle, and many were questioning the sense in carrying on. “When you see on your TV a crowd of villagers waiting to greet the prime minister or some other high-ranking official from Bangkok, who do you think they are? It’s us, the village health volunteers,” Kamphong said. “How else can the provincial authorities recruit a mass of people in a short time?” He said that as well as their original health-related duties, health volunteers were expected to assist the government in its war against poverty, monitor changes in population patterns in the village, help promote new crops and cultivation methods, coordinate the Labour Ministry’s campaign against village men and women migrating to work illegally in foreign countries and help mediate conflict settlement for the Justice Ministry. Despite all this, there was little financial and other support from the government and many stuck with the job simply because they believed they were helping their communities. “Sometimes we can’t meet all the demands, so we have to make up something for the reports we have to submit. Who can find time, with all of that, to do actual household surveys?” Kamphong said he intended to run for a Senate seat next year with a major platform plank of proposing a bill to establish funds for the work and welfare of health volunteers. Chamlong supported the idea, but noted that it was terrible that such legislation might be necessary because the government was not doing its job. “We receive empty promises, over and over again,” Chamlong declared. “We have big gatherings on March 20 every year to mark National Health Volunteers Day. You can replay the videotapes. Officials from the Health Ministry promise every year to take better care of us. Yet nothing ever happens.” Dr Rewat acknowledged the lack of financial support from the government. He said, however, that monetary compensation was not on the ministry’s agenda because it would be against the voluntary spirit and mentality of public service. “We try to give them other incentives, such as scholarships for their children,” he said. “They also get free treatment from government hospitals and pay only 50 per cent, should they want to stay in special rooms as in-patients.” Rewat said his department was pushing the government to approve Bt10,000 per year for each village to be spent by the volunteers to improve community health. “We don’t think about giving them a salary,” he said, “otherwise, they could no longer call themselves volunteers. Besides, I don’t think most volunteers want to have a salary.” Kamphong said he was not talking about salaries, but rather compensation for expenses faced in doing their work, as well as some kind of fund to take care of them when they got old. “Everybody in the ministry we work for has a salary which they want to raise every year. How come they think we should work for them for free? When we do a good job, it’s they who get all the credit.” |