location: nan, 'Thailand 
year: 2002 source: HSRI 
title: The suffering of Thai people within the health system 
abstract:The Suffering of Thai People Within the Health SystemThe Suffering of Thai People Within the Health System is a study that utilizes a qualitative and case study research study design. The data for this study were collected from in-depth interviews of eight marginalized groups including elderly, disabled people, people with kidney problem, chronic patients, people with HIV/AIDS, migrant workers, homeless children, women who are violence victims, and patients who are victims of medical malpractice.	The study specifically focused on: 1) suffering of Thai people from different perspectives, namely social, economic, political, cultural and medical aspects; 2) the coping processes for their suffering caused by different problems, within the context of the existing health and social system of individuals; 3) the social support and social service mechanisms that exist, and the result from these systems. The study of marginalized groups will reflect the nature of their coping with suffering and the context of the existing social structure and services in which they exist. The study found that the nature of suffering includes: 1) physical suffering that includes illnesses that happen which are more severe than those usually experienced by middle class people; 2) psychological suffering resulting from abandonment from family members, feeling of being their family’s burden; 3) social suffering from being in an unjust social and cultural system were exploitation, gender inequality, social stigmatization, and dehumanization exist to varying degrees. These are all factors that exacerbate the victims’ physical and psychological suffering.	 How to Cope with Suffering 	The studied population coped with their own suffering alone. They lack social capital and family support. Most of them are faced with abandonment from the community and society, and they lack knowledge and skills in self-care practices. They were poor and disadvantaged and they must struggle to survive day by day. These life conditions deliberately or non-deliberately cause them to get more and more sickness. The study found patterns of coping strategies including utilizing existing medical and social health services from government and non-government sectors, self-care practices, alternative medicine such as traditional Thai and Chinese herbal medicine, witchcraft, and monk healers. Some victims cope with their suffering by listening to the Thamma, becoming a monk, or interpreting their own suffering as their own karma and accepting it.Medical and Social Services		Support from medical and social services from both government and non-government organizations for the marginalized groups does exist to some degree. The existing problems with these services include:  lack of collaboration in working together; lack of provision of information related to patient’s rights and welfare needed for the patients; lack of sensitivity to the patient’s needs and problems; having discriminatory attitudes toward patients; lack of responsibility in following health professional ethics and principles; and using economic criteria to judge patient’s rights to receive services.RecommendationsForm the study, it should be pointed out that the suffering of the Thai people is not only caused from the medical system but also from the social and cultural systems of the country. Health system reform alone is not enough to solve the problem of suffering of the Thai people. The solution of this problem is also social and educational reform for the existing unjust society.For the government sector, the state must have mechanisms to decrease the gap between the poor and the rich, and reforming the health services and information provided to the patients to make it accessible and equitable. The state should strengthen the capacity of the people to utilize self-care practices. The critical solution is the reform of the existing policy-related structures that are obstacles for the marginalized groups to achieve well-being. Reforming health policy should be similar to the reformation of social policy including providing information and fundamental human rights to the public. Advocacy procedures should be understandable and practical. Partnership between government and non-government sectors should be emphasized. Civil society, especially family, should play a major role in supporting the patients. The community members should create support mechanisms among themselves to take care of their own health, economic and social problems; so that the need to depend on government can be decreased.