Trauma Stabilisation as a Sole Treatment Intervention for Post-Traumatic Stress Disorder in Southeast Asia.

Southeast Asia contains high numbers of traumatised populations arising from either natural disasters or interpersonal violence. Consequently, the need for empirically based trauma treatments, compromised by insufficiency in appropriately trained clinicians and mental health workers, makes the situation more challenging in addressing traumatic sequelae in local populations. In response, the humanitarian/ trauma capacity building organisation, Trauma Aid Germany, trained 37 therapists in psycho-traumatology, based on EMDR Therapy, which included trauma stabilisation techniques. This research analyses the impact of Trauma Stabilisation as a sole treatment intervention for Post-Traumatic Stress Disorder (PTSD) in adults. Each client was screened for PTSD utilising the Harvard Trauma Questionnaire - pre- and post-treatment. Analysis of the data considered only those interventions focussed on trauma stabilisation, including psychoeducation. Participants receiving trauma confrontation interventions were excluded from the data. Trauma stabilisation - as a sole treatment intervention, was highly effective in alleviating PTSD diagnoses. Results demonstrate PTSD symptoms were reduced in both clinical and sub-clinical trauma groups. The data set suggests trauma stabilisation, as a sole treatment intervention, was safe, effective, efficient and sufficient treatment intervention for PTSD. Furthermore, trauma stabilisation interventions have the advantage of being safe, flexible, and adaptable to the cultural and spiritual context in which they were are applied. The research findings also have implications regarding teaching and learning and the potential utilisation of paraprofessionals, and other allied health professionals in addressing the global burden of psychological trauma.

Learning to navigate the healthcare system in a new country: a qualitative study.

OBJECTIVE: Learning to navigate a healthcare system in a new country is a barrier to health care. Understanding more about the specific navigation challenges immigrants experience may be the first step towards improving health information and thus access to care. This study considers the challenges that Thai and Filipino immigrant women encounter when learning to navigate the Norwegian primary healthcare system and the strategies they use. DESIGN: A qualitative interview study using thematic analysis. SETTING: Norway. PARTICIPANTS: Fifteen Thai and 15 Filipino immigrant women over the age of 18 who had been living in Norway at least one year. RESULTS: The women took time to understand the role of the general practitioner and some were unaware of their right to an interpreter during consultations. In addition to reliance on family members and friends in their social networks, voluntary and cultural organisations provided valuable tips and advice on how to navigate the Norwegian health system. While some women actively engaged in learning more about the system, they noted a lack of information available in multiple languages. CONCLUSIONS: Informal sources play an important role in learning about the health care system. Formal information should be available in different languages in order to better empower immigrant women.

Repatriation of a patient under a forensic order from Australia to Thailand.

OBJECTIVE: A person who develops a serious mental illness whilst visiting Australia may encounter substantial barriers to treatment, rehabilitation and eventual repatriation to his home country. Particularly when English is not the person's first language and there are no supports in Australia, the person will have special needs whilst recovering from his or her illness. Further difficulties arise if the person has been charged with a serious offence. METHOD: We present the case of a 23 year old single Thai citizen who had been living in Australia on an overseas student visa before he was charged with a serious violent offence in the context of a mental illness. RESULTS: Following an assessment at the watch-house, the patient was diagnosed with an untreated psychotic illness. The patient was subsequently admitted from a remand prison to a secure mental hospital and became subject to the involuntary treatment provisions of the Queensland Mental Health Act. CONCLUSIONS: With a detailed multi-disciplinary rehabilitation plan and the assistance of a transcultural mental health service, a patient with a serious mental illness may be rehabilitated to enable negotiations with multiple government and non-government agencies to facilitate the patient's return to his country of origin.

Health Workers' and Villagers' Perceptions of Young Child Health, Growth Monitoring, and the Role of the Health System in Remote Thailand.

BACKGROUND: In Thailand, despite widespread improvements in child nutrition, stunting is still highly prevalent among northern hill tribe children. OBJECTIVE: To understand how villagers and health workers (volunteers and officials) gauge health of children younger than 5 years, whether growth monitoring is salient, and the relationships of villagers with the health system in this remote location. METHODS: Qualitative research was undertaken with 8 hill tribe villages. A workshop on infant and young child health and nutrition was held with 8 village health volunteers, 2 per village, selected by a public health officer. In-depth interviews were conducted with 20 villagers and 2 volunteers who had children 0 to 5 years. Eight other health workers were also interviewed. All dialogue was conducted in Thai through bilingual facilitators and recorded, transcribed, and translated into English. Transcripts were coded and analyzed thematically within and across participant groups. RESULTS: Overall, villagers considered strength and independence of children to be hallmarks of health; the size of children featured rarely. Volunteers did not perceive local benefits of growth monitoring, and the extent of child malnutrition was unclear to them. Nutrition counseling was seldom mentioned by villagers or health workers. Across all accounts, and considering silences, relationships of villagers with the health system seemed fragile. CONCLUSION: Villagers understand child health in terms of functional abilities rather than size. Volunteer health workers in this remote location have limited resources and support. Together this helps explain why, against a background of poverty and food insecurity, growth monitoring does not translate to improvements in child nutrition.

Knowledge and attitudes about AIDS: a comparative study of Thais involved in sexual occupations, university students and immigrants living in the United States.

Knowledge about AIDS among: (a) 89 individuals involved in prostitution related occupations, (b) 465 university students, and (c) 220 Thais living in the United States was assessed to further evaluate the efficacy of Thailand's AIDS educational programs. While the average number of items answered correctly by the three groups were not equivalent (p < 0.001), all participants possessed substantial factual AIDS knowledge. As predicted, those involved in prostitution had the least accurate information (92% correct). Contrary to initial hypothesizing, however, AIDS knowledge was identical (95%) for the samples of university students living in Thailand and Thais who have been exposed to intensive AIDS information campaigns in the United States. Taken together, these findings suggest that Thailand's AIDS educational efforts have achieved considerable success. Television, newspapers, and radio provided information for most participants while a few learned about AIDS from their physician or in educational institutions. A majority expressed interest in improving their understanding about AIDS. The extent of infection among prostitutes appears to be high with nearly one-quarter of those in the sexual occupations group reporting that they knew someone with the disease. Techniques to better inform prostitutes about AIDS are discussed and a common outcome instrument to measure AIDS knowledge and attitudes is recommended.

PIP: The authors contrast the level and accuracy of knowledge about AIDS possessed by those who work as prostitutes on a regular basis, previously unstudied university students, and Thais living in the US who have been exposed to assertive and sophisticated mass media AIDS information campaigns. 37 male and 52 female prostitutes of average age 22.05 years; 465 university students from Thammasat University, 67.5% female and of mean age 19.35 years; and 220 Thai families living in the US, 63.2% women and of mean age 40.10 years with average family size 3.52 persons were surveyed. All participants possessed substantial factual knowledge about AIDS, although those involved in prostitution has the lowest level of accurate information (92%). AIDS knowledge was identical at 95% for the other two groups. Findings indicate that Thailand's AIDS educational efforts have been quite successful. Television, newspapers, and radio provided information for most participants while a few learned about AIDS from their physician or in educational institutions. A majority expressed an interest in learning more about AIDS. Techniques to better inform prostitutes about AIDS are discussed and a common outcome instrument to measure AIDS knowledge and attitudes is recommended.

Electoral reform and public policy outcomes in Thailand: the politics of the 30-Baht health scheme.

How do changes in electoral rules affect the nature of public policy outcomes? The current evidence supporting institutional theories that answer this question stems almost entirely from quantitative cross-country studies, the data of which contain very little within-unit variation. Indeed, while there are many country-level accounts of how changes in electoral rules affect such phenomena as the number of parties or voter turnout, there are few studies of how electoral reform affects public policy outcomes. This article contributes to this latter endeavor by providing a detailed analysis of electoral reform and the public policy process in Thailand through an examination of the 1997 electoral reforms. Specifically, the author examines four aspects of policy-making: policy formulation, policy platforms, policy content, and policy outcomes. The article finds that candidates in the pre-1997 era campaigned on broad, generic platforms; parties had no independent means of technical policy expertise; the government targeted health resources to narrow geographic areas; and health was underprovided in Thai society. Conversely, candidates in the post-1997 era relied more on a strong, detailed national health policy; parties created mechanisms to formulate health policy independently; the government allocated health resources broadly to the entire nation through the introduction of a universal health care system, and health outcomes improved. The author attributes these changes in the policy process to the 1997 electoral reform, which increased both constituency breadth (the proportion of the population to which politicians were accountable) and majoritarianism.

A new inequality? Privatisation, urban bias, migration and medical tourism.

Access to health care in developing countries, the main destinations of medical tourists, is notoriously uneven, and often becoming more so. Medical tourism, urban bias and privatisation have combined to exacerbate this trend. This is exemplified in both Thailand and India, where regional areas have been disadvantaged by the migration of health-care workers to hospitals focusing on medical tourism, neo-liberal national financial provision for medical tourism (and related tourism campaigns) and evidence of trickle-down gains is lacking. Medical tourism challenges rather than complements local health care providers, distorts national health care systems, and raises critical national economic, ethical and social questions.

Primary health care for Indo-Chinese children in Australia.

This study reports the detailed analysis of 61 consecutive presentations by recent immigrants from Indo-China to the Casualty Department of a modern Australian Children's Hospital. The parents/guardians were interviewed either in the Casualty Department or in their homes. Indo-Chinese children coming to a Casualty Department manifested the same age distribution and spectrum of illnesses that is seen in the general Australian paediatric population. However, significantly fewer presentations to hospital occurred due to accidents/trauma when the group was compared with the general population attending the Casualty Department. Only 21% of the Vietnamese and Cambodian families can communicate satisfactorily with hospital staff without interpreter help. Fifty-one per cent of parents reported that they did not have enough English for a medical interview without an interpreter. Twenty-eight per cent did not have enough English to communicate at all. Parents of Vietnamese children reported that on occasions they had not sought medical care for their children because of language difficulties. Many families do not know that an Interpreter Service is available, and many believe that access to such a service is available only through a doctor. Many of these children also use traditional Chinese remedies in the context of their contemporary Australian lives. We have found no evidence that this practice causes late presentation with deleterious effects, or any evidence that it compromises modern 'Western' treatment.

From agricultural modernisation to agri-food globalisation: the waning of national development in Thailand.

Agriculture has been central to accounts of Thailand's modernisation and the rise of the national development project between the 1940s and the 1970s. However, the role of agriculture in the waning of national development is rarely explored critically in the Thai context. This paper focuses on agriculture and the role of the state in the shift from national development to globalisation. The first part of the paper examines the beginnings of Thailand's modern agricultural sector, before turning to the state-sponsored diversification of agriculture in the 1950s. The paper locates shifting state responses to agriculture in the late 1950s and 1960s in the context of specific political and historical social forces, before exploring the emergence of agri-food exports in the 1970s and the rise of agribusiness in the 1980s and 1990s. The paper concludes by commenting on the significance of the Thai state's role in the national development project and the globalisation project.