When Community is Life
Life in Chiang Saen, Thailand is pleasant and quiet. This Mekong district of about 55,000 people faces Laos PDR, directly across the river. Myanmar is just a few kilometres away at the Golden Triangle. The town is surrounded by fertile farmland where people grow fruit, vegetables, tobacco and teak.
Khun Rungnapa Boonklueab, also called "Noy" grew up in Chiang Saen - then an even quieter town with dirt roads and not much electricity. Her parents had little education, the norm at the time. Hers, she says, is a generation that was "pushed to learn."
"I always wanted to help people," says Noy. "Becoming a nurse was my dream job." And so she studied, and applied for loans and scholarships. She succeeded. When she graduated 15 years ago she began work at the local Chiang Saen hospital as an HIV care nurse. She was the only one at the time, but as the HIV response grew, so did the HIV team.
Khun Rungnapa Boonklueab, also known as "Noy," on the banks of the Mekong in her hometown of Chiang Saen. Laos PDR is right across the river.
Every week on Tuesdays, Noy helps run an HIV clinic. More than 900 people are registered.
More than 900 people come to the Chiang Saen District Hospital "open" clinic for HIV testing and care. There is also a "closed" clinic, for those who want to maintain confidentiality.
With the Director's permission, Noy invited me to the open clinic, and the staff explained my presence to people visiting. They agreed I could take photos and speak with them.
At the clinic, people living with HIV have their health monitored regularly, and they receive free supplies of antiretroviral therapy, a lifesaving combination of medicines that controls HIV. Given Chiang Saen's location on Laos PDR and Myanmar's borders, people from those countries can also come for testing. Several volunteer members of the HIV health team are also living with HIV - offering peer support.
Khun Orn is an HIV peer counsellor, who helps conduct the health checks at the clinic.
The fact so many people were at this open clinic astounded me, given the discrimination people living with HIV can still face. Noy told me this was because of the hospital's community support model, including HIV peer workers. "There's much better education now," Noy says, "people know how HIV is transmitted." I was glad to hear it. I was also really glad to meet and speak with Khun Vinol, a 56-year-old woman, about her life.
Khun Vinol has been coming to the HIV clinic for 10 years.
Khun Vinol is from Myanmar. She grew up very poor on a farm, and didn't have the chance to go to school. She can't read or write. She came to Thailand about twenty years ago in search of work. She got a job near Chiang Saen at a tobacco factory where she met her husband. Together, they had one daughter. About ten years ago her husband became very ill and extremely thin. He died of AIDS-related illness soon after. "He didn't want to go for treatment," says Khun Vinol. (Noy says that she's seen more men die of AIDS, because they're less likely to go to the doctor for care.) As her husband was dying, Khun Vinol also became very ill. I was shocked to hear she once weighed just 12 kilos (26 pounds). She was on the precipice.
“While my husband was dying, I also became very ill. I lost all of my hair. I lost so much weight, I was just 12 kilos. I was admitted to hospital. ”
Khun Vinol stayed in hospital for several months. She began antiretroviral therapy, gained weight and regained her health. "Today, I feel good and strong," she says. She now lives at home with a niece who is finishing high school. She tends a vegetable farm on her own, where she grows corn, lettuce and cabbage and sells them to market. Her daughter helps her to read about her medication, and she's motivated to take it daily. She comes regularly to the open clinic at the hospital to monitor her health, ask questions and renew her prescription.
She meets with Noy each time, and after ten years, they share a real bond. "I'm so proud of her," says Noy. "It makes me so happy to see her stay healthy. To me, Khun Vinol is like family."
I've read a lot about the Lazarus-like power of antiretroviral medicine. Khun Vinol was the first person I'd met and talked with about it. It was incredibly moving to hear her story. The thought of her - a grown woman - at just 12 kilos is devastating, isn't it? But the combination of her inner strength and the medicine that has her living and thriving today is equally motivating. As is the community that surrounds her, offering their support.
Noy with the HIV team, including the HIV peer volunteers at Chiang Saen District Hospital.
