I have had the privilege of traveling to Thailand to visit and serve with friends who are current missionaries in the Isaan (Northern) region. Before our travels, I spent a lot of time researching the cultural practices of the Thai people in order to express appropriate care to those around me. I had not considered these cultural practices in relation to their influence upon health, until this assignment! I am grateful for the opportunity to apply my knowledge, albeit limited, to the topic of health.
Cultural Values that Directly Impact Health
1. Family is highly valued. Those hoping to accumulate merit for a favorable rebirth, according to Buddhist teaching, care well for their elderly. It is important to "repay" one's parents and children, especially daughters, are obliged to care for their parents based on these Buddhist customs. Children and other family members often serve as informal caregivers and support their parents both socially and financially. An example of the respect for older persons in Thai culture is demonstrated by younger persons performing the “wai” gesture to older persons first. They will look in a person’s eyes and speak quietly to convey politeness and respect (Manasatchakun, 2018).
(Retrieved from https://sites.google.com/site/thaiandjapaneseculture/greeting)
2. "Kreengcaj". This significant cultural value is defined as "the awareness and anticipation of the feelings of others in order to avoid conflict and demonstrate kindness" (Pravikoff, 2015). This will often cause Thai's to pretend to agree with others because they seek to promote harmony. Smiling is very common, but it doesn't always accurately reflect ones personal feelings. This is an important value to consider when providing care to Thai people. They will need to be encouraged to tell the truth as it is, and not as they want you to hear.
Cultural Practices that Directly Impact Health
1. Toileting Practices:
(Retrieved from https://gogoguano.wordpress.com/2016/09/14/a-guide-to-cleaning-yourself-without-toilet-paper/)
Among the Thai people, there is an unspoken etiquette often referred to as the “left hand for cleaning, right hand for eating” rule. You want to use a jug to pour water where necessary, then use your left hand to wipe away any residue. Between each wipe, you must clean your hand again by pouring on some water. You can also use the water jug to thoroughly ‘flush’ your deposit down the toilet hole if needed (Guano, 2016). This toileting practice will inevitably cause sanitation issues, which can lead to disease.
2. Betel Nut:
The betel nut, a seed of the areca palm, is grown and used throughout Thailand. Chewing the betel nut- a mixture of areca nut, spices and lime wrapped in betel vine leaves - has been a cultural tradition for centuries. It is often used in religious rituals as well. In small doses, it creates a sense of euphoria and alertness. Longtime usage can create addiction and the World Health Organization classifies the betel nut as a carcinogen. Sadly, it is often used as a herbal remedy for anything from a toothache to acne (University of Florida, 2015).
3. Traditional Thai Medicine:
Traditional Thai medicine practices entail four branches: medicine, midwifery, orthopedic, and massage. The traditional doctor is said to have mastered all four disciplines. Doctors study under the instruction of an experienced doctor for many years, and through this apprenticeship becomes a physician. Herbal medicine manages issues related to the physical body. Thai massage and yoga focus the energy systems. Lastly, Thai spiritual healing works on the mind and heart. It is believed that the four elements manage specific body parts and bodily functions. For instance, the earth element governs 20 organs, water contains 12 fluid types. The air has 6 wind types, and the element fire holds 4 kinds of heat. This helps the traditional Thai medicine doctor to diagnose and provide treatment for each issue. A combination of herbal remedies, massage, nutritional guidance, acupressure/acupuncture, meditation and physical exercises will be prescribed (Benner, 2019). Needless to say, this system of medicine has little to no accountability or regulation.
In the picture above, practitioners of Thai traditional massage and medicine gather at a Wai Khru ceremony. This ceremony was hosted by the Federation of Traditional Medicine of Thailand to express gratitude and reverence to the teachers in the sanctified customs (Federation of Traditional Thai Medicine in Thailand, 2017).
4. Health Customs:
Thailand as a long history of being a drug and medicine consuming country. Illegal drugs are widely used and people medicate themselves with penicillin and steroids that they buy over the counter in drug stores. Villagers often prefer locally prepared remedies, treatments by local healers and traditional massage therapy to hospitals and doctors. Massage is regarded by villagers as an important form therapy. Illness has traditionally been blamed on spiritual possession, fear, problems, and an imbalance of elements on the body. In the Northeast rituals such as bai sir sukwan (“tying” the soul back into a an ill or disturbed person) is an important form of healing (Hays, 2014).
Gender Norms in Thailand
In Thailand, traditional gender roles are primary. For instance, men and boys do manual work while women and girls work are primarily responsible for the home and family. Although authority typically still rests with a senior male, families in rural areas are traditionally organized around the female members, and authority is passed down through the female line. Within the family structure, daughters are generally preferred over sons. Women receive an advantage in terms of property rights in northeastern Thailand, as each daughter inherits part of the family’s land, while sons inherit capital like buffaloes and cattle. After marriage, a wife must continue to support her parents and siblings until the rest of the children are married. "In many cases, women must leave the village and work in the city as low-paid domestic or factory workers in order to send money back home. Women are generally discouraged from asking for money from their family, while also carrying greater expectations to send money back home" (Lim, 2011).
A picture of "Kathoey"(Retrieved from https://maytermthailand.org/2015/04/27/the-third-gender-in-thailand-kathoey/)
It is also notable how Thailand has an extremely progressive and tolerant view toward homosexuality. It may be one of the most open societies in the world when it comes to transsexuality. Transsexuality is extremely common in Thailand, and in my travels, I would often see "Kathoey" (the Thai word for a transsexual male) working as waitresses, store clerks, travel agents, and in other service-oriented businesses. It is so common, that these "kathoey" or "Ladyboys" are considered the third gender in Thailand. It should come as no surprise, then, that Thailand is the world leader in gender-reassignment surgery. People travel from all over the world for these particular surgeries (Nam, 2020).
References
Benner. (2019). Traditional Thai medicine: Healing traditions in the Kingdom of Thailand. Four Directions Wellness. Retrieved from https://fourdirectionswellness.com/2018/12/11/traditional-thai-medicine-healing-traditions-in-the-kingdom-of-thailand/
Federation of Traditional Thai Medicine in Thailand. (2017). Nuad Thai, traditional Thai massage. Retrieved from https://ich.unesco.org/en/RL/nuad-thai-traditional-thai-massage-01384
Guano. (2016). Tips for using toilets while travelling. A guide to cleaning yourself without toilet paper. Retrieved from https://gogoguano.wordpress.com/2016/09/14/a-guide-to-cleaning-yourself-without-toilet-paper/
Hays. (2014). Health and Healthcare in Thailand. Facts and Details. Retrieved from http://factsanddetails.com/southeast-asia/Thailand/sub5_8g/entry-3299.html
Lim. (2011). Women of northeast Thailand: Privilege and obligation. Berkley University. Retrieved from https://berkleycenter.georgetown.edu/posts/women-of-northeast-thailand-privilege-and-obligation
Manasatchakun. (2018). Conceptions of healthy aging held by relatives of older persons in Isan-Thai culture: A phenomenographic study. Science Daily. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5821976/
Nam. (2020). Gender roles in Thailand. The Hatchet Book Group. Retrieved from. https://www.hachettebookgroup.com/travel/planning/gender-roles-thailand/
Pravikoff. (2015). Thai patients: Providing culturally competent care during labor and delivery. Nursing Practice and Skill. Retrieved from https://www.ebscohost.com/promoMaterials/Cultural_Competency.pdf
Suriyasarn. (2014). Promoting rights, diversity and equality in the World of Work (PRIDE) Project. International Labor Organization. Retrieved from https://www.ilo.org/wcmsp5/groups/public/---asia/---ro-bangkok/---sro-bangkok/documents/publication/wcms_356950.pdf
University of Florida. (2015). Researcher finds key clues about 'betel nut' addiction that plagues millions worldwide. Science Daily. Retrieved from https://www.sciencedaily.com/releases/2015/10/151021161034.htm