Sisters of Isan displays Isan (the northeastern part of Thailand)’s value and their construction at the beginning of the 20th century together with Thailand as a modern state. The book has recorded the stories of two sisters growing up and working from the countryside to Bangkok. At the same time, the book shows the perspectives of Isan people through their belief, lifestyle, culture, social norm, value and fate. This book covers the changes by over 50 years of Isan workers and Thailand. Hence, beyond two sisters who had shifted from rural to urban landscape, the stories inside reflect how Thai society has come. The struggle is not something Isan people choose, whereas, reading this book may imply the answer. Sisters of Isan is not just a book. This infers lives… the Isan’s lives.
As daily deaths reach 300, Thailand’s government has continued the struggle to curb the spread of the Covid-19 virus. It has been unclear with messaging and accused of using Covid restrictions to silence critics. What’s made matters worse is instances where those testing positive suffer stigmatization. Mark S. Cogan looks at the social costs of stigmatization and how the government could do better to limit it.
By Mark S. Cogan
Recently, a young woman from Baan Kam village in Buriram province contracted COVID-19 after working in Samut Sakhon province. After seeking treatment at Satuek Hospital in her hometown, her doctor gave her permission to return home, with orders to self-quarantine for 14 days while obeying public health guidelines.
The local news report noted that she quarantined alone, isolated herself from everyone around her, and stayed inside her home by herself. With her self-quarantine just days from ending, villagers and village health volunteers, around 20 in total, stood in front of her home on August 13, pressuring her to quarantine herself at the Village Hall, which had been prepared to receive COVID-19 patients. The young woman insisted that she remain at home, first because she was following doctor’s orders, and second the doctor explained that she was no longer capable of spreading the virus.
When the local reporter arrived to meet her, a rope was found tied around her house with a sign that read, “Keep distance from the patient (treatment received)”.
This case from Buriram is emblematic of a larger problem both in Thailand and in many parts of the world. While the villagers were concerned for the young woman’s welfare, they were more concerned with their own well-being. Even though the hospital sent a representative to explain the situation to villagers, they were unwilling to change their position. The intractability of the villagers is most likely caused by pervasive social stigma, which has run rampant during the pandemic.
According to the World Health Organization (WHO), social stigma is a negative association between a person or group of people who share certain characteristics and a specific disease. As was the case during the 1980s and 1990s in many countries around the world during the HIV/AIDS crisis, people are often labelled, stereotyped, discriminated against, treated separately, and experience loss of status because of their perceived link with the disease. Social stigma negatively impacts those with COVID-19, as well as those who care for them, including family, friends, and natural helping networks.
The WHO recently reported that community cases in Thailand have increased to three times what they were only a month ago. While more than 22 percent of cases come from Bangkok, several other provinces have confirmed the majority of COVID cases, including Samut Sakhon, Samut Prakan, Chonburi, Ubon Ratchathani, and Buriram.
A similar case was reported in Phrae, after a 25-year old man and his wife traveled from Pathum Thani province after being infected with COVID-19. When they planned to stay at a house owned by relatives, villagers posted a sign outside the home, reading “Please change to a new place of quarantine. Neighbors are concerned that there might be a problem. Please consider it.” The village headman believes that the government should provide places for people recovering from COVID-19.
Harrowing stories of Thai people experiencing great distress and turbulence have been widely reported across the country. A condo manager in Nonthaburi locked a family into their residence with wooden planks after they contracted COVID-19 in July. A husband was fired from his job at a construction site in Pathum Thani because his wife became infected with COVID-19 and were asked to leave, which left them destitute and with just 80 baht to their name.
Social stigma associated with COVID-19 is the major culprit in these cases, evidenced further by the husband of a 24-year-old woman who was physically attacked and kicked out of her house after she became infected with the virus. It has become one of the reasons why people are both hesitant to get tested for the virus, and it in many countries is part of the reason why the pandemic is stubbornly persistent. Stigmatization undermines COVID-19 response efforts, and costs local agencies valuable time in controlling a pandemic that has infected nearly one million Thais.
The WHO has attempted to combat the stigma associated with COVID-19 by assigning Greek letters to COVID-19 variants, as opposed to naming them based on their country of origin. In countries with large rural areas, stigma can be the difference between life and death, as some people are reluctant to receive medical care for fear of burdening their families or fear of being victimized. For example, in Myanmar, stigma drives a wedge between families and volunteers driving ambulances or burying the country’s dead.
Recently, Dr. Suwachai Yingcharoenchai, Director-General of the Department of Health attempted to give further context to Thailand’s COVID crisis. Suwachai said that while there are large numbers of people being infected everyday, the number of people receiving treatment has also increased. The Department of Health noted that doctors allow the patients receiving treatment to quarantine at home for 14 days after the date of infection. Suwachai also urged community members to be sympathetic and not disgusted by those who are recovered and stand ready to support those who choose to return home to quarantine by supplying food and other medical necessities.
At the same time, Thai people are hard pressed to stay safe from the pandemic if the Thai authorities fail to provide clear guidance on the pandemic, evidenced by communications breakdowns and allegations of so-called fake news. Government officials earlier this year delivered contradictory messages, regardless of the existence of the Centre for COVID-19 Situation Administration (CCSA). Thai Prime Minister Prayut Chan-ocha has also been criticized for his contradictory messages, at one time calling for a lockdown of five Thai provinces, then announcing just “strict controls.”
Social stigma is often associated with a lack of knowledge about how the coronavirus transmits, which leads to scapegoating, irrational fears about the disease or preoccupations about death, as well as random gossip that spreads rumors and myths. The Thai government has attempted to control what it deems to be “fake news” which it believes impacts its ability to control the pandemic, but many critics charge that the government’s efforts are merely authoritarian curbs in disguise, aimed at silencing dissent and punishing regime critics.
The reality is that no single person or group of people, as immigrants and migrant workers were scapegoated by Health Minister Anutin Charnvirakul, are more likely to spread the virus or put others at risk. During public health emergencies, fear and anxiety are formidable weapons that perpetuate social stigma, particularly against vulnerable groups and marginalized populations.
Only when community leaders, village health volunteers, and senior level authorities act on widely disseminated and accurate information that the impact of social stigma can be diminished. That means that both the Prime Minister, the Health Minister and the village head persons must know the facts and determine that they are shared with others. Social stigma is a major barrier in controlling the pandemic in Thailand. Only by acknowledging its existence will local efforts to control the pandemic be successful.
Mark S. Cogan is an Associate Professor of Peace and Conflict Studies at Kansai Gaidai University and a former communications specialist with the United Nations.