Lasting Communities

What can one dedicated doctor do to change a community?

Jan 26,2023

Dr. Ratana Monprajak has moved her office outside on a cool, refreshing morning in Bangkok. It’s Constitution Day, and schools and many businesses are closed. A mobile health clinic has been set up at the end of a tucked away soi. The area is buzzing. Kids laugh and ride bicycles on the adjacent volleyball court while parents and grandparents chat in a makeshift waiting area.

The community members are enjoying one another’s company as they wait for their queue to be called for a medical examination, breast and cervical cancer screening, and one-on-one consultation with Dr. Ratana. Before long, one man will start an impromptu massage station to pass the time, and later a group of health volunteers will lead an exercise demonstration.

For Dr. Ratana, the mobile clinic is a great opportunity to reach out to community members who may be reluctant to receive care in formal medical centers. By the end of the morning, Dr. Ratana and her team of nurses will have provided 64 free medical check-ups. That’s a lot in only a few hours.

But it’s not enough. As the Director of Public Health Center 42, she is responsible for the medical care of all residents of Bangkok’s Bang Khun Tien district, a total of 170,000 people across 53 separate communities. Dr. Ratana and her small team of nurses cannot possibly help everyone in Bang Khun Tien, despite their best efforts and the occasional mobile health clinic.

“There is only so much time in a day, which prevents us from reaching everyone in the community,” said Dr. Ratana.

Bang Khun Tien, like Thailand as a whole, is transforming into an aged society. This makes Dr. Ratana’s tall task all the more difficult, since aging coincides with a sharp rise in medical needs and incidences of non-communicable diseases (NCDs), such as diabetes, cancer, and Alzheimer’s.

Dr. Rattana 2

Because all people ought to have access to quality healthcare and given the need in Bang Khun Tien, Kenan Foundation Asia, and the Pfizer Thailand Foundation partnered with Dr. Ratana and Public Health Center 42 under the Pfizer Healthy Aging Society project to pilot a preventative, community-based healthcare model in Bang Khun Tien.

The project works by tapping into an underappreciated part of the healthcare system: community health volunteers. The volunteers have the unique ability to reach people, particularly at-risk individuals, in the community because these people are their friends, neighbors, and family members. Given their life-long ties to the community, the volunteers have built-in trust with community members, which enables the volunteers to enter their homes, monitor their health, and encourage them to seek additional medical treatment when needed.

“People in communities can help each other, like friends help friends, so the project has a higher chance to be successful,” Dr. Ratana explained.

Kenan’s community development team began building the capacity of health volunteers in 2017 on three key factors of healthy aging, namely physical (nutrition and exercise), mental, and financial wellness, to enable them to better support the increasing number of seniors (60+ years old) and pre-seniors (45-59 years old) in Bang Khun Tien. After completing the training, the project supplied the volunteers with grants to lead their own activities to promote healthy living in the community.

Dr Ratana 4

With the grant funding, the volunteers began conducting in-home health check-ups to bedridden seniors, created community exercise clubs, led meditation classes, and organized numerous other activities that promote wellness and preventative care. The volunteers, moreover, remain in regular communication with Dr. Ratana and can alert her when someone is in need of acute medical care. The volunteers in effect become bridges between the informal and formal medical sectors.

“The challenging part of my work is that the Public Health Center hasn’t maintained a close relationship with people in the community,” Dr. Ratana said. “[Because] Kenan invited us to join this project, we can reach communities better than ever before.”

In under three years, the project has already had a demonstrable effect on the lives of people in Bang Khun Tien. When asked about the project’s impact, Dr. Ratana quickly points to one woman who was able to get much-needed support for depression, another who was able to reduce her weight to healthy levels, and still another woman who was able to reduce her blood pressure as a result of project activities that educated her on proper nutrition and encouraged her to exercise.

“Getting trained by Kenan has been a great thing for everybody working in public health,” Dr. Ratana said. “It has enabled people in communities to achieve better health, especially related to nutrition, exercise, and emotional wellbeing.”

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Primary care physicians like Dr. Ratana form the frontline of any healthcare system. Their role takes on even greater importance in an aging society because they are responsible for preventing, screening for, and managing NCDs, and improving individuals’ quality of life. The Pfizer Healthy Aging Society project has extended Dr. Ratana’s reach and enabled her to better support the community members of Bang Khun Tien.

With a dedicated team of health volunteers by her side, and equipped with Kenan’s training and funding, Dr. Ratana has activated an entire neighborhood to care for each other. By building the capacity of community members to support the health of those they love with their own knowledge and time, amplified by the strength of their relationships, the people of Bang Khun Tien have extended the formal healthcare system to become more inclusive and able to provide holistic care for all members of the community.

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