Thailand has the seventh-largest diabetic population in the Western Pacific and the prevalence in adults is up to 9.9% in 2020. Type 2 Diabetes is on the rise in Thailand in major part due to increased urbanization, industrialization, and overconsumption of processed foods and it is now a leading cause of death in the country. People with this condition are unable to properly regulate their insulin levels and have a higher risk for additional health issues such as heart and kidney disease and hypertension. This chronic illness continues to be a major global health concern and the management of this disease is long-term and places a heavy burden on the global healthcare system. In 2009, Thailand kickstarted a national screening campaign for both T2DM and hypertension in an effort to improve access to preventative care and this has majorly increased awareness of diagnosis among the patient population (WHO, 2014).

I participated in a public health field practicum at Khon Kaen University in Khon Kaen, Thailand through CIEE with two other study abroad students in the fall semester of 2019. The School of Public Health at Khon Kaen University partners with local villages that invite international students to work with community leaders to address issues they are facing. At the university, my research group and I learned about the Thai public health system in addition to health issues the country faces on a national scale. We were also taught about quantitative and qualitative data collection and analysis methods that would be useful in implementing a successful health intervention. Our research group traveled outside the city of Khon Kaen and we used a combination of translated surveys and questionnaires alongside the help of translators to conduct interviews and focus groups to gauge the specific health concerns of a particular village. We visited this same village every weekend over the course of the semester to gather our data and work on our intervention. Initially, we did not know exactly which issue our intervention would be addressing, but with the guidance of the staff and faculty at the university, we were able to take lessons from the classroom to better understand the health concerns of the village we were visiting.

Through our work, we were able to determine three major concerns within the village: high rates of alcoholism, limited access to clean drinking water, and high rates of type 2 diabetes especially among the elderly. We then held a community forum in which we asked the attending villagers to vote for the issue they felt was most feasible to address. They voted that we focus our intervention efforts on the high T2DM rates. We analyzed the efficacy and nuances of health interventions related to this particular issue in a localized Thai context and we used our findings to hold a secondary forum with the leaders from the village. At this forum, we proposed various interventions that have been used to combat diabetes. The community voted for a combination of different interventions we proposed that they felt would contribute most to addressing the problem. Our research group was given a budget by the university to implement our interventions and we then used the feedback we got from our second forum to create an intervention day that culminated our work in the village at the end of the semester. On this intervention day, we invited a local healthcare worker to speak to villagers about diabetes prevention and management, facilitated an exercise and stretching workshop that was adjusted to those with limited mobility, and distributed home-made exercise equipment and seeds for home gardens (plants specifically requested by villagers) as access to fresh produce was an issue that was mentioned often.

One of the larger goals of our project was to gain experience with community engagement in public health interventions and through this experience, I understand firsthand how this type of collaborative work is vital to the continued success of such interventions. I learned that health interventions are not without flaws (there is always room for improvement and/or error at every step); in the field, you will not be prepared for everything, but you must be ready to work with what you are given. I also learned that working in an unfamiliar context (especially with language barriers) makes the need for cultural competence and empathy that much more important. There is only so much you can do as someone working in the healthcare field, and it is vital to know the scope of you and your team’s ability to make a difference in a given situation and it is just as important to know when your influence is limited. A lesson I learned with this particular project in relation to the increasing rates of diabetes is that a healthcare system is only as good as its capacity to educate the larger patient population. We already knew through our courses that the Thai healthcare system is at a resource and staff deficit, but in addition to this, many of the patients we interviewed had not been educated on the particulars of their condition or the medication they took to manage it. As someone who wants to work in healthcare, in addition to understanding a patient’s affliction myself, I would like to help provide any knowledge they need in order to contribute to their health and well-being. This type of work requires participation from people at all levels of the healthcare system. Because of this project, I know that regardless of where I end up in the field, I want to continue to work collaboratively with the patient population.