Lost in translation: migrant patients face language gap

crossing purposes: The pier at Pak Nam on the Thai-Myanmar border in Ranong is always busy with Myanmar passengers crossing back and forth. PHOTOS: PARITTA WANGKIAT

Standing at the seaside pier in Ranong province, the noise of engines never really cuts out.

From here, longtail boats carry passengers across the glittering Andaman Sea. Informal transport lanes see a steady flow of traffic throughout the day. In the distance, one can spot the silhouette of Kawthoung, the neighbouring town at the southernmost tip of Myanmar, looming over the salt water.

On an average day, more than a thousand Myanmar migrants cross the border on these boats, headed to Thailand for a variety of purposes, from work to shopping to medical checkups.

Every year, some 287,000 Myanmar migrants pass through Thai immigration using their border pass at one of 21 access points along the 169km length of Ranong‘s shared border.

More than 94,400 documented migrants, mainly from Myanmar, live in Ranong province, alongside 188,311 Thais. The precise number of undocumented migrants is unknown. Only 60 doctors have been recorded as available to treat the whole province‘s population.

Though burdened with a lack of resources, state-run hospitals and clinics play a key role in tending to the diverse population‘s health and wellbeing.

But equal access to healthcare has been recently threatened under the military government‘s new migrant worker law. Critics have called out the measures for “undermining human rights”.

The state-run Mittrapap Health Centre in Ranong, located in a low-income housing area, offers primary care services. The centre, regularly crowded with Myanmar patients, is feeling the harsh effects of the new law.

Some Thai medical personnel and two interpreters from Myanmar work together to provide healthcare to the 14,570 migrants based in the area.

The role of interpreters in health services is an important one, helping bridge a language gap. But since a controversial migrant worker law came into effect in June, the two interpreters have been forced to quit.

The law imposes harsh penalties, from imprisonment to steep fees, for undocumented migrants, as well as their employers for hiring unregistered workers or using registered ones for jobs that do not conform to the role described in the Department of Employment records.

Interpreter is listed as a job from which migrants are restricted from doing.

Prior to the new law, hospital operators frequently hired migrant interpreters under the vaguer title of “language coordinator”, while nonetheless carrying on doing interpreter work.

The law now puts both interpreters and hospital operators at risk.

“Now we‘re experiencing difficulties in communicating with migrant patients,” says Kanokwan Kumpetch, director for the Mittrapap Health Centre. “We can‘t diagnose them properly. We have to reject patients, even though we don‘t want to.”

In the absence of interpreters, the medical staff at the centre now urges patients to come accompanied with fellow Myanmar friends or family that can speak Thai. But some do not have the option.

The centre has thus seen a declining number of migrant patient visits, from an average of 20 to six visits per day since June.

Ms Kanokwan mainly works in promoting health and disease control, as well as designing prevention programmes. These jobs demand strong communication between Thai medical staff and migrant patients.

Interpreters are needed for a range of tasks, from encouraging pregnant women to attend the pre-natal clinic and have newborns vaccinated, to spreading awareness to stop disease.

“I‘m afraid that when an epidemic occurs — how can we stop it?” asks Ms Kanokwan.


In May 2014, one month after the military coup, the US Department of State‘s Trafficking in Persons (TIP) Watch List downgraded Thailand to a Tier 3 country, the lowest rank possible, for its failure to prevent human trafficking.

The release of the TIP ranking was shortly followed by the international media‘s exposure of ongoing slavery in Thailand, particularly in the fishery industry. In these cases, many of the migrants were smuggled into the country and subjected to harsh working conditions. In addition to being denied payment, they were physically abused by slave owners.

Around the same time, the European Union issued a yellow card warning Thailand to take action against reportedly rampant illegal, unreported and unregulated fishing practices.

Though for the past two years, the TIP Watch List upgraded Thailand to a Tier 2 ranking, the country is still at risk as the United States threatens to place a ban on Thai export products.

Facing international pressure, the Thai government has put human trafficking high on its national agenda. They have called the latest law an important step in halting the exploitation of migrant workers.

The law dictates a maximum of five years of imprisonment, and fines between 2,000 and 100,000 baht for undocumented migrants. Employers who hire undocumented migrants face fines of between 400,000 to 800,000 baht per illegal worker they hire.

Registered workers can still face a penalty if they are in a job different from the one described in official records, with a fine of 100,000 baht. Their employers would be dealt a 100,000-baht fee.

These penalties drove over 60,000 migrants out of Thailand in the first week of the law‘s implementation in June — some on their own accord, and some who were dismissed by nervous employers.

The law was criticised for the severity of the punishments and its disregard of human rights, as well as the lack of prior engagement with stakeholders in the business sector about the policy‘s implications.

Small- and medium-private sector businesses have called the law impractical as the Thai economy relies heavily on migrant workers, with numbers of them estimated to exceed one million in the country.

Some critics say the law unambiguously limits migrants‘ capacity to mobilise for a better life.

Responding to the panicked reaction to the law among migrant workers and employers alike, the government declared a six-month indulgence period for some legal articles and placed them in the amendment process.

They further granted an indulgence period for migrants to process legal documents until January next year.

Migrant workers are required to go to a One Stop Service (OSS) office, which are spread across the country. The OSS assists in processing work permits and other identity documents, as well as providing medical checkups. This lets the government systematically record the number of migrant workers and their home base in Thailand, measures described as helping bring migrants “from underground into the light”.

Migrants are required to register with their employers. Many of them are forced to pay high fees to brokers for the registration process.

The OSS has replaced hospital operators‘ roles in selling health insurance to migrant workers.

In 2013, the Public Health Ministry launched the migrant healthcare insurance scheme, promoted as a policy with a humanitarian approach. The scheme encouraged migrant workers to purchase affordable insurance from hospital operators, regardless of their legal status.

The public health minister of the time Pradit Sintavanarong said the scheme was financially feasible. The majority of migrants who are of working age sign up for insurance; thus, helping cover costs for the smaller numbers of ailing elderly migrants who might be less capable of affording insurance.

This would let hospital operators put aside funds for migrant patients who are not covered by any sort of social welfare.

Since the OSS was established in 2014, health insurance must be purchased through its registration procedure, which only grants access to migrants who are already registered.

Previously, those registered under the Social Security Scheme could access healthcare services easily as it requires registration with the employer who willingly co-pay.

After the OSS replaced the role of hospital operators, migrants who do not register with the OSS will not be able to purchase insurance themselves, without assistance from employers.

Employers aren‘t in the habit of taking their employees due to the steep registration costs.

Undocumented migrants can no longer walk in to hospitals to purchase insurance as before.

Under these conditions, hospitals along the Thai border are under more financial pressure to treat incoming migrants who have no healthcare scheme coverage.

The cost of humanitarian healthcare — migrants who are unable to pay for the services in the outpatient department provided by state-own hospitals in Ranong alone increased from 231,000 baht in 2014 to 275,900 baht last year.

The inpatient numbers rose from 2.4 million to 4.7 million in the same time period.

“Our strategy is clear,” says Pornpen Prathanwattana, deputy director for Ranong Provincial Health Office. “We provide healthcare service to migrants in similarity to Thais.”

“We, as locals, live here without the feeling of seeing migrants as strangers. Without them, it would be much more strange.”


Tightened security in border towns after the 2014 coup has further debilitated the ability of medical staff to deliver healthcare.

When the leading coup body, the National Council for Peace and Order, issued an order to target “influential people” who undermine social stability across the country, migrant communities begun receiving regular visits from security officers.

Fear of government officials accumulated over time. When medical personnel made visits to migrant communities alongside security officials, migrants would refuse to engage with them. At some point, the medical personnel would simply stop going to these communities.

Healthcare officials have thus failed in several attempts to collect valuable information about migrants, and plan health and prevention programmes accordingly for them.

One medical team member told Spectrum that soldiers visited his hospital in Ranong and requested maps for migrant communities made my staff for allocating health services.

Another medical personnel member said that some security officers visited his workplace to request information about migrant communities after the coup. They questioned the migrant interpreters, reportedly accusing them of serving as spies for migrant gangs.

“Hospital operators obtained lot of information about migrants then, including their population [numbers] and location,” he says. “But [what we do] is for the purpose of healthcare services. We shouldn‘t be dragged into any security operations.”

Xenophobia is on the rise. On social media, debates about migrants‘ place in Thai society are often met with questions like “Why should government spend for migrants as Thais still have a lot of problems?” or “Shouldn‘t our tax should go to [Thais‘] wellbeing?”

But these questions do not concern Sompong Chainarong, director of the Pak Klong Health Centre in Ranong.

In 2007, a cholera outbreak hit a migrant community in the province, shortly after he had started his post there. With no interpreters on hand to speak for the migrants, he said it proved challenging to contain the disease.

The Pak Klong Health Centre takes care of over 5,300 migrants and 3,000 Thais. About 90% of the patients are migrant workers. In the average busy day, over 60 cases of pregnant mothers migrants would report to the clinic.

in sickness and in health: Local and Myanmar patients wait to see medical staff at the outpatient department of Mittrapap Health Centre, Ranong.

taking a break: Boatmen rest in a canal at Ban Pak Nam, Ranong, which faces the Thai-Myanmar border divided by the Andaman Sea.

diverse origins: A mixed population including ethnic Chinese, Thais and Myanmar live in he Pak Nam area of Ranong.

in safe hands: A daughter of a Myanmar migrant receives vaccine at Pak Klong Health Centre. PHOTOS: PARITTA WANGKIAT

home from home: Myanmar mothers and their children wait for free vacces at Pak Klong Health Centre. Some 90% of patients are Myanmar migrants.

healthy start: A medical staff, right, at Pak Klong Health Centre drops polio vaccine in the mouth of a daughter of a Myanmar migrant. The centre provides free vaccines to all children.

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