Author’s Note: In 1993, during the peak years of the HIV/AIDS epidemic in Thailand, I planned and conducted an independent investigation on child abandonment and HIV/AIDS in northern Thailand, as part of my doctoral program at School of Public Health, University of Hawaii at Manoa, with support from the East-West Center research institute in Honolulu, USA, UNICEF Thailand, and Mahidol University School of Public Health in Bangkok.

The fieldwork incorporated epidemiological and anthropological methods as well as participatory urban and rural appraisal techniques over a nine-month period. I applied computerized data analysis to assess the nature and magnitude of problems within a context of rapid social and economic change, and proposed options for prevention and community based management of abandoned children. The findings were published in a major collaborative study to assist national and regional planning and policy development.

Chiang Mai

Across from Central Shopping Complex, my apartment in Chiang Mai, Thailand’s second largest city, was new and comfortable. The rent was cheap, the building was clean and a public pool was just a short walk away – through choking, dust-filled, traffic snarls.

It also happened to be home to a host of local ‘kept’ women – the ‘minor wives’ (mia noi) of wealthy Thais, their Mercedes and BMWs regularly arriving to pick up and drop off these beautiful women, in some instances with small children – comprising ‘second families.’

My other hangout was a health station on the outskirts of the city where I was hosted by a community health nurse and her son in a peaceful, rural setting, but within a short pickup truck ride to the city. As with many of the peri-urban districts near Chiang Mai, ours had been hit hard with HIV/AIDS and was therefore one of my primary data collection sites.

Almost daily, and for months, local funeral processions made their way to the crematorium directly across the road from our health station. The men were dying from AIDS, and tragically, it would only a matter of time before their wives and girlfriends would follow.

In one neighboring sub-district, fully 30% of pregnant women had tested positive for HIV. These women, as so many others like them, had been infected with HIV by their only sex partner – their husband. Widespread unprotected sex in the many commercial sex venues frequented by single and married Thai men, was the principle driver of the epidemic.

In many cases, the husband was already dead – the child as well, and many of these young housewives would be left utterly alone – rejected by neighbors, friends and family, and unable or unwilling to safely confide in anyone except the local health worker or counselor due to the widespread fear and stigma towards people infected with HIV.

Others, particularly the poor who worked in the widespread commercial sex industry would eventually die as well. Having lifted their families out of poverty – a nice house, perhaps a new pickup truck parked out front – but the daughter (or son) was dead.

It was devastating, and I was forever humbled by the tireless dedication of the many fine individuals in the medical, social welfare and counseling professions – including Yao, the most junior of the eight community health nurses assigned to her health station. She was often the only one who would provide home care for people living with HIV and AIDS, and eventually was the only one who would close the eyes of the deceased.

She also quietly supplied the local ‘gay’ temples with condoms, and tried unsuccessfully to convince the local Abbot – a respected figure and HIV-positive – to ‘come out’ to promote better prevention. Buddhist temples have traditionally taken in young boys as novices, often from poor families wanting a better future for the child, including free education, shelter and financial support.  But without proper oversight, sexual abuse has become a reality, both among the older and younger novices as well as between monks and novices.

However, as the epidemic progressed, many Buddhist temples also became important refuges for the HIV-positive homeless – who had been rejected by their families, and hospices for end-of-life care for people living with HIV and AIDS.

Land of Smiles

Back at the apartment in town, my neighbor Bill was seated in the downstairs lounge reading a paperback, his hulking mass squeezed into a lounge chair – waiting, as always for his phone to ring with the next job.

A former coal miner from somewhere in northern England, he now made a living running contraband between various Asian ports. His large, scarred head was covered with sparse patches of brown stubble. He looked up and flashed a cheerful grin through broken teeth.

“Off somewhere?” he asked.

“Headed to the beach for a few days – need a break from this madhouse, dust-ball of a town.” I replied.

“Good idea! I just got back from Japan – I’m set for money now.  But while I was gone, me woman and two of her friends hocked the TV and stole me clothes, me money…  Bloody headache the damned bitch.”

“Why do you put up with her?” I asked.

“Aw, she’s not a bad girl really. A hell of a lot better than the last one – at least here the girls treat a bloke with some decency.  Back in London if I say hi to a girl on the street she’ll tell me to fuck off.”

Orange Crush

My field research in Thailand was winding down, so Yao and I boarded an overnight ‘VIP’ bus in Chiang Mai and headed south to Bangkok, and then to the beach. Out on the open road, the bus charged into the darkness of the night.

The air conditioner was turned too high and the video at the front of the bus was playing so loud it hurt.  When I went forward to ask the driver to turn down the volume, a collective sigh of relief followed among the mostly Thai passengers, as if to say “thank goodness that foreigner made the awkward request.” Thais typically avoid confrontation at all cost.

I tried to catch some sleep in the swerving bus as it hurtled through the night, but the headlights of on-coming traffic flashing by seemed much to close for comfort. Vivid scenes of wrecked buses along the roadside – sheered lengthwise – came to mind. Horrible road accidents were common on Thailand’s two lane highways, and the local orange-colored buses were jokingly known as “orange crush.”

Indeed, it was prudent to sit in the middle so as not to be crunched in the front or the rear, and on the opposite side to the on-coming traffic. I was seated in the middle, but on the wrong side and couldn’t sleep for fear of waking up with an oncoming bus in my face.

Pulling into Bangkok’s early morning traffic, the day was already heating up into a stifling haze. The city groaned with the sound of vehicles – a gray urban skyline stretched out before us and disappeared into the haze. Then, crammed into a ‘backpacker special’ minibus for another overnight near-death experience at the hands of a reckless driver – miraculously, we arrived safely in the southern town of Surat Thani.

Stretched out on the smooth salt- and weather-worn deck of a converted fishing boat,  we headed to the islands of Samui, Pha-Ngan, and finally to Tao Island (Koh Tao) and soaked up three lovely days of pleasant, breezy walks through coconut groves and jungle-clad mountains, snorkeling in the clear, silky waters decorated with soft and hard corals, brightly colored fish, giant manta rays, diving on a wreck, and enjoying plenty of fresh seafood. It was wonderfully refreshing to finally unwind a bit, and to get rested and healthy again.

Stay tuned for more stories, coming soon!

You can read more about Jim’s backstory,  here and here.

Author’s Note: In 1992, the East-West Center, a federally funded research institution located on the University of Hawai’i campus at Manoa in Honolulu, Hawai’i, USA awarded me with an academic scholarship for four years of graduate study and field research towards the degree of Doctor of Public Health.

I had also been recruited for a summer research project with the Thai Red Cross Society in Bangkok – interviewing street children, residents of crowded communities (a.k.a. ‘slums’) and social workers to assess the current and future impact of HIV/AIDS on children in Thailand – which also helped to refine the focus of my doctoral research project.

Klong Toey Slum, Bangkok

I met Lee at a public swimming pool near my apartment in Bangkok and she graciously offered to assist me with my summer research project. Her excellent English, keen interest in HIV/AIDS and wonderfully supportive and cheerful companionship were a real boost.

Riding hot crowded buses to and from work, roaring through the capital city’s choking air pollution and notorious traffic, our days were spent conducting interviews in the stifling hot and crowded urban slums. Built on a swamp, Bangkok’s largest slum “Klong Toey” is home to over 100,000 residents, crammed into roughly one square kilometer of sludge, rubbish and sewage. Many of the tin-roofed houses are on stilts over stagnant, polluted water, and the area is prone to flooding particularly during the monsoon season.

Seated cross-legged on the floor, there was an easy-going village feeling even in those cramped urban quarters as most of the residents were poor rural migrants who had come to the city to find work. The latest fad among the youth was glue sniffing and many we came across were lost in a glue-fume stupor.

Balancing on rotting boards above the stinking swampland, we made our way along the narrow, broken walkways.

Then one day when we arrived, a crowd had gathered to receive soap and rice from a local relief agency. Twenty percent of the slum had burned to the ground the previous night – two hundred eighty families suddenly homeless – with no food or money, everything lost. 

A young sex worker we interviewed echoed the sentiments of many of the slum residents: “Of course, AIDS can kill you in a few years, but I have to feed my family today.”

A late afternoon downpour jammed the traffic to a standstill. Walking was going to be faster than to creep along in a sweltering traffic snarl, so we hopped off the bus and ducked out of the rain and into a food stall for some soup to wait out the storm.

At home, a cold beer washed down the urban residue. Sharing some late season sweet mangoes, sticky rice and coconut cream, Lee rescued me from my self-destruction and despair and helped translate our taped interviews with social workers, sex workers and drug users. 

Yes, all of this and Willie Nelson (“Blue Skies”) on the radio helped put a guy in a jolly mood.  It was really getting better, as long as I didn’t go insane!  A final trip to the beach left us tanned and refreshed. And at last, a focused dissertation topic on a meaningful and pressing issue was materializing. 

Abandoned Children and HIV/AIDS

With the course work finally done and my ABD (All-But-Dissertation) certificate in hand, I departed Hawai’i in July 1993 to begin nine months of independent field research in northern Thailand to examine the factors underlying the recent escalation of abandoned newborn infants in the northern city of Chiang Mai, with particular attention to the rapid spread of HIV which was devastating the northern part of the country.

Using participatory urban and rural appraisal techniques to assess the magnitude and nature of the problems, and within the context of rapid social change, the research aimed to inform effective policy and planning to address the underlying conditions within which child abandonment was occurring – including options for prevention and community-based management of abandoned children.

The precise number of children abandoned in Thailand at that time was not known, although estimates based on institutional data suggested that more than 2,000 children were abandoned each year in 17 northern provinces – some of the poorest parts of the country.

But this was likely just the tip of the iceberg, as survey research had also found increasing trends of child abandonment by their mothers in hospitals shortly after delivery, as well as children born elsewhere and later deserted at hospitals. At that time, just one quarter of those in need had access to child welfare services.

When I began my research, there was one orphanage in Chiang Mai, Thailand’s second largest city. But within a year, the number of orphanages had grown to six to manage the growing number of abandoned children.

As young people were increasingly moving to towns from their home villages for work or school, the risk for unintended pregnancies increased dramatically among the unmarried young, often poor women who were then being left alone by their partners when becoming pregnant.

So, it was in desperation that these women – typically poor, alone and too ashamed to return to their village as a single parent – would present for an emergency delivery and then escape, leaving the baby on the table. Far from being a malicious act, her rationale was that the clean, modern ‘baby home’ or hospital would surely be able to provide a better future for her child than she could.

Orphanages or ‘Baby Homes’ typically cared for orphaned boys and girls up to age five. But by age six, the orphaned girls would all have been adopted, leaving only the boys in what are known as ‘Boys Homes’ until they are old enough to legally go to work.

Interestingly, baby girls were more highly coveted than boys by Thai adoptive parents — typically older, their own children grown and gone. A girl was considered less trouble than raising a boy, and also more likely to stay home to take care of the parents in their old age.

Stay tuned for Part Two, coming soon!

You can read more about Jim’s backstory,  here and here.