Born in Kanchanaburi, a town in western Thailand, on August 5, 1931, PRAWASE WASI was the fourth of five children—four boys and a girl—of Klai Wasi and Kim Somprasong. His father cut bamboo in the forest for a living, binding it into rafts and floating it down the river to sell. He found it hard to support his family this way so when PRAWASE was five he moved the family to a village in the jungle where he opened a small grocery store.

PRAWASE was left with relatives to attend a Buddhist temple school in town. Although since that time the expanded system of public education in Thailand has reduced the importance of temple schools, PRAWASE was never to forget the vital role played by the monks in his home town.

PRAWASE's parents, though poor, valued education highly. His father had never been to school, yet he could read and write, for his own father had taken time at night—after a long day of farmwork—to teach his children. His mother had left school after only six months, but her son remembers her "as a very strong woman, very decisive, very determined . . . much stronger than myself in character, very stable," who was as keen on the children's education as her husband. All four boys continued beyond the usual primary school education, the two eldest becoming a lawyer and a captain in the army, and the youngest a pharmacist. The daughter, who was the oldest, stopped after primary instruction and went to work in the grocery store to help her parents pay for her brothers' education.

PRAWASE contracted malaria that year in Kanchanaburi, so his parents took him back to stay with them in the village where he attended the local primary school which opened the following year. The building was a simple thatched roof under which all four grades studied together in the same open space. During those years he helped with chores, and as he grew older, paddled the family boat up the swift river with stores.

When he completed the fourth grade at Tambom Kohsamrong in 1942 his parents sent him back to Kanchanaburi, where he lived with an older brother while attending the provincial secondary school.

PRAWASE worried about his father working too hard, and his family in turn worried that PRAWASE was not getting enough to eat. They sent him a small sum for treats each month, which he refused to spend. Years later, when he was studying for his Ph.D. in the United States, his parents wrote him, exhorting him to spend more money on food, lest he be too weak to study.

World War II increased in intensity while he was in secondary school, and American planes bombed the notorious "death railroad" that had been built by Allied prisoners of war under Japanese surveillance to carry Japanese troops and materiel from Bangkok through Kanchanaburi over the River Khwae to Burma. When the Kanchanaburi school was closed because of the bombings, PRAWASE went first to Rachaburi, and then to Nakhon Pathom to continue secondary school. While he was in Nakhon Pathom the war ended. He returned to Kanchanaburi, presumatly to finish his fourth year, but found that students were being allowed to choose which grade-level entrance examinations they wished to take. Instead of trying for the fourth year, he tried for the fifth—and passed. He graduated in 1947 at the top of his class.

Over the protestations of his grandmother, who, in Thai fashion, wanted to keep her family near her, PRAWASE’s mother took him to Bangkok to continue his studies. From his earliest days family, friends and neighbors had recognized his scholastic bent and had urged him to become a doctor—the greatest height, in their eyes, to which a boy might aspire. He applied therefore to Triam Udom, one of Bangkok's most prestigious preparatory schools. Although thousands of young people from all over the country sat for the entrance exams—many of whom had had special tutorials—PRAWASE, fresh from a disjointed provincial education, did so well on the examination that he was placed in the top class, the so-called King's Class. At the midyear examination he placed fourth or fifth in the school and by the end of the first year he was first.

When he took the examinations for Chulalongkom University's premedical course, students were asked routinely to list their priorities: if they failed the entrance exam for medicine, what course would they prefer? PRAWASE put down medicine, and only medicine. His excellent performance at Triam Udom warranted his newfound confidence. He remained at the top of his class at Chulalongkorn, and two years later he entered the Faculty of Medicine, Siriraj Hospital, University of Medical Sciences. The University of Medical Sciences is now known as Mahidol University and includes 14 faculties and institutes in addition to its two medical schools. Siriraj medical school, which PRAWASE entered in 1952, is both the oldest and most esteemed medical school in Thailand.

During his years at Siriraj, PRAWASE stopped living with friends and relatives and moved into a school. At night the students shifted the classroom benches together to make beds. Only in his fourth year was Siriraj able to provide its students with proper dormitories. Despite having to work his way through school, PRAWASE was awarded at graduation the gold medal for the highest academic achievement in his class.

He received his degree of doctor of medical sciences in 1955 and two years later went to the United States to study for his Ph.D. in hematology at the University of Colorado Medical Center in Denver. PRAWASE was supported the first year by a private fellowship from the king, and then by a grant from the Anandha Mahidol Foundation— named for the late king, the present king's older brother. The king's support of medical students reflects the interests of his father, H.RH. Prince Mahidol of Songkhla, who is known as the father of modern medicine in Thailand. PRAWASE received his doctorate in 1960 and, with money saved during his stay in Colorado, went to study for half a year at the Galton Laboratory of Human Genetics at the University of London.

In 1961 PRAWASE returned to Thailand to begin his long teaching career at Siriraj medical school. Eight years later, at the age of 38, he married one of his former students, the engaging Chantapong Prakobpol. Today Dr. Chantapong is a prominent virologist at Siriraj. They have a son, Aran, born in 1970, and a daughter, Nada, born in 1977. The family lives in a small house in the compound of Chantapong's family, sharing a maid and eating in the main house. On weekends they take turns caring for their small daughter and meeting their professional commitments; PRAWASE stays home on Sundays and his wife stays home on Saturdays.

When he returned to Bangkok to teach at Siriraj, which is a government medical facility, Dr. PRAWASE’s impact on the student and medical community was immediate and longlasting. Colleagues often remark that behind his unassuming neat appearance and warm humorous disposition lies a will of iron. One of them describes PRAWASE as "one of the most, if not the most, active teachers of that medical school and probably of all the medical schools in Thailand." In 1969 PRAWASE was selected by his students to be the first person to receive the H.E. Surendrathibodi Award as the school's most outstanding instructor. The award cited his "strong determination and dedication to his responsibility in the field of medical education." "Dedication to responsibility"

is the phrase that best captures the spirit of the award, for Chao Phraya Phra Sadej Surendrathibodi, whose heirs present this award, was the first teacher of ethics to medical students in Thailand. He was also the first and only person in Thai medical history who wrote textbooks on ethical codes for medical students.

A closer look at the criteria established for selecting an awardee reveals much about PRAWASE’s character. A good medical instructor, according to the formula, passes on to his students not only intellectual knowledge, but a sense of what is good and moral in life. He is not only a good scientist, knowing his subject well and working according to the laws of reason, but he sets a good example for his students. Finally, he must be a good doctor, imbued not only with medical knowledge, but with a humane and caring attitude toward his patients. He should be as much concerned with preventing their diseases as with curing them.

One of PRAWASE’s former students, Dr. Vichai Chokevivat, has attested to his professor's devotion to teaching. Other teachers, Vichai wrote, were more concerned with building up their private practices than in attending to their students. PRAWASE, on the other hand, refused to open a private clinic to supplement his income, devoting his time instead to giving his students personal attention and to working with other doctors to improve the curriculum and teaching methods. He and other professors coauthored textbooks and handbooks to help students. To encourage them to use the handbooks he provided in the classroom case studies corresponding to those in the books.

PRAWASE’s concern with his role as a teacher was manifested in other ways. Siriraj hospital has a regular Clinico-Pathological Conference to review post mortem decisions. For most doctors this conference is an occasion for uneasiness; if they had made some error, however small, they felt "loss of face." By contrast, PRAWASE considered the conferences a good challenge and an excellent teaching tool. He saw them as an ideal opportunity for students to see how a patient was treated and to learn from the detailed history what should be done.

PRAWASE has been no less impressive as a scholar than as a teacher, displaying a well-disciplined, clear mind. He has published over 100 articles on the medical sciences, and on hematology, a textbook (1968) and a handbook (1975). In 1965 a special building and research grant were established for the Hematology Division of Siriraj Hospital by His Majesty the King. Beginning in 1967 PRAWASE received an annual grant for research in thalassemia from the National Institutes of Health in the United States. He was invited in 1973 to be a member of the Panel of Experts on Abnormal Hemoglobins and Thalassemia (a kind of anemia that seriously afflicts children) of the International Committee for the Standardization of Diagnostic Materials. Due to his work, the Hematology Division of Siriraj Hospital was designated by the World Health Organization (WHO) to be a training center for doctors and scientists from all over the world.

PRAWASE’s interest in blood diseases—thalassemia in particular— began while he was a house officer at the medical school through the work of Dr. Supa Na-Nakorn in the Department of Medicine. He hoped to study thalassemia in Denver, but the hematologist at the University of Colorado Medical Center did not know enough about this genetic disorder, so, instead, PRAWASE wrote his doctoral thesis on mouse leukemia. During those three years, according to his professor, Dr. Matthew H. Block, "he worked on a variety of subjects, making contributions in the fields of iron metabolism, lymphoid leukemia, and the experimental induction of leukemia and lymphoma in mice, thus showing his real versatility." Block was equally impressed with his student's "skill as a practicing physician. At the time that he arrived in Denver," says Block, "I was very shorthanded, and when I left the city for any reason whatsoever, he would immediately fill my position as Chief of the Hematology Service."

During his stay in Denver, PRAWASE kept in mind the need to study human genetics. He was encouraged by Dr. Carl Moore, the famous hematologist affiliated with Barnes Hospital in St. Louis. He met Dr. Moore through Virginia Minnich, who had worked on thalassemia in Thailand after World War II as part of an exchange program between Washington University (to which Barnes Hospital belongs) and Siriraj. Moore told PRAWASE, "If I were young I would go into genetics. It's a very promising field." On this basis PRAWASE wrote to Dr. Lionel Penrose, Galton Professor of Human Genetics at the University of London, and asked if he might come to study with him on his way back to Thailand. Penrose agreed and PRAWASE was able to return to Siriraj in April 1961 with a solid background in both hematology and human genetics.

As soon as he returned he led teams into northeast Thailand to survey for hemoglobin E, a mild form of anemia that is only lethal when it interacts with thalassemia. Their studies showed that hemoglobin E, while affecting only 13 percent of the population in Bangkok—which is heavily Chinese—affected more than 50 percent of the population in the triangle formed by the junction of northeast Thailand, Laos, and Cambodia.

Another disease, hemoglobin H disease, was also known to be related to alpha thalassemia, but the genetic mechanism was not understood. A child with hemoglobin H disease could have normal parents, only one of whom would even have abnormal red cells in the blood. The red cells in the blood of the other parent would appear normal. Knowing that this was a genetic disease, PRAWASE applied the principles he had learned in London, and concluded that the apparently normal parent must be carrying another type of alpha thalassemia gene so mild that it could not be detected. PRAWASE’s group published their hypothesis in 1964 in the British scientific journal Nature, in an article entitled "The Genetic Mechanism of Hemoglobin H Disease." The hypothesis has since been confirmed, and the two different genes are now known worldwide as Wasi's alpha thalassemia-1 and alpha thalassemia-2.

There are more than 60 forms of thalassemia in Thailand whose effects range from no symptoms at all to lethal. In one form of alpha thalassemia, in which the fetus inherits an alpha thalassemia gene from each parent, all the victims die, either in utero or a few minutes after birth. In other types, the babies are born normal, but after three months they start to be anemic, their liver and spleen enlarge, the bone changes, growth is retarded, and the children may die between the ages of five and ten. On the other hand, people with mild cases can live to a ripe old age.

Sometimes two cases caused by the exact same combination of genes can exhibit very different degrees of severity. The scientists at Siriraj are now trying to find out what other factor, in these genetically identical cases, determines the severity of the individual case. They hope in the future to be able to manipulate severe cases into mild ones. For example, a molecule of hemoglobin A contains two alpha chains and two beta chains. When you have beta-thalassemia, you are not synthesizing enough beta chain, which results in an excess of alpha chain. This excessive alpha chain is deleterious to the red cell, shortening its life span. PRAWASE’s group is now studying the proteolytic activity of the red cells, i.e. the activity of enzymes that digest protein such as the alpha chain. Their hypothesis is that if you have strong proteolytic enzymes, they would digest more alpha chain and the severity of the disease would be reduced.

Normally individuals suffering from severe thalassemia need blood transfusions. If the scientists can confirm the function of strong enzymes, the need for blood transfusions would be eliminated. PRAWASE has already begun to contact large pharmaceutical firms with regard to supporting basic investigation into the nature of the enzymes with the goal of finding suitable drugs to increase proteolytic activity in the red cells. If found, such drugs would be very useful in alleviating the severity of thalassemia throughout the world. He is also working on genetic engineering.

A colleague once wrote that PRAWASE’s academic accomplishments "are far less important than the way of life that he has set himself." He called PRAWASE a "scholar for life . . . a man who is able to learn and change." By serving long hours in the crowded clinics of Siriraj Hospital, he said, PRAWASE "learned that there are much more urgent causes for the people's suffering and the social ills than his academic accomplishment can serve. So he has changed from super-specialization to direct problem-solving methods for the people. The latter have brought him severe criticism from the academicians who have worked for personal gain both financially and academically."

PRAWASE himself points out that his interest in public health arose directly from his academic pursuits. When his teams went out to the provinces to check for hemoglobin E and thalassemia, the villagers would flock to them for treatment of all their diseases. The doctors were made acutely aware that modern medical care had no way of, reaching these poor rural villages so far from provincial hospitals.

Provincial hospitals themselves, as well as the large public hospitals in Bangkok, are so swamped with patients that quality of care has necessarily been sacrificed to quantity. In Siriraj, for example, a visit to the doctor is an all day affair. First a patient must get up early to take the bus into Bangkok; about half the patients come from the rural areas because there are not enough adequate services there. When they arrive at the hospital they must wait in long lines before being examined by a doctor, and that examination may be limited to one perfunctory minute. They must wait in more long lines to fill their drug prescriptions, after which they are again faced with the long hot ride home.

The causes for this unfortunate situation are manifold. PRAWASE himself describes Thailand's medical services as topsy-turvy. Ideally, he says, national medical services could be diagrammed as a broad-based triangle. At the wide bottom of this triangle would be primary health care, which is defined as the extent to which "people and communities are able to help themselves in taking care of their own health, in curing their own sicknesses and those of other people around." The next broadest level should be primary medical care, consisting of small health centers or small hospitals with one or two doctors or even one nurse with assistants, close to people's homes. The narrower part of the triangle would include secondary medical care, based on large general hospitals, and at the tip, tertiary medical care, consisting of specialists

in various fields.

All of these levels are necessary to give good care. If not related to other levels, primary health care could degenerate into primitive health care. Patients that cannot be treated at the primary level must have access to more specialized services. In turn, people at the specialized levels have the capacity to research the causes and cures for primary health problems. Often people in a community are not aware of the problems themselves. All the levels must be able to work together for effective public health care.

In Thailand, explains PRAWASE, this triangle is upside down. There are many specialists, fewer general hospitals and even fewer small health centers. Primary health care has been the most severely neglected of all. Modern education has made the mistake of teaching the people not to take care of themselves, but to see a doctor when they are ill. In Thailand, however, there are only 8,000 doctors to serve about 48 million people. How, PRAWASE asks, can the people manage to see a doctor?

The situation is compounded by the fact that until now doctors have not wanted to go into the provinces. In rural districts public health officers suffer economically because they are unable to supplement their salaries with private practice as they do in urban areas. About half of the doctors still remain in Bangkok. This means Bangkok has a doctor/patient ratio of roughly 1:1100, whereas there is only one doctor for every 10,900 people in the provinces. PRAWASE blames this gap— which was far more severe when he began his career—on the system of education which has failed to inculcate in the medical students an understanding of Thailand's public health problems.

On April 6, 1971 PRAWASE and two other doctors, one from Chulalongkorn and one from Ramathibodi medical schools, wrote a letter to the office of Prime Minister Marshall Thanom Kittikachorn suggesting reformation of the public medical school system. They stated that teaching doctors were not spending enough time with either their patients or their students because the bureaucratic system gave them absolute security. PRAWASE, who drafted the suggestions, proposed that a tenure system be adopted whereby teachers would be appointed for one to three years and then be evaluated to determine whether or not they should be continued as medical teachers.

The cabinet approved the recommendation and sent it back through official channels to the medical schools, with a note requesting more details. There it created an uproar. Teachers who, because of their civil service job security, were able to earn a great deal of money from private practice—to the detriment of their teaching—objected to the idea of being evaluated every two or three years. The three doctors found themselves subject to severe harassment. The matter eventually reached the king who recommended that any change be agreed upon by the teachers. PRAWASE came to understand, he says, that the rigidity of the bureaucracy, which could not be changed even by a military government, was the single greatest obstacle to the promotion of a viable public health system.

Not discouraged, PRAWASE then approached from a different angle the problem of bringing the medical system in tune with reality. Elected to a second term as a member of the Medical Council of Thailand, he was appointed chairman of the subcommittee to recommend a national health plan. During the Sanya Dharmasakdi administration, which succeeded Thanom's military government, he worked closely with Drs. Udom Poshakrishna and Sem Pringpuangkeow, Minister and Deputy Minister of Public Health, on proposals to reform public health, emphasizing the need to rely more on traditional indigenous elements rather than on imported medicines and equipment.

He and his friends also suggested the establishment of a new medical school to operate beside the old ones, but to offer an alternative curriculum. The new curriculum would emphasize humanity, with science and technology regarded as tools to be used in its service. The students, before being admitted to be trained as doctors, would have to prove their ability to work and be accepted in any field whatsoever in the community. The study of medicine for rural services, PRAWASE feels, should start in the community, not in the laboratory. The students, rather than being placed in big university hospitals, should be trained in district and provincial hospitals where they can pursue their medical studies and at the same time earn to deal with the actual conditions faced by the majority of the Thai people. Once again PRAWASE found his proposals blocked by the established teachers, although his program in no way threatened to change the existing schools. Today an approach similar to that of PRAWASE and his friends in Thailand, conceived independently by Dr. Moshe Prywes, is being implemented with great success in Israel.

PRAWASE’s efforts to right the upside down health care triangle have led him to speak out against a number of recent proposals to build more giant hospitals. One such project proposed building four 1000-bed hospitals, one in each section of the country. In 1980 a campaign attempted to raise funds for a very large hospital in Don Muang on the outskirts of Bangkok. In both cases, the hospitals were to be called "King's hospitals," a ploy intended to win support for the projects. This did not prevent PRAWASE from publicly disagreeing with these projects, which would again concentrate doctors in major hospitals rather than dispersing them in the districts.

Within the last five years PRAWASE’s efforts to redistribute the nation's doctors have begun to bear fruit. The change is occurring in the students themselves, who are slowly becoming aware of the rural health situation and volunteering to go into the district hospitals. For some years now, medical graduates have been required to serve in the provinces for three years. Many bought their way out of such compulsory service. Recently, however, they have been volunteering for provincial service in greater numbers than the ration the Ministry of Public Health receives. Some prefer provincial service to being drafted into the armed forces, but the majority of volunteers are highly motivated to serve. The volunteers work in teams of one doctor, one dentist and one pharmacist. Their performance is so impressive that an observer from the Israeli experimental medical school intended to request the World Health Organization to send Israeli medical students to "study" in Thailand's district hospitals.

The new young doctors attribute their motivation to serve to their teachers who now often discuss rural problems with their students. PRAWASE is more inclined to attribute the change to the students themselves, whose social alertness was activated in 1973 when they mobilized to unseat the military government. The students criticized their teachers for their refusal to discuss the country's problems as well as for the time they spent developing their private practices. Gradually the teachers began to change their teaching emphasis to suit the needs of the country.

Thailand is now producing 600 doctors a year, which means, in PRAWASE’s view, that there should be enough doctors in five years to staff hospitals in all 670 districts in the country. Now only about 300 of the districts have doctors or hospitals, usually one doctor to a hospital. PRAWASE is less concerned about staffing the hospitals than in building them. The group planning the next national health plan discussed first the possibility of building 10 to 20 district hospitals a year, each one to have between 10 and 60 beds, depending on the work load. PRAWASE suggested instead that all the remaining 370 district hospitals should be built within the next five years. This proposal was accepted, and the budget for the next two years already provides for 200 of the hospitals.

It is PRAWASE’s opinion that the large provincial hospitals cannot work well because they are presently overloaded by patients from the districts. The quality of care is so poor that newspapers often refer to

these hospitals as slaughterhouses. Surveys show that where there are good district hospitals, only one percent of the problems need to be referred to the provincial hospitals. A proliferation of district hospitals will allow the provincial hospitals to raise the quality of their care at little or no extra cost.

Correcting the maldistribution of doctors is one way of adjusting the health care triangle; expanding primary health care is another. PRAWASE estimates that one percent of Thailand's population gets sick enough each day to need medical care. Unfortunately, all the existing medical facilities in the country can handle no more than 100,000 people a day—less than one-fourth of those who should have medical attention. Furthermore PRAWASE feels that fully 90 percent of these illnesses are preventable, that they are caused by poor sanitation, poor health education and the poor economy.

Good primary health care, he states, must involve all sectors of the community: nurses, midwives, village health volunteers, teachers, monks and housewives. Ideally, of course, each community of about one thousand families should have its own health center staffed by a nurse, a health worker, and a midwife. Since this goal has not yet been achieved, the government has begun training village health volunteers. These volunteers may be farmers or housewives who are trained to treat common illnesses, to refer other patients to the health center or district hospital, to keep health records and to inform the health officer about endemic diseases. This system, PRAWASE points out, is similar to the network of "barefoot doctors" in China, but there is one major difference. China's barefoot doctors are not really volunteers; they are full-time workers supported by communes. Thailand's volunteers, on the other hand, spend most of their time eking a poor living. Their part-time efforts are not enough, he feels, to solve the problem of primary health care, so in recent years he has developed numerous other avenues to reach the villages.

First, a number of health manuals were published at his instigation. These include Khuumeu Kandulaeraksaa Sukhapaap samrap Prachachon (Handbook for Health of the People) edited by PRAWASE and written by him and 10 prominent physicians, pharmacists, and public health personnel on the occasion of the king's 48th birthday in 1975; Kansatharanasuk peua Muanchon (Public Health for the Masses) written by PRAWASE and first printed by the Komol Keemthong Foundation in 1976; Moh Prachambaan (Household Doctor), a 1978 compilation of his columns for a popular magazine.

PRAWASE has long been a board member of the Komol Keemthong Foundation; Puey Ungphakorn (the 1965 Ramon Magsaysay Awardee for Government Service "for his dedication, unquestioned integrity and high order of professional skill brought to the management of Thailand's public finance") has been vice-president. Komol Keemthong was a young teacher who went out from the university to work in a rural community and was killed, some said by the communists but others said by the military. After his death, the communist insurgents came in to the area to fill the gap. The foundation was started to stimulate young people to work for the community. In 1976 when a rightist coup overthrew Thailand's brief democracy, the foundation's offices were raided and all its books, including the pamphlet Public Health for the Masses, were confiscated. PRAWASE himself was accused—and cleared—of communist sympathies, an incident which once again failed to shake the determination with which he pursues his goals.

In 1979 he established a monthly, Moh Chao Baan (Folk Doctor magazine)—of which he is owner, publisher and editor—to provide "self-curing knowledge and knowledge on primary health care to the public." An outgrowth of the magazine is the Fulk Doctor Foundation (Moolnithi Moh Chao Baan) which supports primary health training programs.

In 1981 he published Bantheuk Wechakaam Thai (Thai Medical Record), a small volume of case studies presented in simple and popular fashion, to convey to the general public the complexity of medical care. It illustrates how medical science can be self-defeating if it is isolated from economics, religion, ethics, and the patient's overall mental and physical state. A good doctor, the book implies, must know the whole person if he is to cure him.

In Thailand there is still great reliance on herbs and faith healers, particularly in the provinces where there is little modern medical care. Where health education has been preached at all, people have been taught not to treat themselves, but to rely on doctors—even where doctors are not available. Folk Doctor magazine aims to demystify medicine and to make every villager a folk doctor of modern medicine. People who have feared that this approach may cause adverse effects, that the villagers may not be sophisticated enough to treat themselves properly, are not, PRAWASE points out, taking into account the simple fact that they already are treating themselves, correctly or otherwise.

The magazine is addressed to those among the common people who are literate, as well as to the health communicators: teachers, monks, district doctors, health personnel, village health volunteers. It teaches basic medical and health sciences and explains in simple terms how to make diagnoses and how to treat simple illnesses. It gives the names of medicines—as well as directions, side effects and price—needed to cure common ailments such as headache, stomachache, diarrhea, and malaria. Herbs used in traditional medical treatment are discussed along with modern synthetic medicines.

Realizing that traditional medicines are far more accessible to the people than most imported medicines, PRAWASE has embarked on a program of drug development at Mahidol University, of which he is now Vice Rector for Planning and Development. In 1981 Thailand is importing about US$500 million worth of medications. PRAWASE hopes to make his country more self-reliant by tapping indigenous herbal medicines.

The magazine now has a circulation of 50,000 a month and initially was supported largely by donations. In addition, the World Health Organization bought subscriptions for 12,000 village health volunteers. The magazine depends less on advertisers than most periodicals because it is selective in accepting them. It will not, for example, accept ads for quack medicines—no matter how much money is offered for space. It also insists on printing the fair market price of the drug, which discourages many drug companies that would like to overcharge. Nonetheless, thanks to publicity donated by the media for this non-profit effort, the magazine is breaking even after only two years on the stands.

At the same time that Folk Doctor magazine is spreading basic medical education through the printed word, thousands of yellowrobed monks are becoming, in the words of an English observer, Thailand's "bareheaded doctors."

Thailand is an overwhelmingly Buddhist country. There are over 26,000 Buddhist temples with monasteries that house more than 200,000 monks and 100,000 novices. Over 90 percent of the people profess to be Buddhists. Still, PRAWASE points out, "there are many social problems in the country, a lot of degradation and a lot of crime." When looking at these problems, he says, "a Buddhist cannot help asking himself if Buddhism is good, why are the social problems so great? He has a choice of two answers. The first is that Buddhism is not related to the good or bad aspects of society at all, that it is a separate, unrelated entity. The second is that Thailand is not properly applying the principles of Buddhism to its society. I believe in the second option."

A close colleague calls PRAWASE "a Buddhist in the real sense. He lives his life simply and as close to nature as possible. He knows and understands Buddhism by practicing it himself and not by memorizing and regurgitating it as many people do." PRAWASE himself feels that the most important tenet of Buddhism is that "nothing is permanent except change." The teaching of the Lord Buddha, he says, "is very good, very scientific, and it can be applied to the changing conditions of society." If it is not, it is because "the people are too rigid, too static in their thinking; they do not keep up with an ever changing reality." This, he feels, is a danger in Thai society.

Sociologists have remarked that many Buddhists turn their backs on social problems because of a deepseated belief that a person's present condition is the result of his actions in this or in previous lives. Accordingly, each person must cope with his own karma (fate); it cannot be changed by anyone else. PRAWASE maintains, however, that "according to the Lord Buddha's teaching, each of us has the clear purpose of helping his fellows, both spiritually and physically. Only in this way can we hope to raise our own spiritual level."

While social welfare on the part of laymen may be a relatively new concept in Thailand, it has long been the province of the monks. Traditionally the temples were the centers for education—such as PRAWASE’s own first primary school, for treatment of the sick, and for cultural activities. Modernization has taken many of these activities away from the monkhood, resulting in an increased disruption of society. The Buddhist sangha (monkhood) finds itself, therefore, at a crucial stage in history. It can withdraw, as many monasteries have done, and concentrate on raising money to build finer temples and more comfortable living quarters, or it can recapture its traditional role of community service.

The two Buddhist universities in Thailand, Mahamakutra and Mahachulalongkorn, began adjusting their curriculum in the mid-1960s to prepare monk graduates for educational and community service. In the late 1960s and early 1970s, Sangha Education and Development Centers were established in every province of the northeast and in Chiang Mai in the north to give training programs to rural monk leaders in technical subjects related to community development programming. Still, progress in community development, although supported by the people where it takes place, has been slow and the monk leaders have been considered radical.

In 1975 PRAWASE was invited to give the annual lecture of the Komol Keemthong Foundation. His topic, "How the Monks and Lay Buddhists Can Restore the Nation," was so inspiring to monks and laymen alike that it has often been reprinted. That same year the foundation collaborated with the abbot of Wat Thongnopakun to start a class to train monks in primary health care. The course, designed by PRAWASE, deals with the eight basic cements of primary health care: food and nutrition; clean water and sanitation; immunization; mother and child health; control of endemic diseases; treatment of common injuries and illnesses; provision of essential drugs; health education.

When the first course proved successful, PRAWASE took the idea to the Ministry of Public Health, where he was met with agreement in principle, but a bureaucratic inability to get things started. The Komol Keemthong Foundation, and later the Folk Doctor Foundation, decided to continue the program on their own, with the cooperation of influential monks. One of these, Somdej Phraphutthakosajarn, the abbot of Wat Samphraya, became so interested in the project that he declared the sangha's aim should be to send all the monks in the country to the course. When PRAWASE said to him, "Your goal is very high. What is your budget?" the reply was "Nothing." PRAWASE perked up his ears. If the abbot could run the course with no budget whatsoever, it could run forever. The secret was very simple: monks travel for free, stay in temples, and are fed by the people. PRAWASE’s foundation could pick up the cost of teaching. Wat Samphraya now holds a week-long course for 50 monks each month.

PRAWASE finds teaching monks very stimulating because of their long rural experience. Medical students, despite their extensive background in chemistry, physics and biology, have few or no questions at the end of a lecture simply because they have never been exposed to real problems of real people. Monks, on the other hand, who have no scientific background but are constantly exposed to the problems of the people, are full of questions. People come to them to ask for help, and they do what they can; but when they have the opportunity to learn they are eager for answers to these problems. Furthermore, they often have answers to each other's questions that the teacher himself cannot answer. For example, one monk asked PRAWASE how to cure warts. PRAWASE knew he could not answer that question because the western physician's answer—silver nitrate, say—is not available in the rural villages. Then another monk volunteered: he used a certain plant that got rid of warts every time. This, says PRAWASE, is "the true sense of education," a multilateral, not a unilateral process.

The work of monks has certain innate limitations. A monk can, for instance, advocate inoculations but not give them, since he is prohibited from any sort of bodily contact with women. He can advocate the distribution of nutritional food, but is prohibited from preparing food himself. He can distribute medicines, but cannot receive direct reimbursement for them. Still, it is in this area of distribution of essential drugs that the monks are expected to be most helpful. Nobody can provide free of charge enough drugs to supply the expected needs of 50,000 villages geared to primary health care. Some revolving mechanism of self-help must be established, and the monks have just that mechanism. It is the custom in Thailand for people from the cities to visit rural temples at least once a year with a donation of new robes and money. PRAWASE and his colleagues suggested that the people bring a donation of essential drugs. At least one temple has already posted a list of such drugs.

Doctors of traditional Thai medicine are sometimes invited to teach the monks about curative herbs and plants. These doctors themselves, who are found in virtually every village, would like to have their training upgraded to include basic western health care. In 1979 PRAWASE was asked to organize a seminar on traditional medicine at the university. The traditional doctors were delighted with the opportunity to air their problems. These included lack of standardization, lack of proper schooling and insufficient general education. If, for example, they are unable to copy an herbal text correctly, the results are likely to be unfortunate. There are laws regulating the practice of herbal medicine, and these laws have proved oddly inhibiting in recent years. The law states that traditional medicine must be practiced in the traditional way with no changes in methodology; this, PRAWASE points out, prohibits development. Having discovered this legal problem the university and the Ministry of Public Health organized a seminar to examine the laws related to medicine as a whole; it found that many are out of date and need to be amended.

The Folk Doctor Foundation is increasingly asked to organize primary health training courses for various groups, such as the Border Patrol Police and others. Ideally, of course, it should be possible to organize courses in the provinces as well. Again, the Ministry of Public Health's bureaucratic mechanism tends to operate too slowly to cope with the need. PRAWASE hopes that the trained monks will be useful here, not as teachers, but as organizers. It would be far more efficient if the courses were organized for the doctors, rather than by them—and they were invited to teach, free of administrative details and bureaucratic red tape.

PRAWASE’s thinking revolves around two related concepts. The-first is self-reliance—individual, national, global. The second is that health means more than medicines and doctors; it means quality of life. When asked to speak about the role of monks in promoting primary health care, PRAWASE tells about the young abbot in the village of Yokkrabutr, Samutsakhon province. When the abbot arrived in Yokkrabutr, he found an extremely poor, crime-ridden community whose young people fled to Bangkok. Instead of giving up and asking for a transfer, he began to study the causes of and solutions to its poverty. He concluded that the environment was suitable for raising coconuts, which he immediately began to advocate in his regular sermons. Soon the entire community, including the temple, began to grow a strain of coconut with a high yield of sugar syrup. The village prospered, the temple prospered from high donations, and the abbot was able to start yet another project: provision of a clean water supply. In such a way, even without a doctor, the health of the community improved; they drank clean water and had money to buy good food, all of which made them more resistant to the myriad of preventable diseases that plague the poor.

PRAWASE’s studies have shown beyond a doubt the correlation between disease and poverty. In one of these studies groups of people from different economic levels were examined for anemia. Medical students, who generally come from good families, showed no signs of anemia. Among nursing students, on the other hand, who are generally poorer than medical students, 11 percent were anemic. Forty percent of the farmers living about 50 kilometers from Bangkok were anemic, and in the poorest section of the country, the northeast, over 90 percent of the cases studied were anemic. Poverty and ignorance, PRAWASE reiterates, are health problems.

The solutions to these problems, as PRAWASE sees it, are vast and far from simple. He feels Thailand needs socially-conscious political movements, better management and, above all, a better bureaucratic system. As he understands it, the bureaucratic system inhibits community development, which he sees as the key to the country's overall development. "If Thailand's problems can not be solved in the village," he states, "they can not be solved at all." According to PRAWASE, the bureaucracy is too centralized and rigid to allow the community to initiate things on its own. He feels, however, that bureaucracies do not change themselves, but are customarily changed by the political sector of the government. In Thailand, each Cabinet has lasted only one or two years, not long enough to lay out long term plans or to reform the bureaucracy. PRAWASE feels the solution lies in distributing more power to the local governments. If given the chance, there is much the community can do by itself. The central portion of the bureaucracy, the government departments and so on, should be free to concentrate on research and development of various models, so that the community can choose what is suitable for its individual development. As in the health care triangle, he says, overall development, too, should have its responsibilities parceled out to various administrative levels in accordance with the tasks to be performed.

Dr. PRAWASE has not yet gathered support for these farsighted structural changes; he has only just begun his campaign. But 10 years ago the medical establishment was equally rigid in its refusal to recognize the realities of rural health problems, and primary health care was not the byword it is today. A colleague who described Dr. PRAWASE as a simple man, always polite, humble, honest and firm, added that he was "overwhelmed by the far-reaching but subtle social accomplishments of this 'simple' men."

October 1981
Manila

REFERENCES:

Blanchard, Wendell. Thailand: Its People, Its Society, Its Culture. New Haven, Conn.: Human Relations Area Files Press. 1958, p. 366-397.

Chu, Valentin. Thailand Today: a Visit to Modern Siam. New York: T. Y. Crowell 1968, p. 184-187.

Eyre, John D. Thailand. Boston: Ginn. 1964.

Insor, D. Thailand: A Political, Social and Economic Analysis. New York: Praeger. 1963.

"I'm my own Doctor," Bangkok World. June 8, 1978.

International Bank for Reconstruction and Development. A Public Development Program for Thailand. Baltimore: Johns Hopkins Press. 1959.

Klausner, William. "The Thai Sangha and National Development," Visakha Puja B. E. 2521 (1978), Bangkok: Buddhist Association of Thailand, May 1978.

Moore, F.J. Thailand, Its People, Its Society, Its Culture. New Haven, Conn.: Human Relations Area Files Press. 1974, p. 165-168.

Sulayakanond, Wirasak. "Health Means Wealth," Bangkok World. September 23, 1979.

Thailand Yearbook. Bangkok: Temple Publicity Services. 1970 and 1974 editions.

Thompson, Virginia. Thailand: the New Siam. New York: Paragon Book Reprint Corp. 1967; original 1941.

Wasi, Prawase. "Phrasong lae Phutthasaasnikachon ja Kuuchaat Day Yaangray?" (How Can the Monks and Lay Buddhists Restore the Nation?), Udomkati peua Sangkom (Ideals in Society) (in Thai). Bangkok: Komol Keemthong Foundation. 1978.

______. "Kansatharanasuk peua Muanchon" (Public Health for the Masses), Rak Meuang Thai (Love of Thailand) (in Thai). Vol. 1, (Reprinted from Sociological Society Journal of Thailand, Bangkok. 1976 (BE 2519).

______. "The Sangha and Medical Care: An Appreciation," Visakha Puja, BE 2522 (1979).

Bangkok: Buddhist Association of Thailand. May 1979.

Who’s Who in Thailand. Bangkok: Advance Media Co., Ltd. Vol. 3, no. 11, November 1975.