A visit to Wat Phra Baht Nam Phu.

Last summer, on August 8th, I had an opportunity to stop by the Wat Phra Baht Nam Phu, which translates to 'the temple of Buddha's footprints'.

At least one million Thais have been infected with HIV/AIDS since the first reported case in 1984. The rate was increasing at an alarming rate in the 1990s, however, with the society at that time not well aware of what was becoming a major social issue, those affected were cast aside and left to die. Situated in Lop Buri province, 120 kilometers north of Bangkok in central Thailand, the temple was turned into what it is now, an AIDS hospice, by a Buddhist monk named Alongkot Dikkapanyo back in 1992. Since then, the facility has expanded to accommodate 400 beds from an initial number of eight, thanks to the temple's extensive public relations strategies bringing in donations amounting to the equivalent of millions of dollars. Photos of the temple’s sick and emaciated patients adorn posters and donation boxes across the nation and television stations from around the globe visit to film documentaries. Wat Phra Baht Nam Phu is currently home to over 200 HIV-infected adults, and has been for a number totalling 10,000 over the past, most of whom died from the illness.

The temple's activities have always been controversial in recent years. Tourists from mostly western nations visit in thousands every week, taking tours that are guided by some of the relatively-healthy AIDS patients. They go through the wards where the relatively-weak AIDS patients are, without much explanation, and continue on to the 'Life Museum', a collection of dozens of mummified corpses of dead AIDS patients, who according to the staff, agreed to be put on exhibition prior to their death. That is followed by the crematorium, which is surrounded by what seem to look like sculptures or other pieces of art made from the bones and ashes of those who have been cremated here. Then they walk to a hall which houses a Buddha surrounded by piles of sandbags, or 'ash-bags', which contain the ashes of those who were cremated but have not yet found relatives to take it home. Visitors also have an opportunity to see a dance show done by AIDS patients too. And after all that, they leave behind tons of donations.

Yes, the hospice provides care and 'protects' those suffering from AIDS, but what is it doing to how people see HIV/AIDS patients? Dead AIDS patients whose bodies are not taken back by their relatives become sandbags or pieces of art, or part of the exhibits in the museum that has little explanation of the bodies. Those who are weak, and in their twilight of their lives, simply lie on the bed as tourists pass by giving them that look in the eye. You can often see the visitors covering their mouth upon entering the ward, then swiftly moving through wordlessly. Many don't even say hello. Those who are still relatively healthy host the tours or performances for the visitors, helping to attract more donations. I can't help myself from feeling that all of these together only exacerbate prejudice.

In Thailand, more than 400,000 have died from AIDS, however, it is also one of the few countries to have successfully curbed its epidemic with awareness campaigns, and later pioneered the widespread distribution of anti-retrovirus drugs (ARVs), which slow the progress of the incurable disease. In the 1990s, up to 100 patients died at the temple every month, but now, that number has been reduced to about 10. According to UNAIDS, fewer than 17,000 infections were reported in the country in 2006, compared with 143,000 in 1990, but officials are worried that the rate could climb again. HIV prevalence among intravenous drug users and sex workers remains high, while condom use among Thai teenagers is shockingly low. No time should be spared to come up with a new way to spread awareness.

In Thailand, generally speaking, monks are highly respected. Much more than the government, to be sarcastic. I believe that when it comes to bringing social awareness, they have a vital role to play. :-)

A visit to Magnet.

So, I often talk about community health... but what is it that started everything?

It all started on March 24th, 2007, when I paid a visit to Magnet, a clinic located in the heart of the Castro neighborhood in San Francisco. I was then on a program run by VIA (Volunteers in Asia), a non-profit organization (NPO) originally based at Stanford University. With men walking down the sidewalks holding hands, a movie theater showing dramas of love between men, and shops whose walls are covered with posters of naked men, it was not a scene that you are used to seeing.

The Castro came of age as a gay village following a controversial 'Summer of Love' in the next-door Haight Ashbury district in 1967. The gathering brought tens of thousands of middle-class youth from all over the United States. The neighborhood, formerly known as Eureka Valley, became known as the Castro, after the landmark theater by that name near the corner of Castro and Market Streets. The community was hit hard by the HIV/AIDS crisis of the 1980s, and beginning at that time, city officials began a crackdown of bathhouses and launched initiatives that aimed to prevent the spread of AIDS. Today, kiosks lining the streets have posters promoting safe sex and testing alongside those advertising online dating services, and the city of San Francisco is home to around 100,000 to 200,000 homosexuals.

Asking about the roots of the community, many bring up the name Harvey Milk, a gay rights activist and the first openly gay man elected to San Francisco's Board of Supervisors, or to any substantial political office. He was elected in 1977 representing District 5, which included the Castro. However, I felt that another, more recent activity was helping to bring the gay people together and empowering the community: Magnet.

Although a clinic, it does not look like the conventional one in your neighborhood. The front side of the building facing the street is glass, instead of a wall with small windows, allowing everyone who walks by to have a view of the interior. As soon as you enter, a clean room with leather sofas and tables and a corner that resembles an Internet cafe greets you. A large bulletin free for anyone to post events in the community is near the corner and artwork of gay men adorn the walls with metallic coating. The examination rooms are located at the rear of the one-story building, however, for privacy these rooms are lined with walls and not glass, of course.

Founded by the 'Castro Guys', a group of health care professionals who were gay, Magnet's vision is to promote the physical, mental, and social well-being of gay men. Run by gay men (all staff are gay and half of them are HIV positive) for gay men, it offers free sexual health services such as confidential HIV antibody testing, testing and treatment for syphilis, chlamydia, and gonorrhea, and hepatitis A and B vaccination. Other than for sexual health, it provides services such as ear acupuncture, chair massage, hypnotherapy, general mental health counseling, and a flu clinic. Although financial support was scarce in the beginning, now it is supported by a major pharmaceutical company which pays roughly 80% of the costs, and the rest is paid for by donations from the people in the community.

However, in addition to providing sexual health services, Magnet holds a variety of on-going community activities. This ranges from book readings and art exhibits (as mentioned earlier) to town hall forums and health chats, or karaoke and dance nights to gay weddings. And even when there are no particular events, people drop by the clinic just to chat with others or share stories. In other words, Magnet acts as not a mere clinic, but more like a community center that brings a people together in an affirming environment that embraces the diversity of the culture that exists. This is a place where gay men can access resources and make connections and friendships between each other that not only helps to promote individual health but also community health.

Magnet is an example of community health, but to be more exact, this is a form of primary health care (PHC), as defined by the World Health Organization (WHO). It is health for the people, by the people. Everyone walking on the streets of the Castro knows the Magnet. I was utterly amazed at the potential of how a small clinic can bring together a people who have been isolated and considered socially-handicapped by the rest and act as a catalyst in empowering the community as a whole. It serves as a place to meet people and bring everyone... the entire community together. Like a magnet, it truly lives up to its name, or much more than that.

So this is how everything started for me. Community empowerment for the people by the people through community building and organizing, with a touch of creative thinking and facilitation, in this case, from a health care perspective. Simply exciting. :-)