Isaan Lives: “Are We Holier Than Thou?” – Struggling against the convoluted views of Thailand’s modern ‘life-savers’

Guest contribution by Camille Bridger and Julie Ehrlich

“I’m not a good person,” admits Somkiat “Noom” Soontornsawat, “money comes first.”

Noom smiles shyly in the fluorescent lighting of the Faculty of Medicine’s student library. Wearing the traditional medical student uniform of white shirt and black pants, Noom is the apparent epitome of a regular middle-class medical student from Isaan: a “nerd,” interested in medicine for the income stability and welfare. But once he talks, he has a lot to say about social and political issues affecting the country and the medical profession.

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A self-professed “nerd,” Somkiat “Noom” Soontornsawat, a 29-year-old medical student, poses in Khon Kaen University’s Medical School Library, where he spends a lot of his time.

At 29 years old, Noom is by far the oldest student in his third-year class of medical school at Khon Kaen University. Noom graduated high school in Ubon Ratchathani where he, like many high-scoring high schoolers, took the competitive test for Thai medical schools and earned a place, but his heart lay elsewhere. He decided, instead, to get an undergraduate degree in physics and his masters in mathematics at Chulalongkorn University in Bangkok.

Even while Noom’s mother expressed her regret to friends in the community over Noom not attending medical school, Noom’s family supported him both financially and emotionally through his decision.

His parents are not strict, he says: “I know what they want, but they don’t push me.” Other students are often forced to study medicine by their families because they made good grades. When, years later, Noom finally decided to study medicine, his family was “confused but happy,” says Noom. “They wanted to have a block party.”

Now, sitting in the library, Noom physically blends in among his peers, but his beliefs are far from typical. Unlike other medical students, he is willing and eager to speak up on issues he is passionate about. “Which is pretty much every issue,” says Noom, from small contentions revolving around the Faculty of Medicine and its practices of hazing to larger and perhaps dangerous affairs pertaining to the political situation and military coup.

Noom says that many of his peers might be sympathetic to his causes, but they don’t want to speak out for fear of clashing with authority, or simply because they don’t care enough.

While pursuing his previous degrees, Noom was deeply involved in political activism and other social issues, posting on Facebook regularly and attending candlelight vigils in opposition to the military coup in May 2014.

Now that Noom has started his studies at the Faculty of Medicine, he turns his critical gaze on issues immediately around him. Specifically, Noom voices his opposition to the traditions in the Faculty of Medicine, which he says, “gets heated” to the point where he has had a few run-ins with the administration. When discussing his instigations, Noom felt the need to lower his voice to no more than a whisper in the faculty library.

His most recent rebellion against the administration was about a five-day compulsory meditation retreat at a Buddhist camp. Although most medical students don’t agree with this practice, they attend anyway out of complacency, Noom explains. He is not one of those students.

Noom believes that the Faculty of Medicine “should not impose religious-based commands” on students. He led a group of students to declare that they wouldn’t attend the meditation retreat. The university administration threatened that if these students did not attend the retreat, they would not be allowed to take final exams. As a result, many of Noom’s group begrudgingly decided to attend.

Noom still refused to attend the retreat. And when asked by a professor to write a statement saying what he would do instead, he did not write anything, risking a bar on taking exams. “A professor called me in and told me that they don’t know what to do with me yet,” he says. Noom still doesn’t know whether he will be allowed to take exams this coming January.

When asked why he decided to go into medicine Noom says, “primarily for the money and prestige.” Doctors, especially those practicing Western medicine, are at the top of the Thai social status system. Noom explains that even as a medical student you are treated differently: people call him khun mo, a term people use to address doctors, and treat him a little more nicely than others.

In the eyes of Noom the medical community in Thailand is plagued with hypocrisy and doctors too often behave like "demi-gods in white."

In the eyes of Noom the medical community in Thailand is plagued with hypocrisy and doctors too often behave like “demi-gods in white.”

Unfortunately, because of their high status in Thai society, “many doctors do not give their patients the respect that they deserve as people,” says Noom. He thinks that this lack of respect comes from some doctors’ idea that they are better or “holier” than their patients. This became evident in the controversy over the potential repeal of the universal health care scheme, which Noom feels particularly enraged by.

After the military coup in 2014, the junta’s new government left the people questioning the future of Thailand’s universal health care system. The junta’s stance on healthcare is unclear, and its long-term goals, especially pertaining to healthcare, have not been vocalized. Repealing the 30 baht system would leave many patients facing unaffordable health care costs, and would lead to a host of problems for patients facing issues ranging from chronic to emergency care.

“We are learning to become doctors here and there is a lot of silence on the issue of co-pay” being replaced by a more costly and less accessible system, Noom says in a fierce, passionate whisper.“The repeal of the co-pay system is severe and will negatively affect a lot of sick people.”

Noom is angered by the hypocrisy he observes in the community of medical professionals. “I am being taught by professors to [always] think of patients,” Noom whispers. He points out, however, that there isn’t any attention paid to the possible repeal of the co-pay system, while there is a lot of outrage in the medical community at a court ruling that affects medical practice.

“Several months ago, there was a court case,” Noom begins, lowering his voice again. He tells a story of a child with tuberculosis. The illness spread to the brain, and worsened the child’s condition considerably. The patient’s family claimed the doctor did not correctly diagnose the tuberculosis case in advance and ultimately caused the child’s delayed diagnosis. The case went to court, and the doctor was held responsible even though he did everything according to the medical protocol.

Consternation swept across the faculty and the medical field in general. “There was so much outrage in the faculty of medicine,” says Noom. His fellow students and professors argued that this would be the downfall of specialized doctors in rural areas, saying that doctors wouldn’t want to work in such areas for fear of a similar fate.

When the issue of the universal health care system arises, however, Noom says, there is silence. He asks, “the tuberculosis case was not as severe as the co-pay issue, why isn’t anyone talking about the co-pay issue?”

Looking into the future, the 29-year-old says he will likely stay active as an advocate in social issues. When Noom finishes medical school and becomes a doctor, his dream is to return to mathematics.

“Once I turn 45 or 50 I will finish a Ph.D. in mathematics,” Noom says. “But that’s in my ideal world. If I still have energy left.” He would like to have kids and a good family. Like his own parents, Noom will not push his children to become doctors, it will be up to them as it was up to him.

Although Noom admits to studying medicine for the money, he still believes in the doctor’s responsibility to care for patients as human beings. “There is commitment and then there is money, I came to medical school, I don’t want to eat salt for life but there are things that are not ok.”

Camille Bridger is a student at American University in Washington D.C., studying Public Health and Public Administration and Policy. Julie Ehrlich is a student at Middlebury College in Middlebury, Vermont where she is studying Neuroscience and Global Health. She is an aspiring physician and will be starting her Medical School applications in the United States in the summer of 2018. Both are currently studying Public Health at Khon Kaen University.