Public Health Field Practicum

Kaao Niao/ขา่วเหนยีว (Sticky News)

The final course of the semester was the

Public Health Field Practicum. As a follow-

up to the second course, our group broke

into three project groups, one group for

each of the communities we visited over

the previous month: Khambon (a village

situated next to a landfill), Nong Waeng (a

slum community in Khon Kaen city), and

Bung Tsim (a farming community outside

of the city. The following presents the

research and interventions that we did in

these communities.

CIEE Khon Kaen Community Public Health

Student Group 5

Spring 2012, Issue 3 May, 2012

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Khon Kaen municipality sanitary landfill is a waste disposal area located ap-proximately 17 kilometers from downtown Khon Kaen that has been operating since 1968 and covers an area about 100 rai (160,000 square meters). Located directly next to the landfill is a village known as Khambon. Khambon village consists of 373 households and two sub villages. The sub villages are Moo 7 and Moo 11. For conven-ience purposes, Moo 7 has been chosen as the focal point for this research project. Moo 7 consists of 66 houses holding 142 households and 691 villagers. The distribu-tion of males and females is almost 50/50 with Khambon consisting of 336 males and 355 females. The main occupations for the villagers of Khambon include scavenging, farming, and wage labor. These occupations provide villag-ers with an average personal income of 58,865 baht/year. The villagers of Khambon community face a wide array of health issues caused both by living directly next to a landfill and through daily behavioral choices. One area of health issues in particu-lar that the villagers face is related to the stomach. According to previous research conducted by Khon Kaen University, Public Health graduate student Srikuta, acute diarrhea is the fourth most common disease within the community and the villagers also face high rates of nausea, vomiting, and upset stomachs (Srikuta 2010). Some suspected causes of these stomach related issues include improper personal hygiene, fly exposure, improper food hygiene, and poor water quality within Khambon.

After we conducted research within the community, through questionnaires and focus groups, it was determined that two potential causes of stomach-related health issues within Khambon are poor personal hygiene and con-sistent fly exposure, especially during meal preparation, eating, and meal storage. From this information we concluded that an educa-tion plan involving information on effective hand washing techniques, the health risks asso-ciated with improper washing, as well as health risks associated with fly exposure would be an effective intervention. The first part of our in-tervention focused on hand washing. We pro-vided villagers with information on proper hand washing techniques, when it is important to wash hands, as well as the dangers associated

with not maintaining clean hands. This information was presented both verbally and through bro-chures and posters. We also did a demonstration on how to properly wash your hands. Members of

Hygiene and Flies in a Landfill

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the audience also participated by demonstrating proper hand washing techniques. The two members from the audience were a seven year old girl and a toddler.

The second part of our inter-vention focused on fly exposure, espe-cially during meal preparation, eating, and storage. We provided villagers with information on how flies con-taminate food (how they transmit bac-teria), the human diseases associated with this contamination, as well as suggestions and tips on how to possi-bly reduce the number of flies in the villagers household. This information was presented both verbally and through flyers. We also did a demon-stration where protection measures were shown to the villagers in hopes that they would implement them into their daily lives, protecting themselves and their food from flies. These traps

included nets, food domes, fruit and vinegar traps, plastic water bottles filled with water, and lavender scented cleaning supplies. Overall we believe our intervention was successful within the Khambon community and we hope that the villagers took the information we provided and began implementing these measures into everyday life in order to live a healthier life. We also would like to send out a major thank you to Paw Kom, our host father within the village; without him all the success in Khambon would not have been possible. Digna Pena, University of Massachusetts Amherst Amanda Smith, University of South Carolina

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From the beginning, Bung Tsim made quite an impact on Jesse and me. When it came down to deciding where we wanted to focus our project, we decided that what we wanted to do was look at the dietary habits of the villagers in Bung Tsim. We came to this conclusion when we went back to the village to fully understand their needs and wants and then compare to our inter-ests. It was clear that, although the villagers were gen-erally quite healthy, there was a need for clarifica-tion and awareness of some dietary issues in Bung Tsim. That’s when it became clear to us. We needed to find a way to share basic information on four main sub-jects: Monosodium Glutamate (MSG), Iodine, Pesticides, and Reused Cook-ing Oil. Deciding to look at these topics was also an easy decision as the Vil-lage Health Volun-teers also told us that there were problems with these ingredients and that something needed to be done about them.

With our project theme in place we

began to brainstorm what would be the best way to understand these issues and what would be the best way to raise awareness in the community about healthier behaviors.

We felt that first we needed to get a basic feel for the trends so we created a question-naire focused on MSG, Iodine, Pesticides, and Cooking Oil. Also on this questionnaire was a section for an inventory so we could look in the kitchens of the people we inter-viewed to see if they were using a lot of MSG and Iodized salt/fish/oyster sauce in their cooking. At the end of our data collection we

had collected 31 surveys which helped us figure out our next steps. We had discovered that MSG was used in all the cooking we had seen done by the villagers and that the only effect the villagers identi-fied in the use of MSG was that it made food taste a lot better. We also found out that al-though many peo-ple did not know what iodine is, they were using it in their cooking with-out even knowing it. Being a farming community, pesti-cide use was also shown to be an is-sue, but we learned that over 90% of

the people believe that pesticides can be harmful and that 100% of people care if their fruits and vegetables are treated with pesti-cides. Lastly we learned that, although many people know it is bad, there are still a hand-ful of villagers that reuse their cooking oil until it is too dark to use again. What we found out here was extremely helpful in framing our intervention.

Cooking Behaviors in Bung Tsim

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As we saw in the village, there was a lack of information regarding these four topics, so we felt as though we needed to help facilitate the circulation of information with-out imposing too much on a community that already has strong community ties. We also needed to make this intervention fun and en-gaging while keeping it Thai appropriate. What we decided to do was to have a Som Tam (papaya salad) cooking competition; the catch was that the food had to be completely MSG free. Whoever won would get 2000vBaht, second place 1000 Baht, and third place 500Baht. We also came up with a simple and informative handout that was laminated and handed out to all of the audience. This was based off of two large vinyls that we printed and gave to the community center. With the handout, they also received

a small bottle of MSG-free, iodized fish sauce and a small bag of iodized salt. We presented to them our research findings using our sta-tistics so that our information was simple and clear. After we finished presenting, we asked each audience member to fill out an exit sur-vey to see if we met our intervention goals. Overall, we believe that we had a successful intervention and that we were able to learn a lot from our experience. What we walked away with from this, person-ally, is the confidence to include ourselves in a community and make strong ties as well as the confidence

to implement a project like this in any other community. We also learned that education is very important and that even the most basic pieces of information can be the most helpful. In regards to the community and the pro-ject themselves, Bung Tsim was so very helpful and al-though we looked at this problem only here, it seems this project could easily be transferred to any other commu-nity in Thailand.

Savannah Augunas, Beloit College

Jesse Karppinen, College of the Atlantic

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Throughout the last semester, we were encouraged to utilize our public health experience and implement

a health intervention in a village. We chose to focus on stress management within Nong Waeng, which is a slum

community within the Khon Kaen municipality. We chose to address stress because a previous questionnaire we

had implemented concerning health issues within the village revealed that almost 90% of villagers reported that

stress was an issue within the community. As psychology majors, we were interested in providing a means to re-

lieve stress, which would then reduce other mental and physical maladies. Stress is associated with a myriad of

health problems, such as colds, hypertension, ulcers, and overall reduced immune system function.

In order to address stress in the community we first administered an extensive survey that was designed

to get at the causes of stress, the severity of stress, and the coping methods in response to stress that occur within

the Nong Waeng community. We decided to use Cohen’s Perceived Stress Scale (PSS) to measure the level of

stress in the community. We also asked for basic demo-

graphic information and other general questions about

stress. All of the data collected indicated that there was

an elevated level of stress within Nong Waeng. Many

villagers also indicated that exercise and sports might

help make them feel less stressed. With that in mind, we

designed an intervention that brought sports equipment

and hula hoops to the community for a village fun day.

On May 7th we arrived at Nong Waeng with snacks and

the equipment. The villagers were very helpful with set-

ting up the equipment that we brought so that people

Stress in Nong Waeng: A Community Intervention

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could play badminton, volleyball, and takaw (a game similar to

volleyball, but played with a shorter net and the feet instead of

hands). There were over forty participants and overall we saw

the day as a great success. There was plenty of laughter and fun

to be had with the CIEE students interacting with the villagers.

Ultimately the experience was a great way to learn how to design

and carry out a Public Health project.

Hannah During, George Washington University

Virginia Flatlow, Bates College

Ruthie Mesnard, Occidental College

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Council on International Educational Exchange

David Streckfuss - Resident Director dstreckfuss@yahoo.com

Arunee Sriruksa - Assistant Resident Director

aruneee@yahoo.com

Jintana Rattanakhemkorn - Language Director jeabjin@yahoo.com

Lonny Born - Global Health Fellow

ljborn@gmail.com