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Arch Dis Child. 2007 May; 92(5): 467.
PMCID: PMC2083744

The edge: living and working on the Thai–Burmese border

It all started with an email; well I guess that is not necessarily true! It all began with a love affair starting 6 years ago. During my senior house‐officer years, I took some time to work abroad, I spent some time working and some travelling. It is often said that you fall in love either with Africa or with South East Asia—Africa never had a chance. After a couple of months in Thailand, I was determined to find a way to go back and work there. During the next 6 years, I obtained membership and started specialist registrar training. In my 5th year my deanery granted me an out‐of‐programme experience. And then the question came up: how does one find employment for a paediatric registrar in Thailand? Hence the email.

I am now a research paediatrician employed by Oxford University, based in Mae Sot, Thailand. Mae Sot is a small (but perfectly formed) town located 5 km from the Thai–Burmese border. I am about to undertake a research project, looking at acute respiratory infections in Karen infants living on the Thai–Burmese border. The majority of this work is based at the Maela refugee camp, located 60 km from Mae Sot. The camp houses about 50 000 refugees, many of whom are from the Karen ethnic group. The Karen people call their homeland Burma and not Myanmar, so I will follow their example.

The Karen are the second largest ethnic group in Burma. The Karen state is located in eastern lower Burma, along the Thai border. The Karen National Union was established in February 1947. After the British Government granted independence to Burma in 1948, the Burmese government declined requests from the ethnic groups for autonomy. In the 1970s the Burmese government introduced the four‐cuts programme, which was an attempt to cut off food, information, recruits and financial support to the armed ethnic opposition groups. This policy, which is still in effect today, mostly affected villagers, as a deterrent for supporting insurgent groups. Villagers have had numerous human rights violations perpetrated against them.

The first Karen refugees fled to Thailand after a massive offensive between the Burmese army and the Karen National Union in 1984. Currently, the Karen refugees make up 65% of the registered refugee population. It has been reported that over 77 000 Karen people have been registered as refugees in the camps. Meanwhile, around 15 000 have not been registered.

I am working with the Shoklo Malaria Research Unit which, in addition to undertaking cutting edge malaria research, provides antenatal care for all women in the camp, roughly 1000 deliveries a year. It is this population that I will be enrolling into my study. The Shoklo Malaria Research Unit has an inpatient and outpatient facility for adults with malaria, and an antenatal and delivery area in the camp. Currently, they do not provide general medical care for children.

So now I am working in Thailand, I have my research question and population. All I need now is somewhere to see all the unwell children who will present once the study starts, and yes, I need to train some staff to see these children—let the challenge begin!


Competing interests: None.

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