| 4. In which ways is the initiative creative and innovative?
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The holistic treatment method was conducted under 6 main units in which a special team was set to provide continuing home care services to the victims. In the team, a nurse case manager worked as a coordinator with multidisciplinary experts after complete problem and need assessment. For example, psychiatrists were consulted for those suffering from mental health, depression, anxiety or posttraumatic stress disorder and mental healthcare team would continuously visit them at home. Monitoring system was done by staffs in local healthcare centers who organized the area for nurse practitioners to provide field visits and prepare community volunteers to join the team and to follow up on the progress.
After a year, leaders and the affected groups of 15 families were invited to participate in group activity in order to share their experiences, opinions and challenges in joining the programme. It was found that consolation with treatment and rehabilitation combined with mental care could best recover the victims’ physical and psychological health. Further, medical technology was used in the combined treatment method along with art therapy, aesthetic dialogs, and group therapy. There was no evidence of any patients with anxiety or mental illness after the intervention.
After the activity, a seminar for the victims was held, and the number of participants increased to 54 families. A network of affected citizens was established in Ubon Ratchatani Province for the 1st time in 2009. Also, seminar activities were hosted to exchange the staff working experience with 174 people participating, making Ubon Ratchathani as the 1st province that provides rehabilitation and care service for the victims for the 1st time in Thailand under these 3 strategies:
1. Building up working networks between local and community units with patient-centered approach. There were 6 main organizations from the military, public health, mental health center, local administrative organizations, government units, and the community. These organizations work together by sending staff to assist and support the programme’s activities.
2. Working as teamwork in which a special task team provided services to patients at their homes. Trained Nurse Case Manager (NCM) was also appointed to manage the service planning and request support or assistance from the multidisciplinary team, not only in medical professional, but also social workers as well as experts in specific areas and local volunteering networks to achieve the most efficient physical and mental rehabilitation.
3. Integrating all areas of profession to cover all health problems with holistic approach (physical, psychological, social and soul). The work could be regarded as the integration of health and social services with the support of public and private sectors. Recently, there is a plan to provide prosthetic and orthotic equipments to 140 affected families. Furthermore, there have been non-government organizations and volunteers joining in the home visits to encouraged the victims, making them feel more confident and determined about their positive progress.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The main stakeholders of this program can be divided into 2 groups:
1. Those affected directly from the unrest in the four southern border provinces such as the dead and their families, the disabled, and the injured.
2. Government workers or authorities whose duty was to assist and care the victims and their families. The group consists of 6 main units of military commands under the Royal Thai Army, local public health units, Office of Social Development and Human Security, Office of Social Work for Veterans, hospitals under the Royal Thai Army and the ones in the community, and local administrative organizations. Foundations and private non-profit organizations were also included. Each unit has the duty as follows:
• Local military units under the Royal Thai Army are in charge of rights, welfarecompensation, and rewarding money
• Local public health units support the treatment and rehabilitation including such as physical therapy, wound dressing, changing urinary catheter
• Office of Social Development and Human Security supports additional occupation as well as providing career funds
• Office of Social Work for Veterans is responsible for veterans’ rights and welfare such as career funds, emergency loans, and issuing medical treatment discount card
• Hospitals under the Royal Thai Army or local areas provide treatment, transportation from hospitals to homes as well as in-house services such as medicine and equipment support. They also prepare doctors and combined medical teams to work with local public health units
• Local administrative and community units as well as foundation and private non-profit sectors support daily necessities such as food, beverages, and utensils. They are also responsible for accommodating the in-house environment for the discharged disabled patients from donation for the project though Relieving Coordination Center of Sunprasitthiprasong Hospital.
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| 6. How was the strategy implemented and what resources were mobilized?
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Working resources can be classified in 4 aspects:
1. People – Most of the working staff were local with full knowledge and commitment to their duty. Furthermore, they truly understand the local lifestyle, dialect, religion, tradition, and culture. This understanding facilitated them in building up working networks among units in which the service-receivers are the ones who are concerned of. There were 6 units participating in offering assistance to them: the military; public health sector; mental health centre; local administrative units; government agencies, and the community
2. Budget came from the 2 main sources as follows:
From government agencies – the fund was spent as the government’s aid money for the victims and their families; treatment budget from the Comptroller General’s Department, and other types of budget from the government as indicated in related Acts.
From the Commission in Charge of Relieving the Victims from the Unrest in the Three Southern Border Provinces and Department of Mental Health – the budget was used to elaborate and integrate the performance by increasing the working networks
3. Medical Supplies were supported by Fort Sanprasitthiprasong Hospital such as wound dressing sets, tube-feeding and physical therapy equipments, based on the environment, local resource availability and management to maximize the benefits
4. Management was carried out by the programme’s appointed persons, who were selected exclusively for the task based on their expertise in treatment. These staff or the Nurse Case Managers (NCM) arranged meeting with experts from various professions to identify proper solutions as well as requested any additional assistance from the Provincial Office of Social Development and Human Security for career boost.
These resources were driven by the great support from the subcommittee of relieving the Victims from the Unrest in the Three Southern Border Provinces through Dr. Pechdau Tohmeena, the director of the 15th Mental Health Center, Support and policy of the hospital, effective teamwork, integration and working together with local organizations in all holistic dimensions and strong community and networks.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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The Centre for the Victims’ Rehabilitation has been helping the victims and their families and so far has achieved the goal at 54 families: 30.3% received assistance in physical therapy and rehabilitating supplies; 27.7% was for depression and post-traumatic stress disorder treatment; 40% received compensation money and scholarship for their children while other 9 families of the disabled or dead received funds for career. The satisfaction of the participants of the project was 95%.
A self-help group was established and the group’s members were selected from the victims and their families. Among the 54 families, 12 competent members were chosen to work as volunteers and lecturers to portray their experience, support the programme’s activities as well as playing a part in the mental rehabilitation and home-visit of other victims.
Apart from that, integration of working networks played a part in establishing strong community networks which provided the community and networks to participate in social service activities. It turned the victims, “the lost” into “the sacrificed” which strengthened the victims’ moral support and enabled them to lead their lives in harmony.
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| 8. What were the most successful outputs and why was the initiative effective?
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Fort Sanprasitthiprasong Hospital’s rehabilitation programmes started in 2009 in which the 15th Mental Health Center co-worked with the hospital, Ubon Ratchathani Provincial Health Office, Prasimahaphodi Psychiatric Hospital, and 7th Mental Health Center. A meeting to appoint the guidelines for the affected government workers and the victims who are the native of Ubon Ratchathani Province after being sent back home was made and the process for evaluation and follow-up on these patients is sequenced as follows:
1) Patients’ are transported from the Southern Border Provinces Administrative Centre to their hometown and a system to follow up on their progress. Patients’ are information transfer from the Southern Border Provinces Administrative Centre to their hometown and follow-up system on their progress.
2) The Rehabilitation Centers outside the 3 southern border provinces area check the patients’ status, rights and welfare, and address once they are back from their duties in the South. It will also carry out physical and mental assessment in order to apply in a rehabilitation plan with the multidisciplinary teams.
3) Six concerned units will then be contacted for information and assistance.
4) The home visits to follow-up the victims and their families to heal and evaluate physical and mental health problems such as Post Traumatic Stress Disorders. The home visiting team also coordinated support in various aspects such as right and welfare, scholarship, career training, and other social works.
5) The effort resulted in setting up the network “Self-Help group” for the victims so that they can be encouraged to take care of themselves and join in group therapy, seminars. They and their families can also share experiences with concerned organizations.
Such performance is the public integrated service among every concerned party in the area. The provided services included all aspects of one’s life and the society.
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| 9. What were the main obstacles encountered and how were they overcome?
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According to the data from the Rehabilitation Centre for the 4 Southern Border Provinces, 13,007 victims’ hometown were not in the vicinity of the southern border provinces, and only 378 people or 2.9% were compensated. The Other 97% of police, military, and their families as well as citizens were not treated properly yet. Fort Sanpasitthiprasong Hospital then presented its method as the model for the victims’ rehabilitation by appointing it as national agenda. The objectives for government’s assistance are based on Maslow’s theory of support in psychological needs; safety needs; social needs via the Self-Help group; esteem needs, and the victims’ ability to manage their lives and families as well as elaborating their experience to help other victims during their transition. The main obstacles for the victims and families were the inconvenient system for the requests of compensation, right and welfare. They had to contact many places to complete all requests. Therefore, the hospital recommended the solution to the subcommittee of Relieving the Victims from the Unrest in the Three Southern Border Provinces to have coordinators that the affected people can contact or ask for assistance as one-stop service. This should be set as the national agenda to establish networks of the affected people to cover all 77 provinces of Thailand.
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