The Integrated and Humanized Healing Program for People Affected From the Unrest in Thailand
Fort Sunprasitthiprasong Hospital ,Royal Thai Army

A. Problem Analysis

 1. What was the problem before the implementation of the initiative?
Thailand is among the world’s top ten countries that are prone to or affected by global terrorism. According to the Institute for Economics and Peace’s Global Terrorism Index in 2012, it was ranked at no.8. Such index is the consequences of the ongoing unrest in the three southern border provinces. The situation has been changing constantly with increasing severity: civil servants in the area as well as children, women, and innocent citizens are injured. This heavily affects the nation’s economic, political, administrative, and socio-psychological aspects in both direct and indirect ways. According to the data from the Deep South Watch 2012, there were 11,542 incidents during January 2004 – February 2012 in which 5,086 people were killed, 8,485 were injured, meaning that 13,571 were severely affected by the incidents, regardless other aspects of loss and negative impacts on their families.. Based on the 2004 – 2012 data from the project for helping and restoring orphans and widows in the 4 southern border provinces under the Ministry of Social Development and Human Security, the ongoing violence caused 4,883 children to be orphaned, 94.43% were without fathers, while 2,480 women fell to widowhood. The government had to compensate for such damage at a very high cost: 2,032 million baht was spent during 2005 – 2012 as consolation money for 12,285 affected people. 6,873 citizens were separated as 2,662 dead; 3,913 injured; 298 disabled. While out of 5,415 state authorities, 1,562 were dead, 3,705 were injured, and 145 were disabled. Moving on to the economic aspect, properties, vehicles, agricultural products, and state properties were burnt down. Having to carry on the solution, the government spent the budget of approximately 599 million baht to assist 4,144 victims during 2004 – 2012 and 1550 million baht for more than 629 victims in 2013.

B. Strategic Approach

 2. What was the solution?
Since the end of 2003 until the present, state authorities and citizens who worked in the southern border provinces were ambushed and injured, killed, or disabled. They were all affected physically and mentally and cannot manage their lives as usual. This results in economic and social difficulties since they were not originally from the local areas and once they were injured, they would be sent back to their hometown right away, making them lack the constant treatment. The home visits to 103 affected citizens and families whose hometown is in Ubon Ratchatani Province pointed out that the patients suffer from both physical and mental health and show an increasing signs of negative behaviors such as smoking, drinking alcohol and violence. The survey also shows that 30.3% struggle with health issues and suffers from chronic illness or disability; 27.7% suffer from mental health problem and 42% have to fight for welfare compensation. Based on the Case Manager method, Fort Sanprasitthiprasong or Kai Sanprasitthiprasong (KPS) Hospital under cooperation with Department of Mental Health, Ministry of Public Health then analyzed the data to set up guidelines for the holistic rehabilitation services with patient-centered approach. Home visits offering treatment and rehabilitation have been made. Connection with public and private sectors has also been established to support the parents’ access to rights and benefits with the Sub-Committee for the Rehabilitation Project as the advisor. The aim of the project is to help the victims and their families to have better quality of live and be able to live their lives in harmony. It was started in 2009 with military personnel affected by the unrest in the three southern border provinces as the first target group. The Home Health Care Nursing Team was in charge of the survey and data collection from the affected ones in the area. The data were later be elaborated into the guidelines to provide care using case management approach. Nurse case managers were required to work closely together with doctors or psychiatrists for proper transfer, physical therapy and treatment by using home care method. The team’s main purpose is bringing on the holistic combination of treatment and mental care as well as integrating public and local sectors such as additional occupation and budget assistance, rights and benefits in order to improve their quality of life. The staffs were trained by undergoing community psychological training as a means to support the number of operating staffs for the home visits. This was combined with community networks, villages’ public health volunteers to offer the most extensive service to the affected people, in which some of them were selected to be assisting volunteers. At the moment, there are 12 volunteers working with 174 trained government staff to achieve the project’s purposes which now have been extended to cover 54 affected families.

 3. How did the initiative solve the problem and improve people’s lives?
Before, the victims did not receive continuous care and had to file request forms asking for their rights and benefits by themselves. FHS Model’s idea of establishing the rehabilitation centre is based on the victims’ needs and tackle their difficulties. They do not need to travel to the hospital to receive the treatment since the multidisciplinary team is now delivering services to their doors. Nurse case manager is a key person who assessed their problems and needs of the as well as cooperating with related sectors before organizing the home visits. With the project, many patients could better help themselves, and perform their daily activities, contributing to greater quality of life, physical and mental health and motivation to deal with pain or any problems they were facing. Apart from healthcare, additional services such as an occupational support fund is also provided for the disable people with support from the Office of Social Development and Human Security to improve all dimensions of quality of life and return their normal life to society as much as possible.

C. Execution and Implementation

 4. In which ways is the initiative creative and innovative?
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.

 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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.
 6. How was the strategy implemented and what resources were mobilized?
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.

 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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.

 8. What were the most successful outputs and why was the initiative effective?
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.

 9. What were the main obstacles encountered and how were they overcome?
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.

D. Impact and Sustainability

 10. What were the key benefits resulting from this initiative?
The Centre for the Victims’ Rehabilitation has been helping the victims and their families and so far achieved the goal at 54 families: 30.3% obtained assistance in physical therapy and rehabilitating supplies; 27.7% was for depression and post-traumatic stress disorder treatment; 40% receives compensation money and scholarship for children, while other 9 families received funds for career. Use of self-help group, holistic approach and cooperation among all stakeholders made FSH model highly accepted at national level as effective means to recover these people from physical and mental problems, leading to better quality of life and well-being. Right now there are 54 families in the group and 12 members with ability are chosen to work as volunteers and lecturers to portray their experiences, support the programme’s activities as well as playing a part in the mental rehabilitation and home-visit of other victims. The network in charge of the victims is collaboration between Six main units which are from the military; the public health; mental health center; local administrative units; public units, and the community. 174 network members work together to provide assistance from these concerned authorities with the sub-committee and the FSH Hospital as coordinator. Recently, the Royal Thai Army Medical Department has implemented the model in 37 hospitals under its command nationwide while aiming to set such a method as a standard for developing its hospitals’ emergency care preparedness. From Kamol Kamoltrakul’s qualitative research in title Building Peace in the Three Southern Border Provinces from the Eyes of the Affected People, the report shows that the violence was the result of economic and drugs problems, lack of infrastructure and public health care as well as lack of education opportunities. The local people have to put up with the daily hardships, and thus their dissatisfaction pushes them to join with violent insurgents. The research also indicates that the FSH Hospital’s model for treating the victims can be adapted in the problematic southern provinces and others areas that might be affected. It can also be implemented in different contexts such as natural disasters. Southern Border Provinces Administrative Centre in cooperation with the Department of Mental Health adapted the consoling method in a broader context in support of the Royal Thai Government’s peace policy. Operational seminars were held among concerned organizations and the conclusion of establishing the Rehabilitation Centre under the guideline of the affected people living outside the southern border provinces called “Fort Sunprasitthiprasong Hospital Model of Violence-related Injury Surveillance Center (FSH Model)” in 77 provinces nationwide was reached. The undertaken action aimed to restore and develop the victims and families’ quality of life, and, at the same time, boosted the citizens’ moral support that the government always equally stands by and pays a great deal of attention to everyone (humanized health care)

 11. Did the initiative improve integrity and/or accountability in public service? (If applicable)
For the case management-method for the treatment and rehabilitation for the victims of the violence in the south, it is customer-centered and provides visits at home. With this, complicated problems can be effectively solved and everyone can receive the treatment and does not have to wait long for service, and can save cost and time in traveling. This can also facilitate the process in receiving services as described in the following details. • Treatment and rehabilitation at home When the affected patients are discharged from the hospital and need rehabilitation or any treatment at home. Nurse case manager will assess the patients and manage to deliver service at the patients’ doors. They do not have to bother traveling to the hospitals. Furthermore, if they need any additional assistance or equipment, the nurse case manager who acts as coordinator will work with concerned organizations in achieving the patients’ needs. • Career-building project for the victims Before initiating the program, these people had to ask for help by themselves from the Provincial Office of Social Development and Human Security and it took approximately 1-3 months for the whole process. With this program, nurse care managers assessed needs for career assistance of all affected people asking for help and collected all requests and directly coordinated with the office for them. The staffs from the office then responded to the needs and provided career support in the whole process. Complete one-stop service career support activities have been arranged including career related seminars, career consultation, document preparation for job applicants, document submission and follow-up on the results in which the victims do not have to travel on their own and still get the chance to exchange ideas with their friendship networks. Currently the unrest in the three southern border provinces seems to be escalating. Thus, the numbers of victims who are either government workers or citizens will surely increase. FSH Model is only the model hospital of the Royal Thai Army with the idea to follow up on the rehabilitation of the affected ones. If such method could be considered in a broader context rather than military personnel and their families, it should, and could serve as a working method at the national level to cover all affected people throughout the country by integrated power and work of all relevant ministries. The rehabilitation method based on the FSH model is also adaptable in countries that have suffered from civil conflicts or man-made violence so that the underprivileged could have a better quality of life while the government could earn a higher trust from its people.

 12. Were special measures put in place to ensure that the initiative benefits women and girls and improves the situation of the poorest and most vulnerable? (If applicable)
The survey taken from the victims pointed out that, after being discharged from hospitals and returning to their hometowns, many lived in impoverished or far areas and might not be able to follow up on the treatment and rehabilitation conveniently. Some did not receive enough financial assistance to keep up with the treatment while some of the medical equipments could not be reimbursed either. The suffered victims then feel like they are being abandoned, resulting in mood swings, anxiety, and violence. The coordination among concerned organizations will be a great solution in order to deliver all the necessary services to every village and community. Reliable plans, guidelines, and a framework must also be set as well as adding the role of psychiatrists or counselors in the provincial public health offices to answer the victims’ needs in every way. The rehabilitation programme for the victims of violence in the three southern border provinces is regarded as new innovation in taking care of patients suffering from man-made violent situation that affects directly and indirectly. The programme aims to heal the patients in every dimension from psychical, mental, economic, and social aspects. The government used to pay attention only on the financial aspect that it forgot to look through the victims’ emotional needs. Based on seminar and group activities carried out with 54 affected families, they all felt the need to be healed mentally and to have their faith and confidence restored. Constant attention and care from the authority will warm their hearts and make them feel better than providing aid money and losing all touch. Every of them agree with the idea of setting up a coordination center for healing the victims in every province and implementing the method of case management by nurse case managers. Setting up a rehabilitation centre is then another solution and could serve as public service sector within the framework of peace Act and strategies. It alleviates the citizens’ hardship as well as giving moral support to government workers who have to work in the conflict areas. This method will reflect the nation’s true commitment in taking care of its citizens and, at the same time, boosting the people’s trust in the government. We hopefully expect that this project may play important role to return peace for people in the three southern border provinces of Thailand when they perceive that they are equally cared for and paid attention to. Further, FSH Model can be applied for those affected from similar violent events throughout the world under the key concept that affected ones need to be assessed and managed with holistic approach and long-term continuing care. Integrating power and working together among all stakeholders are keys to success of the program in order to replace the sense of being cared to sense of loss and fear and bring back their happiness and truly maximize their quality of life.

Contact Information

Institution Name:   Fort Sunprasitthiprasong Hospital ,Royal Thai Army
Institution Type:   Government Department  
Contact Person:   Major Pechnapa Puchcharanapaponthorn
Title:   Cooperation  
Telephone/ Fax:   + (66) 45321173-5/ + (66) 45322654
Institution's / Project's Website:  
Address:   383 Warin- Phibun Mangsahan Road , Saen Suk
Postal Code:   34190
City:   Warin Chamrap
State/Province:   Ubon Ratchatani

          Go Back

Print friendly Page