En route to Katmandu, Nepal, for a medical mission, my nephew and I had to take pause in Bangkok because of civil unrest in Nepal. The trouble began when legislators at the Constituent Assembly started throwing microphones, then chairs and finally desks before disintegrating into a full-on brawl. Several security officers were injured. Opposition leadership then called for a general strike. Piles of tires and several vehicles were set on fire. The army was called in, and police with riot gear were deployed throughout the city. Twice before, I had been in Nepal when this impoverished, failed nation descended into burning chaos. Bangkok, we thought, would offer respite. It certainly did, but Thailand has its own problems that affect the health of the nation.
By sunset on the day we arrived in Bangkok, the prime minister of Thailand, Yingluck Shinawatra, was impeached. She also was indicted for dereliction of duty connected to corruption of a nationwide program intended to subsidize rice for the poor. Her brother, Thaksin Shinawatra, another ex-premier of Thailand, was also deposed for corruption, and, fleeing a two-year jail sentence, currently lives in Dubai. During her term, Yingluck also had been called out for attempting to pass an amnesty bill allegedly designed specifically to benefit her brother.
Already, Thailand had been under a coup d’etat since May, when a group of generals led by Prayuth Chan-ocha overthrew the government. As such, neither the impeachment nor the indictment was a surprise or of immediate impact to the daily life of the average Thai. In fact, Thailand has been subject to 12 military coups beginning in 1932. Since Thaksin Shinawatra began to dominate the political scene in 2001, Thailand has been repeatedly convulsed by demonstrations and rancor between the mostly rural Shinawatra supporters and the more educated, urban population living in and around the capital.
In the near term, Thailand’s most recent coup has been a relatively welcome, stabilizing force. Moving about Bangkok, it would appear to be business as usual. Prospects in the intermediate term are more dim. Since taking power in May, the generals have not been able to resolve blocks on government borrowing, curtailed exports or a restrictive monetary policy. Southeast Asia’s second-largest economy is expected to grow only 0.5 percent this year.
Another important variable is Bhumibol Adulyadej, the 87-year-old king of Thailand, beloved by his people. The world’s longest-serving living monarch, he has survived 10 separate coups since taking the throne in 1946 but today has poor health, living in the hospital much of the time since 2009. Succession concerns abound as the crown prince does not enjoy the reverence people have for the king. The crown prince’s sister, Princess Sirindhorn, is popular, but there has never been a female monarch in Thailand. Concerns abound as to whether the constitutional monarchy will survive beyond the current monarch. Regardless, as long as the king is alive, he will confer a stabilizing influence on the country. But his health remains fragile.
It is not only the king’s health that is fragile. Economic weakness of late could compromise access to health care, particularly among the rural population, which had been a priority during the Shinawatra years. The political will to help ensure a cleaner environment also could wane. In addition, medical tourism, a sector in which Thailand has long led the way, could suffer from perceptions of instability.
Globally, the combination of so many nations suffering political instability combined with growing regions of compromised access to clean air, clear water, safe food and reliable medicine is deeply disturbing. Of course, the dynamic lends itself to tremendous potential for Hawaii to fill an important niche. Still, without regional stability and global collaboration, everyone’s health remains at risk.
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Ira “Kawika” Zunin, M.D., M.P.H., M.B.A., is a practicing physician. He is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
