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ASEAN Training Centre for

Primary Health Care Development Mahidol University at Salaya


conducted in conjunction with the international training programme on


at the
ASEAN Training Centre for Primary Health C-are Development Mahidol Universtty at Salaya

3 September 1986

Published by:
ASEAN Training Centre
Car Deryeloprnent

for Primary Health Mahidol Unircrsi$ d Salaya

Thailand 1987

Directing Editor
Krasae Chanawongse,

M.D., D.T.P.H., Dr.P.H.

Melanie Sovine, Ph.D.

Technical Editor
Stephen King, M.Med.Sci.

by Dr. Krasae Chanawongse

Executive Summary
by Dr.Melanie Sovine

Opening Address
by Professor Natth Bhamarapravati

"The Concept of Development in lslam"

Introductory Remarks by Dr.U Kyaw Than, Moderator "The Concept of Development in Moslem Communities: A case Study of Indonesian Experiences" by Dr.Adnan Mahmoed "lslam and.National Development in Southern Thailand" by Dr.Surin Pitsuwan
LECTLIRE:,,The Role of the Monarchy in the lmprovement of Socio-Economic Conditions of


the Thai Muslim Community in southern Thailand" by H.E.General Harn Leenanond Minister of Agriculture and Cooperatives



Health Care Problems in Thailand and lndonesia"

Introductory Remarks 21 by Prof.Noboru lwamura, Moderator Health Care Problems in Southern Thailand" "Primary 22 by Dr.Traivit Taymathiwongse Health Care Development in Indonesia as a Moslem Maiority Country" "Primary 24 by Dr.Adnan Mahmoed Community DeveLECTIJRE: ',Cooperative Efforts among the Muslims and the Buddhists in lopment" 28 by Dr. Pann Yuanlate and Dr. Chavewan Wannaprasert

coNCLUDING REMARKS: "National Social Development:
Disenchantment, and Social Unrest"
Fear of

cultural loss 36

by Dr.Melanie




Krasae Chanawongse,

M.D., Dr. P.H. Director, ATC/PHC

ASEAN Training Centrefor Primary Heatth Care Development, a joint proiect between Mahidol University and the Ministry of Public Health, Thsiland, welcomes and is olways willing to sponsor international collaboration on issues related to primary health core development. This Conference on Islsm and National Development provides an opportltnity for an exchange of ideas between Thai and Indonesian professionals, taking advantage of the Indonesians' three-month residency at ATC/PHC for a training progrom on 'Planning and Manogement for Healt h and Development.' The Rector of Mahidol University, Professor (Dr.) Natth Bhamarapravati, personally suggested the topic for this meeting as a means to consider the important relationship between religion and development. We will be looking at similar issues about the cultural factors that affect our nations' development in the future. Thailand recognizes the importance of spiritual development in general social development and ATC/PHC is happy to sponsor a conference that further highlights the role of religious traditions and leaders in successful primary health care development. We are especially fortunate to hear the experiences and share in the expertise of the Indonesians who are all primary health care professionals in a predominantly Muslim country. Further, the Conference is enhanced by experienced Thai health care workers and government officials who work within the Muslim regions of Southern Thailand.
On behal,f of the ATC/PHC, I trust the results of this Conference witl be beneficial to and effectively supportive of the primary heatth care activities in Thailond and Indonesia. I would like to thank His Excellency General Harn Leenanond, Professor Noboru lwornuro, provincial officers and other government officials, guest lecturers, panelists, and conference participants who have greatly contributed to the success of this seminur.

Executive Summary
Melanie L. Sovine, Ph.D.
With thirty Indonesian health care professionals in residence at the ASEAN Training Centre for training in Primary Health Care Management and Leadership, a special conference was held on Islam and National Development. The conference provided a forum of exchange for Thai and Indonesian health care professionals, government officials, and university faculty on a mutually experienced topic: the development of primary health care among predominantly Muslim populations. Specific issues addressed include the relationship of Muslim beliefs to health, employment and education, community participation, and to leadership development in Muslim communities. While obstacles to development were not denied, the conference purposely highlighted the positive contributions that religious traditions make to a people's general well-being and the potentials for continued successful primary health care development in Muslim regions. The conference began with an Opening Address by Professor (Dr.) Natth Bhamarapravati, Rector of Mahidol University. Dr. Natth described Islam as one of the World's great religions that has contributed to World civilizations. He suggested we look deep into Islam, into its history and religious traditions, to understand the scientific reasons behind the many beliefs related to health and well-being. Dr. Krasae Chanawongse, Director of ATCIPHC, followed by welcoming all participants to the ASEAN Training Centre and said the conference supported a main principle of ATC: to "help people learn and teach among themselves, where everyone is learning and everyone is teaching." The first panel, moderated by Dr. U. Kyaw Than, a Burmese Visiting Scholar with the Social Science Faculty, Mahidol University, focused on "The Concept of Development in Islam." Because "development is the preoccupation of our times," Dr. Than encouraged the use of native models for development, with indigenous goals, and a turning to Thailand's own national resources to implement these models. Among these resources are Thailand's cultural heritage and religious traditions, he explained, and development plans must be linked to this heritage. Dr. Adnan Mahmoed, the Indonesian group leader and a panel participant, presented a case study of planned social change that is consistent with the Islamic Concept of Life. He emphasized the importance of integrating community spiritual leaders in community development plans. Dr. Surin Pitsuwan, a Thai Muslim and a recently elected member of the Parliament now serving as the Secretary of'the National Assembly, described the Muslim religion as often too fatalistic, emphasizing the "other-wordly" side of religion. Dr. Surin encouraged achieving a balance between secular life and spiritual life, a balance he believes will result in an improved Quality of Life for Thai Muslims in the South. He directly addressed the problem of incorporating secular education into Muslim religious education so that Thai Muslims could gain employment and achieve a higher level of social development and satisfaction.

After the morning break, General Harn Leenanond, recently elected Member of Parliament and Minister of Agriculture and Cooperatives, presented a lecture, "The Role of the Monarchy in the Improvement of the Socio-Economic Condition of the Thai Muslim Community in Southern Thailand." General Harn's lecture emphasized the care of His Majesty the King for the suffering of all Thai people, making no difference according to ethnicity or religion in providing for the Thai people. General Harn also described the numerous on-going Royal Initiative Projects for the benefit of Thais in the South. The afternoon session began with a panel, "Primary Health Care Problems in Thailand and Indonesia" moderated by Dr. Noboro Iwamura, Japanese Team Leader at ATC/PHC. Dr. Iwamura noted the many nationalities attending the conference and welcomed everyone's contribution of ideas on primary health care development. He introduced Dr. Adnan, noting his work as a Director of Nursing, and acknowledged the significant role of nurses on the "frontier of primary health care activity." Dr. Adnan presented a review of primary health care problems in Indonesia, emphasizing the difficulty of implementing intersectoral collaboration and other primary health care concepts in social development. He encouraged again drawing upon the native spiritual leaders in the communities to facilitate collaboration among the people, officials, and primary health care workers. Dr. Traivit Taymahiwongse, Provincial Chief Public Health Officer of Pattani Province, presented a review of primary health care problems in Pattani Province in southern Thailand. Dr. Traivit underscored problems in language and communication, illiteracy, poverty and poor health status as areas of primary concern in the province. He discouraged "blaming the people" because they are Muslim and encouraged the consideration of socio-economic conditions, for example, successful access to resources such as an education resulting in employment, as underlying problems in the development of Thai Muslim regions. As a final presentation, Dr. Pann Yuanlate, Deputy Rector of Prince of Songkhla University, and Mrs. Chavewan Wannaprasert, Professor at Prince of Songkhla University, gave a joint lecture on "Cooperative Efforts Among the Muslims and the Buddhists in Community Development." Both lectures emphasized successes through appropriately linking Islamic concepts with development concepts. Mrs. Chavewan spoke specifically about Family Planning issues and described the importance of renaming these efforts "Population Education" for successful implementation. Dr. Adnan Mahmoed, the Indonesian group leader, closed the conference day by underscoring again the importance of a balanced spiritual and social development for people of all regions. The publication of the Conference Proceedings is intended to provide a summary review of the conference for wider distribution. It also provides contact names of Thai and Indonesian professionals for further collaboration among those who continue to work in this area. The panel presentations and guest lectures are published here in abstract format, every attempt having been made to preserve the presenter's main thesis. The afternoon discussions are also abstracted hoping to provide the reader with a more complete sense of the dynamics of the conference.

Opening Address
By Prof. Dr. Notth Bhamarapravati
Rector, Mahidol University

It is my pleasure to open the Conference on Islam and National Development by welcoming all distinguished guests and participants. Mahidol University is privilieged to have the Indonesian health care professionals visiting Thailand. We welcome them as experts with experience in managing primary health care development for the predominantly Muslim population of Indonesia. It is unusual to have thirty Indonesians for three months in Thailand and we are pleased to make use of this opportunity through this special conference. Islam is one of the World's great religions and it has contributed to the building of great world civilizations and empires. We should look deeply into

Islam, therefore, to learn its secrets. We should examine the historical past and the traditions of Islam to learn of its success. We must not interpret religious beliefs as taboos against health development. There are reasons behind religious health beliefs and if we accept them positively, we can use religious traditions to facilitate primary health care development.

Mahidol University is pleased to sponsor this Conference in cooperation with ATC/PHC. The University has a responsibility to involve itself visibly with the issues that concern this nation and its people, and Mahidol University and ATC/PHC are committed to resolving the same through international cooperation throughout the ASEAN region. The presentations and discussions on Islam and development certainly will benefit our mutual commitments to Primary Health
Care development.

Morning Sessions
PANEL: "The Concept of Development in Islam"
IntroductorY Remarks by Dr. U Kyaw Than, Moderator ,The Concept of Development in Moslem Communities: A Case Study of
Indonesian ExPeriences' by Dr. Adnan Mahmoed

'Islam and National Development in Southern Thailand' by Dr. Surin Pitsuwan

LECTURE: The Role of the Monarchy in the Improvement of Socio-Economic Conditions of the Thai Muslim Community in Southern Thailand" by H.E. General Harn Leenanond Minister of Agriculture and Cooperatives

Introductory Remarks

Dr. U. Kyaw Than, Moderator

I am very happy to be part of this morning's proceedings and I will try to contribute initial thoughts on the theme "Islam and National Development." Development is the preoccupation of our times, certainly of the countries of Southeast Asia. Very often we would identify ourselves with our developing goals and plans as being members of the developing nations. Formerly, our national
development plans have been very much influenced by the models which are Western, those coming from the industrialized nations. But more and more as we have gone

through stages of executing our own development plans, we realize that we have to use our own models. We have to think in terms of indigenous goals for the development process. The more we talk about our own indigenous goals, the more it becomes necessary for us to turn to our own national resources. When we speak of the heritage of our own community and our history as a nation. Therefbre, I think it's very relevant this morning that we try to link the concept of national development with the teachings of Islam, experiences of the Muslim nations, and the relationship between the goals of national development and the teachings of the heritage that we have in our own lands. It is not irrelevant to say that if we speak in terms of the theistic traditions of our own lands, and especially when we think of Islam, somehow in the purpose of God, in His providence, we find one of the important national resources for development, viz. oil, as the resource with which many Muslim nations are blessed. In the region often referred to as 'Middle East', the Gulf States, Indonesia and the rest of the OPEC (Oil Producing and Exporting Countries), this important resource, on which the nations of the world depend for energy, is found. And most of these nations have predominantly Muslim populations. Economic assistance that is or could be given out of the proceeds of the sale of oil by these countries to other nations has great development significance. What is the relationship, for example, between having this particular kind of resource 4nd the responsibility of the nation with a predominantly Muslim population within and beyond its own borders? Is there a particular purpose? I think these can be the kinds of thoughts that come up in our minds when we think of Islam and national development. I think it's quite legitimate also for those who are not necessarily Muslim to expect some kind of reflection from the countries with predominantly Muslim populations as to how this can be interpreted, how what Providence had given can be used for the development of the regions, the development of the neighbors, and the World as a whole. Such reflections will require us, not only to look at the teachings in Islam for traditional religious purposes, but also for understanding the implications of possessing such an important resource whicl^ is "c significant for all the nations in the contemporary world.

The Concept of Development in Moslem Communities:

A Case Study of Indonesian Experiences

By Dr. Adnan Mohmoed
This morning, I am very happy to deliver thoughts about the concepts of development in the Muslim community in Indonesia. This will bring us to a starting point of thinking about development, especially with people in the Muslim community. Actually, when we work in the developing countries, and as we take more life in the community, we find still some people are reluctant to accept development activities. If you also find this experience, then it must be something to explain, something we have to examine. So I would like to show you how in Indonesia we try to make the people happier to change and willing to know prosperity in the Muslim community and religion. I would like to deliver a case stpdy from Indonesia and experiences that I experienced in my job as a field-worker in the health department program. I think the best thing to examine first is the Concept of Life in the Muslim community. We can see from this diagram (see figure 1) their way of life is the complete submission to Allah, the only one God, the creator of Man and the whole Universe. A Muslim who has real faith in Allah makes every aspect of his life subservient to the will of Allah, and all efforts of a Muslim in daily life are along this belief. Their goal in this world is to find and possess the blessing of God, and to find a life based on all good, free from evil. So this is the basic concept. I do realize that we could find many basic concepts. I only raise this one in relation to this morning. From this point of view we can see that the community, in seeking the life, the better life, becomes a kind of "Community of Believers" (see figure 2). The Muslim community as a Community of Believers is existing, I think, everywhere in the world as a spriritual community. The value of the spirit of togetherness among each member of the community, the dream of effective communication among them, is the responsihility of the community. Other cultural values could be accepted in the life of the Muslim community if they are not against the religious belief. Their attitudes, values, and ways of thinking are influenced by the Moslem leaders. With this concept of life, that form day to day they are directed to the good way, there must be someone that can show them the very good way. There must be a leader, and the leaders in this case we call the "spiritual leaders."
The community feeling actually is based on the degree of faith and believing. Sometimes with a certain degree of believing we can find what we call a "hard core community." They ore making the horizon very narow and they come refusing or reluctont to accept anything. From the hardcore sometimes develops what we call "fanaticism. From fanaticism we can find a kind of deviation, a little sidegroup inside the community occurs as a reaction to development. In reference to the possibility of fanaticism, I want to focus of the role of the spiritual leaders in the community.


Figure 1

The Islamic Concept of Life

The attitude of complete submission to Allah, the only one God, the Creator of Man and the whole universe

A Moslem, who has real faith in Allah, makes every aspect

of his life




The 'Iman' is the act of reposing

Will of Allah

faith in Allah


It stipulates for a man a system

of life which is basd on all good and is free from cvil

All effort of a Muslim

and possess the Blessing


to find of Allah

God or Allah has revealed to human nature the consciousness and cognition of Good and Evil


Figure 2: Community of Believers

Existed as spiritual communitY

Spirit of togetherness brings

effective communication among them

Unity and cohesiveness of its

members based



beliefs as basic values

Moslem Community CommunitY of Believers

Their attitude and way of thinking influenced by their leaders

Other cultural values could be accepted if not against religious beliefs

Community feeling based on degree of believing


hard core





Muslim communities are very dependent on their spiritual leaders. In o.rrtt country if the leaders say "black", everybody says "black". If the leader says, "white", the community says "white". There is an acceptance of national leaders of the government, but the government leader should be accepted also by the spiritual leaders. There's no acceptance without the confirmation of the spiritual leaders. If innovation or change happens in our country, it happens by confirmation from the spiritual leaders.
So considering the role of the spiritual leaders I present here the "two-srep flow of communication" (see figure 3). Whenever we would like to change the community attitudes for development, whenever we have a new idea for those communities, it is very difficult if we go directly to the community. They are going to be reluctant. If the people from the outside come to the community directly, the leaders feel that "someone is coming here to take my my community, so I have to refuse that." The best way, if there's a new idea or interest, is to approach the spiritual leaders first. And if there is confirmation we go together to the community. It will be acceptable because the leaders have legitimacy and authority to say what is right and wrong. So when people come unconfirmed by the leaders into the community, the leaders will say, "It is wrong and do not accept it. "

Figure 3: The Two-Step Flow of Communication

itual/ community leaders :



The leaders have the legitimacy and authority to say what is right and what is wrong

Community members

to do something, based on sin,/ reward consideration, in the name of God


From this point we can go further to inform you of the kind of leaders in Indonesia. The first ones, the "pure spiritual leaders" in Indonesia, the ulama, Now are active in using the mosque in the development of communities, in changing people's lives and giving them direction for the best life in this world. The ulama also have some activities in the schools and in the pesantren. The second This ones are the community organization leaders in the Muslim social movement. fr,rf"rfi- leader is active in private organizations and in the Muslim political party. This kind of leader was very influential before the 1970's. But according to the development of the political situation, these leaders are still holding a Muslim political party but not a strong one. There are the "intellectual Muslim leaders", the very energetic leaders from the University who are politically unaffiliated. They are using mass media to create opinions of things in the way of life. The bureaucrat with a government position sometimes also acts as a Muslim leader in the community. However, there are only two types of leaders most important in the influence of the community's acceptance of new ideas, the pure spiritual leader and now the intellectual Muslim leader. To approach the Muslim community in Indonesia for development, the first step is approaching the spiritual leaders using the strategies of the two- step flow of communication. We try to select the most prominent influential leaders of the community. From this step we are going down to convince the people of the new idea and program. This idea and program must have a clear linkage between the benefit to the believers and the community leaders. With the leaders communicating the message, we hope there is acceptance of the new idea. That is why the modest way of approaching the community with the recomendation of the spiritual leaders, utilizing the existing mosque or the religious meeting, is the best way to deliver the messages.
The role of the mosque as the center of spiritual and community development should be utilized but when doing so, we need a strategy for balancing between spiritual and formal leaders because the formal leaders from the government also have something to say. The messages delivered by the community committee, of course, have to be continually monitored for remorse. In our country they use the mechanism of remorse to reject any kind of new idea. The remorse is spread among the community and everyone coming from outside they shut out, closing the door. There is a kind of reluctancy to accept something or to refuse something because of prejudices to any foreigner bringing new ideas against their beliefs. They are thinking about their belief, their Concept of Life, the failure of the believers, the Muslim failure. They are afraid ideas coming from outside are going to ruin their beliefs, so they refuse. Also, taking the case of Thailand, maybe there is a kind of psychology of the minority, a great strong suspicion that goes "I om a minority." It is different of course in Indonesia because we are the majority. But this is the kind of thing, maybe we can examine for the whole day of this conference.



ll ; ,[

il*i i

Islam and National Development in southern Thailand

By Dr. Surin Pitsuwan
I very much appreciate this opportunity to come before you and talk from the propective of a young politician working for the development of Muslim communities in Southern Thailand. I have been listening with great interest to Dr. Adnan, about the structure of leadership and the strategies that development workers should use in approaching the Muslim community. Just to elaborate Dr. Adnan's points, I am in a very precarious and special situation because my father was the chairman of an Islamic community in Southern Thailand. My grandfather and my great grandfather were all "Ljlama." I am the first generation who broke the tradition. So when teaching at Thammasat University, and trying to work with the government to bring new ideas into the community, ideas of reasoning, ideas of rationality, ideas of modernity, ideas of accepting secular education along with religious education, I have, along with my colleagues, been faced with tremendous opposition, reluctance and rumors. I think as a community, Muslim leaders and scholars, have emphasized the "Otherjwordly" side of religion, forgetting that the Prophet himself had admonished His disciples to "work as hard as if you will live forever and as hard as if you will die tomorrow." The morality of Islam is balanced. It is not a total emphasis on fatalism, on the other-world. It also puts emphasis on this World, on good life, on quality of life, on all the good things the World has to offer.


I remember very well a phrase in the introduction to Unity.' "human beings are not like animals to be led by the nose." But in the past, we have relinquished our ownership of reason, our participation in reasoning to the Ulama. We have abdicated ourselves from the responsibility of reasoning for every action that we take. We thought that only submitting to the words of Ulama has moral quality, forgetting that acting itself has a moral dimension, the exercise of our reasoning based on our understanding of God's will. That's the mistake of the past.
How about the Ulama? They also need confirmation from us. This is an idea for discussion, for compromise, trying to find out the best way to solve a problem, for consultation, to achieve a consensus of the community. Ayatullah Khomeini rejected everything that all other great leaders have done since the Prophet, and said "Let us return to the pristine concepts, everything sure, everything clear, everything fundamentalist, everything very much as it was in the beginning." This is directly contradictory to the idea of a just balance. I am sure you can remember this phrase and verse, "We have created you as a community, just and balanced, so that you can serve as a witness to all nations, to all mankind." Whatever happened to that? Whatever happened to that idea of a just balance, compromising, compassionate, understanding, open, ready to accept new things if they are not totally contradictory to our faith? Difficulties and conflicts and commotions that occur in our societies are not based on the fundamental issues of the religion, not on the question of God, not on the question of Muhhammed as the Prophet of God, not on the question of the 15 principles of Islam, but on very small points that each community or their religious leaders, Ulamas, take up on themselves, they having the absolute power to make pronouncements on that issue and the unreasoning mass or unreasoning community tending to accept.


How to introduce this reasoning, how to introduce this idea of rationality and compassion into the Muslim community? I think it is a task you will have to face.
The problem in the Muslim community is also a problem of trying to reconcile between the religious or traditional leaders and the leadership of technocrats, and the younger generation of leaders who are open to new ideas, but who are also sensitive to klamic values. The new and the young leadership are not able to convince the mass of their sensitivity to Islamic values because they have been educated in the West. We have these problems in Southern Thailand because the young leaders can't read in the original language. You are in trouble, they don't believe you, they don't trust you. My submission to you is to be patient.

When you finish with the traditional schools in southern Thailand you are "half-baked", you are not good at anything. you can't compete for entry into a university, so you become lost. You become what Prof. Adnan called "the new
leadership, the new intellectual" who is very vocal in opposition to the government but are not themselves very much legitimate in the eyes of the people because they are not good Muslim scholars. There needs to be an opening up of traditional education through economic enticement, at least open the door for a new education. But this in itself has problems so we have to try to find a strategy to solve the sacredsecular problem once again, to improve the quality of instruction both in Islamic studies and in the secular studies.

Then there is the question of employment after education in Southern Thailand. Students'graduating from traditional schools go back and assume the profession of the parents, of grandparents, of the great grandparents. They work on the land inherited from the great grandparents that will no longer support the growing population. There is no professional training, there is no occupational training. How do you get this idea of professional training and occupational training into these institutions? Certainly not from community itself. They don't have the money, they don't have the finance to buy the equipment or to train students in electrical repairing, in various professions, sewing, whatever. So you have to entice the government to allow you, Muslim leaders, to get support from outside organizations (for example, Japan Foundation, Ford Foundation, Asia Foundation)
to provide opportunities for Muslims students in professional training, in occupational training, so that they can hope of having some employment at the end of their education.

I am very encouraged with various private organizations. On every corner in Jakarta, there seems to be a private voluntary organization, "NGo'S", working on development and you are certainly not short of funds from the outside in Indonesia. There are so many organizations and foundations from outside who are willing to help. In Indonesia, there is the Netherlands Foundation, Ford Foundation, Rockefeller Foundation, Asia Foundation, Japan Foundation, Toyota Foundation. You have so many things helping you to strengthen vour efforts to bring new ideas and new things into the country. Now, beinq people from the inside, not being


foreign, you are liable to be accused of bringing foreign ideas into the community. But all these outside foundations and opportunities I am sure are of great help to you to bring change and new ideas into the community, to the older leadership for them to understand. Most of the time the older leadership is more open than we give them credit. They are more reasonable and more accepting than we give credit to them. We just have to be patient. We just have to be open-minded.
Let me end with a verse from the Koran that I am sure you have heard before: "God will not change the condition of a community until people in the community change what is in their own minds, in their attitudes, perceptions, beliefs." We are not able to reason ourselves, we are not able to act as a rational being. We have to listen to the opinions of the leaders all the time. That is the most stifling effect, the negative effect of the culture of the Muslim societies. Change that! Turn around! Don't believe that the door to reasoning for Muslims is closed because all the questions facing Muslim life have been decided by great Ulamas in the past. It is a closing of the door of personal reasoning. Open up again!
So, go to the people. I am very excited about the things going on in your country. There are new ideas, new efforts, new trials, new errors even. But you are at least trying. You are experimenting, you are inventing, starting with ideas. I think that is a great sign for hope and development in the future.



The Role of The Monarchy in The Improvement of Socio-Economic Conditions of The Thai Muslim Community in Southern Thailand
By Gen. Horn Leednanond
First of all, I would like to give some information about the Monarchy in Thailand. It is the oldest institution in the country. Its origin and development has always been with the existence and development of the nation. It is the common sentiment of the Thai citizens that this institution is respectable and worshipful; the feeling which would never be replaced by any other. Towards this sentiment the Monarchy has graciously responded. This is demonstrated by His Majesty the King's Statement: "We shall reign with righteousness for the happiness ond welfare of the Thai people. " This pledge is the moral principle of the Sovereign which His Majesty the King has always abided by, and also the Royal instigation of His Majesty as the guiding principles in His Majesty's contribution to national development. This is the moral principle which all previous Thai Kings have upheld, hence resulting in the national stability and security of the Thai people; from the past to
the present.

His Majesty the King is well aware of the people's problems as he is always visiting the regions. Therefore, His Majesty the King perceives the sufferings of his subjects like his own and feels dedicated to solve them. The most important thing is that His Majesty does not only perceive himself as the Sovereign of a nation, legally or constitutionally, as the leaders of some nations do, but His Majesty has always kept in mind that He is also a Thai. Therefore, He has to share the troubles and happiness with His subjects, without regarding sex, age, religion or profession, and He has a duty to patronize sovereignty and the Thai nation as the other Thai people do. His Majesty the King always instigates help for poverty-stricken people by emphasizing development for meeting basic needs, for self-reliance and for physical and mental well-being.


His Majesty the King has been very much interested in the development towards self-reliance of the poor in rural areas. We can see this from His guiding words on national development, as follows: ".....National development should be proceeded step by step. The first step is the provision of basic needs for the majority of the people, by appropriate meons ond scientifically sound technologies. When this basis hos been estoblished, we proceed to higher degrees of development and higher economic status. If we
concentrote too much only on economic development without regarding the country's and the people's situation, there will be an imbalance in many aqtects, Jinally leoding to failure. This kind of foilure can be seen in several civilized countries which ore now confronted with severe economic Therefore, it is extremely important to assist the people, firstly in their occupations and for self-support


becouse those who are self-reliant by having their occupations and maintoining certain income will undoubtedy be able to pursue higher stages of development. The rationole for promoting development step by step with deliberotion and frugality, is to assure nofailure, but the perfect success....." In short, His Majesty's principle in development is consistent with the problems in each specific area: "Development should be proceeded accordingly to physical geography and social geography." Social geography refers to human habits and attitudes. We can not force people to think, but we can guide them. When we go to the people, do not assume that we are going to make them think the way we do. Once we get there, we have to learn what the people really need, and thoroughly explain to them. By this way, our principles of development will bear fruit.

The Royal-Initiative Projects have amounted to over 900 development projects. Most of His Majesty's development projects are in the agricultural field such as planting, animal husbandry, and the processing of agricultural products to the market. Some projects on supplementary occupations are those of Her Majesty the Queen's project, The Foundation for the Promotion of Supplementary Occupations and Related Techniques (SUPPORT). The Royal Projects can be classified into the following areas.:

1. watershed development and irrigation; 2. agriculture and promotion of occupations; 3. conservation of natural resources;

4. land management and development; 5. communication development; 6. public health; 7. education; 8. research; 9. welfare.
All of these activities are in the main stream of national development of the present government. All of them were initiated by the discretion and instigation
of His Majesty.


most of them inhabiting five provinces in southern Thailand. Those provinces are Songkla, Satun, Pattani, yala and Narathiwat. They occupy more than 20,w square kilometers (approximately 3090 of the Southern Regiori of tne fingAom;, with a population of 2,299,471; including 47Vo Thai Buddhists and 53go Thai Muslims. Since approximately 5590 of the geographical features in the South are mountains and mountainous ranges and thle rdst (+svo; u* pl;i";ilai,"ort or the Thai Buddhists and Thai Muslims take their occupations in the rubber plantation, mining, fisheries and agriculture. In the long historical development and evolutional process of the nation, with a large number of people there being Muslims, (whose ethnic background, religious beliefs and cultural practices are different from those of the majority of the Thai population) there arose some conflicts in this region. rris Majestythe King has recognized the sensitivity of these differences. His Majesty also recognizes that it does not matter whether they are Buddhists or Muslims. They are all Thai. From His Majesty's concern, a concern based on the equality of His subjects, be they Buddhists or Muslims, several royal initiative projects have emerged. Most of them aim at development for the provision of basic needs to the rural residents; especially those who live in the r-emote, poverty-stricken areas. As a result, the projects undoubtedly contribute to government policies, for the benefit of.the majority of the population and of the nation as a whole. Most of the royal initiative projects concentrate on social and economic development, for eiamdtJ, projects to improve education, irrigation, agricultural activities, co-operatives activities, forestry, animal husbandry, fisheries, social activities, communications, and public health. It is clear that the role of His Majesty the King in the improvement of socioeconomic conditions of the Muslim community in Southern Thailand does not differ from his role in other parts of the Kingdom. Through the royally-initiated activities, the People's nationalism and affection for the nation will be enhanced. Moreover, the successful operation of these activities will contribute to the development of rural Thai society towards meeting basic needs, self-reliance, and attainment of a certain level of happiness without regarding any differences among the Buddhists and Muslims.

Since there are so many Royal Projects, and if these projects were carried out individually without coordination with other concerned organization, they will not be as effective and efficient as they should be. Therefore, in l9gl, the government, by the suggestion of His Excellency Prime Minister General prem Tinsulanonda, set about to solve the problem. According to the order of the Office of the Prime Minister,.a national organization responsible for the operations of all Royal Initiative Projects was established. It is dled, .,The Speciai Committee for Coordination of the Royal Initiative projects." This committee serves as a national committee for cbntrol, supervision, evaluation and coordination of the official sectors and state enterprises which operate the ng$ initiative projects. It facilitates quick operation of the projects by the most efficient manner. Moreover, it acts ai a ceniral organization for grantilg suUprojects and activities and necessary budgets for the operation of the ioyal initiative activities which have been proposed by related organizations. Quite a large nember of Muslims reside in the southern part of Thailand;


Afternoon Sessions
PANEL: "Primary Health Care Problems in Thailand and Indonesia"
"Introductory Remarks"
by Professor Dr. Noboru lwamura, Moderator

"Primary Health Care Problems in Southern Thailand" by Dr. Traivit Taymathiwongse

"Primary Health Care Development in Indonesia as a Moslem Majority Country"

by Dr. Adnan Mahmoed

LECTURE: "Cooperative Efforts among the Muslims and the Buddhists in Community Development" by Dr. Pann Yuanlate and Dr. Chavewan Wannaprasert


Introductory Remarks

Dr. Noboru lwamura, Moderotor

Thank you very much ladies and gentlemen. Please allow me to hold this necktie. It is a beautiful necktie made of Thai silk and designed by the handicapped, disabled people. It reminds me of our important work. From this morning's session, I picked up beautiful English words. Our speech was disabled but we are not depressed. I know my mother tongue is not English, and your mother tongue is not English, but we have mainly the same source of ideas.

I am sure all of you ladies and gentlemen, sisters and brothers, can be very much cooperative enough to support this moderator, otherwise my weakness is to be very talkative. I found the role of moderator should be quiet. Then, I would like to introduce the afternoon panel, "Primary Health Care Problems in Thailand and Indonesia."



Primary Health Care Problems

in Southern Thailand




it Taymot hiwongse

I would like to begin my presentation by discussing the problem of language and communication in successful primary health care development. The Muslim
count for more than 7090 of the population in Satul, Yala, Pattani and Narathiwas, with the majority of the population (more than 7090) speaking a local Malay dialect. The people, most of the older people, can't read a language. That means they don't read even the Thai language, so certainly they don't know Malay or Arab or English either. I think one of the primary health care problems for the whole country is you have to get inside, and get inside without the benefit of using a written language. You must know the spoken languages, the dialects, and these are many. Being a Buddhist, how do I look into the problem of southern Thailand? Well, I'm responsible for the health of a province. Pattani is a province with 470,000 population, the most poverty-stricken province among the 14 provinces in southern Thailand. Actually, it is not as poor as some of the provinces in the northeastern part of Thailand. You know the habit of the southerner, they like to live easier. They like a better life. When you compare the life of the northeasterner with the daily expenses in southern Thailand, they need more money in Pattani. The primary health care problems are not only because the population is Muslim, but because of poverty, illiteracy and also their health status is not good. You have heard today that things are improving. There are many programs. Gen. Harn said that the problem of Pattani is the vicious cycle of poverty, ill-health and illiteracy. This is also the cycle of economy, health and education. As for the health problems, you must consider the manpower, material, money and management. But we are discussing now the factor of man, the people. When we consider the people then, as an administrator of the province, I try to analyze the origin of the problem. I try to look into the type of official worker at all levels in the province: the provincial level, district level, and sub-district level. The lowest level is the subdistrict level. Under that is the volunteer. Then I try to think about the acceptance, about the community of those people, of those with whom the health organization is concerned. We don't blame the people, sometimes I try to blame ourselves also. I think it's a kind of vicious cycle between the people and the provider. When I transfered to Pattani more than 4 years ago, I found the demand of the population of the people is very low and the supply on the government side also is not good.


In Thailand,'the program of primary health care frst started with the selection of the village health communicator and village health volunteer. It started 9 years ago, I think 1977, and later came the idea of cooperatives; flrst the drug cooperative. The cooperatives give the volunteer something to do, not just to train the volunteer without having any activity. And more cooperatives are starting up. You see sanitation, water supply, also the commodities cooperatives developing later on. In Pattani, primary health care projects were started in 1977,9 years ago. They are improving but the activities of the volunteers are still very low. We should have more supervision, meetings and try to select volunteers more carefully. In my province, I selected one of the best. Sometimes even the best volunteer is not good enough to get the needed results in the community. To deal with people, sometimes we need to meet and select a community leader, the village leader. He is usually Muslim because in some villages the Muslims are 10090. This leader helps us to provide training about primary health care, especially to make a better understanding about family planning. The problem of family planning in Pattani is not always based on the religious factor. It also depends on the community leader. We have to try to bring those leaders with a better understanding of family planning or any health activity. Or, sometimes you learn by yourself, not by any teacher. That's why sometimes when the people say no, you just let it go, going around elsewhere to work. The results of your work elsewhere may influence others to cooperate. Another problem is medical doctors to provide medical services. The population to doctor ratio in the country is about 7,000 per medical doctor. In the rural areas there may be only two medical doctors for every 50,000 population. Incentives, given to the medical doctor to work in the rural area by the government is needed. Sometimes the health officer of Pattani has to go around, to send letters, or send information to the new graduate medical doctors before they select a place to work to try and get them to come. You see it is compulsory government service for 2 years for the medical graduate. But when they come, there are still many problems in the community because of language problems. As for educational improvements, most of the people in the locality do not have a good understanding of the "entrance examination." They sit for the examination but actually they do not pass. As Gen. Harn said we do have many special projects in the southern provinces of Thailand. But the projects are not successful in allowing entry into further education that would result in more jobs. We select and follow the modules on model village development. We try to improve the communication and language problem, and then we try to improve the health services, both promotive and preventive. On.the village level, we try to make the village volunteers more active. We also select and use the women's group. The model of the village depends on the module, the family planning, the baby immunization with the health center. You see, we follow the concept of primary health care: self-help and self-reliance, cooperation among the leaders and volunteers, the intersectoral coordination, and also the improvement of the health delivery system of the government hospital. Still n. ire.'e many problems due to poor economy, health and education.


Primary Health Care Development in Indonesia As a Moslem Majority CountrY

By Dr. Adnan Mahmoed
It's great pleasure for me to present a discussioh on Primary Health Care problems in Indonesia. Indonesia's population is about 165 million people, making it the fifth most populous in the world. Almost 9090 of the population are Muslims, about 150 million. It is the largest Muslim country in the world. We have more than 13,000 islands scattered from east to west and we have 27 provinces, 351 districts, more than 3,000 subdistricts and more than 60,000 villages. Our annual growth based on the census of 1980 is 2.2s/o per year and the population density is, on average, about 84 per km. sq. If we look at a certain kind of island, let us say Java, the population density is 900 per km. sq. outside of Jakarta of course. Compare it with the island of Irianjaja near Papua, New Guinea, with only about 2 people per km. sq. In South Sulawisi it's about 76 per km. sq. and the proportion of urban to rural is 20-8090. This kind of information has a relationship to primary health care development and we will look at the health problems of Indonesia indicated in the 1980 census. The morbidity rate is about 9.2, based on the house-to-house survey, and the crude death rate is 1.2. The crude birth rate is 3.4, the total fertility rate for each family is 4.8 and the infant mortality rate is very impressive, 90 per 1000live births. Life expentancy at birth for females is 56 and for males is 52 years. Another problem is protein and calories for the children under 5. We find that 3390 of the population is in third degree malnutrition. Also, the newborn weights under 2,500 grams has gone up to 2.890. As for the occurance of some communicable diseases, diarrhea is 400 per 100,000 population and tuberculosis, 3 for every 1,000 population. When we talk about basic sanitation, accessibility to clean water in the rural areas is 3090 of the population, while in the urban areas, its 5090. Ownership of
latrines in the rural areas is only 25u/0, while in the urban areas, its 4590. From this data, we conclude that the potential to stay healthy for the people of Indonesia is still low. The morbidity and mortality rates are still very high. This is why the national health system in Indonesia has the goal for every citizen to live healthy lives, achieving an optimal status of health and a productive life. It is also believed that the key to attain this goal is primary health care development. In Indonesia, we call it "PKMD," Indonesia's contribution to the World's goal, to attain Health For All by the Year 2000. As for the health delivery system in our country, we have also the national 11q le-qgnal hospitals with 50G1000 beds. We also have provincial hospitals with 200-500 beds. In the subdistrict we have health centers with mobile h6alth units where we have medical doctors. Under the sub-district, in the village level, we have the integrated health services post with only paramedics, managed by the community health volunteers. In our country, the kampung (village) has a population of about 1,00G2,000 persons. We have the objective to create one integrated health service post for every Kampung. At this time, it has not been achieved, but we are going to keep working toward that target.


When we talk about health education causing a problem,we have no problem. The people can be convinced as long as we can use appropriate strategies; for example, combining the health message with a religious massage. It is important to mention the family planning program. In Indonesia it is considered the most successful family planning program in the World. It's true because we have been using an appropriate strategy and there is no family planning problem in my country. At the beginning of the program, there were many rejections. People were thinking that family planning is against their religious bdHefs. The strategy we used was to convince their community leaders and religious leaders and since then, the problem has not existpd. The only thing the "Ulama" remains against is sterilization. I believe that in 5 years, even this will change. We can still find some "hardcore" communities, but in general, family planning activities in our country are very acceptable. Our current users are now about 6090 of all eligible couples. I would like to mention again 2-step flow communication. As the lst step, you have to approach the religious leader, get his approval, and get his support. If you go directly to the community, the religious leader will think that you are going to take over his influence in the community and they react to that; even if your idea is good. So, you have to go to the spiritual leaders first and you must convince them. Then, when they accept, they give us support to go together and convince the community. When we use this approach, we respect and acknowledge the leadership of the spiritual leaders. We utilize the leadership to convince the community for the adoption of any kind of new ideas or intervention and some strategy or approaches. There are still so many problems but we are trying to solve them (see figure l). The first one, is the difficulty of finding effective community and spiritual leaders as change agents. Secondly this also means that it's very difficult to find people who can work together. When we find the best one, the program will go very well. But if these people move away, the program will run down. So, it is very difficult to find volunteers in the rural areas and among the urban poor. The third one, when participation is existing, we need a strong and continous effort for maintaining the participation. It is easier to begin the program than to maintain it. The fourth, although we have some good cases, but self-reliance development is another thing that should be given strong attention. We have a very good project geared to self-reliance but in general we still need strong attention to develop this kind of strategy. Finally, the idea of intersectoral collaboration is good on paper. We have known about it, but it is difficult in implementation. At the last, we would like to see these kinds of ideas coming as a cornmunity movement from the bottom in the rural area or from the urban poor. I'm going to mention again about the effectiveness of using the mosque as a center for development of the community (see figure 2). For the Muslim community, a mosque is the center of spiritual development and also the social and economic development of the community. The mosque is a place for strategies to be utilized to send messages to the community, because the message, when we use the mosque, can be associated with the religious belief. It will be more convincing compared with the message going alone, not associated with religious belief. Also in the mosque, people gather daily. They have ample time because they come there



PHC Problems in Field Implementation

Prominent Problems to be monitored:

1. Difficulty of finding effective community and spiritual leaders as change



Volunteerism, in fact, is still scarce in rural and urban poor for pure involvement. maintain the participation.

3. When participation exists, we need strong and continuous efforts to

4. Although we have some good cases, self-reliance in development

another thing requiring strong attention.


5. Intersectoral collaboration is easy 'on paper' but more difficult in implementation.

6. The conduct of 'essential health care' by community health volunteers through'IHSP' still needs strong back-up.

The development of appropriate technology remains only as a model but needs to be introduced into the community.
8. The existence

of a 'hard-core' community which rejects new ideas without reasons, can still be found in some cases.



to pray and relax. There is time to discuss and we can talk about pHC in a more informal way. So it is more effective. Most of the people coming to the mosque are the decision makers in the family. In our country, I am not saying that there is no "Woman's Liberation", but the decision-making pattern is still on the man,s side. It's now moving around to make a good share between husband and wife. But mostly the man is making the decision, even after the "International Women's Conference." The news made mention that "The woman has made her story but the man has made history!" Sometimes the woman or the wife or the mother would like to participate in family planning. Simply, the husband says ,,If you participate, I'm going to divorce you." Anything can happen. That's why its advantageous if you use the mosque, because in the mosque the family decision-maker can participate in an open discussion as a way of receiving the health message. Also there is a kind of psychology, the security of accepting the message because it's associated with the religious belief. Because it has been received in the mosque, it must be suitable and it's acceptable with the religion.

Figure 2 : The Mosque, as centre for the development of the community

Messages of development geared to religious beliefs

Psychologically give security of adoption to the messages

people gather every day and they have ample and relaxing

time -/ -V

Most of the decision-makers

of the family gather

open for discussion after delivering the messages


Cooperative Efforts among Muslims and Buddhists in Community Development : Government Agencies and Servants

Dr. Pann Yuanlate

The Thai society is mixed with various beliefs. We have always had many beliefs in Thailand, and so cooperation has existed from the beginning of our Nation. If we work together in the South, the cooperation must come, not only from the local people, the Buddhists and Muslims, but also from the government agencies. Everyone will have to cooperate for development. About 2090 of the government servants are Muslims and the rest are Buddhists. We also need the government civil servants' cooperation. The other level is the cooperation among the local villagers, Buddhists and Muslims. So, I'd like to divide the presentation into two levels. I will talk about the cooperation and effort of the community with the government agencies and government servants. Professor Chavewan will talk about the local people's cooperation or the factors increasing cooperation among
the Thai Buddhists and Thai Muslims.

I'd like to give you the socio-economic conditions for the border provinces in southern Thailand. If you look at Southern Thailand we have the shoreline, bays, and islands that are good for a coastal culture port. From Chum Phon down
to Narathiwat, the agricultural resources are similar to Indonesia. We have rubber plantations, coconut plantations, orchids and some local industry; for example, rice mills, rubber factories, ice factories' mining, and saw mills. The population of the South is about 6 million and about 250/o are Muslims. Income, per capita per year is ptS,OOO which is about fi2,000lower than the national average income in Thailand. F t if we look at Pattani income per year, it is the lowest in the south at t7,000 or p8,000 per year. The government policy emphasizes industry. The essential para-rubber products are marketed by the development of central warehouses, cooperatives, and organized factories; eliminating the middleman in organizing the central market for agricultural produce at Songkhla. Songkhla is known as the ''Capital of the South' ' . This economic base is linked with the economy of the border provinces in the South and to the rest of Thailand. To develop this linkage, the government is developing the main town of Songkhla; including electricity, telephones and communications, and housing establishments for management of the Institute of Labor for the Southern Region of Songkhla. For electricity, a big dam at Pattani River was developed. The main town of Songkhla is therefore also the center for water. Numerous construction projects are being developed, including construction of a harbor at Songkhla, roads, communications, and bridge construction.


The second goal of the development plan for the South is social development. In social development, we emphasize the indentity of Thai citizenship through extended compulsory education for all by providing free elementary education. We offer pre-school education for the children, one year or 6 months before going to primary school. With this special education, the children are taught to speak Thai to prepare them for school. Compulsary education in primary school extends up to grade six. To train teachers to teach Islamic religion in every level of education, The Center of Islamic Study at Songkhla University, Pattani campus, was established. Instruction in Islam is essential for the province because the majority of the population are Muslim. So, the teaching of Islam is offered at every level of education, primary level, secondary level, and higher education. At Songkhla University we have offered an Islamic study program as a major subject for 7 years. The third goal is to promte understanding between Buddhists and Muslims and support the Muslim religisn. We work with Muslim leaders to help them understand the importance of learning the Thai language and to understand the correct concept of family planning. We try to use the phrase 'Quality of Life' or "population eduction." We emphasize the Thai language because it is the official language and it is the government policy that all Thai citizens should know how to read and write in the official language. In Pattani and in other provinces we have difficulty because they speak Malay or Pattani dialect which is completely different from that spoken in Malaysia. The children learn Thai as a second language. They speak Thai at school and go back at home and speak the Malay dialect. The government is also trying to increase farming production and to develop industry among the people. Farming production, however, remains very low. So, the target villages to generate and increase income are fisherman villages. For developing industry, the government supports fishingboat building for the coastal culture. For those not in the fisherman villages, the government introduces handicrafts, food preservation, cloth making, or cloth weaving; trying to introduce new careers into local villages. In the fisherman village, the targets are the poor farmers. Solving the problem of poverty in the rural areas, developing the villages of poor fisherman in Narathiwat and Pattani, involves supporting career development in order to increase income. In some fisherman villages where the government is responsible for career training, most of the participants are girls because the fishermen cling to their fishing. They want to fish even thought you want them to be carpenters or chicken raisers. Most of them reject the idea and so the government has tried to introduce the harvesting of the green mussle (Thai oyster) to the lower south. This requires the skills of the fisherman, so this approach is working better than changing them to another career. The government is attempting to assure the successful management of private Islamic schools by adding general subjects and occupational training. In Pattani we have about 150 pesantren. I went to Indonesia about 3 years ago and learned that the government has forced private schools to introduce secular subjects for about 70s/o of the curriculum and religious subjects for about 300/0. But in Southern Thailand we must try to persuade them to introduce secular subjects. We realize that, in the past, those who went to private schools received no general education. It was difficult for them to get a job or to find a carreer. So the government tries very hard to persuade them to introduce secular and occupational subjects


to the school. The government provided free T-shirts to the schools that introduced secular subjects. Also the government pays the student about 15 Baht a year to take secular subjects. This is just encouraging the private religious schools to introduce more secular subjects in the hopes of preparing their graduates for employment.

To help the orphans and the poor children receive an education, the government supports special schools and home centers. In almost every province on the border, they have these types of schools for orphans and children from poor families. We call them "welfare schools." There are some families that are so poor they can't afford to send their children to school. So, they can send them to this school free. Youth development in the Southern border provinces is a special case. Many Muslim youths from the schools have no knowledge of career or occupation. The government sees the problem and has quite a few youth training programs especially for technical skill development. Songkhla University has youth training programs for community leadership; working in cooperation with the Rural Acceleration Department. Also the Ministry of Interior has programs in career training, for example, electrical welding, motorcycle repair, TV-radio repair, and water pump repair. Why does the government emphasize these programs? At the primary level, about 8090 of the school children are Muslims. At the secondary level only 27s/o are Muslim and73s/o Buddhist. So what do Thai Muslims do then after primary education? Most of them go to private schools and some stay at home and help their parents work. So the government must offer youth training programs for their economic development.

To develop the role of women in the southern border provinces is also a special case. "Youth" means boys and girls and the women, too. We work in cooperation with the Ministry of Education and the Ministry of Interior for youth and women; training them in the things necessary for the home, for the women's career for example, food and nutrition, child care, sanitation, family planning, quality of life, cloth making and handicrafts.
The most difficult of the plans is solving the problem of land.{or the people in the rural area. So far the main target is the poor people in the district. For the farmer,'the government teaches land use development. Along the coast, instead of doing nothing, the government tries to reform the coast into fishponds or to grow mangroves along the shoreline. The government tries to accelerate the use of vacant forests in order to help the farmers who have no land to occupy.
So this is what I would like to mention as government policies in the national economic and social development plan; activities that have been conducted under its operation.


Cooperative Efforts among The Muslims and rhe Buddhists

In Community Development: Local Communities


Dr. C havewon Wannaprasert

Mulsims in the southern part of Thailand are quite different from the Muslims in Bangkok or in the other parts of the country. They are also different from Muslims in Indonesia. Why? Because Pattani is the central part of the Islamic civilization there. So, we start about 75 years ago and find that some of the Malays even studied in Pattani. We are very proud of Pattani Province. we try very hard in the South, with the Prime Minister, and the Secretary of the Prime Minister's Oifice in Bangkok, to bring the Buddhists and Muslims together in the community. Now Buddhists and Muslims work together to collect data, make plans to find support and construct a budget for community development, to cooperation maintenance of the project and to set up training. We find they are very happy to work

The first factor in encouraging cooperation is the role of the government officer or the civil servant. They play a very important role in bringing Muslims and Buddhists together, but it also depends on the location of the settlement. In one settlement, the Buddhist group and the Muslim group may work together. In some villages, they work separately. If the government officer goes directly (I mean the social worker, agricultural worker, or home economics worker) to the village and works with them, they will eventually convince the people. But the people, Buddhists and Muslims, will not accept them until they watch the government officers to see if they are honest and sincere. If they are honest and sincere and work hard, the Buddhists and Muslims will welcome their help and try to cooperate in finding the problems in the village and their solutions.
The district officer and governor can play a very important role also. In Naratiwat Province, the governor has become involved in many projects in many villages by using civil servants to work on projects introduced by the social worker and the district officer. If the Buddhists and the Muslims accept this idea, it will work very well with few problems at all. The Muslims will accept the idea from the district officer very fast. However, the Buddhists will not accept the idea from the district officer until the project is seen as very useful. So, it takes a longer time to convince the Buddhists. The local leaders are very important to new ideas in the village. The Thai Buddhists pay respect to the monk at the wat. Every village has a wat, a temple at the center of the community. The Muslim have a mosque for the community religious center. The religious leaders are helpful in convincing the people because Buddhists and Muslims in every village follow what thcir r"ligious leaders say, paying more respect to their religious leaders than any other person in the village.


At the sub-district level, Buddhists and Muslims select sometimes a Buddhist and sometimes a Muslim to be the head of the sub-district. At this level, it depends upon the characteristics or the achievements of the person. They don't care about religion. Anyone, whether Buddhist or Muslim, can be the sub-district leader. If they are a good person and they work hard with achievements, people in the subdistrict pay respect to them. Another problem we have to work through is the government's tendency to plan development projects according to common need or general interest. Sometimes these projects are culturally inappropriate in some localities or simply not needed in some villages. For example, the Minister of Interior made it policy for every tambon to collect rain water. The Muslims in the South don't drink rain water because they believe the water is not clean. They say can't wash their face with it before they go to pray. It is against Islamic law. However, the government officer may not know why they don't want to do it. Therefore, they try to force them. We even give them materials and ask them to make the jars. Even so, the people won't do it. Many problems come up for the officer who does not know Islam well or does not know the Islamic ways of life. When it comes to religious beliefs, traditions, and customs, sometimes the people think they cannot do projects because of religious beliefs. Before we set up community development, we should learn what Islam is and what Buddhism is. The social worker or officer should go to see Muslim and Buddhist leaders and discuss with them the best way to make plans for community development. The officer must not only know Buddhism but also Islam. Then, they can work together very well. In the Muslim community, it's quite difficult for the woman. According to Islamic law, the woman has to follow or pay respect to her husband. But she earns money, as you say "Income Generation." The Muslim woman in the South works very hard because they have to earn money. Some men stay at home so the woman has to take care of the husband. The women here are very strict in following Islamic law. Indeed, Muslims in the South, especially in Pattani, Yala and Naratiwat, are very strict in following Islamic law. For example, many will not accept family planning because they misunderstand the meaning of family planning. In their viewpoint, family planning means birth control. We have a hard time convincing them and trying to encourage them to change their attitude. For the woman, we have to change her attitude to the man. To the local leaders, we try to change it to a "Population Education" project. We try to support family planning by using "Population Education" as the project title. In the South, Muslims and Buddhists are very poor with large families and a problem of malnutrition. I just finished a project about food habits of the population in Southern Thailand and I found the Muslims have more malnutrition than the Buddhists. It takes time to make them understand the meaning of family planning so we present "Population Education" which is the best for the Muslim. In "Population Education" we emphasize a smaller family size, delayed marriage through further education and study, and child spacing through two-year breast feeding recommendations. We have made these emphases consistent with Islamic Law by caling upon local Muslim resource persons, the Islamic Committees, to help us write and produce the educational materials used in the Population Education project. So in this way we can motivate them to follow the population education recommendations.


Summary of Afternoon Discussion

Dr. Iwamura opened the afternoon discussion
session by posing two questions:


1. How to raise the level of activity of grassroots volunteers, particularly the women? How to encourage, for instance, successful mothers to be


on the frontier for the primary health care program? How to activate volunteers in a Muslim societv?


Dr. Adnan: As for the woman's participation in the primary health care program, all these activities are well managed by the women. But, in important decision making, the prominent role in the family is for the husband. And, I am talking in reference to the rural area, the man makes the decision but the woman is "just in back of her husband." I have a primary health care project for developing the woman's role in decision making. Before we started the program, we had the hypothesis that the woman makes very few decisions because she's not the one to feed the family; the man earns the money. To develop the program and to have a basic line of information, we made a survey about who makes the decision in family planning. We found wives willing to make the decision in family planning though most of the responses are the husbands'. Then, we educated the women on income generation, marketing or raising cooperatives, and they realized money from it. After 4 years of implementation, we find the role of women changed. How can we change the role of the woman? Through educational intervention. The development of the woman's role through this kind of program is very enriching, and in our country, there is a very great acceptance of the women's organization, especially in primary health care. This program successfully encourages activity by all women in this area.


QUESTION: What specific projects are underway in Southern Thailand to assure a higher quality of life for Muslims, especially for Muslim youths in attaining an education?

Traivit: When we look at the infrastructure, the government has contributed to this. Now we have good roads, more feeder road$ to the main roads. This is

good for the transportation of agricultural products. The government provided free electrical wirings through the village. I think next year every village in the 4 provinces will have electricity. In other parts of Thailand, the government has not given free wiring and electricity to the villages. The local people had to pay half the cost. But in this area, the government just gave it free. They pay only for the use of electricity.

As for education, why is the Muslim education far behind the Buddhist education? Education in Thailand is oriented around the palace, and is in connection with the Buddhist monastery. This is a practice all over the country; even in the areas with a Muslim society. The Muslims are reluctant. They did not send their children to the school, neither to the monastery nor the temple, because the Buddhist
monks are the teachers. When education was provided beyond the Buddhist boundary in the village, without thinking books on ethics about Buddha were introduced. and so the Muslims were still afraid their children might be converted to the Buddhist religion. They continued not to send their children. The government realized this and got rid of the books. The schools now offer Islam in all primary, secondary, and higher education levels. Now Muslim children go to government schools and so the government has made every effort for their education. Primary schools were placed in every village, in every area. The secondary school is in the larger communities. They encouraged the schools to introduce more secular subjects. However, when we had competitive examinations for an official post or when the university entrance examination was given, most of the Muslim students would fail. They could not compete with Thai Buddhists. But now, Thai Muslims are competing with Thai Buddhist. So, in the future, with the introduction of more secular subjects, Muslim education will meet the same standard as Buddist Education.

Prof. Chavewan: Our government, the Ministry of Interior, instituted a policy that every university will fill a special quota to admit Muslim students to study. It was started 9 years ago, first with Chulalongkorn, Thammasat, Chiang Mai, and Songkhla Universities. A lot of the students that meet the special quota for the Muslims are from the southern part of Thailand.


Dr. Adnan: Listening to what has been presented and your comments on the problems in Southern Thailand in the Muslim community, you have suggested that actually we need another kind of policy. Through there are many efforts in the South, the overall problem is merely a socio-economic condition that must be developed. This morning we have listened to Dr. Surin who said that the Muslim people must


create a balance between the spiritual and physical, but what we are doing is so much an emphasis in the reverse! We have to consider also how to develop the spiritual; whether or not the government has given the authority to practice their religious beliefs. We have to see that the government sets a policy to support or encourage the people in their spiritual development.

I think we also must consider the psychology that becomes human nature when we come to the minority. As you mention, we are the majority in the South but we are the minority overall in Thailand. The psychology of the minority is often to reject or negatively prejudice anything coming from the outside. Keeping this in mind the minority asks, "why do we have to accept family planning? we are thinking that if we practice family planning our number becomes less." perhaps the people do not say this consciously but maybe they think this in their heart. ,,If I practice family planning, I will become smaller and smaller, so we remain always the minority." With this psychology of the minority and because developers think in another way, economic development in cooperative efforts like agriculture,fishing or any other kind, we are just confusing them with family planning. We are trying to find many kinds of terminologies for family planning like spacing or delayed marriage. Sometimes we are faced with terrible population problems, then we say planned parenthood or responsible parenthood. You can have as many children as you like as long as you become "responsible parents." If you are wealthy, you can have l0 children. Or think about your mother and your wife because after 3-4 children, it becomes a high risk and be responsible not to make the wife at risk. This is the thing I'd like to emphasize. While we give multiple and often confusing messages about family planning and its relationship to overall economic development, we have not considered the psychology of the minority in the south, the people's feelings, thdt regardless of our well-being, our Muslim numbers become less and less.


Concluding Remarks National Social Development: Fear of Cultural Loss, Disenchantment, and Social Unrest
Melanie L. Sovine, Ph.D.
Throughout the conference, an underlying theme was common to both presentors and participants: In the face of potential gain through social and economic development, the local people often fear loss and therefore resist programs of change. This reaction is not surprising as fear and resistance are common psychological responses to change. Neither is this reaction unfounded. Certainly in the past decades, well-intended developmental efforts have been detrimental and demoralizing to local people and local cultures. Therefore, while the plans for developmental change may be well-conceived in their theoretical and conceptual formats, their implementation in daily life, in the context of local beliefs, attitudes and behaviors, is complicated and never wholly successful. This conference examined Primary Health Care development in two localities, Southern Thailand and Indonesia; both of which are predominantly Muslim settings. The conference, as a whole, has compelled us to consider ethnicity and religiosity as positive contributions to national development, and to continue to work successfully towards Primary Health Care development in Islamic Regions by carefully listening to the people undergoing development. Synthesizing from the comments, three specific kinds of loss can be indentified:
LOSS OF SELF.DETERMINATION AND SELF.RELIANCE: A flEAT that development projects will produce further dependency on and represent unwanted impositions from the governments, national and multinational, resulting in the loss of local initiative.
LOSS OF THE PRESENT COMMUNITY SOCIAL ORGANIZATION: a fear that programs of social and economic change will disintegrate life as it is currently understood to function by the local people, taking with it social support systems and other aspects of social well-being resulting in social disorganization and psychological disorientation.

LOSS OF HUMANITY: a fear that social development authorities will undermine the existing systems of authority and leadership, including especially religious leadership, resulting in an over-secularization of daily life and its sacred
demensions. At the extreme, these losses can result in a pervasive sense of culture loss, a community-wide feeling of social and psychological loss brought on by uncontrolled and unwanted culture change. At this stage whole societies seem to be immobilized by a feeling of community grief, and appear to be mourning the loss of everything

they once held dear.



In concern for avoiding these losses and working effectively against resistance, strategies for a more culturally appropriate and sensitive development were presented in this conference. Taken collectively, the strategies enhance social integration and thereby, cultural preservation. These strategies may be organized around the following principles for effective local development. INTEGRITY: It is important to believe in the integrity of local people, in their beliefs and ways of life, especially their religious traditions.
INTERPRETATION: It is important to re-interpret the concepts and goals of development programs within the people's existing belief system, thereby avoidunnecessary and unproductive confrontations.

IDENTIFICATION AND INTEGRATION: It is important to identify the existing community leaders, especially spiritual leaders, and to integrate this native leadership in the development plans. Development project workers must avoid whole-sale imposition of their own official hierarchy upon
the community.

INCLUSION: It is important not to deny existing differences among people but to celebrate them. Development plans must include provisions for all people regardless of ethnicity, social class or caste, or religious persuasion. Cultural pluralism must characterize regional, national, and world development plans. INFORMATION: It is important to acknowledge the basic human right of open access to information about health and well-being; making every attempt to overcome communication and language barriers that may be operative. The right to be informed does not guarantee acceptance of knowledge. However, the necessity of knowing should not be measured by presence or absence of acceptance.


ln summary, these principles suggest that social and economic development need not result in a sense of culture loss nor must it be a GodJess, wholly secularizing process. This can be avoided by the effective use of cultural-level components, for example using religious traditions, in development plans.
The remarks thus far imply that people will respond positively to social and economic development projects if the goals and the plans include a visible appreciation for local culture and traditions. An alternative perspective was offered during the conference, Added to the focus on fear and resistance to loss was the fact of general lack of well-being among poor people. While planners and developers may perceive resistance based on local religious principles, the people actually maybe expressing, through religious language, the authentic social and economic distress that characterizes their daily lives. Social development, in this perspective, is not singularly a process of planned change involving cultural maintenance. Development also must address the problematical realities of poverty, illiteracy, and poor health status. Social development must be both culturally appropriate and socially corrective of complex social problems. Added to the concern for the cultural integrity of the people, then, is a concern for their economic integrity wherein equity in resource access (e.g. entry into educational institutions) and resource success (e.g. successful passing of examinations) can be enhanced through development projects. Practically speaking, if gaining employment that allows for an improved quality of life is the visible result of development projects, then local people will actively participate in social and economic development efforts.

Social unrest in continued situations of inequality and poverty, and disenchantment for hierarchically imposed, authoritarian development plans are both problems the participants in the conference wish to avoid. A general guideline was very clear at the end of the day: National Development should promote equity and self-reliance and promote cultural (specifically spiritual) and socioeconomic well-being for all people.




Mahidol Univenity, Salaya Cawus 25/5 htthamonthon 1, fulaya Nakhoncluisri, NakhonPat hom

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