"The Nation "


A Belgian doctor tells of life at Wat Phra Baht Nam Phu, which he has just described in a new book released this week

By Jim Pollard. Text before the final editing process. July 25, 2004


Wat Phra Baht Nam Phu used to be a place of death. But the Lop Buri temple, famed for its Aids hospice, has put on a different, more caring face in recent weeks. Bags with thousands of people's ashes remain, numbered and uncollected. But its incinerators are used less often now. For most of the past six years, Belgian Yves Wery was - until several months ago - the sole doctor here for more than 100 people with Aids. He arrived by chance in 1995 and decided to stay longer because one
or two patients were dying every day. "They had no access to basic care. The work was not really pleasant, but interesting. I felt that I had to stay because no other doctor would."

"Mo Yves" (Dr Yves), as he prefers to be called, managed despite severe obstacles. He spoke no Thai, was shy, lacked experience in rare diseases, and had to struggle without any laboratory assistance, x-rays, specialists, or nursing staff. He had to learn the symptoms of diseases through books and by experience -and survive without any financial or logistical
support. He caught tuberculosis and suffered nervous stress, but remarkably, he stayed on. This week, when big-name guests, such as actress Ashley Judd and Taiwanese singer Coco Lee, toured the temple, the scale of grim suffering they encountered was much less than what this extraordinary expatriate has been used to.

"They die less than before," Dr Yves said with a strong French accent, just before the IAC started in Bangkok. "And we have only 20 critical patients - before it was 60. Since we started ARV [anti-retroviral drugs for patients] the problem is less acute." Indeed, the temple has a problem in a sense, because people are not dying at same rapid rate as before - when up to 10 a day succumbed to the disease. People with HIV are now put on down on waiting lists that grow ever longer, and are being forced to fight local hospitals harder to treat them, he said. "With ARVs the patient takes a bed and they don't go
out. It's full now. Before, we used to have coffins stacked up by the doors - it was so depressing."

Dr Yves, 47, has been a full-time volunteer at Wat Phrabat Nampho since January 2000. Relations with the abbot have been strained at times. Dr Yves has no employment papers, and amazingly, still has to do monthly border runs to extend his visa. Officially, he's a tourist. Recently, an American doctor arrived to share the workload, but previously there were no other trained medics - a situation he described as "very difficult".

Dr Yves said the temple receives three types of patients: Those who arrive in a condition too late to be helped - "just skin and bone"; those he classed as social exiles, rejected by their villages because people are terrified of the disease, or landlords in Bangkok who refuse to allow them to rent homes any longer; and thirdly, those who are symptomatic because
their CD4 white blood-cell count has dropped below to 200 per millilitre (doctors are now giving these people medication). The latter category of people come with many diseases, he said, "including some we've never seen before". He has posted more than 1,000 photos of some of these conditions on the website www.aids-hospice.com.
The website has a lot of rare photos of people from all over Thailand in the final stages of Aids. It's now receives more than a million hits a year, he said, and appears to have become popular with doctors.

Dr Yves believes Thailand's HIV prevention policy has failed, partly because middle and higher class Thais are setting government policy and not "low-level people". However he acknowledged that finding the right policy was difficult.
"For me I feel a minimum of three million Thais have HIV. In fact I suspect it's more but I don't want to write it - first, because my patients [at the hospice] aren't typical of Thailand. And second, because I'm a farang, and I project from my experience." Many Thai villagers fear Aids, he says, whereas in Africa "they deal with it". "Relatives come, leave people here - and run away. It can be so cruel. I have 1,000 anecdotes like that.

"What upsets him more is that some Thai doctors and hospitals refuse to treat people with HIV. "They arrive here in a condition you cannot imagine, because they've refused to treat them," he said. "Even the very top hospitals - if people are poor and can't pay for the treatment." The temple has only basic facilities, as abbot Phra Khru Udom Prachathorn refuses to turn the site into a hospital. "This place is not the best to survive - you catch all the disease from your neighbor [in the next bed]. People are better at home. But there is no alternative if the hospitals refuse them," Dr Yves says. Most people are brought from Isaan [the northeast] and the Central region. "The HIV problem is more in control in the South, because of Islam and people are more rich," he explained. "And in the North the problem was so bad that many foreign organizations got involved. So, in fact, its' better to have Aids in the North or South."

While he views Thailand's prevention policies as having failed, the country's treatment policies were "now up with the world's best" - thanks to the Bt30 medical fee, generic copies of the powerful anti-Aids drugs, such as GPOVIR, and the "fantastic" move late last year for these drugs to be included in the national health system. But anti-retroviral drugs (ARVs) were a very difficult treatment, he noted, with a lot of side-effects. "I have quite a lot who die from ARVs - from the toxicity." Normal doctors in Thailand were forced to treat patients with ARV drugs, "but in the West they are
sent to specialists.

For me, Thailand has done it's best. The drugs are the cheapest in the world." Unlike Africa, Thailand has enough hospitals and equipment like CD4 monitors, he said. "But one million people are set to die in a short period of time. That means something for the economy - it's cheaper to treat them, because the vast majority of people here are 25 to 35 years old. States spend a lot of money to educate them and they die of Aids just when they're at an active age. Economically, it's a good choice to give them ARVs. You can't have a healthy economy where 10 per cent of the workforce is sick."

He noted the different value system of Buddhists. Some men became monks to get ARVs, while a mother of five who got the disease from her husband would miss out. "It's another system, but you have to admit they're happier than in the West. Here, they're not concerned [as much] with religion or spiritual values." But people are very accepting of their fate. He told of how the body of one man was taken and put on display in the Wat's "Life Museum", with other mummified bodies of Aids victims - while the man's wife was still alive and being treated there. "The woman had an accident and was put in a wheelchair and sometimes she wanted to go and see her husband, so she would be wheeled down there to look at his body. People are dying, and they know it. The main things are not the same. It's really fascinating."

Dr Yves hopes that eventually Wat Phrabat Namphu will only take dying patients. He said his book, launched by Matichon this week in Thai and German, would sell for just 100 baht. "It's not a scientific book. It's a book to touch the people," he said. "It's a book by a farang in an interesting place - and a lover of Thailand." He likens Thailand's fight against Aids to a war with many dead already and millions more dying. "The first battle failed, and we have the second battle now. If they don't win, the Thais are finished. They'll lose their identity. It'll be like Africa - and domination of the West again, because they are the only ones to beat this disease. "This battle they must win if they want to live in the world. Thailand is one of the strongest countries in this part of the world. But if they don't beat this disease they're finished for 100 years."

By Jim Pollard (With pictures by Steve Sandford)
















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