[Native Thailand music, woodwind instrument]
[Women remove silver headdresses]
[Woodwind music]
[Women undressing for medical procedure]
[Woodwind music continues]
[Woman removes silver headdress]
[Woodwind music continues]
[Surgical instruments]
[Montage, back and forth of women and surgical instruments]
[Surgical room preparation for procedure]
[The Joyful Day]
[Narrator:] Like the lake which lies
in the lap of the mountains, our lives
once lay calm and sheltered, barely ruffled
by the winds of the years.
There were not so many of us, and the hills
were long and rich.
But in time, we saw that there was less and less land
to leave our sons.
The lowland people brought medicines
so that not so many of our children would die,
and there became more and more of us.
We planted the foothills until all the level land was gone.
And with every season, there was less rice for each of us.
It sounds a great sin to say there are too many of us.
But secretly, to ourselves, we have
begun to say...there are too many of us.
[Music continues]
[Narrator:] There are perhaps a quarter-million hill tribesmen
in the highlands of Thailand,
their numbers growing
at the rate of about 3.5 percent per year.
Decrease in the death rate, thanks to Thai government
attempts to provide health care and the inevitable shrinkage
of land legacies for their children, have led many of them
to consider limiting their fertility.
Some of them continue to cling to the ancient ideal
of the large family.
Moreover, their very remoteness makes
provision of family planning services extremely difficult.
But recently, some of the tribes have
been told that permanent surgical contraception, needing
only one trip out of their mountains to the hospital,
is possible, safe, and practical.
On one recent day, 75 tribal women, mostly Akha and Lahu.
Converged upon Pha Yao Hospital near Chiang Rai,
to make use of a monthly sterilization service provided
by a surgical team from McCormick Hospital,
in Chiang Mai.
One woman brought her three daughters
for the sterilization operation she wishes she
herself could have had.
[Background chatter]
Some of the women have reached this point
after nearly two day's journey on foot.
Others have been collected by a missionary anthropologist who
has brought a bus to a rendezvous point.
In either case, their presence here
represents a powerful compulsion on their own part
to limit a pattern of childbearing which often gives
a 33-year-old woman seven or eight living children.
Pha Yao is a government hospital, and good evidence
of cooperation between the Thai government
and the private sector in a complex program of service.
There are other assets to the hospital visit,
usually the only one any of these women
will make in a lifetime.
Their children are examined and treated as needed.
[Children crying]
[Speaker 2:] We got the news to come here from the tribal
radio station, which spoke out our names
and said we should come on such-and-such a day
for the operation.
Most of us had never seen such a place as this,
and we were all a little afraid.
It was strange to lie on these high beds,
and the floor was very hard.
We brought the little ones with us.
Our babies, who still needed food from us,
and the children who could not be left at home alone.
Some of us brought our older daughters, even our husbands,
to help with the children.
It was all very new to us, but the people were kind.
[Children fussing]
Those of us who came here knew we wanted
to have no more children ever.
Perhaps our husbands, who had said
that we could do this thing, would want to father
other children someday, and would take a little wife
to bear them.
No matter.
For us, no more babies.
Never again.
We love our children more than we love our life,
but we will not bear them only to see them run
hungry and ragged in the hills.
[Children fussing]
[Narrator:] For these women to be here at all is extraordinary.
For them to take off their brave silver headdresses
and to permit themselves to be touched by strangers
is extraordinary.
And yet, their need to stop bearing
is overwhelming. Because the burden of many children
falls mainly upon their narrow shoulders.
The comfort of the knowledge that they
can stop their childbearing is such
that the program even attracts women
from the hill tribes in Burma, where sterilization
is not available.
Their way is considerably smoothed
by the work of two persons.
An American anthropologist who speaks their language and has
taken responsibility for bringing them together
in this place.
And a Thai surgeon, Dr. [?]
who does not speak their language,
but who communicates with them with respect and warmth.
Part of the examination is to determine and treat
other problems.
Malaria is endemic in the hills.
An enlarged spleen is the signal.
Parasitic infections are common among the hill tribes.
Any one of these women may come to the hospital
for sterilization and may leave not only sterilized,
but with treatment or medication which
may save her life from wholly independent dangers.
The operation is normally a laparoscopy.
Although Dr. [?] also does mini-laparotomies.
The patients are given sedatives and often simply sleep
through the operation.
The area of the incision and ligation is, of course,
anesthetized.
The operation takes less than 15 minutes,
and the incidence of complications from any source
is very low.
Dr. [?] uses absorbable sutures so that it
is not necessary for the patient to return to the hospital.
Further, she administers antibiotics
to avert subsequent infection.
There is something astonishing about the entire picture.
The setting of the hospital and the elaborate laparoscopic
technique is as modern and disciplined as could
be found anywhere. And yet, the patients
are women who, for the most part,
have had no prior exposure to surgery, even
to modern medical care.
It is a commentary upon the way in which people associated
with the program value the lives of simple, trusting,
tribal people.
The statistics of this program are not in themselves
spectacular.
Fewer than 20 percent of the hill tribe villages
have been reached with the necessary information
and education program.
Among the hill tribes, the Akha, Lahu, and Lisu women
were the first to respond.
Indeed, there is broad general acceptance
of the principle of sterilization
among most tribal women.
Many of the husbands still are reluctant,
[Machine buzzing sound
from unwarranted fears that the operation will
weaken their wives or make them frigid
or uncooperative spouses.
Given the logistical problems involved,
the distances the women must travel,
and the alteration in lifestyle such a journey entails.
This must rank as a deeply successful program.
[Hospital staff murmur]
It has given one small but significant group of women
the means of limiting their childbearing.
[Speaker 1:] Today is the day we go home,
home to our hills and our people.
The old ones will question us, and we
will be the center of attention for a little while,
and that will be pleasing.
Best of all, we can lie with our husbands
again and not ever fear that we will have more babies.
Babies who become not happiness, but a burden.
A heavy burden, because we know we cannot give them all we want
for them of food and warmth and long, good lives.
We can be happy together with the children we now have,
and with each other.
It is a joyful day.
[Music]
[An AIRLIE production]
[Executive producer, Murdock Head, M.D.]
[Producer, Douglas Larson; Director, Paul Noonan; Writer, Miriam Bucher]
[In cooperation with, McCormick Hospital]
[Paul Lewis; Family Planning International Assistance]
[Music fades out]
[Produced by the George Washington University School of Medicine]
[and Health Sciences, Department of Medical and Public Affairs]