Based on oral histories of agriculture and health in the Mae Chaem valley, northern Thailand, this work documents changing child health and medical practice since the 1950's and explores possible connections with increasing pesticide use. The research shows how local knowledge can help us understand relationships between changing technology, ecology, and human health. Parents and farmers in the Mae Chaem valley of Chiang Mai province, Northern Thailand, live at the intersection of multiple local and global streams of land use and child health biotechnology. Based on systematically collected autobiographical oral histories from parents and farmers, as well as interviews and participant observation with land use and child health experts the study considers the relationships between child health and land use change, and particularly the rise of pesticide intensive cash cropping, since the late 1950’s. Introductory chapters on theory and methods precede a description of the ethnographic context. Case studies illustrating parent and farmer histories of child health and land use change spanning fifty years are provided. Seven streams of biotechnical expertise are identified, and mini-ethnographies are provided for each including domestic, Buddhist, Muang, spirit, market, national, and Christian. These seven streams are analyzed using actor-network theory (ANT) with relationships to particular notions of ontology, cosmology, and ecology. Results demonstrate the ongoing importance of parents and farmers as decision making agents at the intersection of multiple and competing cultural and biotechnical streams, even where they face efforts by large multinational corporations or other agencies to advertise, constrain and monopolize local biotechnical choice. Within the fifty year time period under consideration, the oral histories describe particular child health and land use trends. These locally perceived trends provide challenging perspectives on the relationship between ‘development’ and child health in Thailand. While children die far less often now than in the past, oral histories suggest that both children and fields now suffer from more kinds of illness, and more often, than before. In particular, both qualitative and more quantitative analysis suggests differences in the experience of child health among pesticide and non-pesticide using households.

Based on oral histories of agriculture and health in the Mae Chaem valley, northern Thailand, this work documents changing child health and medical practice since the 1950's and explores possible connections with increasing pesticide use. The research shows how local knowledge can help us understand relationships between changing technology, ecology, and human health. Parents and farmers in the Mae Chaem valley of Chiang Mai province, Northern Thailand, live at the intersection of multiple local and global streams of land use and child health biotechnology. Based on systematically collected autobiographical oral histories from parents and farmers, as well as interviews and participant observation with land use and child health experts the study considers the relationships between child health and land use change, and particularly the rise of pesticide intensive cash cropping, since the late 1950’s. Introductory chapters on theory and methods precede a description of the ethnographic context. Case studies illustrating parent and farmer histories of child health and land use change spanning fifty years are provided. Seven streams of biotechnical expertise are identified, and mini-ethnographies are provided for each including domestic, Buddhist, Muang, spirit, market, national, and Christian. These seven streams are analyzed using actor-network theory (ANT) with relationships to particular notions of ontology, cosmology, and ecology. Results demonstrate the ongoing importance of parents and farmers as decision making agents at the intersection of multiple and competing cultural and biotechnical streams, even where they face efforts by large multinational corporations or other agencies to advertise, constrain and monopolize local biotechnical choice. Within the fifty year time period under consideration, the oral histories describe particular child health and land use trends. These locally perceived trends provide challenging perspectives on the relationship between ‘development’ and child health in Thailand. While children die far less often now than in the past, oral histories suggest that both children and fields now suffer from more kinds of illness, and more often, than before. In particular, both qualitative and more quantitative analysis suggests differences in the experience of child health among pesticide and non-pesticide using households. / Arts, Faculty of / Anthropology, Department of / Graduate

Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. Since access to diabetes prevention programs is limited in Thailand, especially in rural areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective and sustainable. Therefore, the main objective of this program is to build capacity for chronic disease prevention in Thailand through application of learning technologies in the education, support and accreditation of community health care workers (CHCWs). This program stems from established partnerships among: The University of Waterloo (UW), Department of Health Studies and Gerontology; Institute of Nutrition, Mahidol University (INMU); The Office of Disease Prevention and Control 10 Chiang Mai province; Ministry of Public Health (MOPH), Thailand and UW, Centre for Teaching Excellence (CTE) . The development of the community-based diabetes prevention education program in Chiang Mai, Thailand was informed by in-depth interviews with health care professionals (n=12) and interviews (n=8) and focus groups (n = 4 groups, 23 participants) with community volunteers, screened as at-risk for diabetes. Coded transcripts from audio-taped interviews or focus groups underwent qualitative analysis by hand and using NVivo software. Health care professionals identified opportunities to integrate health promotion/ disease prevention into CHCWs’ duties. However, they also identified potential barriers to program success as motivation for regular participation, and lack of health policy support for program sustainability. Health care professionals supported an education program for CHCWs and recommended small-group workshops, hands-on learning activities, case studies and video presentations that bring knowledge to practice within their cultural context; CHCWs should receive a credit for continuing study. Community volunteers lacked knowledge of nutrition, diabetes risk factors and resources to access health information. They desired two-way communication with CHCWs. A tailored diabetes prevention education program was designed based on this formative research. Learning modules were delivered over eight group classes (n=5/class) and eight self-directed E-learning sessions (www.FitThai.org). The program incorporated problem-based learning, discussion, reflection, community-based application, self-evaluation and on-line support. The frequency that students accessed on-line materials, including video-taped lectures, readings, monthly newsletters, and community resources, was documented. Participant satisfaction was assessed through three questionnaires. Knowledge was assessed through pre-post testing based on an exam that was pilot tested with 32 CHCWs from a district outside of the 5 districts in semi-urban Chiang Mai province from which the 69 participating CHCWs (35 intervention, 34 control) were randomly selected. The program was implemented over four months. Three quarters of participants attended all eight classes and no participant attended fewer than six. Online support and materials were accessed 3 – 38 times (median 13). Participants reported that program information and activities were fun, useful, culturally relevant, and applicable to diabetes prevention in their specific communities. Participants also appreciated the innovative technology support for their work. Comfort with E-learning varied among participants. Scores on pre-post knowledge test increased from a mean (SD) of 56.5% (6.26) to 75.5% (6.01) (P < .001). The effect of the program on knowledge of CHCWs was compared between intervention and control communities at baseline and the end of the program. Overall, the knowledge at baseline of both groups was not significantly different (56.5% (6.26) intervention versus 54.9% (6.98) control) and all CHCWs scored lower than 70%. The lowest scores were found in the “understanding of nutritional recommendations” section (mean score = 28% in intervention and 30% in control CHCWs). After 4 months, CHCWs in the intervention group demonstrated improvement relative to the control group (75.5% (6.01) versus 57.4% (5.59), respectively, p <.001, n=69). The percent of CHCWs achieving a total score of 70% was 77% (27/35) in intervention and 0% in control groups. The diabetes prevention education program was effective in improving CHCWs’ health knowledge relevant diabetes prevention. The innovative learning model has potential to expand chronic disease prevention training of CHCWs to other parts of Thailand. Ultimately, prevention of chronic diseases and associated risk factors should be enhanced.

Thailand has faced under-nutrition and yet, paradoxically, the prevalence of diseases of over-nutrition, such as obesity and diabetes, has escalated. Since access to diabetes prevention programs is limited in Thailand, especially in rural areas, it becomes critical to develop a health information delivery system that is relevant, cost-effective and sustainable. Therefore, the main objective of this program is to build capacity for chronic disease prevention in Thailand through application of learning technologies in the education, support and accreditation of community health care workers (CHCWs). This program stems from established partnerships among: The University of Waterloo (UW), Department of Health Studies and Gerontology; Institute of Nutrition, Mahidol University (INMU); The Office of Disease Prevention and Control 10 Chiang Mai province; Ministry of Public Health (MOPH), Thailand and UW, Centre for Teaching Excellence (CTE) . The development of the community-based diabetes prevention education program in Chiang Mai, Thailand was informed by in-depth interviews with health care professionals (n=12) and interviews (n=8) and focus groups (n = 4 groups, 23 participants) with community volunteers, screened as at-risk for diabetes. Coded transcripts from audio-taped interviews or focus groups underwent qualitative analysis by hand and using NVivo software. Health care professionals identified opportunities to integrate health promotion/ disease prevention into CHCWs’ duties. However, they also identified potential barriers to program success as motivation for regular participation, and lack of health policy support for program sustainability. Health care professionals supported an education program for CHCWs and recommended small-group workshops, hands-on learning activities, case studies and video presentations that bring knowledge to practice within their cultural context; CHCWs should receive a credit for continuing study. Community volunteers lacked knowledge of nutrition, diabetes risk factors and resources to access health information. They desired two-way communication with CHCWs. A tailored diabetes prevention education program was designed based on this formative research. Learning modules were delivered over eight group classes (n=5/class) and eight self-directed E-learning sessions (www.FitThai.org). The program incorporated problem-based learning, discussion, reflection, community-based application, self-evaluation and on-line support. The frequency that students accessed on-line materials, including video-taped lectures, readings, monthly newsletters, and community resources, was documented. Participant satisfaction was assessed through three questionnaires. Knowledge was assessed through pre-post testing based on an exam that was pilot tested with 32 CHCWs from a district outside of the 5 districts in semi-urban Chiang Mai province from which the 69 participating CHCWs (35 intervention, 34 control) were randomly selected. The program was implemented over four months. Three quarters of participants attended all eight classes and no participant attended fewer than six. Online support and materials were accessed 3 – 38 times (median 13). Participants reported that program information and activities were fun, useful, culturally relevant, and applicable to diabetes prevention in their specific communities. Participants also appreciated the innovative technology support for their work. Comfort with E-learning varied among participants. Scores on pre-post knowledge test increased from a mean (SD) of 56.5% (6.26) to 75.5% (6.01) (P < .001). The effect of the program on knowledge of CHCWs was compared between intervention and control communities at baseline and the end of the program. Overall, the knowledge at baseline of both groups was not significantly different (56.5% (6.26) intervention versus 54.9% (6.98) control) and all CHCWs scored lower than 70%. The lowest scores were found in the “understanding of nutritional recommendations” section (mean score = 28% in intervention and 30% in control CHCWs). After 4 months, CHCWs in the intervention group demonstrated improvement relative to the control group (75.5% (6.01) versus 57.4% (5.59), respectively, p <.001, n=69). The percent of CHCWs achieving a total score of 70% was 77% (27/35) in intervention and 0% in control groups. The diabetes prevention education program was effective in improving CHCWs’ health knowledge relevant diabetes prevention. The innovative learning model has potential to expand chronic disease prevention training of CHCWs to other parts of Thailand. Ultimately, prevention of chronic diseases and associated risk factors should be enhanced.

This dissertation examines the cross-border flows of media texts, migration and the construction of ethnic identity in the receiving state. It focuses on the recent wave of Shan ethnic nationals from Burma who migrate to seek work in Thailand and their relationships with Shan media -- primarily in the forms of audio cassettes, video CDs, and movies -- that follow these mobile people. My purpose in linking mass media and migration is to understand how displacement shapes the social construction of identity and how Shan ethnic media plays a significant role in shaping identity in a situation of displacement. Based on eighteen months of ethnographic work with the Shan migrant community in Chiang Mai, Thailand, this dissertation argues on two grounds. First, while Shan media shows the ability to cross the borders, and hence disturbs the boundaries of the state, transnational flows are also shaped by the politics and practices of a nation-state. The diversification of Shan media that now include a variety of local, national and transnational as well as commercial and community media illustrates ways in which mass media can offer both a technology of state control as well as parallel spaces for alternative transnational practice. Second, I argue for the need to pay attention to diversity within a migrant population, in particular the presence of various groups of migrants at the same point of time. In trying to understand how different social and material conditions and the history of migration shape the ways people ascribe to ethnic and national identity, this study draws on four different categories of Shan migrants -- the new arrivals, the long-term residents, the ethno-nationalists, and the exile prisoners. Each of these points to different ways of engagement with this media and the different meanings the individuals in each category ascribe to the notion of Shan nation and to what it means to be Shan. / text