Weerapong Kriengsinyos is improving healthcare access by integrating folk medicine into modern healthcare delivery systems, and by diversifying healthcare choices at the community level while preserving local knowledge and herb species.
The New Idea
Weerapong Kriengsinyos is integrating folk medicine into Thailand’s public healthcare delivery system. In so doing, he is increasing access, diversity and affordability of healthcare services, particularly for patients who require a combination of physical and psychological care, such as postnatal mothers, chronic patients and the elderly. Weerapong has worked for many years to legitimize traditional and folk medicine in Thai society. In collaboration with others, he succeeded at getting the government to introduce in 2009 a ten-percent-minimum representation of herb-based folk remedies in the National List of Essential Medicines, making them eligible for government subsidy and freely accessible through the national health insurance program. In 2013, Weerapong and many partners successfully pushed for official recognition of folk doctors as legal health practitioners, under the Thai Traditional Medicine Professions Act. He also established Thailand’s first national network of folk medicine practitioners, who were previously dismissed by modern healthcare professionals and the general public as pagan and illicit “ghost doctors.” Additionally, Weerapong has worked with universities to research the impact of traditional medicine. Building on this groundwork and working with the network of folk doctors, Weerapong is now formally institutionalizing folk medicine into rural healthcare delivery and thus decentralizing healthcare in local communities and diversifying healthcare choices. He is making local government medical facilities access points for folk medicine options both directly through folk medicine healthcare assistants and via referrals to other access points throughout communities, including doctors’ homes, temples, elderly care centers, and recreation centers. As a result of Weerapong’s efforts, folk doctors are becoming part of local government healthcare delivery throughout Thailand and increasingly recognized as an important part of healthcare and social services.
To ensure long-term sustainability of folk medicine, Weerapong is initiating local collaborations between aging folk doctors and youth to survey and restore indigenous herb species, as well as integrating folk medicine into public school curriculum. To increase public access to folk medicine and help protect intellectual property in an era of a growing global market in alternative medicine, Weerapong is also developing Thailand’s first national digitized database of folk remedies and folk doctors, ensuring that folk medicine can advance and adapt alongside modern medicine well into the future.
Folk medicine has been part of human civilizations for thousands of years. The World Health Organization estimates that 80 percent of people living in developing countries still rely on herb-based folk remedies. However, folk doctors are not recognized as valid healthcare providers. In Thailand, laws regulating the medical profession used to prohibit folk doctors from treating patients or charging money for their services. Moreover, many modern healthcare practitioners look down on folk doctors, commonly dismissed as “ghost doctors.”
Without folk medicine as a supplementary healthcare service, rural communities are disadvantaged in their access to high-quality healthcare. Modern healthcare services in Thailand are highly centralized – the most specialized doctors and the most advanced medical equipment still remain in large cities. Rural communities have access to only basic treatments in modern medicine, which is insufficient for the growing population of elderly people in rural areas, as well as other patient groups requiring affordable long-term care such as people with chronic diseases.
Before folk doctors were banned from medical practice, rural communities treated their backyards and local forests as a medicine cabinet, rich with herb species. Today, folk medicine is gaining popularity among modern consumers as nutritional supplements, remedies for chronic diseases and primary treatment for common illnesses. The global market value for herbal remedies and supplements is expected to reach 107 billion US dollars by the end of 2017. However, the popularization of folk medicine is focused on commoditization rather than the preservation of folk medicine and the dying profession of folk doctors.
The rapid commercialization of folk medicine, separating remedies from their practitioners, has often resulted in the misappropriation of indigenous knowledge without informed consent. In 1995, an American university medical center filed a patent claim for the Use of Turmeric in Wound Healing and received the exclusive right to sell and distribute turmeric. India’s Council of Scientific and Industrial Research contested the novelty of this remedy, showing evidence that turmeric has been part of India’s folk medicine for thousands of years. The patent was revoked. However, intellectual property battles between medical researchers, pharmaceutical companies and community claims to ownership of indigenous knowledge continue to this day.
The exclusivity of folk medicine as an inherited profession has been an obstacle to the field’s progress as well. In many cultures including Thailand, most knowledge about folk medicine is passed on by family inheritance and kept a trade secret from outsiders. With limited opportunities for professional advancement, young people are no longer interested in practicing folk medicine, resulting in the disappearance of folk medicine knowledge along with the aging population of folk doctors.
In Thailand, there has been an attempt to revive folk medicine, by encouraging modern medical scholars to research and record herbal remedies. However, Weerapong believes that this approach ignores the essential ties between folk medicine and its role as part of the community fabric. In Thailand and many cultures worldwide, folk doctors heal physical wounds through herbal remedies and nutritional guidance, while strengthening the patient’s psychological well-being, which has been proven to yield positive health benefits particularly for chronic disease patients, postnatal mothers and the elderly. Weerapong is bringing the value of folk medicine into the modern healthcare delivery system—and thus also creating economic opportunity for folk doctors—in rural areas of Thailand by driving access to folk doctors and medicine and by creating the mechanisms to sustain the practice.
In 2007, Weerapong established Thailand’s first national network of folk doctors, to revive not only the body of knowledge, but the role of folk doctors as innovators and providers of community-based healthcare services. Recognizing the potential to integrate folk remedies with modern medicine, Weerapong initiated collaborations between folk doctors and modern healthcare service providers at government hospitals. He formed provincial networks of folk doctors and facilitated regular meetings to exchange experiences among themselves and with modern medicine doctors, pharmacists and nurses. As a result, there is a growing body of medical knowledge identifying supplementary uses for folk remedies in modern healthcare services, ranging from the treatment of snake bites and muscular injuries to chronic respiratory problems, diabetes and postnatal care.
To integrate folk medicine with modern healthcare service systems, Weerapong has facilitated official collaborations between folk doctors and local government units particularly hospitals and rural municipal governments. Rural municipal governments are now beginning to allocate official budgets to support folk doctors in providing healthcare services for the elderly. Rural government hospitals and primary care units are beginning to integrate folk doctors as “medical assistants” who take on the leading role in healthcare services for chronic patients. Local healthcare facilities also provide referral lists to folk medicine doctors in the community, and Weerapong is creating a variety of new access points for folk medicine services. He has convinced monks and local government leaders to set up folk medicine service centers at temples and community recreation centers, providing free or low-cost herbal healthcare services.
By establishing the national network of folk doctors, Weerapong has facilitated an unprecedented flow of information and experiences among folk doctors. With Weerapong’s encouragement, Thai folk doctors registered their national network as the first professional association of its kind in 2007. Weerapong has also engaged the Thai Health Promotion Foundation as a key partner in funding folk medicine innovations in local communities nationwide. Many of the innovations focused on ensuring the sustainability of folk medicine. For example, Weerapong facilitated a collaboration between a public school and a local network of folk doctors in designing a “local knowledge curriculum” which integrates folk medicine knowledge with mainstream educational subjects such as language, mathematics, science, social studies, health education, vocational training and art. Folk doctors, formerly dismissed as pagan and illegitimate ghost doctors, are now respected by schoolteachers and local youth as teachers of indigenous knowledge. Today, the Regional Office of Education recognizes this school as a regional training center for central and northern Thailand.
To ensure the long-term sustainability of folk medicine, Weerapong is initiating collaborations between aging folk doctors and local youth and other community residents to conduct surveys and conservation programs to preserve herbal plant species and related ecosystems. Over the past five years, Weerapong has assisted communities in more than 17 provinces throughout Thailand to set up conservation programs that link the intellectual knowledge of folk doctors with the sustainable use of herb species, in the form of community-managed herbal forests as well as for-profit businesses providing economic incentives to preserve folk remedies and indigenous herb species.
At the national level, Weerapong is instrumental in advancing policy changes to integrate folk medicine into the national healthcare system. In 2009, Weerapong advocated for the Thai government to introduce a ten-percent minimum for folk medicine remedies in the National List of Essential Medicines, which is eligible for free access through the national health insurance program. In 2013, Weerapong and many partners successfully pushed for official recognition of folk doctors as legal health practitioners, under the Thai Traditional Medicine Professions Act. Weerapong is also facilitating formal collaboration between government hospitals and medical schools, to integrate folk doctors as teachers for medical professionals.
To ensure that folk medicine outlives the aging population of folk doctors and advances alongside the field of modern medicine, Weerapong is now developing a national digitized database of Thailand’s folk remedies and folk doctors. He plans to use this open source database as a tool for promoting the role of folk doctors as an integral part of healthcare delivery systems and for protecting the intellectual property of these doctors in an era of growing global popularity of alternative medicine.
Weerapong was first introduced to the dynamics in rural areas while in high school, where he organized a club through which students volunteered in rural areas, helping construct playgrounds and other things. At that time, Weerapong witnessed the Thammasat University Massacre of 1976, when hundreds of students were shot and thousands arrested for protesting the military regime. In response, he organized a network of young pro-democracy activists from 13 high schools. Later in university, Weerapong continued to lead student volunteer activities, but shifted his interest toward the approach of social change through non-violence.
Still drawn to rural areas and the traditional wisdom prevalent there, Weerapong joined the Thai Holistic Health Foundation in its early years in 1982. Back then, the organization focused on gathering knowledge about herbal remedies. Over the years, he realized that one important key component was missing: the practitioners. He began collecting information about folk doctors at first out of personal interest. Over time, Weerapong was a key leader in the movement to popularize folk medicine and ultimately took over leadership of the Foundation. In 2004, he organized the first National Herb Fair in Bangkok, gathering hundreds of folk doctors from remote villages throughout Thailand. Today, the National Herb Fair has become an annual weeklong event sponsored by Thailand’s Ministry of Public Health, with more than 350,000 visitors in 2015. In 2007, he organized the national network of folk medicine doctors, and achieved formal legal recognition for the profession in 2013. In Weerapong’s view, folk medicine can help bring about social change at both the community and personal level by valuing community resources and using them to create better healthcare access and quality.