The majority of the inhabitants of the villages included in the study earn their living as small farmers and wage-earners. Chaiyapoom’s villages, as compared to Chiangrai’s, are poorest; they are situated in the high, dry and infertile areas. They have had a problem of drought for some years. It has been very common for villagers of working age there to move into big cities, particularly Bangkok, to get both temporary and permanent jobs. Massive seasonal labor-migration after harvesting (November to April) to work in construction sites and sugar cane plantations in other provinces is also common. In Chiangrai’s villages, the economic situation is relatively better; due to the better environment (i.e. fertile land, good water supply), villagers can work all year round.

In such rural socio-cultural and economic contexts, many specific health problems emerge and drug demands develop. The availability of drugs at the village level, which was characterized earlier as plentifulness, undoubtedly also facilitates the development of a specific drug use culture among the villagers.

Work-related illness and drug use

Each year, during the planting and harvesting season (May-January), there is a lot of hard physical work for both men and women in the villages. Changing weather conditions, specifically the unpredictable rain, force many villagers to hurry to finish their field work. In order to have sufficient money to spend while waiting for the end of the year as well as to pay back their debts, most villagers usually earn their living by working both in their own fields and as wage labourers for others. During a year such enduring physical work can cause many illnesses and complaints such as: muscle pain, which ranges from bodily fatigue to serious sharp pain; stomach ache due to irregular meals during working days; cold, fever and headaches caused by overworking and not having enough time to rest; wounds and injuries. Over the years, for many villagers, some illnesses become chronic and the use of some drugs becomes habitual.

Muscle pain, pain killers and anti-inflammatory drugs

Symptoms of muscle pain can range from bodily fatigue (muey-nue mue-tua), back and waist ache (puad-hlang-puad-aw), leg pain (puad kha), which are relatively minor but sometimes chronic, to sharp pain (york) which is more serious. Many kinds of drugs were found to be used for these symptoms; many are modern; some are traditional; some are used for cure, but many more for prevention.

Overuse of muscles or working in the same position for hours each day (i.e. bending over while planting and harvesting in the rice field) normally result in bodily fatigue and back and waist ache; sometimes they come together with slight fever. Pain killers, which usually come as a packaged powder or tablet preparation and widely called “Ya-Song”¹, are commonly used to solve these problems. A lot of villagers used “Ya-Song” to cure such pain; but many also to prevent it. It was felt by many villagers that taking pain killers in the morning or during the working day would help them to work more energetically and longer, and prevent them from having any pain at the end of the day. Using “Ya-Song” during hard working days is, in fact, a usual practice of villagers in many villages of both provinces. Many villagers and grocery store owners told us that it is a tradition for rice field owners to provide “Ya-Song” to their wage-earning workers or mix it in the drinking water as a part of their working conditions.

The frequent use of “Ya-Song” by many villagers, particularly those who are strong and young (i.e. less than 30) normally lasted till the working season ended. Yet for many, the frequent use, over years, and always coupled with chronic muscle pain, developed into another pattern of pain killer use: the habitual use of or the dependence on pain killers. Data from the household drug use survey, especially from Chaiyapoom, reveal that up to 27% of the sample households reported that at least one of their members still used or had at some time used pain killers every day.

Serious muscle pain or joint pain (york) were found to be usually treated with various kinds of anti-inflammatories; phenylbutazone, piroxicam, and corticosteroids (dexamethasone). These drugs usually come in two forms. The first is “Ya-Chud” or a combination of four to six tablets or capsules, with anti-inflammatory drugs as a main component, and locally named as “Ya-Chud” for muscle pain or “Ya-Chud- Mornuad”. The other is a single tablet of dexamethasone locally called as “Pradong no. 5”.

For some acute and relatively serious sharp pains, private clinics and injection doctors (specifically in Chaiyapoom villages) were resorted to. This was also the case for villagers who had developed chronic pain. In such circumstances, injectables (locally called “Ya-Cheed”) were usually provided.

Muscle pain and traditional drugs

Causes of muscle pain can also be explained by two of Thailand’s traditional medical concepts; Kasai and Pradong. Traditionally, Kasai is an adult chronic illness; it can produce various symptoms, but backache will always be among these. It is also conceived that the occurrence of Kasai is related to the function of Tai or kidney. To name the illness, it always goes together as Kasai-Taipikam. For many Thais, backache is believed to have a relation with problems of the kidney, traditionally named as Tai-Ugsaeb.

Pradong is, in fact, a syndrome whose apparent symptoms can cover a wide range. Again, muscle pain is the most important indication. To cure these illnesses, apart from many herbal drugs, many traditional drugs are available in the market, of which the majority has to be mixed up and taken with alcohol, namely “Ya-Dong” or “Ya-Dong-Lao”. However, most interesting is the availability of modern drugs whose name is derived by borrowing the traditional concept i.e. “Ya-Chud Pradong 108” (“Ya-Chud” for Pradong), and “Pradong No. 5”. These drugs are, in fact, corticosteroids.

Apart from curing Kasai, many of “Ya-Dong-Lao” have been described and are believed to affect a wide range of health problems including enhancement and maintenance of body strength. Such beliefs, and, probably, also because the medicine has to be taken with alcohol, are behind the wide availability and the popularity of “Ya-Dong-Lao” in the villages.

Muscle pain, weakness and injectables and intravenous solution

Bodily weakness, another work-related health problem, is treated by injectables and intravenous solution. Prolonged fatigue among women was frequently interpreted as Leaud Noi or “inadequate blood”, the cure for which was a visit to a private clinic for an injection of “Ya-Cheed Perm Leaud” or “blood-increasing drug” which was in fact a vitamin. An intravenous solution, with the local name of “Nam-Klue”, was believed to help in restoring health and vigour. In the Chaiyapoom study villages, it was not unusual to see people have “Nam-Klue” at a tambon health official’s clinic or even to see them purchase “Nam-Klue” from drugstores to have it administered at home by one of their neighbours or by an injectionist. To have “Nam-Klue” to boost bodily strength before going into an intensive piece of work i.e. as a wage-laborer on a sugar cane plantation, was also found a prevailing practice among villagers in Chaiyapoom.

The use of antibiotics

Antibiotics for infected wounds, diarrhoea and cold and cough with sore throat

“Trex 120”, “Trex 250”, “Rotexin 120”, and “Rotexin 250” are trade names of yellowish capsule tetracycline, which locally known as “Ya-Orio” or “Ya-Kae-Taiy” (medicine to cure diarrhoea), are widely used specifically for diarrhoea. Capsules of 120 mg. of tetracycline (“Trex 120”, and “Rotexin 120”) were used for children; the 250 mg. capsules for adults. It is unclear why and how such concepts have been developed, but the practice was reported by villagers in most of the study villages.

For general infected wounds, “penicillin G” (tablet), “Heromycin”, “Kanamycin”, “T.C. mycin”, “Bomcin”, tetracycline (capsule), and chloramphenicol (capsule), were widely used. Interestingly, the way such antibiotics were taken was not only through swallowing but also by grinding the tablets and applying the ground powder directly to the wound. It was said by many villagers that it would help to dry up the wound very quickly. For seriously infected wounds and in case of sexually transmitted disease (STD), injectables of antibiotics were applied.

Antibiotics are widely used in self-medication for serious cough and cold, especially when it comes with fever and a bad sore throat, in children. Many brand names of dried syrup antibiotics could be obtained at the village level i.e. ampicillin, amoxycillin, “Mychochlolin”, and “Ampido”. Adults, as was mentioned in FGD sessions, sometimes use antibiotics to cure a bad cold with a sore throat.

Antibiotics for uterus pain or Mod-Luk-Ugsaeb

For Thais in general, any kind of antibiotic is always called “Ya-Kae-Ugsaeb” meaning “drugs to cure an infected wound”. The term (“Ugsaeb”) is always used by lay people to characterize any kind of wound which has pus (hnong), abscess (Fhee) and is swollen (buam). Medical professionals also use this term to communicate with the general public, but in a broad sense: sometimes by referring to infection inflammation, sometimes non-infection inflammation. However, “Ya-Kae-Ugsaeb” is also often associated with sexually transmitted disease or any kind of infected wound of the reproductive organs. Many “Ya-Kae-Ugsaeb” i.e. “Kanamycin”, “Penicillin”, “T.C. Mycin”, or any other one which has the suffix “mycin”, would have a second connotation as drugs that cure an infection occurring in the reproductive organs.

It is interesting that villagers in Chaiyapoom study villages widely used “Gano”: a popular trade name of tetracycline, or another tetracycline to cure Mod-Luk-Ugsaeb, a complaint of the uterus, because of the misconception of the term Ugsaeb or inflammation: they were made to think through promotion by a local drug company that any kind of Ugsaeb needs “Ya-Kae-Ugsaeb” to cure. The result of which is the wide use of antibiotics called “Kano” for Mod-Luk-Ugsaeb.

The use of “Ya-Chud” and “Ya-Cheed”

“Ya-Chud” is a culturally unique mixed preparation of modern drugs, usually most of them prescription drugs, which is illegal but widely obtainable in grocery shops and drugstores. It is indeed a set of pharmaceutical containing 4-6 different shapes, sizes and colors of tablets or capsules, put together in a small plastic bag, which normally costs around 3-5 Bahts. “Ya-Chuds” are available for a wide range of diseases. Yet the most popular ones are: 1) “Ya-Chud” for muscle pain which can have many specific names; 2) “Ya-Chud” for a bad cold and fever; 3) “Ya-Chud” to enhance appetite; 3) “Ya-Chud” for diarrhoea. “Ya-Chud” that is available at the grocery shop at the village level usually comes from two sources. The first and the most important source is drugstores in district or provincial towns. The second source is the drugs peddlers. The reason why “Ya-Chud” is popularly used in Thailand is not clear. Yet one can think about its efficacy, as many contain corticosteroids as a major component, its low price, and its inherent promise of a cure combined with increased chance of success because of a combination of many drugs.

“Ya-Cheed” or injection is a popular form of drug application among villagers. Data from FGDs in almost every village of Chaiyapoom, both from male and female groups, reveal that villagers have been familiar with injections for decades. Injections are usually perceived as having a superb efficacy; they are seen as more powerful, stronger, faster and more effective than other types of drugs. Treatment received from clinics of tambon health workers and medical doctors reinforce villagers to think positively towards injections, as injections are frequently provided by these health professionals. “Ya-Cheed” seems to be self-medicated frequently in situations that: 1) the complaints are more serious i.e. a bad cold with severe headache; or 2) fast cure is desired. The wide use of “Nam-Klue” (intravenous solution) by villagers in the study areas to relieve body fatigue can be explained by this desire for the fast cure. The popularity of “Ya-Cheed” among our sample households can be seen from the data presented in Table 15.

Table 15: Percentage of sample households which ever used prescription drugs in Chiangrai and Chaiyapoom

Note: 1),2),3) phenylbutazone; 4) mostly piroxicam but phenylbutazone was also found, 5),6) = mostly dexamethasone.