1. !
Summary: Master Thesis Medical Anthropology and Sociology
Illegal and Unhealthy?
! -
The influence of illegality on the illness experience of illegal Burmese migrant
workers in Thailand -
Noortje van Langen
April 2010

2. 5812518
Supervisor: Marian Tankink
II
Poverty, fear, hiding, are always in my life
I was born in poverty. I grew up in poverty. I have children and grandchildren and they are

3. Acknowledgements
This thesis would not have been possible without the contribution of numerous
people. First of all, I would like to express my gratitude to the participants who have
made the effort of sharing their stories with me in the little spare time they have.
Even though it is not possible to meet again, your faces and stories will always be
remembered. I would like to
thank Dr. Cynthia Maung, the founder and director of the Mae Tao Clinic for giving me
the opportunity to conduct my research at the Mae Tao Clinic. Special thanks go out
to Saw Aung Than Wai, the head of research at the Mae Tao Clinic, who did not only
bring me in contact with other organisations but also actively thought with me about
the practical implementation of my research. Thanks go out to Aung Myant as well,
the head of the counselling department of the Mae Tao Clinic for sharing all his
knowledge about the mental health of the Burmese and for helping me setting up a
workshop concerning these issues. At the MAP foundation I would like to thank Naing
Naing and the rest of the Promotion of Occupational Safety and Health team for
letting me participate in their activities and for helping me organize focus group
discussions. The World Vision Foundation of Thailand needs to be thanked for their
commitment to my research. I would like to emphasize that all these health and
community workers are doing a great and rewarding job to improve the conditions of
the Burmese. Next to these people I would like to thank my translators, Sofia, Ohn
Jana and Nwe Ni. Without their help I would not have been able to conduct my
research. Besides all the
professionals I have worked with, the people I have met in my spare time have
contributed to my fieldwork as well. First of all I would like to thank my roommates
for letting me ventilate all my thoughts and feelings during the sometimes difficult
periods in my fieldwork. Special thanks go out to all the Sunday Funday people who
have brought lightness and laughter to my stay in Mae Sot. Of course all the other
inspiring people I have met who cannot all be listed by name need to be thanked for
sharing their thoughts about Burma, the world and life. This leaves me to
thank the people who have supported me through the whole process of fieldwork and
thesis writing. I would like to thank Marian Tankink, my supervisor, for sharing her
knowledge with me and assisting me through this process. Many thanks goes out to my
all my friends who have supported me this last year. Special thanks go to my aunt
Katie de Haan who has made the effort to correct my English. Last, but not least, I
would like to thank my parents, brothers and sister for their unconditional trust and
faith in me.
Acronyms
CBO = Community-Based Organization
FGD = Focus Group Discussion
NGO = Non-Governmental Organization

4. Summary
The devastating economical and political circumstances in Burma make numerous
Burmese migrate to Thailand. The constantly changing immigration policies together
with the costs of a work permit make many migrant workers unwillingly decide to live
and work illegally in Thailand. This excludes the undocumented migrant workers from
health insurance and labour rights protection though also affects the social world of
the undocumented. By using the theory of sociosomatics, which states that illness is
an embodiment of social problems, the following research question is examined: How
is the illness experience of Burmese undocumented migrant workers in Mae Sot,
Thailand, influenced by their illegality? Through observation, interviewing, focus
group discussion and literature review an overview of the dynamics throughout
different levels of the social world is created. This ecological approach reveals the
lack of interaction within the Thai-Burmese society due to stigma, the social capital
within the Burmese community and the powers of the police and the employer on the
lives of the undocumented. Applying the basic principles of the sociosomatic theory to
these findings leads to the importance of work, money and freedom for the illegal
migrant worker, here described as the moral experience of survival. This moral
experience is entwined through the whole illness experience. In the phase of symptom
experience the stigma and the powers of the Thai government, employer and police
gives feelings of not being recognized by their environment. The power of the police
and the employer causes a constant state of stress, tiredness and physical pains. The
illegal migrant worker’s adherence to the sick role is little due to the fact that the
survival has a higher priority than the expression of distress. Rather the illegal
migrant workers use an idiom of distress by ‘ putting something in the heart’. Within
the decision to seek health care and adhere to the dependent sick role the external
power structures of the employer and the police result in showing little agency and
remaining mute about the experienced distress in order to survive. This results in late
detection of diseases however when medical contact is achieved, full control is given
to the physician. When either the treatment is not successful or no medical contact is
achieved, the undocumented have adopted several coping strategies which are all
embedded within the external power structures that threaten the undocumented
migrant workers. By using these strategies the illegal migrant workers are able to
survive though, without expressing the distress, a moral statement about the
conditions in which the undocumented work and live cannot be made. Without this
moral statement the cycle of social disharmony caused by the illegal status can not be
broken.