1. 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 also
poor. In my country, just to get a regular income to survive was a struggle. We did not have time
to think about why it was like this. We felt so weak. We were scared of almost everything. That’s

3. why we left home. Now I have lived with my family in another country for twenty years. We still
do not have any money to save, even though everybody in the family has worked. None of us has
any legal status. Police can arrest us for this. Police can come and check anytime. We can not
sleep well in the night. Before we thought: “if we come and work here it will be better than it is
in Burma”. Really, the situation we face right now is not the same as we thought it would be.
(Text and Water colour painting on title page by Tinn, 2007)
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

4. FGD = Focus Group Discussion
NGO = Non-Governmental Organization
MAP Foundation = Migrant Assistance Program Foundation
SLORC = State Law and Order Restoration Council
SPDC = State Peace and Development Council
WFVT = World Vision Foundation Thailand
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.

5. Contents
Chapter 1. Introduction 1
1.1 Reasons for migration 2
1.2 Previous studies on illegal migrants and their health 5
1.3 Research questions 6
Chapter 2. Methodology 8
2.1 Research population 8
2.2 Research area, access and sampling 8
2.3 Research methods 10
2.4 Ethical considerations 11
Chapter 3. Theoretical framework 13
3.1 Theories 13
3.1.1 Theory of sociosomatics 13
3.1.2. Ecological framework 14
3.2. Theoretical concepts 16
3.2.1 Stigmatization 17
3.2.2 Power 17
3.2.3 Social capital 17
3.2.4 Coping strategies 17
3.2.5 Agency 18
Chapter 4. Societal level 19
4.1 The cultural and political system in Burma 19
4.2 Thai immigration law 21
4.3 Implications of the Thai Immigration Law 23
4.4 Conclusion 24
Chapter 5. Community level 25
5.1 The Burmese community in Mae Sot 25
5.2 The Thai-Burmese community in Mae Sot 26
5.3 Power of the police 27

6. 5.4 Conclusion 29
Chapter 6. Relationship level 31
6.1 Family and friendship 31
6.2 Power of the employer 32
6.4 Conclusion 35
Chapter 7. Individual level 36
7.1 Symptom experience 36
7.2 Assumption of the sick role 37
7.3 Medical care contact 40
7.4 Dependent sick role 41
7.5 Recovery and rehabilitation 42
7.6 Conclusion 44
Chapter 8. Final conclusion 46
8.1 Importance of social events, conditions and relations 46
8.2 Conceptualization of social events as potentially productive of disease
states 47
8.4 The role of experienced emotions in the bodily experience 48
8.5 The sociocentric society and the role of social capital 49
8.6 The role of expressed emotions and agency in the moral experience 50
8.7 Shaping and patterning the moral experience of survival 51
Chapter 9. Discussion 53
9.1. Research population 53
9.2 Study design and theoretical framework 54
9.3 Methodology 54
9.4 Ethical discussion 55
9.5 Recommendation for further research 56
References 58
Appendix 62
Appendix I: Topic lists 63
Appendix II: Rapid appraisal techniques 67
II

7. Chapter 1. Introduction
This thesis focuses on the Burmese illegal migrant workers[1] in Thailand and their illness
experience. I chose this topic for several reasons. First of all I have always been fascinated by
the migration process. What makes people decide to leave their home country, what feelings
are generated by the migration process and how do you build up a new life in an unfamiliar
environment? These questions often arose to me, especially in relation to the health problems
that migrants face worldwide. Studies show migrants have a high rate of specific stress related
health problems though utilize health care little (Janes 1990, Peng et al. 2010). At that moment
I became interested in how the migrants experience their life, their health problems and what
makes them decide to seek healthcare.
During my orientation period I focussed on involuntary migration and
refugee health in different places around the world. While most articles discussed refugee
populations I was familiar with, one article about Burmese refugees in Thailand drew my
attention (Brees, 2008). Why is this refugee flow unknown to me while Medecins Sans
Frontières reports the situation in Burma as one of the top ten worst humanitarian and medical
emergencies in the world in 2008 (Medecins Sans Frontières , 2008)? As I was not aware of the
problems inside Burma nor of the Burmese people seeking shelter in Thailand, I searched for
further information. Little was written in academic literature and all focused on refugees living
in the refugee camps and their health situation. However one particular recurring
recommendation mentioned in these articles struck me: the situation of the undocumented
Burmese migrant workers inside Thailand is unknown and under researched. Conducting
research on this specific population can therefore contribute to the knowledge on and
hopefully also the situation of the undocumented Burmese migrant workers. I adapted
my initial idea for the research, migration and health, to the circumstances of the illegal
migrants in a small town at the Thai-Burmese border, Mae Sot. Changing the focus solely on
undocumented migrant workers, brought up new questions. To what extent does your
environment and especially the law restrict you to build up a new and healthy life? How do the
Burmese undocumented migrants experience these restrictions and are there any health
consequences connected to these restrictions? If so, how do they experience this illness and
when do they decide to seek healthcare? By looking at all these factors, the influence of the
illegal status on the illness experience of the undocumented migrant workers will become
apparent.
In this thesis I will discuss the reasons for migration, my research questions and previous
studies conducted concerning illegality and health worldwide in chapter one. In the second
chapter I will elucidate on the methodology used for this research. Not only the access,
sampling and research methods will be mentioned, also the ethical considerations in
conducting research within a vulnerable target group will be discussed. Chapter three is
dedicated to the theoretical framework and concepts used to support the design of the
research. In the following chapters four, five, six and seven I will present my results according to
the ecological framework on respectively societal, community, relationship and individual level.

8. Each of these chapters will end with a sub conclusion. In chapter eight, final conclusion, the
results will be connected to the theoretical framework. In the discussion, chapter nine, I will
finalize this report with the strengths and weaknesses of the research and recommendations
for further research.
Let me first introduce the research by describing the background leading to my research
question. Throughout the thesis I use the old country name Burma instead of Union of
Myanmar, the official name at the moment. I have decided to do so, since the new name is
introduced by the military dictatorship of the junta, which has been violating human rights for
many years already. Out of respect for the people who suffer under these conditions and due
to the fact that the majority of the Burmese use the name Burma, I will do so as well.
1.1 Reasons for migration
The process of migration is always stimulated by push factors which make people decide to
leave their country and pull factors, which makes a country attractive to move to. In the case of
Burmese migrant workers, both legal and illegal, the overall push factor is the devastating state
which the country is in at the moment. This destruction is a consequence of years of political
mismanagement. To understand the conditions of these push factors and the situation of
migrant workers in Thailand, I will take a closer look at the characteristics and history of Burma.
Being the largest country in South East Asia, Burma has a population of approximately forty
eight million people. The country is rich in resources; especially gems, oil and gas are abundant
(Hulst, 2006). Due to the historical background there are a mixture of religions and ethnic
groups present in Burma. Buddhism is the major religion with 89 %, followed by Christianity
(4%), Islam(4%) and animism (1%). The ethnic majority is the Burman (68%) . The Shan (9%),
Karen (7%), Rakhine (4%), Chinese (3%), Indian (2%), Mon (2%) live as ethnic minorities mainly
in the border states (The world factbook: Burma, 2009).
The ethnic and religious rivalry started already in the 8th century, when both the Mon
and Burman established kingdoms on Burmese soil. In 1531 the era of kingdoms got to an end
and powerful dynasties started to rise. The climax of these expansions was the ransack and
burning of Ayutthaya, the capital of Siam which is now known as Thailand. This historical event
still plays an important role in the feelings towards each other. When the British attacked in
1825, more than sixty years of Anglo Burmese wars followed resulting in the victory of the
British in 1886. During the following colony period the country got reformed; infrastructure and
schools were built and the British justice systemwas introduced. The economy bloomed, with
Burma as biggest rice exporter worldwide and an increase in oil and teak wood export.
Dissatisfaction grew under the population though, as the Burmese nobility lost their power and
there was no financial benefit for the Burmese; all the money went directly to the British
Empire. This opposition was lead by Aung San.
The British colony came to an end after World War II, where the Japanese had ruled brutally
over Burma. With a temporary government consisting of the former opposition leader Aung
Sun and six Burmese ministers working under supervision of a British governor, an independent

9. Burma was nearby. Due to the horrible fact that six ministers and the Prime Minister were
assassinated in 1947, a change of power was inevitable. Under U Nu, the only surviving
government member, Burma became independent in January 1948. Soon after the
independence, ethnic minorities started fighting for their independent states, which still
continues up till now.
A military coup in 1962 made an end to U Nu’s leadership. General Ne Win took power
with the promise to build a socialist Burma. Through the disappearing of democratic rights,
violation of human rights, isolation from the world and extreme media control, the Burmese
population became oppressed and poor. This resulted in the ‘888 uprising’; massive
demonstrations led by students. Though the demonstrations led to approximately 300 deaths
through the interference of the junta, a new generation of generals enrolled with the promise
of banning socialismand introducing democratic elections. While this State Law and Order
Restoration Council (SLORC) changed the name from “Socialist Republic of Burma” to “Union of
Myanmar”, the majority of the high educated people fled the country out of fear for
imprisonment and the military took over their positions.
Though elections were held in 1990, with an overwhelming majority for the National
League for Democracy led by Aung San’s daughter, Aung San Suu Kyi, the SLORC refused to step
down. The hope of the population was destroyed when general Than Shwe changed the name
SLORC into the promising State Peace and Development Council (SPDC) however at the same
time tightened democratic rights and increased the human rights violations. Even an uprising of
monks and millions of Burmese citizens during the saffron revolution in September 2007, could
not change the situation and was brutally ended by the junta (Hulst, 2006). Mean while
opposition leader Aung San Suu Kyi has been under house arrest for almost 14 out of 20 years.
The military rule has devastating effects on security, educational, health care and
financial level of the country and its population. The constant state of fear, suspicion and
paranoia affects people their daily life and feeling of well being. Forced labour and violent
forced movement of ethnic minorities also play an important role in the difficult situation of the
Burmese.
The basic facilities of education and health care have been neglected in the last
decades. Even though the enrolment in free and compulsory primary education seems high
(80%), the completion of primary school is less than 55 %. Access to secondary education is
limited due to high costs and lack of secondary schools in rural areas. The fact that children
from non state-run primary schools do not get accepted to state-run secondary schools also
plays a role. At university level, students are restricted in several ways by the SPDC; there is a
lack of free speech or expression and critical thinking is highly discouraged. A brain drain caused
by the imprisonment and exodus of high educated people together with the fear of more
student demonstrations has resulted in the closing of several universities throughout the
country.
The different sectors in health care (public, private, traditional and military) have all been
affected in their own way. Public hospitals are in bad condition due to the fact that Burma has

10. the lowest budgetary allocation for health care in the world. Traditional health care suffers
under an increase in untrained medics. For the majority of the population the private hospitals
are simply too expensive and only military families get access to military health care (Human
Rights Documentation Unit, 2008).
All these factors together result in an extreme unequally divided society. The rich military has
access to a developed education and health care systemwhile possessing dominant powers
over the rest of the population. Throughout the junta history the middle class vanished and
only a low educated, poor and vulnerable underclass subsists. It is this part of the population
which seeks a possibility for a better future in Thailand (Hulst, 2006).
The pull factors for Burmese to come to neighbouring Thailand are highly related to the push
factors of Burma. Expectations of living in freedom with high standards in education and health
care together with plenty of well paid job opportunities made people seek a new, temporary
life as migrant worker in Thailand. Especially during the booming economic growth in the
1990’s, when there was a need for unskilled workers, the majority of the Burmese preferred
Thailand over other neighbouring countries (Min, 2000). If all these expectations are fulfilled for
migrant workers who end up living illegally in Thailand, will be shown in this study.
1.2 Previousstudies on illegal migrantsand their health
Relatively little research has been conducted on illegal migrants and their illness experience.
One of the reasons for few publications on this topic is the difficult access to the target
population (Rust, 1990). Illegal individuals around the world are marginalized and avoid contact
with authorities out of the risk of deportation (Holmes, 2006). The majority of international
studies have focused on the US-Mexico border. The main motive for this research area is the
large number of undocumented workers at this location (Ortega et al., 2007). The idea that
these migrant workers overuse health services, resulted in numerous researches on the access
to and usage of the health care with the thought to improve policy to release the burden. The
little research conducted in Asia, where the mobility of people across borders is increasing
rapidly due to high-speed economic growth of several countries, shows little interest in
improving the situation for the illegal migrants. Another factor is the lack of reliable data linking
health outcomes to migration and the background and experience of migrants (Jatrana et al.,
2005). Though the US-Mexico and Asian migrant problems are not completely comparable, I
will discuss both situations briefly to illustrate the main factors which might influence the
health of migrant workers.
In the daily life of Latino migrant workers at the US-Mexico border health experiences
are influenced by the fact that they endure, as Benson (2008) describes, conditions of structural
violence. Deplorable wages, endemic poverty, forms of stigma and racism, occupational health
and safety hazards, limited access to services and the constant threat of deportation have a
negative effect on the overall well being. A literature study done by Ahonen et al. (2007)
describes that through these circumstances, employees feel low and replaceable and the
employers do not promote work safety. This lack of work safety and health promotion results
in major occupational health problems like chronic and acute pesticide exposure, lack of safe

11. sanitation, skin diseases, acute injuries, chronic back and joint trauma (Rust, 1990). When ill,
undocumented Mexican and other Latin American migrant workers have less access to health
care. And when they utilize them, difficulties with understanding the medics arise due to the
language barrier and racism(Ortega et al., 2007). Benson (2008) has analyzed in his study that
inequities of political and social power, differences in living conditions and the unequal
distribution of citizenship and belongings become embedded in long-standing social structures,
normalized in institutions and naturalized in everyday experiences.
One of the few internationally published studies on the Asian situation shows similarities with
the US-Mexico problems. In the case of Filipino illegal migrant workers living in Malaysia, a
hostile attitude towards these migrant workers and the lack of access to public health care
influences general health. Though many Malaysians have the idea that the illegal migrants put a
burden on their public health care facilities, in reality the majority of the Filipino’s seek care in
the private and traditional sector. The ethnic background, whether or not they migrated with
family members and their occupation are variables that could influence the experienced health
of migrant workers (Jatrana et al., 2005).
1.3 Research questions
Taken all this information into account, I developed the following main research question:
How is the illness experience of Burmese illegal migrant workers in Mae Sot,
Thailand, influenced by their illegality?
I will use the theory of “sociosomatics”, which will be described in detail in chapter three. To
answer the main research question I will focus on the following sub questions:
(1) What are the limitations of being illegal by law?
(2) What are the living and working conditions of the illegal migrant workers?
(3) How are the social networks of illegal migrant workers constructed?
(4) Which illnesses occur in the illegal migrant workers community?
(5) Which social factors connected to their illegal status influence their health?
(6) Where do illegal migrant workers seek health care?
(7) What are the coping strategies of the illegal migrant workers who feel ill?
By answering the first question I will get a view on what the illegal migrant workers are
excluded from. All the other questions will be approached from the perspective of the illegal
migrant workers. The second and third questions will give a view on the daily circumstances of
the illegal migrant workers. By knowing which illness occur in the community and which social
factors are connected to these illnesses I can understand which symptoms are connected to the
illegal status. Finally by answer the last two questions I will get to know what illegal migrant
workers do when they feel ill; if they seek health care, where do they go and if not, how do they
cope with their illness. All the sub questions will be answered within the ecological framework.

12. Chapter 2. Methodology
In this chapter I will discuss the methods I used while conducting the research. First I will start
with describing the access to the target population. I will continue with the research methods
used in the field and during analyzing the data. I will finalize this chapter with the ethical
considerations taken into account during the research. Before I start with elaborating these
items I would like to emphasize my research will be broad, exploring and describing to get a
clear view on this under researched area. It will focus mainly on qualitative data, on the
individual illness experience and micro level. However the way I analyzed the data reveals the
effects the Thai Immigration Law has on the illness experience of illegal migrant workers.
Though the research question is centred around the illness experience at micro-level the results
might be interesting on the macro-level for policy making. The results can be used to improve
the situation of illegal migrant workers and to control health problems throughout the whole
population.
2.1 Research population
The target population of this research were Burmese migrant workers living and working
illegally in Mae Sot area. I focused on migrant workers in the age range of 18 to 40 years
preferably living in Thailand for one up to five years. In this way I reached the relatively new
migrant workers who are not familiar with the Thai systemand language. The migrant workers
in this age range are building up their lives and still have a future ahead of them.
The Burmese migrant workers in Mae Sot area mainly work at factories, farms,
restaurants, shops or markets, as domestic workers, garbage pickers or as sex workers. All
activities in these occupations are characterized as 3D; Dirty, Dangerous and Demanding. Days
of working more than 10 hours frequently appear. Factory workers, farmers and domestic
workers often live at their work place. For the other occupations they can either have their own
place or live at the working area.
2.2 Research area, access and sampling
The research took place in Mae Sot area. This area includes Mae Sot town and villages
surrounding Mae Sot. Mae Sot town is a situated five kilometres from the Thai-Burmese border.
The first access to the target population was through the Mae Tao Clinic, which I already
contacted prior to my departure to Thailand. This medical clinic is based one kilometre outside
of Mae Sot and is specialized in giving free health care to Burmese people, either living in
Burma or in Thailand. Through the Mae Tao Clinic contacts were made with various Non-
Governmental Organizations (NGO’s) and Community-Based Organizations (CBO’s). After an
expert meeting with all the organizations, I decided to work together with World Vision
Foundation Thailand (WVFT) and with the Migrant Assistance Program (MAP) Foundation.
World Vision Foundation Thailand is an NGO focusing on TB and HIV/AIDS prevention, screening
and treatment in Mae Sot area. The MAP foundation its focus is on HIV/AIDS prevention, labour
rights and the promotion of occupation health and safety of migrant workers in Mae Sot area.

13. All three organizations work with legal and illegal migrant workers. The Mae Tao Clinic was the
gatekeeper for illegal migrant workers with access to health care. Illegal migrant workers with
little to no access to health care were reached through World Vision Thailand and the MAP
Foundation. In addition to the three gatekeepers I approached people who I had met in my
spare time.
At the Mae Tao Clinic the research took place at the reproductive health department
due to practical limitations. First of all, patients who visit the Mae Tao Clinic come relatively late
to seek medical treatment according to a health worker. These patients might be too ill to join
the research and the burden might be too high. The women at the reproductive health
department on the other hand come for monitoring pregnancy and are therefore relatively
healthy. Another practical limitation was an overcrowd of patients and people seeking shelter
at the Mae Tao Clinic. Due to an increase of violence inside Burma there was an increase of
refugees which resulted in little to no privacy at other departments. At the reproductive health
department there was no increase in patients and therefore more space and privacy to conduct
interviews. All pregnant women had to examine their blood during
medical check-up. The time between examination and the results, approximately half an hour,
was used to interview the women. The procedure to seek participants started at the waiting
room. My translator asked the women who was living in Thailand. Women who reacted
positively were asked in person if they are migrant workers and if so, if they had a work permit.
Women who wanted to give this information and agreed with the purpose and goals of this
research were interviewed at one of the examination rooms. While I was waiting either in the
waiting room or the examination room, the doctors at the examination room informed patients
about the research as well.
Because the illegal migrant community is not easy accessible and people are reserved
to answer questions about their illegality due to security reasons, I used the convenient
sampling method. This method is characterized by the fact that the researcher finds
participants by virtue of their accessibility (Bryman, 2004).
2.3 Research methods
There were different methods used to collect data, namely observations, focus group
discussions, in-depth interviews, rapid appraisal techniques and literature and media research
for qualitative purposes. Using different methods results in cross checking of a social
phenomenon, known as triangulation (Bryman, 2004). As preparation on using these methods,
topic lists were developed which are attached in appendix I. The materials for the rapid
appraisal technique are included in appendix II. Except for the observations and literature and
media research a translator was used. I will discuss the different methods briefly.
The research started with overt and covert observations. The overt non-participatory
observations took place while joining organizations in their activities in and around Mae Sot.
The covert participatory observations took place predominantly in the community in Mae Sot,
during work and free time. While observing the community the social relations and interaction
inside and with the Burmese migrant community became apparent. Next to these data the

14. living and working conditions of the migrant workers became visible to me.
The second research method used was the Focus Group Discussion (FGD). The first FGD
focused on physical health problems due to the illegal status. The MAP foundation helped me
bring nine illegal migrant workers together in one of their libraries outside Mae Sot town. A
second FGD took place in the form of a workshop for the MAP foundation on psychosocial
hazards at work. The participants of the workshop were legal and illegal migrant workers
volunteering for the MAP foundation. During this workshop the following topics were
discussed: work-related stress, substance abuse, harassment and coping strategies.
Prior to the interviews three expert meetings took place with successively an employee of an
ex-political prisoner organisation, a traditional healer and counsellors. This resulted in general
information about the political and cultural background, health seeking behaviour and health
problems of the illegal migrant workers. The findings of the observations, focus group
discussions and expert meetings were used to adopt the topic lists of the interviews.
In total 38 interviews took place, of which 34 were short interviews held at the Mae
Tao Clinic and four long interviews organized by the MAP foundation and by myself through
personal contacts. Thirty-three interviews were held with women; there was one man who
accompanied his wife and wanted to join the research. The short interviews took place at the
examination room, where two patients were examined by doctors at the same time. Due to the
limited time span of the women at the Mae Tao Clinic, every interview focused on three
themes. With the last 13 interviews I used rapid appraisal techniques to get more detailed
information on the emotional experiences in daily life and coping strategies. After finishing all
short interviews I had a broad overview of the experiences of the women and the man. In the
long in-depth interviews the themes that needed more clarification were discussed.
These interviews had a semi-structured character
and were held at people’s houses. Two interviews were held with illegal male migrant workers,
one with a female illegal migrant worker and one with a legal female migrant worker. Though it
was not my intention to interview a legal migrant worker, I was informed incorrectly about her
legal status, it gave an impression on how legal migrant workers experience their life and how
they interact with illegal people. The short interviews were not recorded due to constraints of
the participants concerning security and unacquaintedness with this technique. Practical
considerations in the sense of too much noise in the examination room played a role as well.
With the long interviews on the contrary it was possible to record the interviews, which
improved the quality of the data.
To get a better view of the general situation of the migrant workers and the discourse about
distress and the migrant workers’ situation, literature and media research was conducted. The
literature consisted of publications by local organizations and local newspaper written in
English. The media research was focused on documentaries and health promotion materials
developed by NGO’s and CBO’s.
The advantages and disadvantages of the research methods used will be discussed in chapter
nine.

15. 2.4 Ethical considerations
Conducting research always contains ethical considerations, though doing research in the field
of refugee studies brings even more ethical thinking, for the participants and for the researcher
them self (Mackenzie, 2007). The four main issues concerning ethics in the case of participants
are the possibility to harm participants, informed consent, privacy and deception (Bryman,
2004). I will discuss these issues briefly one by one for my own research.
My participants may have serious physical, psychological and emotional
problems caused by their experiences in Burma, the migration experience and living illegally in
Thailand. By participating in my research there is a possibility these will be aggravated. To
minimize this aggravation, I interviewed experts and observed the community prior to
interviewing the participants. The fact that no names were used and therefore anonymity was
guaranteed was particularly important in this research due to security reasons.
Next to harm reduction I took informed consent into consideration. This means
that the participants are fully and adequately informed about the purpose, methods, risks and
benefits of the research and that agreement to participate is fully voluntary (Mackenzie , 2007).
As my participants were generally low educated or illiterate this was done verbally by the
translator. Using a translator may enhance ethical problems. Poor translation of the purpose,
methods, risks and benefits, may inform the participants incorrectly.
In this research it was not always possible to give as much privacy as desired,
due to practical reasons. Nevertheless I have strived to create a private atmosphere, when
possible in a private room.
Deception occurs when researchers represent their research as something other
than what it is (Bryman, 2004). By informing the participants about the purpose of the research
and the fact that the data is used only for this thesis, the risk of giving high expectations
concerning improvement of their personal situation is reduced.
Chapter 3. Theoretical framework
The theories used for this research are based on previous findings on this topic. To support the
research design and data analysis I have used two models which will be discussed in paragraph
3.1. In paragraph 3.2 I will further explain the concepts used to answer my main research
question.
3.1 Theories
The approach of this research design is based on the theory of sociosomatics, in which social
events and conditions affect health and the illness experience. Since all these social events and
conditions take place at different levels (societal, community, relationship, individual) and
interact with each other throughout the different levels, the ecological model is used to analyze
the interactions. In the next two paragraphs I will explain these two models in more detail.

16. 3.1.1 Theory of sociosomatics
One aspect of the medical anthropology this research focuses on is social health. Social health
is seen as a mixture of political, economic, moral and medical issues. It is acknowledged that
besides the biological causes of disease, these social factors too play an important role in
developing diseases. Kleinman was the first to introduce the theory of “sociosomatics”
(Kleinman et al., 1998). This theory is focusing on the dynamic interaction between
experiences, cultural ideas and the social context of an individual. These factors all influence
the bodily experience of illness, wherein emotions are seen as bodily reaction linked to their
personal background, actions and social context (Tankink, 2009). So there is a change of focus;
in previous theories the focus was on the relation between illness and psychological and
psychosocial events. The sociosomatic theory rather sees it as the embodiment of social events
and conditions. The main focus of this theory is social conditions/relations and their effect on
bodily and illness experiences, where they mutually interact with each other (Jenkins et al.,
1998). To be more precise, this theory holds the following basic principles: (1) importance of
social events, conditions and relations; (2) conceptualization of social events as potentially
productive of disease states; (3) the role of bodily experience in relation to the social world; (4)
the role of emotion in bodily experiences; (5) conceptualization of the self as intersubjectivity
constituted in the social world; (6) shaping and patterning of bodily processes through a
dynamic interaction of subjective experience, cultural meaning, and situated context.
There are two points in this theory which need further explanation, namely the concept of
emotion and agency. The experienced emotions and the expression of these emotions
are not only seen as a physical reaction from the individual towards the social disharmony, it is
also seen as a collective articulation of moral and idealistic values of the whole research
population. The degree in which the emotions and bodily experiences are expressed in the
social world depends on the agency of the individual, which will be further explained in
paragraph 3.2. Here the dynamic interaction of the theory emerges; the agency has his roots in
the way the social world is constructed and the degree in which agency is used depends on the
social conditions.
3.1.2. Ecological framework
The social events I focus on all happen at a different level and have different consequences
which eventually affect the illness experience. To analyze these social conditions and events
and their interaction I choose to use the ecological model by Bronfenbrenner (1977), visualized
in figure 1.
Society → Thai immigration law

17. Relationship → Family, police, employer
Community → Thai–Burmese community
Indivual → Illness experience
Figure 1: Ecological model
Bronfenbrenner (1977:514) states that “the ecology of human development is the scientific
study of the progressive, mutual accommodation, throughout the life span, between the
growing human organism and the changing immediate environments in which it lives, as this
process is affected by relations obtaining within and between these immediate settings, as well
as the larger social contexts, both formal and informal, in which these settings are embedded”.
In the case of this research the changing environment is the fact that the Burmese worker
migrates to Thailand and lives and works there illegally. This environment can be divided in
different levels: societal level, community level, relationship level and individual level[2].
The societal level refers to the overall institutional pattern in a society such as economic, social,
educational, legal and political systems. All other levels manifest within this level. In this level a
climate of health encouragement or inhibition is created. In this research the focus of this level
will be on the political systems of both Burma and Thailand. The Burmese political system of
the regime with numerous restrictions has much influence on the individual illness experience
of the Burmese, even if they migrate to another country. The illegal migrant workers take the
experience of the political systemfrom Burma to their new environment, in this case Thailand.
In Thailand the Thai Immigration Law creates illegality and the Thai government therefore has
power over the lives of illegal migrant workers. Other systems might affect the illegal migrant
workers on a smaller scale though that is beyond the scope of this research. To understand the
environment this law creates, it is important to describe how the policies are constructed and
what their implications might be for the social interaction and illness experience of the illegal
migrants.
The community level can be defined as the social structures, both formal and informal, wherein

18. the individual itself does not actively participate though where the setting is created wherein
this person is found. This setting influences the ways the individual actively participates. In this
case the focus will be on the Mae Sot community. This community will be viewed in two sub-
communities, namely the Burmese and the Thai-Burmese community. Within the Burmese
community the social structures among the illegal migrants and between the legal and illegal
migrant workers will be discussed. The interactions within the Burmese community are
influenced by the limitations of the immigration law and the political background of Burma. The
interactions between the Thai and Burmese are influenced by the ideas about one another,
which might lead to stigmatizing and the level of agency that all actors show. Both concepts will
be further discussed in paragraph 3.2. In the community problems might arise which need to be
solved by adjusting the Thai laws, so in this way the community level influences societal level.
At relationship level the total of social interrelations wherein the individual actively participates
is described. Next to the characteristics of the community, the relationships people have affect
the illness experience of the individual as well. The social bonds that affect the health of the
illegal migrant workers in a negative way are the relations with the employer and the police.
These relations are unequal and based on power and lack of agency. The social bonds with
family and friendship on the other hand have a positive influence on the illness experience.
These social bonds can be part of someone’s social capital. The concepts of power, agency and
social capital will be further explained in paragraph 3.2. These negative and positive influences
of social bonds, is reflected in the way the Mae Sot community is constructed.
The political system, the social interaction and structures have an effect on the personal
experience at the individual level. In this case the personal experience of illness will be
discussed. This illness experience can be described as the process of being ill. A commonly used
model to describe the illness experience which I will follow is Suchman’s stages of illness
(Suchman, 1965). Five stages can be distinguished in this process, namely symptom experience,
assumption of the sick role, medical care contact, dependent patient role and recovery or
rehabilitation. Each stage is characterized by decisions, behaviours and end point. These
decisions and behaviours are shaped by the agency of the illegal migrant worker. The concept
coping strategy plays a role in the recovery and rehabilitation stage and will be further
explained in paragraph 3.2. The way in which illegal migrants experience their illness, can have
an effect on the way they actively engage social bonds and how they function in the
community.
The emphasis of the ecological model is on the dynamic interaction between the different
levels, either in the direction from the macro-level to the micro-level or the other way around
(Bronfenbrenner, 1977). These interactions are time and space dependent meaning that in
another place in another time in history, different effects will occur. There is no starting point
within the ecological model since all levels and interactions are dynamic and have a looping
effect. For practical reasons I will follow the tendency of my main research question; starting at
societal level where illegality is constructed and ending at the individual level where illness is
experienced.

19. 3.2. Theoretical concepts
To fully understand the theoretical framework the previously mentioned theoretical concepts
needs to be clarified. In this paragraph I will elaborate on stigmatization, power, social capital
and finally coping strategies and agency.
3.2.1 Stigmatization
Stigmatizing is caused by categorizing people; certain attributes are given to people from that
category, in this case given to the illegal immigrants (Goffman, 1963). Link and Phelan (2001)
suggest in their stigmatization model that stigmatization exists when persons differentiate and
label human variations. Tied to these labels are prevailing cultural beliefs. The labelled
individuals are placed in distinguished groups that make a difference between the in-group (us)
and the out-group (them). Finally these labelled individuals experience status loss and
discrimination that leads to unequal circumstances. They believe that labelled groups are
disadvantaged in life chances such as income, education, mental well-being, health and medical
treatment. These unequal circumstances may lead to a difference in illness experience.
3.2.2 Power
Power can be defined as an entity his ability to control the environment around itself, including
the behaviour of other entities. According to Foucault (1977) power is exercised intentionally
and results in behaviour of people which differs from their initial behaviour. Foucault states
power and knowledge are connected. Knowledge is seen as a form of power; by not informing
people completely you can influence their behaviour.
3.2.3 Social capital
One person’s power or powerlessness can be connected to the level of social capital a person
has. Putnam (1993) -one of the most influential writers in this field- explains that social capital
refers to the collective value of all social networks and the inclinations that arise from these
networks to do things for each other’ He distinguishes two main components of social capital,
namely bonding social capital and bridging social capital. Bonding refers to the value assigned
to social networks between homogeneous groups of people and bridging refers to the value
assigned to social networks between heterogeneous groups (Edmondson, 2003).
3.2.4 Coping strategies
The way people express their distress and cope with it can influence the way they experience
illness. The only research conducted on this specific topic describes that Burmese have a
specific idiom of distress; they “put a thing in the heart” when they are confronted with
negative emotions (Marshall, 1922). Another example of this process in South East Asia is given
in the study by Kemp (1985). She first emphasizes that South East Asian patients in
psychological distress most often complain about physical ailments without being able to say
where, and there may be no clinical evidence of a problem. Emotional distress may be
expressed as heart problems. In Western medicine talking about (traumatic) problems seems to
be the best way of solving the problems, though in certain circumstances this is not possible
due to external factors and keeping silent might be the only possible way to cope with a
situation (Tankink, 2004).

20. Next to this, belief systems can be seen as a coping strategy (Brune, 2002). Folkman and
Lazarus (1988) describe these belief systems as a redefinition of the actual circumstances in a
threatening situation, where the threatened person fights for his rights or sees an emotional
difficulty as a rationally solvable problem. As previously mentioned these intra personal factors
are shaped by personal background, like family composition, education, migration experience,
language and economic situation.
3.2.5 Agency
Social researchers throughout history have had different views on the concept agency, often
linked to the concept structure. Agency refers to the capacity of individual humans to act
independently and to make their own free choices. In this research I will focus on the view of
Bourdieu (1977), who focuses on the concepts of habitus, field and capital. According to
Bourdieu agency is socialized in a field, which can be described as the total of roles and
relationships in a social world. These roles and relationships depend on the different forms of
capital which are at stake. By following the role a person has in his field, he internalises the
expectations and relationships which are operating in this field. Through internalizing these
relationships and expectations a habitus is formed. The main point that Bourdieu makes in
theory is that the external structures are internalised by the agent though at the same time
through actions of the agent the social relationships in these external structures change.
Chapter 4. Societal level
“I do this job secretly. So I don’t get paid fairly for the work I do. I come from
Burma, so Thai employers want to pay low wages. I feel bad, but it’s my nature.
My own government doesn’t care about me, so others don’t care about me. It’s
not unusual.”
(SHWE, 2009)
In this chapter the political systems of both Thailand and Burma will be discussed. The regime
of Burma has an effect on the culture within Burma and how illegal migrants react on their new
environment after migration. Within Thailand the illegal migrants are faced with the Thai
political system, where their illegality is created by policies of the Thai Immigration Law. These
policies shape the environment in which the illness experience is formed. A law can be seen as
a reaction to what is at stake in society, so not only is this the overall level within the ecological
model, it is influenced by the other levels as well.
4.1 The cultural and politicalsystemin Burma
The way illegal Burmese experience their life in Thailand is much influenced by the years they
have lived in Burma under military rule. The military rule has penetrated through Burmese

21. culture. Though it is difficult to talk about ‘the Burmese culture’ due to the fact that there are
several different ethnicities inside Burma, each with their own habits and traditions. There are
some overall characteristics: family, visiting teashops, religion, listening to music and expression
of emotions.
Family members are seen as the most important people in the lives of Burmese.
Most families all live and work together to survive in the poor economic condition the country
is in. The father is seen as the head of the family and respect needs to be paid to older family
members. The gender roles though differ between the ethnic groups.
Social life inside Burma is centred around tea shops. Friends meet
each other there, have some food and tea together and listen to Burmese music. Burma has a
long history of traditional music though during the military rule music has been given a new
meaning: an alternative to give voice to the repressed. During the political upheaval in 1988
and 2007 music played an important role. Though the Press Scrutiny Board censors all media,
sometimes seemingly innocent songs with a deeper meaning get released. Next to the political
and traditional music, Western copied music is very popular too (Htwe, 2010).
Another important aspect of the Burmese
culture is religion. Though there is no state religion in Burma, the military regime actively
promotes Buddhism and tries to alienate other religions. According to the SPDC 90 percent of
the Burmese is Buddhist though independent research suggests only 70 percent (Human Rights
Documentation Unit, 2008). A belief which is closely connected to Buddhism is Animism which
includes the belief in nats. There are 37 great nats which are the spirits of people who died a
violent death. Next to these great nats there are numerous other natural spirits which play an
important role in protecting people, buildings and land. The nats are mostly worshiped in rural
areas in Burma as subordinate to the Buddha at temples or at home (Fink, 2001).
Other religions practiced are
Christianity, Islam and Hinduism. Though the SPDC made promises of religious freedom in 2008,
the majority of non-Buddhist groups have been discriminated inside Burma. For Buddhists it is
easy to participate in religious acts, like going to one of the pagodas which are abundant in
Burma. Giving donations to the monks, meditating to get a sense of calmness and stability and
the belief that suffering in this life is a result of bad deeds in the past are main aspects of
Buddhist daily life. For other religious groups it is made more difficult to actively practice their
religion inside Burma. Next to these religions astrology is practiced inside Burma (Human Rights
Documentation Unit, 2008).
A major effect of the military rule on the emotional life of the Burmese is the lack of freedom of
speech. Everybody has to obey the junta. If not, they will be imprisoned. To fully control this
situation there is an abundance of military intelligence and informers active inside Burma to
trace people. This has the effect on the population that they are in a constant state of fear and
suspicion towards one another. People only share their feelings with their family and close
friends. Though even inside the family atmosphere the children are trained to be obedient
towards the military just to be sure that they will not be imprisoned and can help the family to
survive (Fink, 2001). Through this strategy of the junta a docile society is cultivated.
Another aspect of the Burmese culture, which is misused by the junta as well
creating a silenced and inactive population, is the concept of ‘ah nah day’. This concept

22. describes the desire not to impose on each other to maintain smooth relations. Especially the
feelings of people with a higher status need to be considered. Fink (2001:120) describes this
phenomenon very clearly: “Although fear is the main reason to stay quiet, they may all tell
others that they felt it was not their place to speak up. They were too ah nah day. When people
do speak up, military authorities react with shocked anger, telling them to remember to whom
they are talking”. A psychiatrist working inside Burma explains the consequence of the military
rule:” People have regressed under military rule. They have become more dependent. They have
had to endure so much hardship that they have become immunized to it. They can handle and
cope with it. There are positive and negative consequences: they survive, but they do not
overthrow the regime. They have learned helplessness. They see no point in resisting. Individuals
are not allowed to represent their communities or even their neighbours, making people feel
separated and weak” (Fink, 2001:122).
It is this lack of showing agency and little experience in expression of thoughts and feelings
which illegal migrants take with them to Thailand. Here the illegal migrants face the limitations
of not being part of the Thai Immigration Law.
4.2 Thai immigration law
To fully understand the implications the Thai Immigration Law has, it is important to know how
the law is constructed. From 1990 on the number of unskilled workers increased significantly
and the government was forced to adapt their policy towards the influx of migrants. All policies
are based on the Immigration Act of 1979 (IA ’79) and Foreign Employment Act 1978 (FEA ’78).
The IA ’79 states that an immigrant who enters the country without visa and/or who violates
the Thai Immigration Law is illegal and may be deported or sanctioned in other ways. The FEA ‘
78 proclaims that migrant workers must have a work permit to work in Thailand and are only
allowed to work in activities designated by law or by relevant authorities. Since the
development of the first policy in 1992 twelve adaptations have been made. Due to the
constantly changing policies, the migrant workers can get confused and the risk of not being
fully informed about the procedures is enhanced. This may result in unwilling illegality.
The latest rules concerning the registration of newly arrived migrant workers to live and work
legally in Thailand starts with the free registration at the Department of Provincial
Administration to obtain an identity card. Since 2003 migrant workers need to verify their
nationality during registration, due to the signing of a memorandum of understanding between
Thailand and Burma. After the process of registration, a one-year valid work permit can be
purchased with the ID-card. Migrant workers who already have a work-permit need to renew
this document yearly. The total costs of the work permit are 3,800 baht (approximately 80
euro’s);
“I have been living for 5 months in Thailand. My husband works at the market
but I never go outside. I am too scared of the police. Even inside my own house I
am scared. That makes me very sad.”
100 baht for a new card, 1800 baht for a one year work permit, 600 baht for a medical check up
and 1,300 baht for health insurance (Labour Rights Promotion Network, 2007). This is a high

23. amount of money for people who on average earn not more than 100 baht a day. There are
strict registration periods for obtaining these work permits. All work permits given out expire
the 28th of February of 2010 and all Burmese migrants officially have to return to their home
country. In Burma they can apply for new legal work permit papers at the Burmese authorities
(MAP Foundation, 2009). Few Burmese migrant workers will do this due to security problems
and human rights violations in their country; they rather stay illegally in Thailand. This will
either result in a mass deportation or an increase in illegal citizens.
Migrant workers are extremely mobile due to changing jobs and therefore they are difficult to
trace for the Thai authorities. This makes it difficult to fully inform them about the possibilities
they have to obtain a work permit. The fact that the registration database has been under
supervision of different ministries the last few decades, resulted in an incomplete overview of
migrant workers and an inability to control their well being (Paisanpanichkul, 2001).
The work permit gives several privileges. The first one is travelling around in the registered
area, which is in this case only in Mae Sot. Secondly the migrant worker gets health insurance
which covers four types of services: (1) medical treatment for 30 baht per visit, (2) health
promotion, disease control and prevention services, (3) health support and general medical
check-up and (4) rehabilitation. Another advantage of holding a work permit is receiving a birth
registration after the birth of a child. This official paper proves a relationship between parents
and child, proves nationality in the future and verifies the exact age of the child (International
Rescue Committee, 2008).
Next to this medical support and travelling permission, the registered
migrant workers work under the Thai Labour Protection Law. According to the Thai Labour
Protection Law the maximum working hours are 8 hours a day or 48 hours a week. If the job is
hazardous or affects the health of the employee, which is the case for most migrant workers,
the maximum working hours are 7 hours a day or 42 hours a week. After every 5 hours of
working, 1 hour of rest is required and all workers should at least have one day off a week. Next
to the regulations of working hours, sick leave is controlled by the Thai Labour Protection Law
as well; the employee has the right to have 30 days of paid sick leave a year. The final issue
which is important for this research is the minimum wage. In the Tak Province, in which Mae
Sot is situated, the minimum wage is 153 baht a day in 2009. If these regulations are not
followed by the employer, the migrant workers with a work permit have the ability to get legal
aid to fight for their rights (Labour Rights Promotion Network, 2007).
4.3 Implicationsof the Thai Immigration Law
There are several implications the Thai Immigration Law has on the daily life of the illegal
migrants. First of all, not having the ability to travel safely in the Mae Sot area limits the
undocumented. To limit illegality in Thailand the Thai police are responsible for tracing illegal
people and arresting them if they have no ID-card. Therefore numerous police men patrol on
the streets, in houses and at work places. Due to these patrols illegal people try to reduce the
risk of arrest by little mobility. Some women have stated that they only leave the house when
there is an emergency; staying inside feels safer. This reduction of mobility also reduces the
access to resources to live a healthy life. This means little access to social networks, health care

24. facilities and other facilities like the market or shops. Living at or near the work place reduces
the risk of arrest, though little as the police checks working areas too. These circumstances
create densely populated migrant worker communities, mainly on the outskirts of town or at
the working place outside of town.
Next to creating secluded living areas, living outside of the law results in having no
health insurance. This has major effects on the health seeking behavior of the illegal migrant
workers, since the cost of medical treatment at the public hospital, the Mae Sot General
Hospital, are high. This leaves the undocumented with three other health seeking options,
namely self treatment, traditional healing and medical treatment at the Mae Tao Clinic
according to a health worker.
A third implication that arises is the fact that the undocumented are excluded from
annual medical checkups. Even though this seems like a privilege to have, it is of great
importance to reduce public health risks within the community. The deprived healthcare of
Burma, little health education and poor living and working conditions of the undocumented
lead to an overall poor health condition. Lack of medical monitoring of the undocumented
therefore results in late detection of diseases.
The fact that the illegal migrant workers cannot rely on the Thai Labour Protection Law
makes them very vulnerable for exploitation by the employer. Though it is officially not allowed
for an employer to hire migrant workers without a work permit, there seems to be insufficient
control by the Thai authorities.
4.4 Conclusion
The first political system where the illegal Burmese migrant workers are faced with in their life
is the military rule in their home country. By penetrating through each part of the Burmese
culture the military regime has power over their population. The lack of freedom in speech and
the concept of ‘ah nah day’ results in a lack of showing agency. A constant state of fear and
distrust towards one another is caused by the presence of military intelligence everywhere.
These experiences play an important role in life in Thailand.
When the Burmese migrate to Thailand they are confronted with the Thai political
system, in particular the Thai Immigration Law. The constantly changing policies and little
information passing through to the migrant workers creates an environment in which economic
interests seem to play a more important role than the well being of the migrant worker. Leaving
the migrant workers confused and not informed about the registration process, creates
illegality in which there are few options for fair working conditions and healthcare. The
withholding of this information and therefore the disparity in knowledge gives the Thai
government power over the lives of the illegal migrant workers.
Living illegally in Thailand excludes the undocumented from safe travelling, health
insurance and working under the Thai Labour Law. These conditions results in little mobility of
the illegal migrant workers, secluded living areas, limited health care access and a high
vulnerability for exploitation by the employer.

25. “Burmese are criminals, make Mae Sot poor and spread infectious diseases.”
Chapter 5. Community level
As previously mentioned the community level entails the social structures wherein the
individual itself does not actively participates however the setting wherein the person is found
is created. This chapter will focus on the interactions within the Burmese community, the
interactions between Thai and Burmese people and the role of the police. Within these social
structures the effects of the experiences in Burma and the limitations of the Thai Immigration
Law will be discussed. Furthermore the implications these social structures have on the
relationship level will be revealed.
5.1 The Burmesecommunity in Mae Sot
The Burmese migrant workers community in Mae Sot contains approximately half of the total
population. The majority of the Burmese migrant workers are illegal, though precise numbers
are unknown. They live in densely Burmese neighbourhoods, often bound to the workplace.
This is either chosen by the illegal migrant worker himself to reduce mobility and therefore the
risk of arrest or by the employer, who supplies housing. The majority of illegal migrant workers
experience these densely Burmese neighbourhoods as positive. Frequently illegal migrant
workers describe their community as Burmese on Thai ground. They feel safer and more at
home with only Burmese around them; other Burmese will not report them to the police and
they share the same background and language. The feeling that the undocumented are left out
by both the Burmese and the Thai authorities enhances the social cohesion. This social
cohesion between illegal migrant workers is reflected by trying to help friends or family to find
a job or by informing them about police checks. It is a mutual understanding the undocumented
have; they all know the difficulties and dangers of living illegally in Thailand. The legal migrant
workers sometimes try to help the undocumented, mostly friends and family, however the legal
rights and little more money they have cannot fight the power of the Thai institutions.
Though the illegal migrant workers experience social
cohesion with family and friends, there is distrust towards other Burmese, as one illegal person
illustrates: “There is something weird about Burma and the people from there, sometimes
people have strange ideas. No one trusts anyone any more, never mind, they will not help us, so
let it be, here people are so afraid of each other” (Koetsawang, 2001).
This distrust is the consequence of living under military rule in Burma for many years
and results in little interaction as one illegal woman explains: “I do not talk with other people
for two reasons: they cannot help me because they are also in the same situation and they
might feel better when they hear I have problems.” Though a certain degree of distrust is felt
towards other Burmese migrant workers, this is experienced less than towards Thai people.
5.2 The Thai-Burmesecommunity in MaeSot

26. The distrust of the Burmese towards the Thai causes little interaction between both
nationalities, though this is not the only reason. The prevailing negative ideas about the
Burmese and Thai effect the social interaction as well. The ideas of the Thai towards the
Burmese is not specifically aimed at the individual illegal Burmese migrant worker as it not
possible to see who is illegal and who is not, though they are formed by the density of illegal
migrant workers. This is pointed out by a young Thai man: “I am born and raised here and I am
Thai. I do not like it that people think I am Burmese, this is my country and I do not like it that
there are so many Burmese here. They make Mae Sot poor and they are violent.” He illustrates
his idea with an experience he had: “A small Burmese boy was begging on the streets and I gave
the boy some money. When I met the boy again another day I did not want to give him money
again. The Burmese boy got angry, followed me and scratched my car.”
The point the young Thai
man makes about Burmese being violent seems to take an important place in the Thai-Burmese
community, though different stories roam about the experienced violence. It is mostly Thai who
say Burmese are violent, and Burmese believe the Thai are violent. An illegal Burmese man
explains how these ideas are derived from the history between both countries: “In the night
there is robbing of Burmese by Thai young men. It is only the Thai robbing the Burmese, not the
other way around. They wanted things from me, I did not ask why but I just started to fight. It is
because of their education. In their schools they learn Thai history. And in the monastery they
talk about the highlands and how much they took. So it is a sort of revenge when they get the
chance. Most of the Thai people they hate the Burmese and most of the Burmese they hate the
Thai. It are mostly young Thai naughty boys, the adults are usually good for me.”
Another illegal woman confirms this idea with her experiences: “The police always take Thai
side, now it is Thai doing it to the Burmese but we know that one time in history we will be
doing it to the Thai. This is how it has always been.” Though these feelings were created a long
time ago, the Thai citizens also know a time when they were happy with migrant workers,
including the Burmese. All throughout history Thailand has been a receiving country for migrant
workers and traders from China, Laos, Cambodia and Burma (Koetsawang, 2001). At first the
Thai seemed to encourage this influx; the economy was booming and the workforce needed to
be expanded. Though when the majority of migrant workers stayed for a longer period of time,
this viewpoint changed. Especially during the economic crisis in 1997, migrant workers became
accused of stealing jobs from the local people and were being held responsible of the
unemployment of two million Thai citizens.
These ideas are felt by the illegal Burmese, however they have their own viewpoint on it. One
woman explains: “I think some Thai are good and some are bad. They are bad because they are
not happy with the Burmese making money”. Most Burmese though have come to Thailand
with the idea they are needed for the workforce, since the educational and economical level of
the Thai is improving and they reject to work in low-paid jobs. The negative ideas have an effect
on the daily life of the illegal migrant workers and how they experience it. Some undocumented
adapt their daily activities as one woman explains: “I do not like Thai people because they do
not treat Burmese people very good. I do not want to depend on them………If there are no
Burmese people working in a shop, I do not want to buy anything there.” Another

27. undocumented explains how the negative ideas affect him emotionally: “When I walk on the
street, I have the feeling that the Thai people know me but I feel separate. It makes me feel
down when I see that they are pressing us. We are different, we are workers here. Yes I come
from another country poorer than Thailand and we are not the same and they always separate
me and I feel a bit low.”
Not all illegal migrant workers have the same experiences; there are mixed marriages
and undocumented working outside of Mae Sot live in an area with few Thai. Nevertheless
within Mae Sot town there is a visible separation.
5.3 Power of the police
The little contact the undocumented have with the Thai is mainly involuntary with the Thai
police. This can either take place at the roads leading to Mae Sot, on the streets and market of
Mae Sot
“Money for Burmese people seems to have become the most important thing, as
sometimes it can buy some form of freedom”
(Koetsawang, 2001:54)
though inside houses or at the workplace as well. Occasionally police raids take place where on
large scale undocumented get arrested. These raids cause an extreme sense of fear within the
illegal Burmese community. Though it is the duty of the police to check for work permits, they
frequently misuse their power. Bribing and corruption are common in this situation. In Mae Sot
bribing happens on a large, mainly by paying a 100 baht to cancel the arrest. Without payment,
two days of detention at the police station will take place, followed by imprisonment for 10
days and eventually deportation by truck to the Thai-Burmese border. Only by paying 300 to
1500 baht to the police officers the undocumented can get bailed out, though for the
undocumented who on average earn 80 baht a day, this price is too high. Most migrant workers
know the procedure of the arrest; after deportation they immediately illegally cross the border
to go back to work in Thailand. This is by some illegal migrant workers experienced as an
advantage compared to the situation in Burma:”In Burma the political situation is less
predictable; you do not know what will happen. Here in Thailand I know what will happen when
I get arrested.” Nevertheless they fear the police as they experience the arrest as degrading
and the days without working cause economic decline.
Through co-orporation with other authorities the power of the Thai police is
multiplied. One case is known where the Burmese authorities were involved. During a police
raid at the Mae Sot dumpsite, where approximately 38 Burmese families illegally live and work
for 30 baht a day, all undocumented were arrested, including children. After destroying the
houses and taking all the belongings of the arrested, the Thai police sold the group of illegal
migrant workers to the Burmese authorities for 2000 baht. There the undocumented were
tortured, did not receive any food for 48 hour and had to be bailed out for the price of 300 baht
per male, 100 baht per female and 50 per child. Without payment, forced labour for the regime
would be the consequence. Fortunately some migrant workers just received payment and all
could return to the dumpsite though frightened and left without any money, belongings and

28. housing. By misusing the unpredictable powers of the Burmese authorities, the undocumented
probably will pay the Thai police immediately the next time they come to the dumpsite to
prevent any contact with the Burmese authorities.
More frequently though other Thai police
officers or employers are involved in case of corruption. Police officers sometimes check
vehicles leaving Mae Sot just before a permanent check point. They receive a bribe from every
illegal person knowing these people will get arrested at the permanent checkpoint further
down the road. A sex worker explains that her boss pays the Thai police a 1000 baht a month to
secure the safety of the illegal sex workers. In this case the well-being of the undocumented is
improved, though in most cases the co-orporation between the police and the employer results
in arrests, as an employer of a migrant organization explains: “The workers go on strike and the
employer calls the local authorities to arrest them and send them back to Burma” (SHWE, 2009).
These cases show that not all Thai police officers follow the law; they rather want to earn more
money. This is why it is popular to work in Mae Sot as a policeman, according to a Thai police
man.
The bribing and corruption have an effect on the illegal migrant workers. One woman
explains she gets sad and angry when she sees the Thai police taking money from the poorest
people. The fact that police actions frequently take place in public places affects the relations
within the Thai-Burmese community. The Thai people are often confronted with the arrests of
illegal Burmese migrants on the streets and they regularly see the half blinded truck with
deported undocumented going to the Thai-Burmese border. This confirms the idea that the
illegal migrant workers are criminals. The Burmese who get in contact with the police on the
other hand, experience it as humiliating and their hatred against the Thai gets stimulated.
5.4 Conclusion
Mae Sot community can be viewed as two separate sub communities wherein the illegal
migrant workers move, namely the Burmese and the Thai-Burmese. Within the Burmese
community bonding social capital is visible, through shared background and shared feelings
about life in Thailand. Though the embodied distrust experienced during life under Burmese
military rule, reduces this social capital to mainly contact with family and friends.
The situation for bridging social capital is opposite; there is little to no interaction between
illegal Burmese and the Thai population. This lack of interaction is caused by stigmatizing ideas
both nationalities have about each other. Eventually this results in avoidance behaviour of the
undocumented and feeling low about their social status. The fact that they are labeled by the
Thai government as illegal contributes to this feeling. The lack of bridging social capital
conserves the stigmatizing ideas among both nationalities.
These stigmatizing ideas are enhanced by the power the police
shows towards the undocumented. By bribing and corruption the undocumented are not only
deprived from their money, they also feel humiliated and fearful.

29. Chapter 6. Relationshiplevel
“I have seen many workers killed. I could not do anything but just close my eyes
to it because we are illegal in Thailand”
(SHWE, 2009)
In the previous chapters an image of the environment the illegal migrant workers move in is
created. This chapter will focus on the social relationships where the illegal Burmese daily
actively engage in, namely family ties and friendship and their relation with their employer. I
will clarify how these relations are formed by the environment and the individual experiences
of the illegal migrant workers and how it affects their social world and personal illness
experience.
6.1 Family and friendship
The embodied distrust that the illegal migrant workers have towards others is not felt towards
their family and friends. They are seen as the only people the illegal migrant workers can fully
trust. Generally the Burmese either migrate together with family members and friends or they
already have family and friends living in Thailand. For the undocumented these social relations
are their only point of reference within their insecure life in Thailand. Especially at the moment
of arrival in Thailand, these relations can lower the burden as one man explains: “I was worried
and nervous because I had to pay and I had never been outside of Burma, outside of the farm
and outside of the village. So I was nervous. But one thing is good because my sisters are
here”. As family members are seen as most important people in Burmese
culture, they is a need felt to take care of these family members. By working in Thailand the
undocumented can financially support the family members still living inside Burma. Though
many migrant workers have several relatives living in Mae Sot, the migration always causes
family separation. Lots of young Burmese leave their children behind with their parents to earn
enough money in Thailand for their education and future. This constant missing of their loved
ones together with not feeling part of the Mae Sot community causes homesickness. For illegal
migrants this homesickness has a different dimension than for documented Burmese. Due to
their economic situation and hence the possibility to leave Thailand with enough money are
limited. One woman clearly describes the feelings that the majority of illegal Burmese have to
deal with: “I feel very sad when I remember my family. I can only worry about money here. I
want to go back to Burma but I do not have enough money. I cannot work more to earn more
money.” Other illegal migrant workers explain that keeping in contact with family is very
difficult. Calling from inside Thailand is costly, though crossing the Thai-Burmese border to
make a cheap call enhances the risk of arrest.
It are mainly these worries the undocumented share with family and friends who are
living in Mae Sot. Due to little spare time that illegal migrants have, most undocumented

30. workers rely on old friendships from inside Burma or make friends at work. The restrictions of
the illegal status limit the possibilities of actively maintaining family and friendship bonds. Long
working days and fear of the police leaves little chance of meeting other people in Mae Sot. The
importance of having family and friends in the vicinity becomes visible when illegal migrant
workers do not have these relations, as an undocumented woman emotionally explains: “I
came to Thailand to work and live with my sister. Two months after I arrived my sister got
resettled to the United States of America. Just to survive, I have married a man. I do not know
anybody and I feel desperate and lonely.”
6.2 Power of the employer
Since illegal migrant workers have no labour rights, their well being at work largely depends on
the employer. This power is frequently abused by the employer, negatively affecting the health
of the undocumented. The first and most important factor which influences the illegal migrants
is the irregular payment. Through withholding the payments, the employer claims his workers.
The undocumented are forced to stay and work for their current boss until they do receive
money. If they would complain, they are at risk of getting fired. With the little money the
undocumented receive from time to time, they are not able to pay for decent food and
housing. This leaves the migrant worker in a situation where they are forced to live at the
working area for free. Though this is a good facility, it generally gives illegal people a negative
feeling; they have no control over their life. If they receive more money, they would be in the
opportunity to rent their own house and thus spend their free time in a space where they feel
more comfortable. Now people at factories are obliged to live with
strangers in a dormitory. One man working at a garment factory as a mechanic explains how
this affects his well being: “Yes living still is the same as Burma, lying on the floor with seven
people. But the feeling is different; I am used to living with my family, now I am living with
strangers which makes me homesick”. Another young man, working at different factory
elaborates about the physical consequences living together with strangers has: “I have sleeping
problems. They like to call me at night and sometimes they want to kick me. Sometimes they
drink all night and sometimes they play all night and make noise. I just pretend I do not care. I
get so angry and sad. I want my own place and my own space. If I feel like that at night time, I
feel so grumpy in the morning and cannot work properly.” Not only factory workers are forced
into this situation, it occurs in the lives of farmers and construction workers too. A 23 year old
woman living and working with her husband and parents at a farm explains her situation: “The
owner chooses where we have to live. I do not like that; I would like to have freedom of choice.”
This feeling could be enhanced by the expectations that the majority of the illegal migrant
workers had before their migration; living in Thailand freely after a life of oppression in Burma.
Next to the fact that the employer has power over the living conditions of the illegal
migrant workers, they also control the working conditions. Though a health worker explained
the working conditions have improved the last years, there are still health risks. First of all,
there is no control on the working hours. Numerous migrant workers have to work more than
10 hours a day, often with little time to rest. Some are forced to work overtime without
payment. These long working hours cause physical complaints. Furthermore, the working
conditions are unsafe. The risk depends on the occupation; mainly farmers, construction

31. workers, factory workers and sex workers are at higher risk of occupational accidents. These
accidents can be the result of giving little or no information about the health consequences the
work entails. Farmers, for example, work with pesticides they are not familiar with. The
information supplied on the materials is in Thai language, which most people do not master.
Frequently there is a lack of protection materials for farmers, construction workers and sex
workers. The illegal migrant workers have no possibility to improve this situation; demanding
protection materials may result in dismissal and their own economic resources are too poor to
buy protection themselves.
Another domain where the employer uses his powers is the possibility to seek health care.
When the undocumented are paid per piece, for example in a factory, they can take a day off,
though this results in a double economic burden; no payment for a day and the illegal migrant
worker has to pay for transport and medical treatment himself. With payment per hour or per
day undocumented migrant workers have different experiences. A 28 year old undocumented
woman working at a launderette has positive experiences; she gets a day off when she is ill and
still gets paid. This situation seems to be very exceptional. Other illegal migrant workers have
the opportunity to see a doctor during working time, though the terms may differ. There are
factory
“Most people working at the factories are women because they are easy to
control.”
owners who regularly organize a bus trip to the Mae Tao Clinic for the sick factory workers. The
illegal migrant workers only have to pay for the transport. A 22 year old undocumented man
working at a garment factory is opposed by the employer as he has to pay sixty baht to get a
day off to see a doctor. A woman working at another factory is even in a worse position: “My
Thai employer does not want me to see a doctor because I might get arrested. When I really
have to go to a clinic, I can barrow a temporary pass to go to the clinic, but I have to pay 500
baht for that”. Other employers do not give the possibility at all to see a doctor as a female
farmer explains; she can only see a doctor during one of her few days off.
Though the living and working circumstances for the legal and illegal migrant workers might not
defer substantially, the possibilities to protest against these conditions do. A young illegal
factory worker explains these differences: ‘They did not pay us enough money for all of the
hours of overtime working. I have the same problem as all the others but I cannot go to an
organization or the police. So only the group who has an ID said we are working so long and the
same as in other factories but we get much smaller money as at the factories. This is our right.
The manager at the factory was called and he had to give the money. But I did not receive
anything.’ Protesting against these practices by illegal migrant workers results in the risk of
losing the job without any compensation. A group of young factory workers confirm this and
illustrate how the power of their employer is used during inspection: “I earn 45 to 60 baht a day
for at least working 12 hours a day, sometimes the whole night. If we speak out, we will lose our
jobs. We cannot speak out like this. When the authorities come to inspect the factory, we hide. If
we meet the inspectors, we have to tell them we get 135 baht a day. There are two time cards,
a regular one and an overtime card. When the inspectors come the overtime card is taken by

32. our employer” (SHWE, 2009). Not only do the illegal migrants risk dismissal, in some cases they
even risk death, as an employer of a migrant worker organization points out: “ Every case when
migrant workers take action against the employer for exploitation, employers will threaten
them and they hire a gang to follow the migrant worker and threaten them again on their life”
(SHWE, 2009).
For the illegal migrant workers it is extremely difficult and unsafe to try to change this situation
when they are desperately in need of money. By not demanding anything and obeying the
power of the employer, they minimize the risk of dismissal. The employer in his turn
deliberately uses his power to control the obedient employees and to improve his own
economic situation.
6.4 Conclusion
The environment of the illegal migrants gives little time and space for relations where they
actively engage in. The main interactions of the undocumented are with family, friends and the
employer. With family and friends the undocumented talk mainly about money and
homesickness, their two main worries in life. This form of bonding social capital has a positive
effect on the well being of the undocumented, it releases the burden of life for a moment as it
is their only point of reference in Thailand. Maintaining these relations is difficult though, due
to the limitations of the law and the powers of the police and employer.
The power of the employer further influences the
lives of the illegal migrant workers through irregular payment, controlling the living and
working conditions and the possibilities to seek healthcare. The fact that the undocumented
cannot rely on the Thai Labour Protection Law, makes it impossible to protest against these
circumstances. If they take action, they risk dismissal or their lives. The little agency that the
undocumented show, gives the employer space to further control the illegal migrant
workers.
Chapter 7. Individual level
“I have no interest in my health, only in money.”
This main focus of this research is the individual illness experience. In this chapter the illness
experience of the undocumented will be analyzed according to the five stages of illness namely
symptom experience, assumption of the sick role, medical care contact, dependent patient role
and recovery or rehabilitation. Within each stage decisions need to be taken which might be
influenced by the illegal status.
7.1 Symptomexperience

33. There is one factor which affects all illegal migrant workers: a constant state of fear of the
police. The scale in which the undocumented experience this fear depends on several factors,
namely the living area, the Thai language skills, the employer and the duration of the stay in
Thailand. It seems illegal migrant workers living in the countryside experience less fear due to
the fact that there is less police present in these areas. Illegal Burmese who speak the Thai
language seemto have less as they can negotiate with the police. When migrant workers just
arrive in Thailand illegally, they are more scared since they do not know where the regular
police check points are and how to deal with this new situation. This constant state of fear is
reflected in several physical and mental symptoms. One illegal woman complains about pain in
the eyes from always looking for the police. Other symptoms that undocumented migrant
workers connect to the constant state of fear are insomnia, pain in the neck and head. The
constant state of fear also makes them feel low and stressed. Though stress is sometimes seen
as a Western concept, there are words for stress and depression in Burmese which reflect to
the Western concepts of these words. Besides the stress
experienced by the fear of the police, the economic situation is causing tension as well. The fact
that undocumented are deprived of their money by irregular payment and bribing of the police,
makes them sad and worried. Often illegal migrant workers only feel happy with their life in
Thailand at payment day. This is experienced as a temporary relief of a burden. A 28 year old
woman living illegally for 2 years in Thailand explains how she experiences her situation: “I am
not happy right now, because I have to do the same work every day and I do not get any money.
I am only happy when I receive money and I can spend time with my family.” Another
undocumented woman, pregnant with her first child and living for 7 years in Thailand, describes
how her money problems make her feel sick:”We do not have enough money to financially
support the baby. My husband works at a construction site but we need more money. He needs
to work more. That makes me unhappy and causes headaches.” There are illegal migrant
workers who experience serious mental health problems caused by their long-term stress. A
health worker illustrates how one of his illegal patients suffers from this long-term stress
caused by her economic situation: “The girl who was sitting here is a factory worker. She has
family to support in Burma. They have a lot of debt, where they have to pay 30 percent interest
on. So you come and have to pay the interest monthly. That is quite a lot of money. The parents
have raised money to send her here and she has to send money back. But that is not enough,
though it is still more than they would earn in Burma. That gives so much stress, she had a
psychotic experience.”
Next to the stress symptoms, there seems to be underlying mental problems which this
young man explains: “I am not happy here; there is no recognition for me as a person. If I would
disappear, nobody would miss me and that is the same for all illegal Burmese persons in Mae
Sot. I sometimes feel like a zero, not important in this world.” According to this man, the direct
health problems occur mainly in the first years of living illegally in Thailand. Living illegally for a
longer period in Thailand enhances the feelings of hopelessness and not being recognized by
their environment. These feelings can be described as an accumulation of the worries,
difficulties and health problems illegal migrant workers face. One of the main reasons the
majority of undocumented describe for these negatives feelings are the unmet expectations of
life in Thailand: freedom, easy to find work and good payment. On the contrary, they daily

34. experience a constant fear of the police, power of the employer and low wages in an
environment where they are stigmatized. The illegal status not only affects the mental well
being of the undocumented, it also has an effect on physical complaints. The long hours and
repetitive work causes tiredness, pain all over the body and numbness in limbs. The illegal
migrant workers who work with chemicals complain about respiratory, eye and skin problems.
7.2 Assumption of the sick role
The next stage after symptom experience is the assumption of the sick role wherein the
undocumented seeks symptom alleviation, health information or advice and a temporary
acceptance of his condition by family and friends (Suchman, 1965) .
Symptom alleviation is reached either by sleeping, substance use or by
self-treatment. In spite of the fact that few undocumented admit using substances like alcohol
or drugs, a health worker confirms that this is a serious problem in the illegal migrant
community of Mae Sot. Some undocumented confirm they know other illegal migrants who
drink to forget their problems. A community worker explains that lots of young illegal men
working as porters drink a great deal at night not to feel their painful bodies. Due to the stigma
attached to admitting substance abuse, it is not clear what the extent of this way of symptom
alleviation is. Self-treatment is another manner of
symptom alleviation the illegal migrants mainly use for physical complaints, either by
biomedical medicine or by herbal treatment. Though contact with a pharmacist or herbal
medicine seller can be seen as the first step in medical contact, the medicines sold generally
come in larger quantities than needed at the moment. The residual of medicines can be used
without having any contact or advice from the pharmacist.The advantages of self-treatment are
independence of the employer, relatively low costs and little risk of arrest, due to a smaller
distance travelling. The herbal medicines are sold at the market and for biomedicine the
undocumented can go to one of the numerous local drugstores in Mae Sot. At the drugstores
Burmese people work too so non-Thai speaking migrants can get advice and medicine as well.
This female illegal migrant working at an orange farm illustrates how and when she uses self-
treatment: “I do not think I am healthy. Sometimes I have headaches after work. It is physically
heavy work, with a lot carrying and climbing. I also get pain in my legs from doing this work. If I
have pain, I take medicine. I buy them at the drugstore. I first think by myself what I should get
and then I discuss this with the drug seller.”
Though several illegal migrant workers consider self-treatment as a good option, lots
of others do not seek this, neither health information or advice. One of the reasons
undocumented women give for this decision is their economic situation, reflected in their
responds on questions about health: “I do not care about my health. I only care about money.”
Following this idea the body can be seen as merely an instrument to make money and
therefore to survive. This lack of care about health issues reflects the little health knowledge
Burmese generally have as well. The Burmese curriculum does not entail any health or hygiene
education anymore since the military rules. The majority of the undocumented cannot explain
how they have become ill, neither in biomedical sense nor through traditional medicine. This
lack of knowledge could be improved by health education in Thailand. Few employers offer this
opportunity, however when there are occasional health trainings little interest is shown by the