A shortage of skilled medical personnel could threaten Thailand's lucrative medical tourism industry.

It is undeniable that Thailand is an important destination for medical tourism. Every year Thailand receives 1.4 million foreign patients who visit the country as tourists. The figure is far higher than those of our regional peers: Singapore and Malaysia treat 600,000 and 300,000 foreign patients a year respectively. Thanks to Thailand's international standard of health care and its comparatively lower costs, the medical tourists are from a good selection of countries, like Japan, the United States, United Kingdom and the United Arab Emirates.

Despite its popularity as a medical hub for international visitors, Thailand still draws far fewer medical tourists from within Asean that its two closest competitors. Around two-thirds of foreign patients in Singapore and Malaysia hail from Asean countries, largely because of an emerging Indonesian middle class who wish to get their medical treatment abroad. Yet, opportunities that will arise with the arrival of AEC are going to change all this.

On the supply front, Thailand's reputation among international visitors as an attractive destination for medical tourists will draw new service providers from other Asean countries to participate in the lucrative business. Healthcare is one of the four AEC priority service sectors for which the foreign ownership cap for investors of Asean nationality will be raised to 70%. Currently, hospitals in Thailand have only 15% foreign equity participation on average.

The fact that Asean entities can become majority stakeholders and the proven profitability of private hospitals in Thailand may usher in innovative medical care and tailored services to better cater to Asean customers' medical needs.

Domestic patients will also benefit from competition in the form of a better standard of services, more choices and enhanced medical technology.

However, there is a significant obstacle to this notion _ Thailand's shortage of medical personnel, both in terms of quantity and quality. This could hamper the country's hopes of becoming the medical hub of Asean.

To put it simply, Thailand cannot produce adequate numbers of medical workers _ doctors and nurses included _ to satisfy even domestic medical needs. In addition, many of these workers are not well prepared to face the cultural challenges that will arise from the integration of the AEC and globalisation in general. Deficiency in second-language skills _ English, Mandarin and other regional languages _ will increasingly become a major disadvantage that will end up plaguing Thailand's medical tourism industry.

A recent study by the Health Systems Research Institute found that Thailand needs 50,000 more registered nurses to meet demand, the result of declining numbers of new nursing graduates in the past decade. Even after efforts to produce more practical nurses ie caregivers who assist doctors and registered nurses and who only need to complete one-year training as opposed to the four that is required of registered nurses, the number of medical personnel is still far below satisfactory levels.

Yet, Thailand could benefit from the AEC by importing nurses from other Asean countries, such as the Philippines where nurses are in surplus and currently receive lower pay. The labour movement would be made easier under Mutual Recognition Agreements (MRAs), which aim to facilitate the movement of skilled labour in priority sectors, among which medical personnel are included. These imported nurses who would be treating mostly foreign patients would relieve pressure on domestic healthcare services which would otherwise face greater competition for resources from hospitals that cater to international patients.

However, despite the MRAs, foreign nurses will still need to be proficient in the Thai language to pass the examination for a full nursing licence in Thailand, which is taken in Thai. Shouldn't such regulatory limitations be relaxed as it is not in the interests of the patients, domestic or foreign? Foreign patients naturally prefer nurses who can speak their mother tongue or an international language. Meanwhile, domestic patients should not be left wanting as a result of a greater shortage of medical personnel. Medical tourism and domestic healthcare would not be in direct competition if medical workers could easily come to Thailand to work. In fact, the two could complement each other by improving the availability and quality of health care for all.

Regulatory barriers such as this exist in medical services, but also in other sectors. They need a thoughtful review by the authorities concerned and any changes should align with the needs of consumers.

Nonetheless, the private sector could do with more training of medical professionals to combat the labour shortage. Helping fund the education of medical and nursing students in exchange for future jobs, or allowing them paid training in a real work environment are possibilities. They can also help design curricula that equip students with relevant professional skills as well as marketable skills such as a second language or cultural awareness.

The AEC provides a new opportunity to promote Thailand's medical tourism, but critical adjustments must be made both on the regulatory front and in the long-term planning for producing new medical personnel.

The shortage of skilled labour is also common among other sectors with less of a competitive edge than that of medical tourism. With the imminent arrival of the AEC, skilled labour will be under intense competition. And time is not on our side.

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Sutapa Amornvivat is chief economist and executive vice president at Siam Commercial Bank. She has international work experience at IMF, ING Group and Booz, Allen, Hamilton. She received a BA from Harvard and a PhD from MIT.

--- http://www.bangkokpost.com/learning/learning-from-news/298913/medical-tourism-looking-ahead-to-2015

The melting of the polar ice is expected to raise sea levels around the world, raising fears that some of the world's largest cities could be flooded.  Earth Techling reports on a plan for saving one historic site in Thailand.

The city of Ayutthaya, Thailand, was founded when King U Thong ran there to escape a smallpox outbreak in Lop Buri way back in 1350 and proclaimed it the capital of his kingdom. Located on an island in the Chao Praya river, the city’s easy access to water played a part in its economic success, offering farmers access to freshwater for rice crops, as well as a convenient way to bring those crops to market. But that same water — once the lifeblood of the city — has now become a source of catastrophic flooding. Last year, the river’s annual flooding surged beyond historical records and overcame the city’s protective embankments, causing massive damage to this UNESCO World Heritage site and leaving 200,000 people unemployed.

With global climate change and rising sea levels all around, the city’s outlook for the future, sans some serious intervention, clearly is not all that cheery.

image via Shma/eVolo

Shma Designs has developed a vision for how Ayutthaya can save itself by moving into a new balance with the Chao Praya river, and become more sustainable in the process. This vision, known as the Water City of the Future (which comes to us via eVolo) consists of five modules: Agriculture + Water Infrastructure; Agriculture + Food; Agriculture + Energy & Waste Exchange; Agriculture + Industry; and Agriculture + Tourism.

The firm’s design calls for turning agricultural areas into large water detention reservoirs capable of storing large amounts of water during the annual flood season for use during the dry season. This would be achieved  via bioswales that direct the water into these reservoirs, which would be equipped with drain channels to filtrate overflow water biologically before releasing it to the river. A key part of making this system work  is adjusting local farming practices. Currently, farmers in the region practice what is known as the In-Season Rice Field method, which overlaps with the annual flood. Switching to the Double-Cropped Field method would leave these lands open to function as a protective barrier around the city.

image via Shma/eVolo

Shma likewise envisions a more sustainable connection between agriculture, urban infrastructure and energy in the area. Agricultural wastes would be converted, via gasification, into electricity for the city, while the city’s food scraps and yard debris would be picked up curbside and composted into fertilizer for the rice fields.

The plan also calls for high speed rail, which would create an economic corridor connecting Dwai (Myanmar) to Kanchanaburi (Thailand) and Bangkok to Ho Chi Min City (Vietnam). This would turn Ayutthaya into a logistic hub for the region, attracting an influx of goods, labor and investment, while giving the city a convenient way to turn its increased agricultural productivity into cash, by shipping its rice farther afield.

That same high speed rail system was envisioned as a way to bring tourists to the city as well, who would be attracted not only to the architectural remnants of ancient Ayutthaya, as they have been for years, but to this gee-whiz Water City of the Future. Shma even sees the potential for water-based activities and attractions during the flood season, with visitors lodging on flooded fields in floating tent accommodations. (Anyone up for a little rice-field paddle-boarding in the morning?)

http://www.earthtechling.com/2012/06/in-thailand-a-deep-green-vision-for-saving-an-historic-city/

The NASA climate project in Thailand is off  for now, but Reuters is reporting that it could be revived in the future. The news agency is quoting NASA officials as leaving the door open for the project to be conducted next year.  Reuters also says it's also possible that the research could be done at another site in Thailand.

U.S. Coast Guard HC-130 landing at U-Tapao in 2005

The project was originally approved in 2010 by a government made up of politicians opposed to former Prime Minister Thakin Shinawatra.  Now that the government is led by Thaksin's sister and his supporters, the opposition politicians are denouncing the plan as a violation of the country's sovereignty.  There have also been rumors that the project might be a cover for US spy activities.  NASA officials have denied those rumors.

Prime Minister Yingluck

NASA said it needed final approval for the project by June 26th. This week, Prime Minister Yingluck's government said the Thai Parliament would need to vote on the plan, a move which couldn't come before August 1st, prompting NASA to scratch it.

Another twist came today when the Ms. Yingluck's Pheu Thai party announced that it would file suit against the previous prime minister and cabinet members who originally approved the plan for failing to follow proper procedures.

NASA has cancelled plans for a weather research station in Thailand.

WASHINGTON : The US space agency Nasa announced Wednesday it has cancelled the August research mission it had hoped to base at U-tapao airbase after the government refused to endorse the project.

The official announcement, on the Nasa website early Thursday Thailand time, said:

"Nasa cancelled the SEAC4RS mission, which was scheduled to begin in August 2012, due to the absence of necessary approvals by regional authorities in the timeframe necessary to support the mission's planned deployment and scientific observation window."

The single paragraph was added to a website page which described the project in glowing terms as "something that has never been done before: probing a vast expanse of the Southeast Asian atmosphere from top to bottom" during the monsoon season.

Nasa posted the cancellation notice in a simple "Editor's Note" atop a previous article describing what it called an unprecedented research mission.

A few hours later, Nasa confirmed the cancellation with a tweet:

"We have, unfortunately, had to call off this airborne science mission planned for Southeast Asia this year."

In Thailand, the Democrat party on Wednesday rejected all blame for the cancellation.

The scheme was scrapped after the cabinet decided to forward the project proposal to parliament for debate in August, as delivery of equipment and preparations must take place ahead of time for the research to begin in the same month.

Democrat leader Abhisit Vejjajiva said critics did not oppose Nasa's request to use U-tapao airport for its programme, but wanted the government to carefully consider the project and disclose more information. 

It was absurd that the government was pointing the finger of blame at the opposition for doing its job, he said.

"Why doesn't the government back down on the reconciliation or charter amendment bills? Things would have been better," he said.  Mr Abhisit said the government should admit it had not thoroughly vetted the project, and that any loss of benefits that would have arisen from the study was partly because of this.

Deputy Democrat leader Korn Chatikavanij said the government was to blame for any loss of opportunity because it was avoiding questions instead of looking into them.

He challenged the government to grant Nasa permission to proceed if it was certain the scheme did not violate the constitution.

"I'm sure the scheme has something to offer to us. But I doubt there is no hidden agenda," Mr Korn said.

Democrat spokesman Chavanond Intarakomalyasut called for the removal of Foreign Minister Surapong Tovichakchaikul and Science and Technology Minister Plodprasop Suraswadi for distorting facts and lying to the public about the shipment of equipment for use in the weather research project.

Senator Somchai Sawaengkarn - who had previously compared the project to US requests to use the airport during the Vietnam War and said it would raise suspicions in Cambodia, Vietnam and China - suggested a special parliamentary session to debate the scheme if the government insisted it was essential for the country's benefit.

"There are six weeks to go before the project is scheduled to begin. Why waste another month if it is really important?" Mr Somchai said.

Mr Surapong told US ambassador Kristie Kenney about the cabinet decision on Tuesday before leaving for Dubai.

"The US ambassador expressed disappointment but understood Thailand's internal process and hopes to cooperate with Thailand in other aspects," Foreign Ministry spokesman Thani Thongphakdi said.

Ms Kenney will convey the decision to Nasa, he said.

http://www.bangkokpost.com/news/local/300003/mission-aborted

The Wall Street Journal has an interesting piece on the controversy over NASA's request to use an airbase in Thailand.  Here it is:

BANGKOK–Plans for the U.S. government to expand its use of a Thai military airbase have created a stir in Thailand, with domestic politics likely playing a significant role in the controversy, according to a Thailand security expert.

The U.S.’s National Aeronautics and Space Administration, or NASA, had appeared set to use the U-Tapao naval airbase, located approximately 100 miles southeast of Bangkok, for a six weekatmospheric research study in August and September. The project would examine, among other issues, how emissions affect the atmosphere and monsoon rains. Separately, the U.S. and Thailand have recently held discussions about establishing a regional humanitarian assistance and disaster relief center at U-Tapao – which became famous as a staging ground for U.S. missions during the Vietnam War – that could be used to respond to future natural disasters.

Opposition lawmakers, however, have railed against the NASA plan in recent weeks, saying Prime Minister Yingluck Shinawatra should more carefully examine the proposal because it could compromise Thai sovereignty and upset the country’s relations with China. Critics argue that the arrangement could signal American intentions to ramp up its military presence in Thailand in order to counter Chinese influence in the region, and that NASA aircraft could be used for espionage. The U.S. and Thailand have been treaty allies since 1954.

Some detractors have even claimed that the agreement with NASA could represent a tit for tat scheme between Thailand and the U.S. According to this theory, Ms. Yingluck would grant the U.S. access to U-Tapao so that her older brother, the divisive former prime minister Thaksin Shinawatra, could receive a U.S. visa in turn. Mr. Thaksin has mostly lived in self-imposed exile since he was overthrown in a bloodless military coup in 2006, and his travel is restricted to a handful of countries.

“The NASA program is purely scientific in nature and is intended for the good of all humanity,” said Kristin Kneedler, a spokeswoman at the U.S. embassy in Bangkok. “All the data generated will be available to anyone via the Internet and scientific results will be published in the open scientific literature.”

Ms. Kneedler told Southeast Asia Real Time that Thailand and neighboring countries “stand to gain substantial benefit from collaborating with NASA on this project,” and that the study will generate information that will enhance Thailand’s “ability to anticipate and mitigate the impact of future floods and better understand climate change.” Parts of Thailand were swamped last year by the worst floods in decades, with several industrial estates hit and global supply chains disrupted.

Asked about speculation regarding a supposed deal to grant Mr. Thaksin a U.S. visa in exchange for NASA’s use of U-Tapao, Ms. Kneedler said simply that “all visa applications are reviewed on a case-by-case basis in accordance with the requirements of U.S. immigration law. We do not exchange visas for favors.”

The issue has dominated local headlines in recent weeks, even though the plan has been in the works for some time, according to Thai officials. Thai Foreign Minister Surapong Tovichakchaikul last week noted that the Thai government and NASA signed a joint statement of intent for civil space activities in 2010, when former prime minister Abhisit Vejjajiva — now head of the opposition Democrat party — was in office. Mr. Surapong added that both Singapore and Cambodia — countries whose airspace would also be used in the study — have given NASA the green light. He also noted that Thailand had informed China of the project, and that no objections had been raised.

Now, Mr. Surapong says, a deadline is looming. He has warned that NASA will cancel its plans to use U-Tapao if it does not receive an answer from Thailand by Tuesday, since the agency needs ample time to arrange for the transport of its equipment. (Ms. Kneedler did not comment on the deadline, but said NASA “needs appropriate time to organize logistics.”)

On Tuesday afternoon, a report from the official MCOT news agency said that Ms. Yingluck’s Cabinet had “resolved to forward the request” from NASA to Parliament for a debate — though that body will not be in session again until August. The report said that Ms. Yingluck’s Cabinet had agreed to allow NASA to use U-Tapao, but only if the issue is open for parliamentary debate in order to provide transparency. Ms. Yingluck noted, however, that the body’s approval is not required to give NASA the go-ahead, and that the delay could result in the project’s cancellation.

Anthony Davis, a Thailand-based security analyst with global research firm IHS-Jane’s, said that while the U-Tapao issue is naturally a sensitive one for Thailand since American agencies would be using a Thai airfield, the uproar is “almost entirely about domestic politics and bad American timing, but primarily the former.” Thailand has experienced continued social and political upheaval since Mr. Thaksin was ousted, and Thai lawmakers last month scuffled in Parliament over an amnesty bill that could lead to his return.

Democrat Party spokesperson Chavanond Intarakomalyasut has denied that his party is attempting to disrupt the government’s plans, according to official news reports. He says the Democrats simply want the government to provide the public with more information about NASA’s project.

Mr. Davis noted that the U.S. request to use U-Tapao comes not merely amid Thai political turbulence, but also at a time of heightened perceptions of strategic competition between the U.S. and China in the region. Still, “the primary driver here is Thai domestic politics and its ongoing dysfunction,” Mr. Davis said.

The U.S. government has a long history with U-Tapao. In addition to its use during the Vietnam War, the facility was used during relief operations following the 2004 Indian Ocean tsunami, as well as after Cyclone Nargis in 2008. American, Thai and other troops now access the airbase in an annual multinational joint military training exercise called Cobra Gold. U-Tapao is also home to a commercial airport that was used briefly in 2008 to take in an overflow of passengers who were stranded when anti-government protesters shut down Bangkok’s main Suvarnabhumi international airport.

--- http://blogs.wsj.com/searealtime/2012/06/25/u-s-plans-for-u-tapao-airfield-cause-stir/