Mot Luuk problems in northeast Thailand: why womenʹs own health concerns matter as much as disease rates

In this paper, we consider womenʹs illness experiences, above and beyond the presence of clinically identifiable disease. In Northeast Thailand, epidemiological data suggest that the prevalence of major womenʹs reproductive tract infections is relatively low and not a cause for significant public health attention. Conversely, we found that self-reported rates of gynecological complaints are high and a significant womenʹs health concern in rural Northeast villages. Womenʹs embodied experiences and interpretations of these complaints affect their lives dramatically. Moreover, womenʹs responses to gynecological problems (regardless of diagnosed morbidity) constitute an important health issue in their own right. In this regard, we document the dangers of womenʹs self-treatment practices that rely largely on small doses of medically inappropriate antibiotics, the manner in which family life and sexual relations are disrupted by fears that gynecological problems will progress to cervical cancer, health care seeking patterns and expectations from health staff, and most importantly, how womenʹs concerns about the seriousness of recurrent ailments result in substantial suffering. This study demonstrates why attention to womenʹs own health concerns is as important to address in health programs as rates of disease, and why common gynecological problems and work-related complaints are important to take seriously rather than dismiss as psychological or routine and expected. We argue that there is a strong need to conduct ethnographic research on womenʹs health problems as a complement to, and not merely a support for, epidemiological research. An evidence-based approach to health policy needs to be accompanied by a more humanistic approach to understanding health care needs.