A burmese family took their child to Mae Sot hospital. The boy has tumor on the back of his head   PARITTA WANGKIAT TAK—When Britain ruled Burma in 19th century, several treaties were signed with Thailand to demarcate the boundary between the two countries. That brought certainty to area under territorial dispute. Published Caption A Rohingya family take their child to Maesot General Hospital in Tak province. The boy has a tumour on the back of his head. Border hospitals in Tak have to shoulder more than 100 million baht a year to provide healthcare services to those with citizenship problems.   But many ethnic and minority—whose ancestors lived in where they were for hundreds of years—were suddenly pushed to the rim of Thailand. Uncertain and invisible, like those in Umphang district of Tak province whose status is identified as stateless—undocumented hill tribe, long-term migrants and Thai descendant who obtain ID card’s digit started with 0 or have no ID cards. As much as poverty, spread of disease such as tuberculosis, cholera, malaria have threaten their living. Limited health care access is major problems of these borderline people. Like in a case of a Karen named Lai Poh, 39, who died in 2011 by last-stage kidney failure. Lived in a village near Thailand-Myanmar borderline in Tak province for all his life, he had just obtained a Thai ID card 5 months before the illness took his life. Thai citizenship allowed him to benefit from the government’s 30-baht Universal Health Care Scheme (UC), and also, a brief kidney therapy from Umphang Hospital in west of Tak. But his previous status of a stateless person worsened his condition. He was afraid of being arrested if he came out of his village for medical service of which high fee he could not pay off. “They can’t jump across the wall of money,” said Umpang Hospital’s director Worawit Tantiwattanasap. “Public health system does not offer space for them.” Registration Administration Bureau’s 2011 record show more than 200,000 stateless people are living in Thailand. But the number is believed to be higher. But these groups are usually unrecognized. Authorities seem to more focus on healthcare for migrant labors. Public Health Ministry has recently promoted a-year 365 baht health insurance package for a migrant child, and a-year 1,300 baht package for an illegal migrant adult. Even though their origins are in the land of smile, stateless people don’t have rights to participate in any health insurance programmes. If they could, believed Dr Worawit, few of them will be able to afford the insurance as they have no jobs like migrant workers. Stateless people’s limited healthcare access have created financial burden to some borderline hospitals that provide them free treatment—cost more than 250 million baht in each year according to Public Health Ministry. More than 104 million baht is spent for non-health insurance people in Tak’s borderline hospitals alone—in Umphang, Mae Sot, Mar Ramat, Tha Song Yang, Phop Phra district. Donation is the main source to fill the hospitals’ deficit. Such as in Umphang hospital, 55% of patients in inward patients department have no healthcare insurance. About 62%—52,273 people—of population in the area have no health insurance. Public health permanent secretary Narong Sahametapat told Tak hospitals last week that about 310 million baht might be available at the end of this year to relieve borderline hospitals’ financial burden. “It is no question that the government must establish a universal healthcare system for these people,” said Supat Hasuwannakit, Director of Chana Hospital in Songkhla province. "Many of them could be considered Thai." “Just a chunk of budget will not expand healthcare access to them.” Dr Supat—who has studied on healthcare condition of stateless people—believes that health security should not rely on tedious process of the government’s nationality verification. The case of Lai Poh’s death is a great sample of long wait that killed a life. In 2010, the government at the time approved a fund for universal health care scheme for 450,000 people having problems with citizenship, About 70,500 of those are stateless people, But their visits to hospitals are low because of the lack of promotion. The scheme's members cannot benefit healthcare in hospitals located outside their registrative area, which they could still not access healthcare service if they move to work beyond their home.Analysed Dr Supat, an annual budget of 716 million baht (approximately 2,000 bath per head in a year)—about 0.66% of UC’s budget—will be capable to expand the scheme to cover more than 350,000 stateless people.With the healthcare scheme for stateless people, plus pervasive promotion, Dr Supat believes that the scheme will encourage them to visit hospitals more frequently. But that means the government have to invest on these people's health, said Dr Supat. However, it won’t be so soon that the government to accept such a proposal which push borderline hospitals to apply approach strategy in their area. Due to poverty and steep terrain geography, Umphang stateless people have behavior of leaving their aliment until in a crisis stage before visiting hospitals. Such as in a case a senile man, told by Umphang’s staff, who walked 6 hours from his village to the hospital to ask for help to relive his severe toothache. His teeth condition was extremely bad, which a dentist spent more than 12 hours to fix his mouth. Umphang hospital has learned from several cases that it needs to arrange mobile clinics and community-based health promotion programme in far villages. Vaccine, basic therapy and dental care are offered to stateless people with an aims to reduce their risk of severe alignment, and also, economic lost. “It will be too late if we expect them to come to the hospital,” said Dr Worawit. “We have no choice here. If we wait for fund, they will never reach healthcare. ”