Post 24: Smoking has a Bad Smell

The Impetus
Back in June, the teachers and I made a list of the problems facing our school. Through conversations and questionnaires, it became clear that one of the biggest issues is juvenile delinquency. Most of the students come from poor, farming families, and either have parents who are very young or absent. As I may have mentioned before, it is common for people in their twenties to leave the village in search of work, regardless of whether or not they have children. Many students thus live with their grandparents, who are for the most part too old to be diligent caretakers. There is not a ready supply of role models or guiding hands, and the kids have a fair degree of freedom. Furthermore, many students believe that they are going to become rice farmers anyway, so school is not important. All these factors lead to behavioral issues. I have 11 year old students who ask me for smoke breaks and get drunk on weekends. Yaa baa, or methamphetamine, is on the rise, which leads to fights and theft. Many girls do not continue their education past 9th grade due to pregnancy.
Part of the problem is ignorance. There is no anti-drug or sex education in Thai schools. For boys, smoking and drinking are promoted as signs of masculinity, and often fathers will have no qualms if their teenage son downs whiskey or smokes a cig every now and then. That smoking is addictive, and exponentially more so if begun at a young age, is unknown. When the teachers lecture their 7th graders about not smoking, they say it is because smoking is smelly and impolite for girls. Cancer and other side effects are not brought into the equation. These kids have no-one giving them substantive, factual information. American students had sex ed and D.A.R.E. Granted, many American teenagers begin smoking and sleeping around at shockingly young ages, but at least they are aware of the consequences of their actions, and will not find themselves surprised at pregnancy or emphysema in their 40s because they simply did not know. Health education is a powerful thing, empowering students to make their own informed decisions, and in my opinion desperately needed in Thai schools.
I decided to work on developing a sex ed/D.A.R.E. like program for the middle schoolers, where a few times a year, the school would hold an educational seminar on a relevant topic, to spread accurate information, raise awareness, and open up discussions. My list if topics ranged from personal hygiene to rape prevention to HIV/AIDS. I decided to make the pilot project “anti-smoking”, because it was relevant, uncontroversial, and I know Pii Som cared about it. I began pushing for the campaign at the end of the first term, hoping that if I sowed the seeds well enough we could kick off term two incorporating health into the curriculum. I mentioned it every day, and usually received lukewarm responses in return. But as soon as I returned to site after my vacation, Pii Som asked me to pick a date. We selected November 19th, and cross-checked the date with the school’s director and the hospital staff.
At first, I felt a sense of disbelief at first that I was actually able to do a project which my school supported. It seemed too good to be true; none of the usual obstacles stood in my way. I heard horror stories during training of volunteers whose counterparts did not support their projects, and thus disabled them from executing any successfully. Pii Som was willing, or at least obliged me, in translating multiple documents and helped me write the formal project proposal/budget to give the school’s director. Additionally, many volunteers have problems finding funding. I specifically designed the project so money would not be an obstacle, and the school had sufficient money in the budget. The whole thing cost under $100.
Another dreaded Peace Corps legend is of the volunteer who spent 6 months planning a project to have it canceled the day before, or have no-one show up. Lucky for me, the staff at the local hospital seemed excited about the project and motivated to help. I wanted to include the hospital staff as a way to expand the project community wide, as well as imbue it with credibility. The teachers are constantly lecturing the students about one thing or another, which the students generally ignore. However, if health “professionals” are explaining to the students the health consequences of smoking, the kids are more likely to believe it and listen. My main challenge with the hospital staff was their lack of knowledge on the topic- they were not well-versed in smoking-related diseases and health effects. I remedied this by creating an informational packet with a description of each topic and activity; a list of 15 smoking-related facts, including smoking in general, smoking in Thailand, and youth smoking; and an outline of the various health-related consequences, from lung cancer to addiction to gum decay. The fact that cigarettes are addictive was a surprise to many. It felt bizarre that me, a 23 year-old with no background in health was teaching hospital staff about the symptoms of emphysema, but there is so little access to health education in the villages that many people genuinely do not know basic things, like washing hands staves off disease, eating massive amounts of deep fried white rice is not good nutrition, and smoking can kill you.
The project
I structured the seminar around 4 rotations: long-term health consequences, short-term health effects, temptation and refusal skills (saying no) and spreading information. There were 160 students total, and thus 40 kids per rotation. I designed each rotation myself, but the people from the hospital would lead them. The first rotation focused on lung cancer, oral cancer, emphysema, and cardiovascular disease. I created a poster and flashcards with the name of the diseases, their symptoms, and [gruesome] pictures. After reviewing the poster, the kids were divided into groups. Each group received an envelope with the flashcards and pictures all jumbled up. The task was to reassemble the diseases, symptoms, and images. It put the kids face to face with what smoking can do to the body, and made th`em consider each illness individually.
The second rotation focused on short-term health effects, primarily lung damage, shortness of breath, addiction, and tooth and gum decay. I had a range of activities planned. My favorite was a “gross mouth” contest, where the students could use a smorgasbord of gummies, dried fruit, raisins, chocolates, and cookies to make their mouths look as if they were rotting. There was also a demonstration of smoking’s effect on the lungs, where a cigarette was stuck through a hole in an empty water bottle filled with cotton balls. By squeezing the bottle, the air flow simulates inhaling and exhaling, and the cotton balls turn brown. The students also breathed through straws and coffee stirrers to simulate shortness of breath. In the “Saying No” rotation, the students played a game where they refused toffees (it is difficult to explain) and then talked about peer pressure. Finally, small groups students had to make informational posters with what they learned and why they shouldn’t smoke. This was meant as a way for the students to process the information, as well as create something tangible to look at after the seminar was over and use to teach the younger students.
Pii Som and I went to multiple meetings at the hospital to brief the hospital staff and I spent hours and hours working on posters and the rotation activities at school and at home. I felt a huge sense of responsibility, because this project was my idea, I cared deeply that the students learn from it, and I wanted it to be the first of many. If it was a disaster, that could be the end to my grand vision of a health curriculum. I wanted to leave as little as possible up to chance or the efforts of other people. This meant I spent my evenings cutting up and organizing disease/symptom flashcards, after hours spent researching online and translating into Thai. I also made two educational posters, information packets for the hospital staff, photocopied worksheets and activity descriptions, and went personally to buy every material. I prepared everything I could and hoped with such a strong structure the seminar would go smoothly.
The day off, I was something of a nervous wreck. I enlisted Dan and Kelsi (my closest volunteer pals) to come help and keep me calm. Of course, their bus to Phitsanulok was stopped by the police and searched for drugs, delaying their arrival. Of course, the hospital staff showed up a half an hour late. Still, everything went remarkably well, if not exactly according to plan. Pii Som acted as MC and introduced the hospital staff before beginning the opening activity. We had each student write a question or statement related to smoking and then the teachers selected students to read out loud. Many of the students were facetious in their comments, which elicited laughter, but the questions were incredibly helpful in letting us know what the students knew already, and were curious about. Next, the hospital staff gave a presentation, using much of the information I gave them. After the presentation (which lasted about 30 minutes), the rotations began. Dan and Kelsi arrived just as they were starting. I grabbed their bags from their backs like a madwomen and shoved them into their rotations, promising to bring them food and water as soon as I could. I ran around from room to room answering questions, helping the hospital staff, and supplying missing materials. The first rotation was a bit shaky, but things quickly hit their stride and by the third rotation I was able to step back and act as photographer.
When the day was over, I felt ready to collapse and an overpowering sense of relief, as well as of accomplishment. The kids responded to each rotation and were smiling all the way through. The hospital staff did a wonderful job and the teachers were pleased with the outcome. I, for my part, squirreled away a pack of cookies we bought for the “gross mouth” activity and happily returned to my house with Dan and Kelsi after everything was clean to relax with a few beers (behind drawn curtains of course) and finally have the project off my mind. I used all my newfound free time to read The Idiot by Dostoyovevsky, buy food at the market, write a letter or two, and look forward to the Peace Corps Sizzler Thanskgiving Extravaganza.