Sowing the Seeds of Grassroots Health Care

If you're hanging around a street fest or a community event this summer and 10-year-old girl with long, frizzy brown hair and a shy smile hands you a condom-don't be freaked out-she's just doing a favor for her mom. Manith Thaing, a community health specialist for Asian Health Services(AHS) in Alameda County just loves taking her daughter, Jesse, to work. "She helps me pack condoms and pass them out and do outreach with me," Manith said proudly. "I don't think it's too early for her to be educated, because education is the best way to be empowered."

Empowerment is the focus of Banteay Srei (which translates from Cambodian as "Temple of Women"), a new program that Manith is launching this fall in collaboration with women from several, local Asian-Pacific Islander(API) health agencies and teen peer leaders. Although the program is geared toward confronting a growing problem in the Bay Area-prostitution and sexual exploitation of Southeast Asian(-American) minors-Manith stressed that community-building is a primary ambition. "This class is about support and providing a safe space where [the girls] can express themselves," she said of the program, which will incorporate traditional cooking and multi-media art projects into the curriculum. "My job isn't to tell them what to do. I just want them to know that they have options other than prostitution and to help them realize that they can be leaders."

Right now, Manith spends most of her time working with AHS's Youth Program, which offers free reproductive health-related services such as pelvic exams, birth control and HIV tests. So most of the girls who Manith sees haven't been sexually-exploited; many are simply confused, caught between the cultural expectations of their families and a desire to "Americanize." Maybe they're engaging in dangerous behavior because they don't understand the risks, or maybe they just feel like they can't communicate with anybody. Either way, Manith's warm demeanor, patient ear, and especially her personal history make her perfectly suited for her position at AHS.

Providing Health Care, Building the Community

Manith's family fled Cambodia's genocidal Khmer Rouge regime when she was two years old and settled in California in 1976. Although Manith admits to fitting the "submissive Asian woman" stereotype when she was growing up, her inner woman warrior sometimes clashed with her parents’ traditional values and customs. "When I was 16, my mom tried to set me up in an arranged marriage," Manith explained. "She had the guy come over to check me out and I was in my room crying my eyes out, because I'd never even been kissed, but she was about to pawn me off to this guy who was ten years older than me. I told my uncle to tell him that if he was willing to wait until after I finished college I would marry him, but of course he didn't want to wait."

But she was mostly obedient and followed her mother's rules about staying away from boys-until she got to college. "Then I took some ethnic and women's studies classes and I realized that I'm my own person, I'm independent . . . then I got a boyfriend and got knocked up and decided to have my daughter," she said, laughing. "Having my daughter taught me about public health systems, because I had to figure out: How am I going to live? How am I going to get medical? Do I have to quit school?" she continued.

Even though her belly was so big that she couldn't even fit into the desk, she took her last final of the semester on a Tuesday and gave birth three days later ("The professors were like, 'Please don't have your kid right now!'"). Even though it was tough, Manith finished her degree taking night classes while her parents-who finally decided not to disown her-watched her infant daughter. After graduating, Manith found a job through Asian-Americans for Community Involvement trying to help transition people off of Calworks benefits into employment, but quickly realized that she preferred working with young people. "Young people are still open-minded and not as judgmental," she said. "You can provide them with options, so they can make choices with their lives."

From her first experiences working with the East Bay Asian Youth Center during college to her latest work launching Banteay Srei, Manith found that the biggest problem facing many teens is simply that they feel like they can't communicate with their parents and they have no one to turn to. Surveys taken by patients have shown overwhelmingly positive responses to the care-both physical and psychological-given at AHS's teen clinic. This is undoubtedly due very much to Manith's, and the other doctors and counselors, abilities to connect with the population they are serving on a personal level and make them feel comfortable and secure about discussing sexual-related health issues. "Sex is stigma in many Asian families," she said. "It's taboo to even say 'penis' or 'vagina,' even in my family. I sometimes crack jokes about getting knocked up, because I'm comfortable with where I am now, and people are shocked. When I tell my parents' friends that I pack condom packets, they just stare at me. People don't even want to touch the subject of STDs or HIV."

Unfortunately, reluctance to discuss a problem doesn't make it disappear, and can often lead to even more serious problems than embarrassment or "dishonor." A 2004 community-based study entitled "REACH 2010: Promoting Access to Health" found that, "Many women felt that complications that led to the need for a Pap Smear or pelvic exam was caused by poor hygiene" and that a prevailing attitude was, "many women who need doctors are presumed to be ill or 'dirty.'"

Through Banteay Srei, as several other local Asian-American health-related programs, Manith and her co-workers are striving not only to provide medical care, but also to wipe out such negative views regarding women's sexual and reproductive health issues. One of the most effective ways of accomplishing this goal has been building strong community relations at the grassroots level through peer leader programs that allow teens to take an active role in spreading education.

Amy Han, a former peer health educator, is now an American Ethnic Studies Major at University of Washington, but when she first visited the AHS youth program, she had just dropped out of ninth grade and was involved with "ecstasy and a bad crowd." Her testimonial for the benefits getting involved with AHS is inspirational, but hardly atypical. "I feel like I'm much more aware of what's going on within the API community, whether it be health or political issues," she said. "I can even say that AHS saved my life. Without the guidance of the mentors and staff, I'd probably still be a dropout. They helped me with accomplishments, brought me up from my struggles and gave me more confidence. Since the day I started with AHS, I've been active in my community."

Amy is only one of the many young women who have entered the AHS community seeking help and transformed themselves into knowledgeable and confident leaders. Even Manith started out as a patient-even though she was too young to remember her first visit, when she was actually treated by her future co-worker, Dr. Sue Chan. "Finding that out was so ironic," Manith said of discovering this quirky fact during a conversation with her mother. "Because it came full cycle. I had been a patient there and 30 years later, I'm working there and even bringing my own daughter there. That's what keeps me going; I know there are young people that need to talk to people who can understand where they're coming from."