This article was downloaded by: [Umeå University Library]On: 18 November 2014, At: 09:56Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Anthropology & MedicinePublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/canm20

Thai monks and lay nuns (mae chii) inurban health careDavid L. Gosling aa University of Cambridge , Clare Hall, Cambridge, CB3 9AL, UKPhone: 01223 332360 Fax: 01223 332360Published online: 06 May 2010.

To cite this article: David L. Gosling (1998) Thai monks and lay nuns (mae chii) in urban healthcare, Anthropology & Medicine, 5:1, 5-21, DOI: 10.1080/13648470.1998.9964546

To link to this article: http://dx.doi.org/10.1080/13648470.1998.9964546

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoeveror howsoever caused arising directly or indirectly in connection with, in relation to orarising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Anthropology & Medicine, Vol. 5, No. 1, 1998

Thai monks and lay nuns (mae chii) in urban healthcare

Date accepted: 12 August 1997

DAVID L. GOSLINGUniversity of Cambridge, UK

ABSTRACT In the process of defining their identity in relation to other social institutions, Thaimonks and increasingly, lay nuns (mae chii), have been adopting social and community rolesin rural areas. Studies conducted in the early 1980s and repeated more recently indicate thatthese can be adapted to suit urban situations such as paramedical roles in hospitals in whichmae chii may prove more effective than monks as counsellors. But although the young scholarmonks whose views were solicited were mostly open to such roles on the part of the mae chii,the majority were opposed to their full ordination as bhikkhunī.

Background

During the period 1993-94 a questionnaire and interview investigation wascarried out among Thai monks and mae chii to ascertain the extent to whichthey see themselves as practitioners of health care and how such roles can bejustified from a Buddhist perspective. The research built upon earlier workcarried out in the early 1980s using the same techniques and in one case usinga comparable group of respondents. In the last few decades Thai monks havebecome increasingly involved in community development programmes. Someof these were initially government-sponsored and had political overtones(Suksamrau, 1976). In time they became more diversified and centred onparticular temples (or wats) and educational establishments such as the twouniversities in Bangkok attended by monks (Gosling, 1980a). The investigationwas based on one of these, the prestigious Mahachulalongkorn Buddhist Uni-versity, where several hundred monks and novices study for BA degrees.

Mae chii resemble nuns in some respects, although in others they differ quitesignificantly. Mae means 'mother' and chii or ji in Thai can refer to Buddhistmonks, non-Buddhists such as Jains and also to Buddhist women who shavetheir heads and wear white robes. There are no female Theravada monks

Correspondence to: Dr David L. Gosling, Clare Hall, University of Cambridge, Cambridge CB39AL, UK. Tel: 01223 332360. Fax: 01223 332333.

1364-8470/98/010005-16 © 1998 Carfax Publishing Ltd

5

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

6 David L. Gosling

{bhikkhuni) in Thailand, the order having died out centuries ago. There are,however, some bhikkhum ordained in the Mahayana tradition of Taiwan.

During the Buddha's lifetime there were both fully-ordained women bhik-khum and women who led lives very much like mae chii. In Thailand there is noevidence for the existence of bhikkhuni during the reign of King Ramkhamhaeng(1283-1317), which probably means that they had died out by then. In anunpublished thesis Samer Boonma lists some of the possible reasons for theirdecline as follows: an excessively long noviciate, brahmanical hostility and lackof political patronage (unpublished MA thesis: Boonma Samer, Bhik-khum in Buddhism. Chulalongkorn University, 1978; 114-25). The bhikkhumOrder has never been revived in Thailand, but there is evidence for thereappearance of mae chii from the 17th century onwards.

There is no precedent for mae chii initiation in the Pali Canon, but therequirements for membership are fairly similar to those for a monk. An aspirantmust be a woman, must not be or become pregnant, must exhibit goodbehaviour, enjoy good health, be free from debt, be free from habit-formingdrugs, must not be absconding from home or a Government job, must not havea criminal record, suffer from infectious disease, be too old to perform religiousduties, be lame, and must have permission to become a mae chii from herparents or husband (1979).

These requirements have been standardised by the Nun Institute of Thailand,which has its headquarters at the Wat Bowomives in Bangkok. The Institute alsoregulates the rules for initiation into membership, which cannot, strictly speaking,be described as ordination because mae chii are lay women. A woman who fulfilsthe qualifications for initiation goes to a wat and makes her request to the abbot.If this is granted, she will be put under the care of an abbot or senior mae chii.

The mae chii ceremony itself is conducted by four monks and several mae chiiand thus imitates full bhikkhum ordination in that both male and female ordersare involved. During the ceremony the aspirant is told that meditation is herhighest religious duty and is reminded of the Three Refuges of Buddhism—theBuddha, the Dhamma and the Sangha. She is also given eight precepts; these arethe five followed by all lay Buddhists prohibiting harm to any living being,stealing, sexual misconduct, lies and insults and the taking of intoxicants—which cloud the mind and hence inhibit meditation—plus three more. Theseadditional precepts are to abstain from untimely eating (which means having thelast meal of the day at noon), to abstain from dancing, singing, music, garlands,scents and all kinds of embellishments, and to avoid sleeping on a high orluxurious bed. These eight precepts governing the conduct of a mae chii shouldnot be confused with the Gurudhamma, the eight stipulations made by theBuddha before he would permit women's full ordination as bhikkhum.

After initiation mae chii reside in monastic communities attached to wats, eachhaving its own head mae chii. These communities may be quite small, consistingof half a dozen members, and are usually called institutes by English-speakingmae chii. Other communities, such as the one at the Wat Paknam Phasi Charoenin Thonburi, may contain up to 300 mae chii at any one time.

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

Thai monks and lay nuns in urban health care 7

One hundred and eighty-five monks and novices at MahachulalongkornUniversity completed and returned questionnaires. Questions included infor-mation about their background (age, place of birth, etc.), the appropriateness orotherwise of specific paramedical activities investigated in 1984 and the appro-priateness or otherwise of a range of counselling roles in a hospital. Respondentswere also asked whether or not these activities and roles would be appropriatefor a mae chii and they were requested to specify if any family member had everbeen a mae chii.

Thirty-five mae chii were interviewed, but on the advice of Dr ChatsumarnKabilsingh, whose Thai Women in Buddhism is currently the definitive work inthis area, they were not given the same questionnaire, although a few senior maechii were asked to complete and discuss it (Kabilsingh, 1991). Preliminaryconversations indicated that the monks were unlikely to object to women as maechii, but their full ordination as bhikkhunï was much more problematic; theywere therefore asked about this and invited to state their reasons for or against.They were also asked to give their opinions about the social effectiveness of fiveurban Buddhist movements centred for the most part on charismatic monkssuch as Phra Payom Kallayano. The results of this part of the questionnaire havebeen published elsewhere (Gosling, in press, a).

The questionnaire respondents at Mahachulalongkorn University were askedto give their status: 81% were monks, 19% novices. Half were between 20 and23 years old, 5% were under 20 (all novices), and the remainder fairly evenlydistributed between the ages of 24 and 34, with 6% over the age of 34.

The distribution of places of birth was as follows: north-east, 59%; north,17%; south 13%; central, 9%; Bangkok/Thonburi, 2%. These figures reflect apattern whereby young men in the poorest provinces ordain as novices at anearly age and then migrate via well-defined monastic routes to the capital. Theresults of an earlier investigation carried out in 1978 were very similar: north-east, 50%; north, 16%; central, 16%; south, 14%; Bangkok/Thonburi, 2%(Gosling, 1980b). Three per cent of the respondents came from other countries.Further analysis showed that half the north-eastern (Isan) monks had been bornin 4 of the 15 provinces (Nakhon Ratchasima, Surin, Khon Kaen and Si Sa Ket)(Gosling, 1986a). These are among the poorest areas, though they are also moreheavily populated than, say, Loei. The north also contains poor areas plus alarge number of hill tribes from among which special schemes such as the PhraDhammajarik (wandering dhammd) programme recruit young tribals and sendthem to Bangkok for ordination.

Respondents were not asked about their educational qualifications and par-ents' occupations, but in view of the similarities between other data andcomparable material gathered in previous investigations, it is probably justifiedto assume that the majority of respondents' fathers were farmers and that morethan half had been ordained largely in order to obtain educational qualifications.Reasons for ordination given in an earlier study included such statements as 'toget both a worldly and a dhamma education', 'to pay an obligation to myparents', and 'because of faith in Buddhist doctrine'. One monk originally from

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

8 David L. Gosling

Surin province gave his father's occupation as 'feeding elephants'; when askedto state his reason for ordaining, he put 'tired of feeding elephants'.

The Thai educational system is extremely sophisticated and monks oftenmove between the secular and the religious sectors. Novices and monks areusually not permitted to study in a secondary school because this presupposesan inappropriate amount of contact with women. But they may sit the examsand in recent years have been able to attend secular adult education classes,which are often held in wat compounds in the evenings when they have sparetime. The levels of educational achievement of scholar monks at Mahachu-lalongkorn and Mahamakut universities and the different routes taken in orderto achieve them, were studied in the investigation conducted in 1978 (Gosling,1980a). The various types of grade obtainable and the levels of equivalencebetween them are also discussed in another published study carried out inChiang Mai province in 1980/81 (Gosling, 1983).

Appropriate actions

A distinctive feature of Thai Buddhism is the importance of appropriatebehaviour on the part of monks. The reason is that when King Mongkutreformed the Sangha during the second half of the 19th century, he insisted onstrict adherence to the Vinaya, the first of the three 'containers' of the PaliCanon, which governs monastic life generally and includes the 227 rules of thePâtimokkha.

Mongkut's reforms led to the emergence of the royally favoured Dhammayu-tika movement within the more broadly based Mahanikai body of the Sangha.The monks at Mahamakut University are Dhammayutika; those at Mahachu-lalongkorn are mostly Mahanikai. Although the former claim a closer historicassociation with Mongkut's reforms, both take the Pâtimokkha rules veryseriously—more so than in other Theravada countries.

According to the Pâtimokkha, a monk may not dig the earth, damage plantsor pour water containing living things on to the ground (Thera The Ven, 1966).But a novice, who is subject only to the first 10 rules, or a mae chii, who mustusually observe only eight, may do so. Clearly these point in the direction ofenvironmental sensitivity and many monks have become increasingly aware ofthis dimension of Buddhism. But some of the Pätimokkha's strictures invitequestions as to how they came into being and whether or not the Buddha, whowas essentially anti-authoritarian, would really have wanted his teaching to betaken so literally.

In practice many monks will break the rules of the Pâtimokkha if there is anoverriding reason that has strong Buddhist overtones. Thus, for example, PhraChamrun of the Wat Tham Krabok in Saraburi province, cures drug addictswith remarkable success using a herbal preparation (Gosling, 1986b). To do thishe must accommodate young men and women in a wat compound in such amanner that it is almost impossible to avoid a level of contact between monksand women which in most circumstances would be inappropriate. Furthermore,

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

Thai monks and lay nuns in urban health care 9

the monks, many of whom have been heroin addicts themselves, clear up laypeople's vomit, operate sauna baths and pursue patients who abscond before thecompletion of their treatment. But all this can be overlooked by many peoplebecause one of the five precepts of Buddhism is not to take intoxicants.

Although Phra Chamrun's work with drug addicts represents a response to anessentially modern problem exacerbated by international travel—many of hiswat members are Malaysian—he is best understood against the background ofa much older tradition of religious roles in relation to health care. This includesforest monks who are adept at treating particular illnesses and ex-monks whouse their monastic knowledge to cure sickness. The methods utilised by suchtraditional practitioners include the extensive use of medicinal plants {samunprai) and meditative techniques such as vipassana (insight contemplation) andsamatha (concentration meditation). Such meditative techniques complementand thereby extend more conventional and modern approaches to psychiatrichealth care (Irvine, 1982). Chamrun uses a combination of samun prai andvipassana.

Whether or not the work of Phra Chamrun is ultimately regarded as appropri-ate depends on the monks themselves, on senior Sangha members (e.g. theMaha Thera Sama Khom or Supreme Sangha Assembly) and on public opinion.In July 1978 Phra Kittivuddho, a leading politically rightist monk, was discov-ered to have been in possession of a Volvo car that was smuggled into thecountry. The newspapers erupted into a public debate on the inappropriatenessof such behaviour; one journalist, an influential Nation columnist, even went sofar as to compose a Volvo Sutra\

During the late 1970s, Dr Prawese Wasi, a distinguished professor of haema-tology, set up an imaginative scheme to train monks in elementary health care.He based his programme on two major wats in Bangkok and by 1980 groups ofup to 50 monks were regularly attending 5-day courses. These included primaryhealth care for adults and children, elementary diagnosis, using such instru-ments as a sphygmomanometer, and the administration of herbal medicines andinexpensive modern ones.

The effectiveness of these schemes was the focus of two investigations carriedout by the author in the early 1980s. In 1982 a series of interviews wasconducted in the home settings of monks who had undergone Maw Phra(doctor-monk) training (Gosling, 1985). In addition to questioning them aboutthe continuing relevance of the course, a careful study was made of all themedicinal plants {samun prat) in their wat compounds—a rich resource ofbiodiversity. On the basis of these interviews a questionnaire investigation wasconducted in 1983 into the views of young scholar monks at Mahachu-lalongkorn about the whole concept of the Maw Phra (Gosling, 1986a).

It will be clear that this present investigation into the potential involvement ofmonks and mae chii in urban health care has grown out of an ongoing study ofthe developmental activities of the Sangha, and that there are factors such as thenotion of appropriate behaviour and the public response to the success ofparticular individuals that must be taken into account.

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

10 David L. Gosling

TABLE I. The appropriateness of paramedical activities for a monk(1983).

Activity

Teach sanitationCure a feverGive herbal medicineTreat psychological illnessCure diabetesCure stomach painsInject a laymanUse a sphygmomanometerTeach family planningCure sickness through meditationCure venereal diseaseRemove a bad spiritCast a spell to remove sicknessInject a womanDeliver babies

Whether appropriate(%)

98898887818075666256302824155

Ongoing research

It is instructive and interesting to compare the results of the present investiga-tion with some of the data obtained 10 years previously from a comparablesample.

The first questionnaire and interview investigation was conducted in 1978among monks and novices at both Buddhist universities in Bangkok. Respon-dents were permitted three choices of answer to a range of questions concerningthe appropriateness of specific actions: appropriate, inappropriate and some-times appropriate. Thus 4% considered the felling of a tree to be appropriate,53% inappropriate and 44% sometimes appropriate. The third category meant,for example, that if a tree needed to be cut down because it was likely to fall ona wat, then if nobody else was around, a monk could do it (Gosling, 1980a).That 72% believed that it is appropriate for a monk to cure drug addictsreflected general public interest and approval for the work of Phra Chamrun atthat time, while the 89% who believed that a monk should not drive a carreflected strong disapproval of Kittivuddho's activities. A visit to the Mahachu-lalongkorn monks' residential quarters during the investigation revealed anironic wall cartoon of a monk sitting in an armchair watching television with aVolvo car parked outside the door!

Subsequent investigations omitted the 'sometimes appropriate' category andconcentrated on paramedical activities. The results of the 1983 and 1993questionnaire investigations relating to the appropriateness of the same range ofparamedical actions are shown in Tables I and II. The questionnaires wereanalysed using computers at the University of Hull and the Amdahl 5680-16M

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

Thai monks and lay nuns in urban health care 11

TABLE II. The appropriateness of paramedical activities for a monk (1993).

Questionnumber

5.035.015.115.025.145.055.085.065.095.135.075.125.105.04

Activity

Teach sanitationCure a feverTreat psychological illnessCure stomach painsCure diabetesTeach family planningGive herbal medicinesUse a sphygmomanometerInject a laymanCure venereal diseaseRemove a bad spiritCast a spell to remove sicknessInject a womanDeliver babies

Whether appropriate(%)

9382828074696562482323181110

computer at Chulalongkorn University. In the latter case the Statistical Packagefor the Social Sciences programme (SPSS) was used to perform cross-tabulations based on respondents' ages and whether or not any member of theirfamily had ever been a mae chii. The full questionnaire is included as anAppendix; numbers on the left-hand side of the tables refer to question numbersand parts of questions for the 1993 questionnaire only. Cross-tabulations wereperformed for questions (5), (6), (7), (8) and (10), according to age, and (6),(7) and (8), according to whether or not there was a mae chii in the family. Theprogramme produced a range of statistical tests, but the only one of anyassistance was %2.

Table I is based on the analysis of 340 questionnaires returned by 400Mahachulalongkorn monks and novices via the deans. The high ranking givento herbal medicines probably reflects the popularity of Dr Prawese Wasi at thattime. The high proportion of monks who would give an injection to a man(75%) is not so easily attributable to the same reason since Dr Prawese Wasiwould probably have wanted them to be more cautious, but perhaps they didnot appreciate this. Monks in remote areas who are diabetic know how to injectone another and Thais generally seem to be more impressed by injections thanpills; the figure none the less seems high.

Table II is based on the analysis of 185 questionnaires similarly distributedand returned. It omits cure of sickness through meditation, which was addressedin more detail in another part of the questionnaire. With the exception of herbalmedicines and the giving of an injection to a layman, the results are remarkablysimilar. From both tables it is clear that more than 90% of the monks are willingto teach the principles of environmental sanitation—they can do this by digress-ing during a Sunday sermon and also more systematically. Curing a fever maymean requesting a lay assistant to powder and add water to some borapet

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

12 David L. Gosling

(Tinospora Tuberculatà), readily available in many wat compounds. Or the monkmay just happen to have a strip of paracetamol available in a cupboard!

It is interesting that in both investigations more than 80% of the respondentsconsidered the treating of psychological illness as an appropriate role for amonk. A more detailed analysis of the 1983 questionnaires showed that evenwhen respondents were permitted to state that they could receive treatmentfrom a local health clinic or the district (amphur) hospital, 40% still preferred toconsult a monk (Gosling, 1986a).

The herbal medicines that were identified in wat compounds during theinterviews conducted in 1982 included treatment for diabetes (Thai: 'sweeturine sickness') and venereal disease (Thai: 'love's sickness'—usually gonor-rhoea). It is therefore not surprising to find a significant proportion of monkswho believe that they can treat, if not completely cure, these ailments. Thaimonks will discuss sexually transmitted diseases with young men in the presenceof their female relatives with a frankness that would startle religious practitionersin the West!

Reluctance to inject a woman and deliver babies reflects to some extent thePätimokkha's strictures against contact with women—the delivering of babies isin any case unnecessary because there is an abundance of midwives. Spirits areincreasingly the province of specialists in such matters or simply not to be takenseriously by good Buddhists!

When the same question relating to appropriate paramedical activities formonks was asked in relation to mae chii, the responses were as set out in Table III.

The most obvious differences between Tables II and III concern the giving ofinjections to men and women and the delivery of babies. Otherwise theresponses are remarkably similar. It be may be tentatively concluded thereforethat the role of a paramedical religious practitioner as envisaged by the monksis denned primarily with reference to Buddhism and the needs of society, but isnot particularly gender specific. There is no suggestion, for example, that themonks consider mae chii to be any less well able to treat psychological illnessthan themselves—in practice, of course, mae chii are likely to do it far betterbecause they can probe domestic situations more sensitively.

Four mae chii from the Mae Chii Institute at the Wat Bowornives and the WatPaknam in Thonburi commented on the questions about mae chii paramedicalroles as follows. All felt that mae chii could teach sanitation, cure a fever andcure stomach pains. Three believed that they could treat psychological illness,use a sphygmomanometer and teach family planning. Two considered it appro-priate to cure diabetes, give herbal medicines, inject a woman and deliverbabies. One believed the curing of venereal disease to be appropriate, but nonewould have anything to do with injecting a layman, removing a bad spirit orcasting a spell to remove sickness.

Once again the consistency is quite striking. The main difference seems to bethat whereas 51% of the monks believe that mae chii may deliver babies, the maechii do not agree because they know that this is the proper function of midwivesand that there is no shortage of them. Thirty-four per cent of the monks believe

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

Thai monks and lay nuns in urban health care 13

TABLE III. The appropriateness of paramedical activities for a mae chii (1993).

Questionnumber

6.036.016.026.116.066.056.146.086.106.046.096.136.076.12

Activity

Teach sanitationCure a feverCure stomach painsTreat psychological illnessUse a sphygmomanometerTeach family planning"Cure diabetesGive herbal medicinesInject a womanDeliver babiesInject a laymanCure venereal diseaseRemove a bad spiritCast a spell to remove sickness

Whether appropriate(%)

9487868077757372535134301514

that a mae chii may inject a layman, but the mae chii do not agree. Mae chii mayinject women, of course, but if the religious role of a monk prevents him frominjecting a woman (only 11%), then, the mae chii argue, their religious rolemakes it inappropriate for them to inject a man!

One of the four mae chii who were asked to comment on the questionnairewas the head of the Mae Chii Institute at the Wat Paknam, mae chii La-ongNuan Tongklam, a qualified nurse who is very interested in the work of DrPrawese Wasi. She confirmed the opinion of Dr Chatsumarn Kabilsingh thatmae chii at her institute would have had difficulty in answering the samequestionnaire as the monks. In so far as she is well-known for her medicalknowledge, the mae chii would probably have asked her opinions and filled inthe questionnaire accordingly. The monks were given the questionnaire by theirdeans in regular teaching periods and told not to talk. "Your questions areharder than the examinations", one novice commented later!

Hospital roles

The frequency with which Mahachulalongkorn monks visit patients in hospitalwas as follows: once a week or more, 9%; once a month or more, 20%; onceevery 3 months or more, 34%; less than once every 6 months, 51%; never, 34%.Just over half the sample were therefore in the habit of visiting a hospital at leastevery 3-6 months to meet a sick relative or some person already known to them.

Respondents were asked to state the appropriateness or otherwise of eightpossible roles for monks and mae chii in the context of a hospital. The resultsare given with shortened labels in Tables IV and V.

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

14 David L. Gosling

TABLE IV. The appropriateness of hospital roles for a monk.

Questionnumber

7.097.017.037.027.047.067.087.057.07

Role

Explain prevention of AIDSCounsel maleCounsel unknown maleCounsel femaleCounsel unknown femaleCounsel AIDS personUse wat as AIDS hospicePatient's message to familyPermit AIDS man to touch

Whether appropriate(%)

968986858382666357

The potential paramedical roles for a monk given in the questionnaire were:(1) counsel a male patient he already knows (counsel male); (2) counsel afemale patient he already knows (counsel female); (3) counsel a male patient hedoes not know on the recommendation of hospital staff (counsel unknownmale); (4) counsel a female patient he does not know on the recommendationof hospital staff (counsel unknown female); (5) take an important message fora patient to their family (patient's message to family); (6) counsel a person withfull-blown AIDS (counsel AIDS person); (7) permit a man with full-blownAIDS to touch him (permit AIDS man to touch); (8) for an abbot to arrangefor a male patient with full-blown AIDS to spend the final part of his life in aspecial area inside a wat (use wat as AIDS hospice); (9) explain to a youngperson who requests him how to avoid contracting AIDS (explain prevention ofAIDS).

The corresponding question relating to the appropriateness of the same rolesfor a mae chii was the same for the first seven questions using the femalepronoun. Question (8) asked how appropriate it would be for the head of themae chii to arrange for a female patient with full-blown AIDS to spend the finalpart of her life in a special area (use mae chii institute as AIDS hospice).Question (9) was the same (explain prevention of AIDS).

The resulting percentages are shown in Tables IV and V.The enthusiasm with which the monks were willing to tell young people about

the prevention of AIDS and felt that mae chii should do the same is reflected inthe high percentage in both tables. However, their concern that they should notbe touched by people with AIDS demonstrates a lack of awareness of the waysin which the virus is spread. Otherwise the responses are extremely positiveabout what both monks and mae chii can contribute towards the well-being ofhospital patients.

When the four mae chii consulted earlier were asked about their roles in ahospital, their responses were in the following order: counselling known andunknown women and taking a message, 4; counselling known and unknown

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

Thai monks and lay nuns in urban health care 15

TABLE V. The appropriateness of hospital roles for a mae chii.

8.098.028.018.068.048.038.058.088.07

Explain prevention of AIDSCounsel femaleCounsel maleCounsel AIDS personCounsel unknown femaleCounsel unknown malePatient's message to familyUse mae chii institute as AIDS hospicePermit AIDS man to touch

Whether appropriate

959490888683706755

men, a person with full-blown AIDS and a young person, 3; permitting a manwith full-blown AIDS to touch them, 1. None was prepared to see a mae chiiinstitute used as an AIDS hospice—probably they were being realistic about thesize of their living quarters and the facilities available. The monks, of coursewould not know about such things, with the result that 67% considered itfeasible!

Only 7% of the respondents stated that a member of their family had everbeen a mae chii (question (4)). When cross-tabulations were performed on thebasis of responses to this question, the statistics were therefore poor. In additionthe higher proportion of respondents who did not reply at all to questions (7)and (8) about the paramedical roles of monks and mae chii, although seldommore than 15% of the total, further diminished the quality of these statistics.But in spite of these difficulties, cross-tabulations for questions 6.08 (give herbalmedicine), 6.09 (inject a layman), 6.10 (inject a woman) and 6.14 (curediabetes) are significantly higher. These all have a domestic flavour to them—amonk whose mother has been a mae chii would be as likely to have been givenan insulin injection by her as his sisters, and he would therefore be unlikely todiscriminate between the giving of injections by mae chii to men and women. Adomestic mae chii might also be expected to know something about herbalmedicines and the use of herbs in food preparation and would also be aware oftheir relatively low cost.

Respondents were initially classified into nine categories according to age: lessthan 20, 20-21, 22-23, 24-25, 26-27, 28-29, 30-31, 32-33 and more than 34.These were then grouped into threes and cross-tabulations were obtained forquestions (5), (6), (7), (8) and (10). Significant differences were obtained forthe following questions: 5.05, 5.07, 5.12, 5.13, 6.08, 6.10, 6.11, 6.13, 7.04,8.06, 8.09. The middle age group (24-29) responded in a significantly differentmanner from the younger or older monks. The explanation may be that theolder and younger monks have not been confronted by the need to rethink theirattitudes to conventional roles.

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

16 David L. Gosling

Most of the percentages in Tables I—III are accurate to within 5% (i.e. ± 5%)and are seldom worse than± 10%. Question 5.11 (treat psychological illness),for example, was a favourite role for the respondents and only 2.7% did notreply. The corresponding figure in Table II is therefore 82 ± 2.7%. Fewerrespondents answered questions (7) and (8), with the result that percentages inTables IV and V are less accurate; few are worse than ± 12%.

People with AIDS

In August 1991 discussions were held with medical personnel at the BumrasNaradul Hospital in Nonthaburi, where people with AIDS from the BangkokMetropolitan area are accommodated, and with senior monks, about ways inwhich monks could be of pastoral assistance to AIDS sufferers and help raisepublic awareness of the problems associated with HIV infection (Gosling, inpress, b). Hospital director Dr Chachawan Hoontongkham expressed the viewthat monks could be of considerable pastoral support to the dying and that theirpresence in AIDS wards would help to reduce the fear and superstitionsurrounding the disease.

At the end of June 1991 the Population and Community DevelopmentAssociation of Thailand estimated the number of HlV-infected Thais at around300 000, but the total number of hospital beds was only 90 000 and could noteasily be increased. However, if Thailand's 250 000 monks, 100 000 novicesand 10 000 mae chii could be induced to offer even a proportion of the country's30 000 wats as hospice facilities for people with AIDS, then a major resourcewould become available.

It can be seen from the more recent questionnaire and interview responsesthat monks and mae chii believe that they have a counselling role in hospitals andthat they are willing to talk to people with AIDS and also to help raise publicawareness by talking to young people about the problems associated with thedisease. It was clear from conversations that they were apparently willing to dothis much more explicitly and non-judgementally than their counterparts inother religious traditions. There remains, however, a reluctance to come intophysical contact with people with AIDS, and there is a need for educationalprogrammes for monks and mae chii to explain more fully the aetiology of thedisease.

Various claims have been made for the effectiveness of insight contemplationor vipassanä as a means of delaying the onset of full-blown AIDS. The termneeds to be distinguished from samatha or concentration meditation, whichcould also have been used in the questionnaire, since both have traditionalmedical connotations. After discussion with monks and doctors it was decidedto use vipassanä (Aimawatana, 1993). Respondents were asked:

In your opinion does insight contemplation (vipassanä) improve mentalhealth so as to affect a person with AIDS in the following ways?

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

Thai monks and lay nuns in urban health care 17

(1) Delay the progression of the disease from being HIV-positive to full-blown AIDS ( ) Yes ( ) No

(2) Stop permanently the progression of the disease from being HIV-positive to full-blown AIDS ( ) Yes ( ) No

(3) Other (specify) ...

Seventy-eight per cent replied affirmatively to part (1) of the question, and53% to the second part. Comments on part (3) included the following:

Meditation (i.e. vipassana or insight contemplation) can create a strongmind, happiness and calmness and helps patients not to think abouttheir illness. (Monk, age 22, from Udon Thani.)

Meditation helps the patient to be calm even when HIV-positive.(Novice, age 19, from Sukhothai.)

It's better to protect than to cure. (Novice, age 20, from Roi Et.)

Meditation cannot cure AIDS but can give relief by allowing more timefor the patient to live. (Monk, age 29, from Loei.)

Meditation will help people with AIDS to be strong in order to fightthe disease. (Monk, age 32, from Nakhorn Ratchasima.)

When the mind is healthy, the body will be healthy as well. (Monk, age25, from Phang Nga.)

Meditation inspires the patient to live in this life and in the next.(Monk, age 31, from Phatalung.)

Meditation decreases lust. (Monk, age 30, from Surin.)

Meditation helps people with AIDS to realise that everyone must diesooner or later. (Monk, age 22, from Nan.)

Practising meditation will bring about acceptance of reality, whichmeans knowing what it is to be born, to be old, to be sick and to die.It will slow down AIDS because the mind and the body are related.(Monk, age 38, from Nakhorn Ratchasima.)

The Government should give more encouragement to monks toparticipate in helping people with AIDS. (Monk, age 40, fromPhetchaboon.)

Thus, although half the respondents claimed that vipassana or insight contem-plation could arrest the progression of AIDS permanently, it was not apparentthat they had any real justification for this view in terms of specific examplesrelating to AIDS or other life-threatening illnesses. However, their sense thatvipassana can help people to face up to their situation calmly, without fear orundue stress, and to act accordingly, is probably well-founded. Insight contem-plation can certainly delay the onset of full-blown AIDS and thereby prolong life.

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

18 David L. Gosling

Conclusions

For generations Thai rural monks have played a secular as well as a religiousrole in their communities and villagers expect them to do so. In the rural areasthe question is not whether to be socially responsive; rather it is a matter of howto maintain a traditional secular Sangha leadership role in the face of increasedgovernment services and a more educated rural populace. Villagers respectmonks who adhere to the Vinaya, but they do not respect those who ignoresecular community service responsibility unless they have an exceptional talentas meditation adepts (some women are also highly respected by both monks andlay people for this).

While the Mahachulalongkorn student monks may well have expectations andattitudes that are different from the wider monastic community, it should not beforgotten that the majority of them are drawn from the peasantry, especially inthe north-east. This is also true for Mahamakut University. Unlike the layuniversities such as Chulalongkorn and Thammasat where the student bodiesare drawn largely from the metropolis and provincial centre urban élites, theBuddhist university students come from rural farm backgrounds. In that sensethey are quite representative of the larger Sangha community because themajority of monks were born in rural areas. Even though many of the Buddhistuniversity graduates will eventually disrobe, start families and take up secularemployment, they are pioneers in terms of reforms in the fields of education,social and community service and definition of secular role play.

Phra Rajavaramuni (also known as Phra Prayudh and elevated to PhraDhammadilok in 1995), former deputy General Secretary of Mahachu-lalongkorn Buddhist University and a major influence on monks' education,comments on the contemporary role of the Sangha as follows:

The Middle Way begins with Right Understanding as its first factor.To be sure, this Right Understanding involves in the first place theintellectual responsibility on the part of the Thai monkhood to defineits identity and to identify its specific function that will distinguish itselffrom other institutions of the society. This knowledge is a prerequisitefor the monks' survival and for their meaningful existence. Without it,they will not know even where to start and where to stand. ThaiBuddhism is now just on the way to rinding its Middle Way (Rajavara-muni, 1979).

This study explored ways in which the monks' quest for self-identity hasexpressed itself in community development, at first in rural areas where theSangha still plays a major role in education and social life, and how the variousindividual roles arising from such activities need to be evaluated from aBuddhist perspective in terms of their appropriateness or otherwise. The notionof appropriate behaviour has also been considered from the point of view of maechit who, although less inhibited in terms of their need to observe the fullPätimokkha rules, are still accorded much less respect than the monks.

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

Thai monks and lay nuns in urban health care 19

On the one hand, the findings are limited by the fact that the studyconsidered only the views of young scholar monks at one of the two Buddhistuniversities and neglected the other. On the other hand, as argued already,the Mahachulalongkorn monks are drawn from all parts of Thailand and arein many respects the 'pace setters' of tomorrow's Sangha. Moreover theearlier investigation, conducted in 1983, included monks at both universities,and there is considerable consistency between the data obtained then and inthe present study.

The statistical data on the paramedical roles of mae chii have been biasedby the fact that much of it is based on the opinions of monks. The paper hasexplained that it was not feasible to give the same questionnaire to mae chiiand why, had this been done rigorously from the point of view of sociologicalmethodology, the conclusions would probably have been flawed. However,detailed interviews were conducted with 35 mae chii, and although the mainfocus of these conversations was not the same as at Mahachulalongkorn, theiropinions were taken into account in evaluating the data.

There is considerable potential for both monks and mae chii to fulfilparamedical roles in Thai society generally and more specifically in hospitals.Although some roles may continue to be problematic from the point of viewof appropriate and inappropriate behaviour, there is a general consensus thatmonks and mae chii, simply by their presence among the very sick, can lift thegloom which is associated with what some Thais still quite unjustifiably de-scribe as roong khaa sad (slaughter houses, i.e. hospitals). However, they cando a great deal in terms of using pastoral skills, putting patients in touch withtheir families and generally providing a warm and compassionate network ofsupport. This is especially true of mae chii, who need feel less inhibited thanmonks in exploring areas of the personal lives of patients which monks eitherdo not understand or are reluctant to probe.

More detailed analysis suggests that monks with mae chii in their familieshave a slightly more 'domestic' view of their roles and that monks in the24-29 age range are more willing to rethink their roles than younger or olderones—probably for different reasons. Monks in this age group are more will-ing to envisage paramedical roles for themselves and for mae chii (includingespecially psychological counselling) and do not see the need for exorcismsand spirit-related activities. The mae chii interviewed have similar thoughsomewhat less 'starry-eyed' perceptions of their roles.

Where AIDS is concerned5 there is a readiness on the part of monks tobecome involved at the level of counselling and preventative advice (96%would be willing to explain to a young person how to avoid infection),coupled with unease at the prospect of physical contact with a person withAIDS (only 57% would permit this to happen). Clearly there is a need foreducation about the modes of transmission of the disease. That 66% would inprinciple be willing to see part of a wat used as an AIDS hospice is highlysignificant in view of the general national shortage of hospital beds. Insightcontemplation (vipassana) could also play an important role in calming the

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

20 David L. Gosling

fears of the terminally ill and delaying the onset of the full-blown disease,although it is unlikely to arrest it permanently.

The suggestion that wats could be used as hospices for the terminally ill isnot as opportunistically naïve as it may appear at first sight. From time totime there are attempts to persuade monks to support projects and pro-grammes in order to encourage public acceptance. But the role of wats asplaces where people may go to die in a peaceful and dignified manner hasalways been acknowledged and there is no reason within Buddhist teachingto exclude people with AIDS—on the contrary. Buddhism is intrinsicallyinclusive. That the Thai Government may encourage wats to serve as hos-pices for people with AIDS also reflects the twin facts that Thai Buddhism isas civic as it is personal and that the Thais themselves are extremely prag-matic.

It is interesting that the monks appear to have an overall view of what areligious practitioner can contribute to community development and healthcare that applies similarly to both monks and mae chii. There are someobvious exceptions and few would deny, for example, that a mae chii is amore suitable counsellor for a woman than a monk. The general acceptanceby the monks of the potential of mae chii roles in areas of life that theythemselves consider to be important is significant, but needs to be set againstthe undeniable fact that only 12% of them believe that women should befully ordained as bhikkhunïl

Monks and mae chii together represent an enormous potential for socialimprovement in terms of the community development roles which some ofthem are already fulfilling and paramedical roles in rural and urban healthcare and in hospitals. They need education to develop their pastoral skillswithin the context of appropriate and inappropriate behaviour, to improvetheir knowledge of the aetiology of various diseases and to explore new possi-bilities for health care such as meditative techniques and the use of wat andmae chii institute facilities as hospices.

Acknowledgements

The research was made possible by a Visiting Fellowship grant from theChaiyong Limthongkul Foundation and the author would like to thank DrChai-anan Samudavanij, the Foundation and the Institute of Security andInternational Studies at Chulalongkom University for their generosity and forthe use of their facilities.

The author is grateful to the following for their assistance: Dr ChatsumarnKabilsingh of the Faculty of Liberal Arts at Thammasat University, DrSuchit Bunbongkarn and Dr Kusuma Snitwongse of the Faculty of PoliticalScience at Chulalongkom University, Phra Maha Tuan Sirid Hammo (Pim-Aksorn) of Mahachulalongkorn University, Khun Jaruwan 'Top' Dejprasert,and Dr Charles Cole.

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014

Thai monks and lay nuns in urban health care 21

ReferencesAIMAWATANA, T. 1993. The use of vipassana meditation as a strategy for developing a qualitative

counselling service. International Conference on Thai Studies. London: School of Oriental andAfrican Studies.

GOSLING, DL. 1980a. New directions in Thai Buddhism. Modern Asian Studies, 14, 433-39.GOSLING, DL. 1980b. New directions in Thai Buddhism. Modern Asian Studies, 14, 421.GOSLING, DL. 1983. Redefining the Sangha's role in Northern Thailand: an investigation of

monastic careers at five Chiang Mai wats. J. Siam. Soc. 71, 100.GOSLING, DL. 1985 Thailand's bare-headed doctors. Modern Asian Studies, 19, 761-96.GOSLING, DL. 1986a. Thailand's bare-headed doctors: Thai monks in rural health care. J. Siam.

Soc. 74, 96.GOSLING, DL. 1986b. Thailand's bare-headed doctors: Thai monks in rural health care. J. Siam.

Soc. 74, 89.GOSLING, DL. in press, a. Urban Thai Buddhist attitudes to development (paper presented to the

Thai Studies International Conference, School of Oriental and African Studies 7.7.93). J.Siam. Soc.

GOSLING, DL. in press, b. Facing death with dignity: Buddhism's Middle Way. J. Siam. Soc.IRVINE, W. 1982. The Thai-Yuan 'Madman' and the Modernising Developing Thai Nation. London:

School of Oriental and African Studies.KABILSINGH, C. 1991. Thai Women in Buddhism. Parallax Press.RAJAVARAMUNI, PHRA. 1979. Thai Buddhism: a trend. Visakha Puja. Buddhist Association of

Thailand.SUKSAMRAN, S. 1976. Political Buddhism in Southeast Asia, St Martin's Press.1979. The Rules of Foundation of the Nun Institute of Thailand. Bangkok: Suntisiri Press.THERA THE VEN, N. (trans.) 1966. The Patimokkha. Bangkok: Maha Makut Academy, Social

Science Association Press of Thailand.

Dow

nloa

ded

by [

Um

eå U

nive

rsity

Lib

rary

] at

09:

56 1

8 N

ovem

ber

2014