TRANSCRIPT: Mechai Viravaidya

Fred de Sam Lazaro, TPT: One of the ironies that you reflect on is that you’re so successful that you’re no longer viewed as a needy case. Is that in fact the case?

Mechai: Well we move from one job to another. You start doing one task. And if that has been fairly well accomplished then you move onto other needs.

FdSL: At what point did it occur to you when you launched this so many years ago that family planning involved a lot more than the goal of getting people to have fewer kids by giving them contraception of some kind?

FdSL: Tell us about that realization from day one in your case that based on what — on experiences, on observations since family planning first came into being ‘cause that clearly wasn’t how it all began.

Mechai: We wanted to do income generating activities or development activities and family planning. But the people who had the money and who were generous enough to give us the money, the International Planned Parenthood Federation only had money for family planning. So we thought well, that was a pretty good start — better than no start. So we started having a family planning program, public information, public education; take it to the grass roots so it became their program. Then we found luckily some money to add to this work in some income generating activities. But in the early days it was linked very much to family planning. We asked the people of the village, the women of the village who were using contraceptives as to how we should distribute whatever resources we had. Who should have the first opportunity to take a crack at the chicken raising program or the pig raising program or a vegetable program? And they gave us the ideas of what should be done and how it should be done.

FdSL: At what point did the rural population come to the realization that children — I mean the thing that we hear in certain parts of the world, in the sub-continent for example is that for a lot of poor people more children means more hands, more income. It’s pooled income. It’s pooled farm labor. At what point does the realization come to them or at what threshold does it come and they say fewer children means a better life?

Mechai: Most important of all, whatever action we’re talking about or whatever information we’re talking about must be discussed at the grass roots level. You can’t do it in the urban areas, in the broadcast, on radio, television, newspapers and expect these people to participate and understand it. So it’s discussed at the low level. We start asking how many acres of land did your grandparents have? And how many do you have? Why didn’t you get 100? Why did you get 10? Well, because there were 10 children to split up the 100. And we say, "How many children do you have now?" And they may say 5. And we say, "How many acres per child will your children get?" And they say, "Only two." Wow. And many come up and say, "Gee, I wish my grandparents had fewer." And so on and they realize that. So that’s a start. The other point is that it is very well to send people into town for labor as long as there’s a market for employment. Once it’s full it becomes a burden rather than an asset. You can’t send them for employment; there’s no employment. On the farm at the same time you’ve got lots of land you need more labor. When you have a little land you don’t need all that labor. In fact you have to sell your labor to other people because of too many children in the family the pieces of land became so small. The realized this pretty soon. And then they know that education, while free, there are the costs: transportation costs, food, books. And apparently, Thailand values education so a lot of people said, "I would like my children to have better education so I can’t afford to have many children." So it’s like land. So also we had a very strong program with the Buddhist monks who are the most influential in the villages and at the same time with teachers, rural schoolteachers. We trained almost 100%, 320,000 rural schoolteachers about population family planning. And then we added in the new alphabet where the B for birth, C for condom, I for IUD. We had a children’s song that would be equivalent to the west like Jingle Bells and changed all the words around. And the song had about the misery of having too many children and not enough to eat, the heartache of parents, and then the realization that we don’t have to worry we now have contraceptives. So the song mentions every contraceptive method. So every school child of age 8, 9, 10 knew of every contraceptive method. And so that’s how the whole system began.

FdSL: How key has that universal education been? Thailand’s literacy rate is almost universal. How important a component is that in accounting for the success?

Mechai: I would say it helped a lot for the future generation but for the current generation of adults then it was a matter of first having child survival. If children keep on dying no one can practice family planning. And a lot of people have to have 8 children to have 3 survive. So maternal and child mortality was very important. So maternal and child health is a very important partner of any family planning program. If your children die who’s going to practice family planning? So the children have to survive then you can limit. And so those are the very important elements. And then the ones who were adults at the time apart from that then you just say these contraceptives are easy. They’re safe. You can choose whatever method you wish. You can have the condom, the pill or you can have the IUD or the injectable. Or when you’ve had enough children then you go on to sterilization. Choice, totally voluntary, grass roots operated. And those people understood. And the next generation were the children who heard about it in school. They also saw what was happening. So the two went side by side, one for the future generation and one for the current generation.

FdSL: And this dispensing of all this contraception and information was happening in a public health kind of context?

Mechai: No, it was happening in a local village shop where people go where the shopkeeper knows the customers. So they sell sugar, milk, bread, fish sauce, toothpaste, cigarettes, matches. Add to that were pills and condoms. So it was sold in a very normal way, not in a clinical way. We wanted people to feel that family planning was like soap and toothpaste and powder, an ordinary health product that you didn’t have to go a clinic for. Because that means it’s very difficult and very sophisticated and therefore quite dangerous. We made it simple.

FdSL: But in order to provide better public health overall so that these children survived, the infant mortality improved was there a concurrent effort?

Mechai: We were a key partner with the Ministry of Health. They did — we did the public education. And they did the actual immunization of children, for the pregnant women to go for prenatal care, postnatal care, breast-feeding. And we did the contraceptives. But we told about it, the service of these was provided by the government. You had to travel quite a long way for it but they did it.

FdSL: Talk a little bit about the advent of contraception as an item akin to soap and toothpaste as opposed to something that you discussed in hushed tones with your doctor. How did you manage to go about that?

Mechai: The first key — I think the two key issues were the pills and the condom. The pills, in most countries of the world to this day, are prescribed by doctors. Now when we started in Thailand in the early 70’s, we had one doctor per 110,000 people outside municipal areas. So it was a virtual impossibility. The program introduced by the Ministry of Public Health was to train nurses. There was a checklist. And if you have these conditions then you shouldn’t take the pill. But if you don’t have these conditions, it’s safe. This is how you do it. It succeeded very well. It expanded the horizon. But that only covered the town. So we went one step further in the country with auxiliary midwives to do the same thing. And they were very successful also because it was woman to woman. However, that only covered 20% of the villages and that was already the end of the line of health service people. So we came in for the next 80%. And we told the government, explained and they approved that this would extend the service out to the people so they wouldn’t have to walk or travel for 60, 70 kilometers or miles to get contraceptives. They could get them right there in the village. So that’s where we came in. So we became a sort of link in the chain, very close cooperation. When they needed something more sophisticated than pills and condoms they came to the government clinic. They paid a small amount of money for the pills and condoms. But the pill was made available in a very simple way, as you would buy your toothpaste. In fact it’s put beside the toothpaste and soap. You don’t have to clinic for it. Soap’s not dangerous. Toothpaste isn’t dangerous. So the pills and the condoms of course are not dangerous.

FdSL: Although there is a difference medically between pills and condoms obviously.

Mechai: The perception, the perception - with pills, the perception of pills as against toothpaste and so on, that if you are of a particular health standard it’s safe. It doesn’t kill you. It’s not dangerous. And that was perception. If you had some side effects it was explained. And if you persisted with the side effects you could change. Or go to see the midwife further in town, change to another kind of pill or to another method altogether. So everything was there and you had a choice. And the condoms were particular in terms of desensitization. People were embarrassed. They didn’t talk about it. But the condom, rather than the pill, generated the most excitement, controversy, or reaction. And wherever we did that it brought out that issue. So we said, "Look one must not be embarrassed by the condom, it’s just from a rubber tree like a tennis ball. If you’re embarrassed by a condom you must be more embarrassed by a tennis ball. There’s more rubber in it." We said, "You could use it as a balloon, as a tourniquet for snake bites and deep cuts. You can use the lubrication for after-shave lotion. And use the ring of the condom as a hair band. What a wonderful product, why be embarrassed by it? Knives kill. And you’re not embarrassed by that. Condoms save lives and you’re embarrassed. Something’s wrong. So let’s get used to condoms". And we gave them out all over. And we said, "Look the condom is clean if your mind is not dirty so please take one." And a lot of people laughed. And then next was the condom blowing championship. This really brought people a great sense of relaxation. They laughed. There’d be an audience of 200. We’d ask everyone to get a condom. They would touch it, fold it, hold it, blow it up. And then we would have a competition for the one with the biggest blown-up condom without bursting. So they saw the strength of it, the cleanliness. Once they put the condom to their lips things had changed in their minds. So this is what we did to desensitize not just the issue of condom but of contraceptives as a whole. So that was a major thing. And of course they don’t teach this in universities. We picked it up by observing the public.

FdSL: And I know people thought you were crazy when you began this?

Mechai: Yes, they thought I was a little odd. But I said that you can’t allow a person to be embarrassed by contraceptives. A reporter embarrassed by the microphone gets no news. A writer embarrassed by the pen gets no news. So we said hey, they’ve got to be friendly in terms of atmosphere and relaxed about the contraceptives. And of course now nobody thinks I’m mad.

FdSL: There’s something about sexuality, which has made all of this difficult in many, many countries if not all of them to talk about. Activity related to sexuality whether it’s in the AIDS context even or in just family planning it’s something that brings something out in the social milieu most places of the world. What do you think accounted for Thailand’s success in desensitizing?

Mechai: Possibly it was our understanding that sex education is a very explosive word — so many connotations. So when we understood that we decided to take this particular road where we said we’re talking about family planning. We’re talking about the numbers of children. We’re not talking about sex. Sex is a very important matter. Only parents can decide. We will not step over the boundary. If you want to teach your children about sex education, we’ll be happy to help you. But it’s your responsibility. We’re not going to teach your children anything about sex. And throughout the entire program over 60 million people in Thailand, not once were we attacked by parents because we took that road. But imagine if we said oh, we’re going to tell your children about sex education. You can imagine all the connotations.

FdSL: But in some minds they would say well, what about teaching children about condoms?

Mechai: That’s family planning — very sacred.

FdSL: Not sex?

Mechai: Not sex, just about knowing how to prevent birth. It’s not about sex. That was our line. Of course it’s related to sex. But we know how it’s so misunderstood. We wanted to make sure ours was not misunderstood. And we were correct.

FdSL: So you didn’t get parents saying what if the children ask embarrassing questions?

Mechai: No, they trusted us because we first went to the children in all the villages. Firstly, we trained their schoolteachers. And then we went to the school we played football with the kids. And the kids go home and we’d have relay races, fun. And the kids went home to say there’s a group of people, uncles who played football with us. They’re fantastic, nice people. So the first news to the parents is good news. Then we talk to the parents later on. We don’t walk in and say, "How many kids do you have? Do you practice contraception?" We say hello. How are things? How’s the rain? How are the buffaloes and the chickens? And eventually we get around to you have nice kids. We don’t ask how many. We say nice kids. They’ll say how many they have. And then they say, "Wow, my mother has four. She can’t keep up. You’re terrific. You can have six. You’re much smarter than my wife." Then they eventually say, "Well, I’m not that smart. If I had means I wouldn’t have the six." And so on. So it was never an attack on them. They never felt insecure. It was just friendship.

Mechai: And then we said, "But look we have a method to space children like you space your coconut trees or your rice plants or your fruit trees. You can decide to have one and how many years in between." And they say, "Really?" And then we explain there are some pills. And so it became as a friend not looking down at them. Oh, my gosh, you’re terrible. You’re having too many kids. We’re saying if you wish here’s a way. So you give them a choice. Once people have taken the choice to space. It seems logical that later on they’ll take the decision to limit. Before we began our work I guess it’s like any product you do a market survey. We surveyed who were the most influential people in rural settings. Number one was the religious leader regardless whether it was Buddhist or Muslim, religious leader or religious persons. And number two were teachers. So the first thing we did was to study the Buddhist scriptures. And we got a team of specialists on to it. And we found so many instances in the so-called Buddhist bible about family planning. Buddha was married so he had some real knowledge of sex rather than theoretical. He was a father of one child. And he was a teacher. And we felt that if he wanted to have lots of kids he would have had lots of kids because he’s a teacher of all good things. But a very clear quotation that we found was — in English translated as; "Births cause suffering. To prevent birth is also to prevent suffering." So therefore it’s not a sin. So Buddha, Buddhism is not against family planning. So this message was sent throughout the country to every monk, who then because a lot of them didn’t know what it was. So now they knew. A quote from the Buddhist scriptures that Buddhism is not against family planning, number one. But one of the interesting were the villagers saying, "Can’t you ask the monks to help us more in this because we have a new house or a new addition to the building, a motorcycle, a car? We get the monks to bless it with holy water. Why don’t you ask the monks to bless contraceptives with holy water so it will be good for the sanctity of the family? Now that was new to me. So I came to Bangkok, this is from rural Thailand. I came to Bangkok. Went to one of the chief abbots of one of the temples and said, "Sir, this is what the people said to me." He said, "I’ll do it for you. So a date was arranged. And this chief abbot came out to an organization, sprinkled holy water on pills, condoms, t-shirts in the whole warehouse. And this picture was sent out throughout the country. And so these were the things that helped us. Buddhism didn’t promote family planning. It didn’t obstruct family planning. And then the teachers — that’s why because of their strong influence we had a training program for 5 years. Over a quarter of a million rural schoolteachers about what family planning was. Why it was necessary and then went on to the kids. They were taught the new contraceptive, the song, the contraceptive alphabet and a snakes and ladders game for children. You say mother takes a pill every night. Move ahead 3. Mother forgets to take the pill. Uncle buys condom. Go ahead 6. Uncle gets tired of new condom. Come back 9. The children love the snakes and ladder game. They want to win — right until number 100 — win. So again we used entertainment and education and fun. If I could wake up in the morning and say, "I want to go to school as much as I want to go to the movie theater." That’s when education really becomes successful.

FdSL: Talk a little bit about the Islamic minority, the Islamic religious leadership. Was it a completely different ball of wax?

Mechai: You use a different style with the same respect. We have many successes in the Muslim villages. Of course we go and pay our respects to the imam. But very important, imam have wives. So we walked to the imam’s wives. And they became a key agent of change to the women. The imam’s wives to the women. And then she would then pick a midwife for us, not so much a shopkeeper but often that midwife later became a shopkeeper because we helped her. So she became a midwife. And because with declining births how could she make more income? I knew this. So we said, "Hey look, you’re going to be delivering fewer babies in the program. You’re going to be making more money through your shop." So we took a look at that. And they were delighted. All of a sudden the midwife — many of them were fairly elderly women, had daughters so that we helped them. We loaned them some money to establish a small grocery store. And they were terrific. And again, there was nothing compulsory about it. And it’s not a sin. You can use pills, no problem.

FdSL: So you didn’t have any scriptural based -?

Mechai: Oh, basically this had already been done by the IPPF, Islam and Family Planning. The lord Allah says that if you have children and you can’t take care of them, it’s a sin. So the said that if you want to have children you’ve got to be able to take care of them. But in the meantime, we’ll help you space it so that you can really take care and praise the lord. So of course all religions were affected by us. We worked with them. And even the Catholics never came up against us because they knew what we were trying to do. We were trying to help the people to have a choice in life. Not once were we opposed by the Catholic Church in Thailand. And the Cardinal, the Catholic Cardinal in Thailand shares the same name, first name as me. And my name since 1973 also means a condom. So a lot of his friends refer to him as Cardinal Condom. And in the Philippines you have cardinal sin. We were never attacked by the Catholic Church because what we did was truthful. It was normal. It was trying to help people have a choice. And none of it was top down or any type of compulsion. It was totally voluntary.

FdSL: How replicable is the Thailand experience elsewhere in the world? None of it seems to be.

Mechai: If you want to work hard of course it’s replicable. It’s just like food - you cook it slightly differently in different cultures and different tastes. Our part of the world you put some more chilies and some more garlic in it and use the same meat, the same vegetables. When you cook it over in France you put some wine and a few other things. But it’s the same ingredients — hard work, let the people be involved, don’t give up, regard it as important, and combine whatever you can in together. We have a training center here. And over the last 18 years we’ve trained about 47 countries to say this is how we do it. Now, don’t do it the way we do it but pick the basic ingredients and adjust it back to your own country. But most importantly, you can do the same as us — work hard!

FdSL: Why hasn’t it taken off? Is it as simple as not working hard?

Mechai: I think it’s just we have a lot of governments who are more interested in votes. If they think something is wrong or something may take some votes away from them they will not wish to do it. Of course I’m not a politician. I regard myself; I’ve always regarded myself as totally dispensable. And a lot of these people regard themselves as indispensable. And you just have to keep on pushing at it and it will work. You have to keep pushing. Again, a lot of people aren’t interested in it because it doesn’t bring you fame. It’s a dull area of work. It’s preventive health rather than curative. It’s not very sexy to be involved in it. People want to be bankers and so on — this is before the crash. But there are some people around. And you give them resources — often they don’t have the resources to do it. A lot of people with ideas are unlucky enough to have a very elderly boss who belongs to the last generation from the last century. So I was lucky. I came along and I was young and I was able to get some resources to get started. I had better luck.

FdSL: So you think it certainly can be replicated in other -?

Mechai: Yes. And don’t go looking for people in the medical field. Look for those who perhaps are children of doctors because you have to come with a whole new perspective on the whole thing. I’m totally untrained in family planning. But common sense taught me how to approach it. Rather than take the traditional way that’s taught in western universities — doctors prescribing the pill. I’m sure had I been trained I would believe in it that only doctors prescribe the pill. I came from the other side that the pill is to be taken. And we have studies from the Royal College of Family Practitioners back from 1974 that says the pill is safe as long as these conditions are satisfied. So get somebody from outside the health field to be involved in doing it. If you get it from the health field it’s more of the same.

FdSL: I have a couple of final questions. First of all talk a little bit about this enterprise that we’re sitting in right now.

Mechai: Well, we are in the Cabbages and Condoms Restaurant. It’s one of our 16 businesses. As a non-governmental organization, a charitable organization we depend on other people’s resources and generosity to give us the funds to do our programs. But this will not last forever. Countries that give you money change through policy, economics, sociopolitical. When we do better we climb up the income ladder. And when we become sort of a middle income country we no longer qualify for gifts and grants. And then begging has never been a great event otherwise Coca-Cola and General Motors would have done it. So we realized that we have to generate our own resources. What people give us comes from their surplus or profits. We have to generate our own profits and not be so dependent on donors. And so for 25 years now we’ve had business registered as a separate legal entity, paying tax, and the profits are given to us as others give to us to run our programs. Almost 70% of our financial needs come from these companies. And we call these companies business for social progress. The reason for establishing this business is to generate profits for social progress not to buy yourself a Mercedes Benz. And we want to expand. We’re taking our Cabbages and Condoms restaurant worldwide. If McDonalds can do it, why can’t we? And our food tastes even better. So we’re taking a look at whatever else we can. We have hotels. We have factories. We have tour groups. We’re going to be a lot more in food. But in line with our strength, not to dream up something and then go belly up. Conservative but keep on expanding. And the future of funds and the present is in the hands of business. What government has is pocket change. It’s business. And so we are engaged in businesses. We also lean with businesses to help fund activities. So we have many types. And we know that the more money we can get from businesses the more work we can do for social change.

FdSL: Do you at any point get too big and therefore become a business threat and a competitive threat to businesses?

Mechai: Well, luckily we’re not that smart. Businesses are big and they understand what they’re doing. They in fact appreciate what we’re doing. We think carefully what do. We certainly do not want to put anyone out of a job. But we’ll compete with them like restaurants. No one is being negative about our restaurant. If we’re not good enough in the commercial sector you won’t last. So we have to be very clear that we compete in the commercial sector. We have to be good, efficient. People come here not because we have good hearts. They come here because our food is the best in Thailand. So they come here. It’s got to be that way. Otherwise only a few will come. And that wouldn’t be a viable economic unit. So nobody is being angry with us at all because they know what we do with our resources. And we’re not big enough to threaten anyone.

FdSL: I have a follow up on that. You’ve got business not threatened by you. How did you manage to work around the bureaucratic hurdles and the government hurdles?

Mechai: Well, there are hurdles everywhere. When you say you want to do something you need government permission. A lot of people feel like giving up. So we decided our ambitions, our desires, restaurants, and others and so we said well, in development must be easier to ask for forgiveness than to ask for permission. So we often just went ahead and did something. And then I’d apologize for it and tell them later. For instance, we trained over a quarter of a million rural schoolteachers without asking permission of the Ministry of Education. For 5 years they didn’t even know about it. And when they found out about it they were rather pleased. They said, "Oh, we knew what you were doing. We just wanted to let you go." So it gave them some positive reaction when it’s discussed. Or some elderly women or some writers would criticize me in the early days. I would go to them and say, "Look I’m so sorry that what I did was not favorable in your understanding. I’m just a young man. Please forgive me. Can you tell me what you think I should do to make it better?" And I would go back and do exactly the same thing I was doing before. I never criticized the issue. They wanted to be consulted. They regarded themselves as important people in society. You need to come and consult with me. So I went and said hello and consulted - no more problems.

FdSL: Final question. The reason we’re here is to look at what has worked by way of programs to control population growth. Do you despair, as a lot of people do, at the global situation, the 6 billion people prospect?

Mechai: I don’t despair because if I despair then I should die soon after that. But I am disappointed. And I’m surprised. And I would definitely like to see a much more active program. And if there’s anything I can do to help, I’ll be happy. But each country decides for itself. If international organizations with resources would like to use us to help, in a very respectful way to help things to get going in other countries, I’d be more than delighted to do it. For instance, you take another country, even an African country. And you say we have some money. And if you do these things we’re going to put money into your loan fund. That is yours. For instance, every child, every girl in primary school, every girl in secondary school — bonus points. Every child that is inoculated against this or that and all the positive things that you want every tree you plant we put money into the fund. It can be done. You start out by giving trust. You don’t change people first. You win them over. And then together they will decide whether your counsel is wise or not. If it’s wise they will follow. But it starts out with credibility before changing. And we’d be happy to help if people came along and asked us. And of course, we don’t have the money to help other countries. We’re just helping ourselves. But we’d be happy to help.

FdSL: Well, they all know who you are. Why aren’t they coming to you?

Mechai: They come for training. But that money has to be supplied by somebody else. But if they’re serious, sit down and take a good look and see what can be done. It’s not difficult. It’s not difficult.

FdSL: There just isn’t the will to do it?

Mechai: Basically, for instance when our people travel they have to sign documents your occupation? We put Family Planning. Others put Public Health because they’re a little bit embarrassed about their work in family planning. We’re proud of it rather than embarrassed. I go to hotels and they say fill in all this — your father’s name, mother’s name, all this. I said, "Why did you ask me do I practice family planning?" They’re shocked. But again you have to keep on pushing. This is a value in the world that is positive. I was asked one day back in 1975 when the North Vietnamese came to Thailand for the first time. I busted in very sweetly and gave them all condoms and pills. They were delighted. They thought it was the government. The government had no idea who it was. It was me. But the North Vietnamese couldn’t imagine it was not from the government. And the next day it was headlines in all the newspapers. And half were very positive. The other half were a bit dicey. And one newspaper, an English language, said to me, "Don’t you think you went too far and too high a place for family planning and giving out condoms?" I said, "Family planning is the highest place. There’s nothing higher." You have to live what you do. I think that’s a very important element.

FdSL: Do you fear the world is going to hell in a hand basket at this rate?

Mechai: Well, it’s tough. We’ve been able to get to the moon, go to Mars, and do all sorts of things and some very basic issues that we haven’t resolved. And that is sad.

FdSL: Is there anything else that you’d like to add that we haven’t touched on?

Mechai: Thailand has a lot of terrible things about it. My country is the only place I’ve got. But we also have probably one of the greatest assets in the world, the 8^th wonder of the world. It’s the willingness to accept differences in people, different religions, different colors, different everything. We say that is part of nature. We are a fruit salad. And it’s a great gift. And to me this will outlive any economic problems that may occur. And this is something that Thailand has. And it’s in the hearts of most Thais. And we are a fruit salad. And it tastes terrific.