Sex and sanuk

With Egypt in turmoil, the Arab world abuzz with expectation, oil traders on edge and a pall of uncertainty hanging over global markets, it may seem an odd moment to talk about relaxation techniques. But a crisis hour is precisely when one taps into stress-busters. And my vote goes to the Thai message of sanuk which loosely translates to playfulness or an inherent sense of fun.

In Bangkok recently for a symposium on the global crisis caused by a shortage of health workers, I discovered sanuk’s many facets. Sanuk is not just about having a good laugh. In the Thai scheme of things, everything has to have a touch of sanuk. “We view the smile as an appropriate reaction to every possible situation — happiness as well as fear, tension, embarrassment, nervousness etc. You can’t let your sadness show in public. It is not polite”, the girl at the travel desk of my hotel explained. Sanuk, from what I saw, is potentially the ultimate advocacy tool — whether you are in the hospitality industry, or any other area engaged in bringing change. It tosses humour at life’s grimmest moments and trivialises taboos.
For a taste of sanuk, I dropped by Cabbages & Condoms, the restaurant that’s the brainchild of Mechai Viravaidya, a former Thai politician and one of the main architects of Thailand’s successful family planning campaign and its 1990s anti-AIDS programme. The restaurant is a brash, quirky and trademark Mechai-style attempt to make people laugh about sex and force the topic of sexuality out in the open. Contrary to popular perceptions abroad, middle-class Thai society is still traditional with socially conservative mores. It was even more so in the 1970s when Mr Mechai, a former Thai minister of health, decided to champion the cause of birth control. Through Population and Community Development Association (PDA), a non-profit he founded, Mr Mechai took up the challenge of making condoms as cheap and accessible as cabbages. The restaurant, mentioned in every tourist guidebook, offers free condoms instead of after-dinner mints. It rose to prominence when the AIDS epidemic exploded in Thailand in the 1990s. Rampant sex trade and drug abuse were blamed for the situation. But at this critical juncture, sanuk came in handy. With public health advocates like Mr Mechai, the Thai government pushed through an aggressive national campaign to promote the use of condoms. More and more brothels and sex workers started using them. The results are well-known. Thailand, at one time feared to be going the way of many countries in sub-Saharan Africa ravaged by the AIDS epidemic, turned the corner. What worked were its strong public health system and pragmatic policies along with a liberal dollop of sanuk as evidenced by many Mr Mechai promoted initiatives like condom-blowing competitions and handing out condom key rings at official dinners and functions. Thanks in part to such public messages, the HIV infection rate in Thailand came down sharply.
Today, Thailand remains an inspirational success story in public health. But the heady anti-AIDS activism of past decades which brought the condom centrestage in public discourse has given way to complacency in some quarters. Teenagers are particularly at risk from unprotected sex.
At Cabbages & Condoms, however, sanuk is alive and at its scandalous best. Last week, at the entrance to the open-air restaurant decorated with fairy lights and lampshades made up of condoms, I saw a group of Italian tourists cracking up at the sight of a giant Christmas tree made up of coloured condoms. Inside the bar, there was a reprint of Mona Lisa with two condoms stuck at the bottom. The retail store inside sells condom memorabilia like T-shirts with images of condoms and the message: “Weapons of Mass Protection”.
Sanuk is even useful in giving an everyday touch to death. A field trip during the Prince Mahidol Award Conference 2011/Second Global Forum on Human Resources for Health took me to Wat Pra Baht Nam Phu, a Buddhist temple that has acted as a hospice for nearly 20 years to many people living with HIV and AIDS. Located in Lopburi province, about 120 km from Bangkok, the temple-hospice led by 53-year-old monk Phra Alongkot Dikkapanyo started at a time when stigma against the HIV-infected was very high in Thailand. The hospice, home to about 130 patients, has links with the provincial health administration which provides antiretroviral drugs to those inmates who need them.
A taste of sanuk in such a place? Surprisingly, yes. We were welcomed by hospice inmates and others dressed up as showgirls while slides of men, women and children in the terminal stages of AIDS flashed in the background. I blinked when a staffer told us that recreational activities included a relay race carrying empty coffins. And that was not all — there were bone resin sculptures — inmates sculpted artefacts out of bones of others who had died. Many who were at the terminal stages wish to have a part of them remain in the temple, a doctor attached to the hospice informed. That had probably led to the setting up of the AIDS Human Body Part Museum inside. Jars containing the remains of a heart, a liver, and even a penis lay on tables, as exhibits.
Many in our group had questions after the visit. Some were outraged. Was not death a private matter? Did the patients receive appropriate medical treatment or was the hospice running mostly on compassion and volunteerism to the detriment of science? The doctors we met assured us that the patients were regularly checked at the provincial hospital. We did not get answers to all the questions, but what lingered was the normality attached to death. “Death is normal. We discuss it at home. I tell my mother that my only concern is I should not look ugly when I die”, a Thai woman working with an international foundation told me back at the conference. Her eyes glinted playfully. Was she serious? I will never know. But here was sanuk at work.
Can it work in India? We have as many policies as problems. Many of them do not have the desired impact often due to cultural mores about what we can talk about. Will sanuk help us be less squeamish about death, disease and unsafe sex — subjects that remain taboo despite so many attempts? It may be worth a try.

Patralekha Chatterjee writes on development issues in India and emerging economies