By Letchimi Devi (23 Sept 2021)
A month ago, I experienced terrible lower abdominal pain, was feeling nausea and vomiting. Seeking treatment at public hospital was not an option as the government hospitals were overwhelmed with Covid patients. As it was late evening and due to Covid SOP, private clinics nearby my house, closed early. Found one anyway. The doctor asked me few questions including to describe the pain. The consultation was within 10 minutes. He gave me some medicine. It cost me about MYR70. But I was still having acute pain. I was still vomiting, unable to consume anything. The same night went to a private hospital. I paid deposit MYR150 and then the health worker asked me several questions. They took some tests. They gave me some jabs. When the pain recedes, they asked if I want to be admitted for observations and more test. I was worried about cost and refused. In total I paid MYR648.30. The next day, I was still vomiting. Decided to go back to the clinic. Only then I realized when I met the doctor earlier, I forgot to tell him about the vomiting symptom. The doctor gives me a jab and it costs me about MYR50. Till today, I don’t know what triggered the problem, was it the Covid vaccine I took a day before or my poor food habits?
Being a private person, sharing my health condition is unthinkable. But the intention here is to explain
- the challenges in articulating the medical conditions to health workers
- the pain factors
- the financial aspect
that many are facing silently especially the migrant workers from countries that does not have Malay or English as their native language. Malaysia has million of migrant workers in mostly hazardous industries such as construction, manufacturing, and plantation.
How do I explain?
For example, while I was in pain, the health workers asked me ‘where is the pain’, ‘do you feel pain here, there while pressing my stomach’ and I was clueless how to describe the pain and end up saying, ‘I feel pain where you press so hard’. The doctor tried to explain. While I am writing this piece, I had to look up Google for the right words to describe the health conditions including this, “Abdominal pain can be crampy, achy, dull, intermittent or sharp”. I can only feel, can’t really put a term for a pain, despite my ability to speak English and Malay. Now, imagine a migrant worker who might only know few basic words to survive in Malaysia, how would they explain the pain? Or tell exactly where the pain is? During treatment, these conversation between a patient and health worker generally takes place when the person is in extreme pain. And then we also need to answer about menstrual period (for female), personal details, medical record, and blah blah blah. I didn’t even have the energy to think or talk. In fact, I forgot to tell about some symptom. Imagine a migrant worker who does not speak the same language as the health worker. The most they can do is point to the pain. Can’t even explain symptoms. Would he or she, have understood what the doctor explained during the consultation? Would they able to remember their health record? Also, when the health worker explained about the doctor’s prescription/medicine, nothing went to my head but since I can read the instruction, it’s still okay. But this is not the case for a migrant worker who also can’t read Malay or English! How would they know how many pills to take, at what time and about follow-up treatment?
While writing this, I can only visualize ‘a wet chicken’ in place of the migrant worker (patient): feeling of shame, dejected and fear of unknown! It doesn’t stop there; they still need to pay for the treatment.
Do I have enough in my wallet?
In terms of social economic ranking, I am privileged. I paid about MYR768 for the treatment which is 17-18 days salary of a laborer who generally earn minimum wage of MYR1,200 per month. I can claim from medical insurance if I have one. Assume a migrant worker having same symptom as mine, would he/she seek treatment? Probably only at the clinic. Should be noted that in Malaysia, for documented migrant workers, the employers must register them with Social Security Organization (SOCSO) for employment injury (since Jan 2019) and to provide insurance (since 2011). The insurance coverage is MYR10,000 for treatment and hospitalization charges. The general perception, the coverage is not enough because the workers are charged foreigner rate at Government Hospital. For example, registration fees for outpatient treatment for Malaysians in government hospital is MYR1.00, while the migrant workers are charged MYR50.00
Can we bridge the communication gap?
A team of us from the Equity Initiative, from different countries (Vietnam and Philippines), with the help of some migrant workers in Malaysia, opted to study on how we can help bridge the communication between the Migrant Workers and Health Workers. Here are some of the findings based on our qualitative study, using small sample:
- Communication
- 54% of the Vietnamese migrant workers (service and manufacturing) interviewed, believe that they do not have communication barriers with the health workers while the same percentage of workers admit that their ability to speak English or Malay is very poor. Despite the difficulty, the workers use local language to communicate with our Health Workers, either on their own or with the help of their friends/co-workers. About 46% of them said that they use sign language as well to support their narrative. 70% of the workers also expressed fear to visit doctors alone. They prefer to take someone with them especially friends who are able to speak and read the local language. This is to help them explain their health issues to the doctor, read instructions, fill up, to navigate, and others.
- All the health workers (100%) responded to our questionnaire, confirmed that language and communication is a major challenge followed by cost or financial limitations and transportation. The health workers added that the consequences of the communication challenges are the inability to gather medical history, lack of follow-up appointment for both treatment and monitoring of recovery, lack compliance to medication and information on health care as well as occupational hazards. They are also of the view that the Migrant Workers are not concern about their health. Their views cut cross all migrant workers and not specific to Vietnamese workers.
Based on the health workers response, though 54% workers said that they communicate in local language during their visit for health care, the fluency and clarity in communication is high likely at the lowest level. Also, as per the Maslow hierarchy of needs, psychological needs (e.g. food, shelter, sleep) are primary, which most migrant workers are struggling with to attain. Safety needs including health is secondary.
- Health Issue & Treatment
- On the common health symptoms, 92% of the migrant workers complained about having ‘headache’, followed by feeling stressful (62%). Other minor symptoms (31%) including cold, fever, stomachache, toothache, and body pain. Treatment for symptoms are obtained by visiting health workers at government or private clinic including panel clinics, according to 54% of the workers interviewed. The others, 46% relies on home medicine or over the counter purchase/pharmacy. 60% of the workers interviewed said that during consultation with doctors, they are unable to remember recommendation/advices or understand the prescription and they fear to ask any question, in the brief consultation time.
- The feedback from Health Workers corroborates on the common health symptoms reported by the Migrant workers, in addition to gastric/abdominal problem, bowel problem, lung infection, skin irritation and cancer.
Covid-19 pandemic
The Covid pandemic situation that the whole world is experiencing since 2020, was a significant highlight on how the migrant workers, documented or undocumented were subjected to discrimination. The team experienced this during the field work.
There is a deep fear factor among the workers, especially among the sample population targeted. The Vietnamese workers were reluctant to give interview or share information. The team believes the ongoing mix messages and actions from the government on Covid-SOP and vaccinations, led to many believe that they will be arrested and detained. This is because, many workers lost their job, passport and work permit expired and some did not get any salary for months or only paid small amount. Some employers just abandoned the workers. Some of these workers have no choice but to endure the ill-treatment while some runaway to find other employment, for their survival. During the course of our field work, reports were made to the Human Resource Ministry and the relevant Embassies on the labour right violations witnessed including Covid-19 SOP violations.
Proposed Interventions
Language barrier leads to complex issues such as low health literacy, the workers unable to prioritize their own health, uncertainty on the effectiveness of treatment provided as they don’t go for follow-up treatment and compliance to medical advices. The current pandemic has further strengthened the importance of health literacy among the migrant workers as they continue to face discrimination and access to health care becomes even more challenging.
The recommendations from both the health workers and the migrant workers are:
- to increase health literacy including self-care as prevention measure.
- translator service, either provided by the company that hires the workers or through community support system or use of technology such as Translation App.
Policy level intervention to ensure affordable access to health care for migrant workers is a long-term goal for many activists working with migrant workers. The team is thinking of something intermediary. We are now working on a health toolkit for our Migrant Workers to be better equipped in sustaining a healthy lifestyle, access health and post health issue management. Migrant Workers have helped shape and sustain our economy. It is time we recognize their support by helping them sustain their health.
Call for Action: If you are design thinker and has some relevant working experience, reach out to us, letchimi.devi@gmail.com or WhatsApp 016-9268776.
Thank you
Anjung Kiri 