By Goh Wei Leong and Loh Cheng
There is a large community of migrant workers in Singapore who are employed in manual labor. Besides work-related injuries and physical illnesses, these workers also face psychosocial problems working in a foreign land. A group of local doctors and other like-minded individuals founded HealthServe* in 2006 to contribute to their well-being.
*HealthServe is a non-profit organisation providing low-cost medical care and support to migrant workers in Singapore.
Behind the Label
One day I was working at the HealthServe clinic in Geylang and a migrant worker named Arjun* came in, looking rather lost. He asked, Can you treat me? I have diabetes. I replied that I could not. At that time, HealthServe had a policy not to treat chronic diseases because we couldn’t offer adequate follow-up. Arjun showed me a receipt from his last visit to a polyclinic. It was for $149.50 —payment for consultation ($40), diabetic counseling ($30), blood tests, and medications. He had not been able to understand what the diabetic counselor said.
I felt very conflicted when I saw Arjun’s receipt. I knew that he earned only about $20 a day, that he very likely had debts to pay off, and that he probably also has to send money home to his family. Paying $149.50 for a routine diabetes consultation would be a tremendous recurrent financial strain. I looked at him and said, Brother, I’ll treat you. At our next Medical Committee meeting I suggested that we needed to change our chronic disease policy.
Arjun and his receipt got us started on treating patients with chronic diseases at HealthServe. We are now working on improving our clinic systems to ensure that our migrant brothers with chronic diseases get the best care possible at an affordable price.
Over time, I have got to know Arjun better. He is a bin centre worker and earns $18 a day. He supports his wife and three children, as well as his brother’s family. His brother has died in a road traffic accident.
One day Arjun had come to see me at the HealthServe clinic near closing time. I was about to leave, and I knew that I would be driving near where he lived, so I offered him a ride. He thanked me throughout the journey; he was so thankful that he had saved a two-dollar MRT fare. I asked him to show me exactly where I could drop him off. He directed me to a bin centre — that was where he lived.
I asked, Can I visit your house?, so he brought me in. It is the most horrendous thing to live inside a bin centre! I walked past the wet-trash compacting machine and it smelt awful. I went into a room with four mattresses on the floor, two refrigerators, and two washing machines that had been salvaged. He told me that he worked twelve hours a day from six to six.
He introduced me to one of the three friends who share his room and to a different world. He was proud to show me his room in the bin centre. I was privileged to be invited to his personal space. It helped me to understand the context in which he worked and lived, and it reminded me why I had to persuade the Medical Committee to change our policy and start treating migrant workers with chronic conditions.
*name has been changed
—-Dr Goh Wei Leong
Good Employers
The drawing depicts some psychosocial problems faced by migrant workers who are injured at work or who are taken ill. A migrant worker sits in a wheelchair after treatment at the Emergency Department. He is worried about the cost of treatment and the loss of income resulting from his injury, as this will impact the amount of money he is able to send home.
We sometimes hear stories of irresponsible employers. However, there are also caring employers who take good care of their workers. Here are two personal experiences.
I saw an Indian worker one evening in the Emergency Department. He had just begun working in Singapore when he suddenly experienced some neurological symptoms. He was more worried about the cost of hospital admission and neurological imaging than about his illness. I was pleasantly surprised to see his employer arrive, and without hesitation assure him that the company would foot the bill for the hospital stay and treatment.
Another worker from China had worked in Singapore previously, and was now referred for a new pre-employment test. After his last Singapore stint, he had returned to China, and had been doing well, handling large government projects in his city. He had now returned to Singapore when his previous employer had requested for his help. When probed for the reason, he cited his friendship with his employer.
These encounters remind me of the importance of being compassionate, restraining my prejudices, exercising empathy, and respecting migrant workers as fellow human beings.
—Dr Loh Cheng
Goh Wei Leong is in private practice. He co-founded a charity to serve migrant workers in 2006 and was named the Singaporean of the Year in 2017 by The Straits Times.
Loh Cheng is in public service and in the past has been involved in rehabilitation and elderly care training in Yunnan, China.
The commentary and vignette were reproduced with permission from the book “Being Human, Stories from Family Medicine” edited by Cheong Pak Yean and Ong Chooi Peng and published in 2021 by the College of Family Physicians Singapore.
Pictures of illness experiences were drawn by NUS medical students in workshops conducted from 2012-2017 by A/Prof Cheong Pak Yean. Senior family physicians subsequently shared vignettes and commentaries based on the pictures.
