Bangkok Post
Thai employers want migrant workers' cheap labour but most won't take responsibility for their health care. This is not only unfair, it constitutes a direct challenge to public health in the general population, writes SUPARA JANCHITFAH
|
It was still early in the morning, but a large crowd of people were already waiting to see doctors at a local hospital in Phangnga province, Win Win (not her real name) and her husband were among the crowd.
|
They could feel the stares of Thai locals, and perhaps could understand some of the murmuring about Burmese workers coming to use Thai health care services.
"There are not enough doctors and nurses for us. Why should these Burmese be able to come use our hospital?" asked one local. A more thoughtful local replied that they might harbour fatal diseases that if untreated could spread among the general population.
The discussion in the hospital emergency ward went far beyond health care, and touched on a number of prejudices commonly held against migrant workers.Areerat, from Kuraburi district in Phangnga, said that in Kuraburi hospitals Burmese sometimes made up more than 50 percent of the total number of patients. She complained that some Thai people who were born on Phrathong island, but hold no Thai ID cards because they were never issued birth certificates, get less benefits.
"Some of us have to pay in full, while Burmese pay only 30 baht," she said.
It is not only members of the general public who play on unfounded fears and stereotypes to make the case that these undocumented workers are taking away health care services from native Thais. At a meeting recently organised by Medicins San Frontiers on the third anniversary of the 2004 tsunami, many participating public health officials expressed some similar biases.
 |
| To allow undocumented workers and their children access to primary health care is also good for the health and economy of Thailand. — SUPARA JANCHITFAH |
 |
 |
| In general these undocumented workers live in an unhealthy environment, and treat themselves before seeking public health care. |
 |
| Young Burmese children walk back to their temporary home after school. |
"We treat these Burmese better than Thais," one said, to widespread agreement. Many came up with similar complaints against both registered and non-registered migrant workers. Perhaps this is understandable, as these public health officials have to work harder while making the same amount of money providing services for many more people who may not even pay taxes.
One official explained that the head count for hospital budget and personnel purposes was based on the number of Thai citizens in an area, regardless of the number of Burmese who also use the hospitals. He said that ethics would not permit them to turn away the foreigners, but the central government is uninterested or unaware of their predicament.
Yet another official from the Phangnga Provincial Public Health Department said that in 2007, three million baht of the allocated budget went to all local hospital in Phangnga to care for migrant labourers.
Migrants' contribution
Many Thai employers are all too eager to hire Burmese workers for jobs they might have trouble filling otherwise, but health care insurance is usually not considered part of the bargain. Nevertheless, in contrast to the perception held by many Thais that migrant workers are taking advantage of Thai government health services, registered migrants or their employers must pay 1,300 baht each year for heath insurance and 600 baht for a medical check-up when they renew their work permits.
According to the Ministry of Labour and Social Welfare, there were 826,796 registered migrants in 2006, declined from 841,277 in 2005. Granted, this is less than half of the estimated 1.8 million migrant workers in Thailand, but it is likely that most migrants would register if they had the chance. The government has not allowed new registration in recent years.
What's more, according to report from the International Labour Organisation (ILO) late last year, Thailand's migrant workers earned $2 billion in wages last year, but may have contributed $11 billion, or 6.2 percent, to the gross domestic product. The report goes on to say that about 75 percent of the migrant labourers came from Burma, with most of the rest coming from Laos and Cambodia.
Many business operators in Phuket and Phangnga provinces can attest to the migrants' contribution to local economies.
A commercial pick-up driver in Phuket said that he relied mostly on Burmese workers for his income.
"Now many Thais are getting well off. They have their own cars or motorcycles and they no longer use my services. I have to wait for Burmese workers to hire my car," the driver elaborated.
The owner of a barber shop in Phangnga's Takua Pa district said he owed the survival of his shop to Burmese workers.
Grocery shop owners in many districts had similar comments.
"Most of our local (Thai) people go to shop at big supermarkets in the cities. We make our living from the Burmese, who cannot go too far," said one.
Both registered and unregistered migrant workers in Phangnga and Phuket provinces most often rely on state hospitals for their medical care, but some are turning to nonprofit organisations such as Medecins Sans Frontiers (MSF) and other NGOs which set up operations after the tsunami.
MSF, for example, has two mobile health care units which regularly visit fishing ports, rubber plantations and construction sites where large numbers of migrants are working to provide health education and care. Up to 10,000 workers have access to the mobile units.
Min Min (not his real name) is infected with HIV and cannot speak Thai. MSF provides him with medication and also a translator. He came to Thailand when he was 16 years old and worked on fishing boats for 10 years for 1,800 baht a month. Until recently he was unaware he has HIV. Although still very frail, the medication provided by MSF has probably saved his life.
"I can't go home, there is no medicine back there," he said.
Barriers to treatment
There are many thousands of Burmese workers deep in the forested mountains along the Andaman coast tapping para-rubber trees, living in simple row houses. They get better pay and working conditions in comparison to those working in construction and fishing jobs.
Some plantation owners pay attention to their workers' health care, but most do not. The younger workers seldom get sick, so it may not be much of an issue to them. It is more important to the older workers and those with children. Those who have just come to Thailand, or who have lost their status as documented workers because of a change of employers, are not eligible for public health care.
Many of the undocumented workers do not come to the hospital no matter how sick they are.
"We might be arrested," one said, adding that this would mean deportation.
Some workers said that the distance between the plantations and the hospitals is a barrier. Others worried about the cost and still others about the language barrier.
Inna (not her real name) said most workers on the plantations try to find the means for a cure among themselves.
"When someone has an accident and needs his wounds stitched up, we cannot send him to a hospital as he probably has no money and no health card. So we do it ourselves," she said.
She added that most women also choose to have their babies at the plantation because it is safer (no worry of being arrested) and cheaper. They can also pay the midwives by installment.
Some said they want to register even though the process is complicated, but as mentioned there is as yet no new policy to allow newcomers to register.
"We are willing to pay for the health insurance and want to be registered," was a common refrain at one para-rubber plantation. Many workers said registering would allow them to travel without fear and be sure of getting proper care.
"Last year, a Burmese worker died because he did not know he had malaria. When he was sent to the hospital his condition was beyond cure," said Suksri Saneaha, a nurse who works for MSF.
Suksri said most workers at present only go to hospital as a last resort, if they are really sick and can no longer tolerate the pain and sickness.
"Some workers thought they had an ordinary fever, but actually they had developed dengue. Only when they felt they could not handle it by themselves would they risk seeing a doctor."
She added that she knew of persons infected with TB who had decided to go home without the taking the full course of medication for the disease, in the belief they would die soon anyway.
"This will only spread such disease in their home country," she said.
Improve access
On International Migrants Day (December 18), MSF asked the Thai government to put more effort into improving access to health care for the migrant workers living in Thailand.
Kannikar Kijtiwatchakul, MSF Access to Essential Medicine Campaigner, said: "If employers still need their cheap labour, these migrants will remain here, but they present a huge risk for Thai people when they do not receive proper medication for TB and other infectious diseases. Therefore, employers should not deny their responsibility to take the matter of health care seriously."
Richard Veerman, MSF migration coordinator for Thailand, said that all migrant workers should possess health cards. "Without the card, they have to pay full cost for medical care, but most can't afford it as they make very little."
In order to improve migrants' access to health care in all provinces, MSF strongly recommends that the registration process be opened up again and that it be made simpler and cheaper, and that all migrants be made eligible for a health card regardless of their registration status.
Dr Charnwit Tharathep of the Ministry of Public Health (MoPH) said that progress in allowing undocumented workers to register would depend on employers and also on whether or not the workers were perceived as a security threat.
"Some employers might be afraid that their money would be wasted if their workers change jobs," he said.
Dr Charnwit added that the MoPH is proposing a policy to allow workers to purchase a health card even if they are not registered, but it's still in the process. He also said the health care insurance proposed by the MoPH was the "cheapest in the world".
Dr Charnwit said that as a matter of principle all hospitals must take in the sick and uphold the physicians' credo of doing no harm.
"I want to emphasise that it is not in the business of public health officials to file charges against these undocumented workers when they gave birth or otherwise seek assistance at a hospital," he said, adding that hospital officials will cooperate with other state agencies only if they seek information directly related to an ongoing criminal investigation.
He said the MoPH has initiated a number of progressive schemes to facilitate migrant workers, such as providing volunteer translators. Registered workers are also given a medical check-up and some vaccinations are provided.
Dr Charnwit said the 1,900 baht collected yearly from migrant workers is usually enough to break even, but sometimes the MoPH has to shoulder higher costs for their care. To him, this falls under the philosophy that "an ounce of prevention is better than a pound of cure". He says the ministry provides primary health care to the workers partly because it "is for the safety of all Thai as well".
Face the reality
Three years after the tsunami, Phangnga province is undergoing an impressive economic recovery in the tourism, agriculture and fishery industries. It cannot be denied that migrant workers have made a major contribution to the resurgence.
Certainly there are some disadvantages in having so many migrant labourers inside Thai borders. For example, a very small percentage of them engage in criminal activities such as trafficking in drugs and people.
As described in the opening paragraphs, immigration can become a social issue as well. Perceptions that migrants get undue benefits can raise tensions and hostilities.
However, the reality is that in jobs which are essential if economic growth is to continue, migrants make up the majority of workers. This includes most construction projects and at many hotels. A number of hotels in Phangnga province which were severely damaged by the tsunami have resumed operations in the past year and a half, and last month hotel occupancy was more than 90 percent.
The contributions of the migrant workers are seldom acknowledged but well recognised.
"Without these labourers, the cost of construction would be higher and the process would be slower," said a manger of a construction site who asked not to be named, pointing to some workers on the top floor of a building-in-progress.
Yet lingering prejudices continue to make their hard lives even harder. Last year, authorities from different provinces issued many regulations to restrict the movement and freedom of migrants, such as prohibiting them from owning a mobile phone or gathering in groups outside their living compounds.
For the Thai locals who fear that children of migrant workers growing up in Thailand get better health care services than their own, it might be helpful to consider the predicament of Thai workers overseas who are denied equal access to health care. Kannikar recently conducted research in Japan and found some poignant examples.
"A Thai worker got really sick but was refused treatment at eight hospitals, until the 9th decided to admit her. Another woman was very ill with HIV and wanted to come home, but she was detained at immigration for two weeks without care.
"In 2001, a man with no means to health care died in front of the Thai embassy in Japan. "
Kannikar stressed that the more migrant workers were prevented access to health care, the more consequences there would be for Thailand in the future. For example, a limited knowledge of reproductive health would lead to unwanted pregnancies, which would further tax the Thai health care system, and lack of vaccinations will facilitate the spread of disease among the general population.
"Access to treatment for migrant workers, apart from being a basic human right that must be protected regardless of nationality or legal status, is closely interrelated with the public health of the host country. This is due to the fact that disease does not respect nationality or recognise borders," added Kannikar.
ความเห็น (0)
ไม่มีความเห็น