A Bangladeshi citizen was brought in critical condition to the ADK Hospital recently. He didn’t have money to pay for his medical expenses and the hospital cannot send him back as he was too sick. It took over a week with the joint efforts of the Hospital, Department of Immigration and Emigration, and the High Commission of Bangladesh to identify his legal employer only to find that he lives abroad now!
Most of the expatriate labourers have no health insurance and no means to get adequate treatment when needed. Ironically most employers prefer to send them back home when they get a serious or long lasting illness to avoid medical expenses and keeping a ‘slave’ who makes no money to them!
The Maldives has seen fast development in the past couple of decades, moving from a ‘least developing country’ status to that of ‘developing country’. We owe a lot of this to expatriate workers who filled the skill gap as well as doing ‘low class’ work the Maldivians didn’t want to do. We wouldn’t have reached where we are without them, neither can we go on without them. Despite of this fact, how we treat them is a matter of disgrace to the Maldives.
Both local and international bodies have been raising concern over human trafficking and ill treatment when it comes to the expatriate labourers in the Maldives. They are forced to live in hot and humid steel warehouse like shelters, with poor or no ventilation and inadequate lighting. They have to be crammed up on multi-level bunk beds, often sleeping on shift basis. Usually there is no running water or water will be supplied on quota, which is insufficient to maintain normal hygiene and sanitation in the toilet that would be shared by several people. There can be no better places to harbour and spread almost all the contagious micro-organisms causing serious diseases, in addition to being a safe haven for vectors like bedbugs and lice! The stink of one such labour quarter I visited couple of years ago, as part of public health inspection campaign, was noticed several feet ahead. It was so dark that we had to use torchlight to look inside. The Bangladeshi worker from Male’ Municipality who was with us made a remark saying, “Even cats and rats cannot live there”.
The big companies who employee these labourers have neglected them in every way, and are happy as long as they work and the money keeps on flowing in. I’ve seen many patients in my clinical practice who would want to go back to work despite of being sick, only because their employer deducts their salary for taking sick leave! Some of these patients were working in popular café chains whose illnesses like typhoid not only put them at risk but also causes an equally greater risk to those who eat there.
We talk about the low hygiene standards in the local cafés and restaurants. But what we don’t normally talk about is the even worse condition of the places where the expatriate workers eat or food is prepared for them. I am sure no self-respecting human would want him or his family to be fed with the food that comes out of such places, but we conveniently turn back on this reality.
The labourers working in Maldives come from the poorest areas of Bangladesh, Nepal and India where a lot of contagious communicable diseases are highly prevalent. We have either eliminated most of these diseases or have been able to keep the incidence very low. However, if we don’t provide the basic shelter, food, sanitation and healthcare to these people; such diseases will emerge and spread from them to our community, which will be happening to some extent even now!
All of the cases of Filaria we have seen in the Maldives in the recent past were seen from them. Hundred percent of the Malaria cases seen in the Maldives are imported and mostly seen in this subgroup. We have seen foci of diseases like Typhoid, TB and sexually transmitted diseases like Gonorrhoea and Chlamydia among them. The expatriate medical screening has picked several cases of HIV among them. For every case we detect, there will be much more that we don’t, enabling it to spread to their colleagues and to our community. There is no way it can be limited only to the expatriates; what they have will eventually come to us. Couple of years back we saw an isolated single case (confirmed with lab test) of Shigella in a nearby island (Maldives have been free from the disease for a long time). Though we couldn’t trace its source, it so happened that there is a high density of expat laboureres in the island. Imagine an outbreak of Shigella or Cholera, starting in the Maldives! If we aspire to live a happy and healthy life, we need to clean not only our homes but our backyards too. We cant compartmentalize the society and keep one compartment free from diseases while the other is neglected.