In Malaysia, one group of residents in this country that the government has not dealt with are the UNDOCUMENTED MIGRANTS and there are many in Malaysia, some say maybe about 5 million. Most of them come from our neighboring countries like Indonesia, Thailand and Philippines - as travel in and out of Malaysia avoiding officials ports of entry is not that difficult.
The Department of Statistics Malaysia estimates that there are 3.2 million non-citizens in 2019. Non-citizens is a broad term that encompasses migrants (both legal and illegal, with another study estimating a total of between 3.9 and 5.5 million people in Malaysia), refugees (estimated 180,000 people) and stateless people (at least 12,000 in Peninsular Malaysia and unknown numbers in Sabah, comprising Bajau Laut, nomadic tribes, street children and children of migrant workers, and unwed foreigners with local partners).
The government needs to rethink its healthcare policies towards undocumented migrant workers as the current policy drives them underground and made contact tracing and quarantine difficult for management of outbreaks, said epidemiologist Dr Chan Chee Khoon.
Now, being 'undocumented', they are considered 'illegal' and are always worried of being arrested, detained and deported by the police, immigration department, etc..
Being undocumented, they also will not have access to the Malaysian health care facilities - primarily due to fear of arrest, detention, prosecution, 'whipping' if convicted, etc...
During this Convid pandemic, the Malaysian restrictions in place may have little effect if they do not deal with 'undocumented migrants' in the country.
...most specifically the large pools of undocumented migrant workers (easily a million in the Klang Valley) who have strong incentives to avoid contact with government agencies, making contact tracing more difficult in an outbreak situation....Nonetheless, most fatalities and severely ill cases that might occur among undocumented migrants presumably would come to attention at some point, but this would be much delayed, which greatly complicates efforts at containment and mitigation, not to mention treatment.
PROPOSED ACTIONS
Immediate moratorium on all enforcement against UNDOCUMENTED migrant workers (no arrest, detention, prosecution, deportation). Hospitals and government facilities will not 'inform on undocumented migrants' - safe to come for testing and treatment...) - in this way, Malaysia will be able to deal with ALL in Malaysia, and no more have a significant class, who may be infected and too afraid to seek treatment - hence, possibly infecting others. No need for the production of PASSPORTS or Identity cards...as most do not even have this.
FEES at hospitals and government health facilities waived during this period. Now the fees charged for non-Malaysian citizens is quite high. We do not want people who may be showing symptoms or are sick to stay away because they simply cannot afford to pay. Now, while Malaysian need to pay a registration fee of RM1, non-citizens have to pay RM50 just to see a doctor at the clinics or hospitals. To see a Specialist, it cost even more. While we tackle Convid, maybe the government can waive fees for non-Malaysians, or just require them to pay the token RM1 to see a doctor. [No need to have documents for registration too].
Many of these Undocumented migrant workers earn daily/monthly incomes through work. But since, the Convid restrictions until end of the month, has basically stopped most work - hence no income. Government should also consider what to do with the daily livelihood cost of these undocumented migrants. Prolonged deprivation of work or means of earning income may result in desperation and other negative things happenings. Note that increased police presence also makes it more difficult to return to their countries, maybe through the same way they came in.
Considering the numbers, and the fact they live in Malaysia amongst all of us, IGNORING them will not help Malaysia deal with Covid, would it?
Remember that identification of these undocumented migrants is very difficult as they look very much like Malaysians
How many UNDOCUMENTED MIGRANT victims of Convid-19 in Malaysia now? None?
Covid-19 and contact averse undocumented migrants
Letters
Saturday, 14 Mar 2020
Covid-19 and contact averse undocumented migrants
Letters
Saturday, 14 Mar 2020
EPIDEMIOLOGISTS attempt to model quantitatively the course of an infectious outbreak by plotting the number of cases over time in a curve-fitting exercise whose shape reflects parameter values like the reproductive number (average number of secondary infections produced by a typical existing infection) and incubation period (duration between exposure to an infectious organism and the emergence of noticeable symptoms).
Such exercises have been undertaken by researchers at the University of Hong Kong, Imperial College (London) and National University of Singapore, among others.
It was on the basis of such fitted epidemic curves that Dr Bruce Aylward, team leader for the WHO-China Joint Mission on Coronavirus (Feb 16 to Feb 24,2020) assessed that the Chinese government may have averted hundreds of thousands of additional infected cases through their extraordinarily robust containment efforts in Wuhan, Hubei, and other cities and provinces.
The mainstays of these containment efforts were:
> Isolation and treatment of virus positive cases;
> Contact tracing and quarantine of close contacts who were untested or who tested negative; and
> Massive social distancing in various forms, all carried out in unavoidably disruptive ways but which nonetheless allowed for the basic living essentials and needed care, by and large, to be delivered.
Malaysia, however, has specific demographic characteristics that are not easily modelled upon such simulations of epidemic dynamics, most specifically the large pools of undocumented migrant workers (easily a million in the Klang Valley) who have strong incentives to avoid contact with government agencies, making contact tracing more difficult in an outbreak situation.
Nonetheless, most fatalities and severely ill cases that might occur among undocumented migrants presumably would come to attention at some point, but this would be much delayed, which greatly complicates efforts at containment and mitigation, not to mention treatment.
Citizens’ Health Initiative (CHI) knows that our Health Ministry is aware of these potential spillover scenarios through previous discussions with Dr Chong Chee Kheong (formerly director of disease control and currently deputy director-general for public health) as well as via recent communications with senior officers of the WHO and UNU-International Institute for Global Health in Kuala Lumpur.
What is less clear though is the proactive measures and contingency plans the Health Ministry may have for coping with such scenarios.
Are there, for example, initiatives to engage more closely with those channels of healthcare access that undocumented migrants resort to when in need of care, like voluntary clinics such as those run by Tzu Chi Foundation, Pertiwi Soup Kitchen, Teddy Mobile Clinic and Global Doctors Hospital Mont Kiara (assuming they also cater to unsuccessful asylum applicants and undocumented migrant workers in addition to refugees)?
These laudable endeavours operate as de facto “safe(r) spaces” which could supplement the Health Ministry’s efforts in outreach and communication with marginalised communities, especially those that need some assurance of sanctuary when accessing needed care.
Beyond that, civil society organisations, migrant networks and communities, UN agencies and indeed embassies of the labour-sending countries could assess the information and health communication needs of the respective migrant communities, and translate and disseminate useful, actionable information for individual as well as community coping responses.
How might we know if the Covid-19 outbreak in Malaysia has spilled over into the undocumented migrant population?
At the moment, the Health Ministry is relying on its existing sentinel surveillance for influenza-like illnesses (ILI) and Sari (severe acute respiratory infections) to also detect sporadic cases of SARS-CoV-2 positives as a red flag for community viral transmission with no traceable contact history. This could be how infected undocumented migrants might directly or indirectly come to attention.
Somewhat reassuringly, the sentinel surveillance so far has not detected any sporadic cases. The reported first case of a presumed sporadic case has now turned out to have a contact history traceable to a known infected case, as reported in “Sporadic no more: Source of Covid-19 infection traced to religious event” (The Star, March 12; online at https://bit.ly/2wTY46a).
We should treat this as a wake-up call for the urgency of an “all of government” effort led by Prime Minister Tan Sri Muhyiddin Yassin to respond proactively to an escalating emergency.
We should not need the ijtimak tabligh incident at the Seri Petaling Mosque – “Covid-19: Health Minister urges those at mosque gathering to come in for screening” (The Star, March 12; online at https://bit.ly/2vRsSVj) – to drive home the urgency for proactive measures by a health minister or director-general who might have felt constrained in proposing bans on large religious gatherings and sporting events, school and university closures when necessary, and policy changes pertaining to immigration and home affairs, income maintenance/employment security, and etc.
The PM needs to step up and take charge with the overarching authority of his office.
CHAN CHEE KHOON
ScD (Epidemiology)
Citizens’ Health Initiative CHI is an informal grouping of individuals seeking to promote citizen involvement in healthcare reforms and health policy in Malaysia. - Star, 14/3/2020
Proposing a Non-Citizens Health Act for Malaysia
- Letters
-
Saturday, 11 Jan 2020
THE recent polio case in Sabah highlights the people
our health system has left behind. Therefore, we propose a Non-Citizens
Health Act for Malaysia to achieve universal health coverage, which is
both our Health Minister’s stated aim and a World Health Organisation
commitment.
The Department of Statistics Malaysia estimates that
there are 3.2 million non-citizens in 2019. Non-citizens is a broad
term that encompasses migrants (both legal and illegal, with another
study estimating a total of between 3.9 and 5.5 million people in
Malaysia), refugees (estimated 180,000 people) and stateless people (at
least 12,000 in Peninsular Malaysia and unknown numbers in Sabah,
comprising Bajau Laut, nomadic tribes, street children and children of
migrant workers, and unwed foreigners with local partners).
Naturally,
there are caveats. Calculations can differ for legitimate reasons, but
it’s reasonable to believe that the official statistics undercounts the
number of non-citizens. The list of categories is not exhaustive (e.g.
foreign students and asylum-seekers aren’t included). Each category has
different legal definitions, and the same individual might change
categories over time.
These are important caveats, but they can detract from more useful discussions about solutions.
The fundamental problem is easily articulated but difficult
to solve. In general terms, Malaysia doesn’t even recognise the
existence or concept of refugees, stateless people and illegal
immigrants.
As a result, non-citizens have almost no health rights and
cannot meaningfully access Malaysia’s health system either public or
private.
Access to healthcare has many additional barriers:
financial (too costly), legal (risk of arrest), physical (a nomadic
lifestyle or life in remote jungle camps) or cultural (misinformation
and fear).
There are two insurance schemes for legal foreign
workers, the Employment Injury Scheme by Socso and the Foreign Workers
Hospitalisation and Surgical Insurance Scheme (SPIKPA). However, the
coverage is minimal, excludes outpatient treatment and maternal or
antenatal care, and only supports legal workers.
To make matters
worse, non-citizens are being charged between 24 and 100 times more
than citizens to access care in public hospitals since January 2016
after the Fees Act (Medical) 1951 was amended for foreigners.
The
Immigration Act requires everyone to report the presence of
undocumented foreigners to the police, which creates an ethical dilemma
for doctors and nurses who are simply trying to save lives.
Other
than very basic care at general practitioner clinics, private care is
generally unaffordable to non-citizens. Private hospitalisation is
almost completely inaccessible except for ad hoc interventions by
private hospitals and non-governmental organisations.
There are
many reasons to extend health rights to non-citizens, especially
children and pregnant women. Many are powerful moral, ethical,
humanistic, religious, philosophical, international law and human rights
reasons. There is also the public health case, especially if we want to
prevent communicable diseases among citizens and non-citizens alike.
There is even an economic case to provide health rights to migrants
because healthier migrants will increase Malaysia’s prosperity.
However,
we are aware of the countervailing political realities. The justice of
using scarce taxpayer money for non-taxpayers is an important
consideration. The government has to secure our borders, as our
generosity can’t be bottomless. There could be pushback from Malaysians
whose own rights are still being secured, and Malaysia could be a more
attractive destination for free riders.
After carefully
considering both the case for and against providing health rights to
non-citizens, we believe that Malaysia must pass a Non-Citizens Health
Act to provide certain health rights for non-citizens. In this case, we
are proposing a realistic framework for action.
This act would
prescribe basic health rights for all non-citizens, starting with
vaccinations, maternal and antenatal care, child health up to the age of
five and treatment for certain communicable diseases such as pulmonary
tuberculosis.
Maternal health should include sensitive,
non-coercive and thoughtfully delivered family planning services so that
non-citizens do not misconstrue this as attempting to control their
numbers.
The government can consider additional services at
regular intervals of three to five years because international
standards, health systems and financing capabilities would evolve over
time.
These services must be provided free or nearly free,
alongside effective education and decriminalising non-citizens’
attendance in public health facilities. The funds can come from a
combination of existing levies on foreign workers, private insurance or
taxation.
All non-citizens should be allowed (indeed,
encouraged) to purchase private insurance (similar to Thailand since
2001), and this can be run by NGOs on a privately-held, non-profit
basis. Allowing more non-citizens, legal or otherwise, to purchase
health insurance reduces adverse selection, increases the risk-pooling
effect and may even reduce the premiums over time.
The public
health reason for enshrining such rights deserve elaboration. Thailand
has kept its rate of tuberculosis at a constant low despite the influx
of migrants from Myanmar and Indochina, which have higher rates of
tuberculosis.
This is due to their dual policy of extending health rights to all migrants while simultaneously securing their borders.
If
Malaysia continues to pretend that non-citizens don’t exist within our
borders, we’ll see more outbreaks of polio and tuberculosis on top of
the human cost of these unnecessary diseases.
There are also
compelling ethical and logical reasons to enshrine these rights.
Children and mothers are among the most vulnerable populations, and they
deserve our care. Preventive care is cheap and cost-effective. It will
not only prevent outbreaks but also emergencies when non-citizens come
to hospitals with massive complications requiring heroic (and expensive)
curative care.
Standard practice on the ground is to provide
emergency life-saving measures for foreigners, although this is not
explicitly mandated, allowed or prohibited by the government. In this
silence, doctors and nurses will do what they deem necessary for the
patient’s benefit. Therefore, the law must protect healthcare
professionals from punitive action if non-citizens fail to settle
hospital bills.
This act must also remove the requirement for
health professionals to inform the Immigration Department if they are
treating undocumented migrants to avoid a professional conflict of
interest.
The Malaysian government must also implement durable
legal solutions for all categories of non-citizens in the country. In
addition, the national registration pathways must be strengthened so
that every child born in the interior parts of Malaysia will receive the
MyKad, which determines their legal rights as citizens, including
health and education.
We urge the government to debate and then
pass a Non-Citizens Health Act, and assert our soft power by
demonstrating a humane, practical and politically feasible solution to
the world.
DR KHOR SWEE KHENG
DR JOHN TEO
PROFESSOR PANG YONG KEK (President, Malaysian Thoracic Society)
PROFESSOR TANG SWEE FONG (Secretary, Malaysian Paediatrics Association)
FEDERATION OF REPRODUCTIVE HEALTH ASSOCIATIONS, MALAYSIA HEIDY QUAH (President, Refuge for the Refugees)
JAMES BAWI THANG BIK (President, Alliance of Chin Refugees)
ALL WOMEN’S ACTION SOCIETY
DATUK DR AMAR SINGH-HSS
DR SUBATRA JAYARAJ
DATUK DR RAVINDRAN JEGASOTHY
DR TIMOTHY CHENG
Source: Star, 11/1/2020
‘Rethink healthcare for migrant workers’
Nation
Tuesday, 03 Mar 2020
By LOH FOON FONG
Chan Chee Khoon
KUALA LUMPUR: The government needs to rethink its healthcare policies towards undocumented migrant workers as the current policy drives them underground and made contact tracing and quarantine difficult for management of outbreaks, said epidemiologist Dr Chan Chee Khoon.
He said Malaysia could not ignore its large pool of undocumented migrant workers as long as contact tracing (those who have come in close contact with those who have been tested positive with Covid-19) and quarantine remained as tools for managing the outbreak.
“The Health Ministry and Home Ministry need to rethink their policies towards undocumented migrant workers, which currently drive them underground rather than encourage them to come forth to seek treatment when afflicted with infectious and other ailments.
“It would be extremely difficult to carry out contact tracing when undocumented migrant workers have strong incentives to avoid contact with government agencies, ” he said.
Dr Chan was asked whether Malaysia should change its strategy of handling Covid-19 following reports saying that the Covid-19 was different from the SARS and has more similarities with H1N1 and spread as quickly as influenza but not as deadly as SARS.
On Saturday, Universiti Malaya academician Emeritus Prof Datuk Dr Lam Sai Kit said the government could refer to the National Influenza Pandemic Preparedness Plan it developed in 2006 should the Covid-19 outbreak turn pandemic.
But Dr Chan said that when countries moved towards Red Alert (out-of-control epidemic spread), contact tracing and quarantine may be less useful.
“At that point, the emphasis may shift to include tracing recovered cases, and even infected individuals who shrugged it off with mild symptoms or even without symptoms, and who never came to attention.
“An antibody test to identify those who have been infected and subsequently recovered would be very useful to allow for collection of plasma from them.
“China has been attempting to use the plasma to treat the severely ill cases, ” he said.
Based on China’s statistics, there would be four times more cases of recovered persons than of severely ill persons, which is a potential huge pool of plasma to harvest, he said.
“So, the challenge is keeping track of these cases and having the capacity to produce safe and efficacious plasma in the required volumes, ” said Dr Chan.
He said that this would be useful while awaiting vaccines and more effective treatment modalities to be introduced, on top of stepped-up measures at social distancing.
Asked if the same would be done if the outbreak reached pandemic level (out-of-control community spread in many countries), Dr Chan said countries would have to deploy multiple measures or reallocate resources to include social distancing and mandatory self-quarantines when targeted contact tracing and institutional quarantines no longer suffice.
Individual measures to reduce infection risk such as frequent, proper handwashing, informed risk avoidance behaviours and institutional responses which are not unduly alarmist should be undertaken. - Star, 3/3/2020
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