In a span of five years (2014 to 2019), 24 candidates who went overseas for employment were sent back by the host countries on medical ground. Of the 24, maximum candidates were sent back with an impression of scar in their lungs, while the rest with hepatitis, blood infection and mental disorder cases.
The collected data are from Bhutan International School of Hospitality and Tourism (BISHT), iED jobs, Employ Bhutan Overseas Employment Agent (EBOEA not to be confused with the suspended BEO) and RUMI.
In five years time, they had sent 2,050 candidates for employment overseas, mainly to Qatar, Kuwait, Dubai, Oman and Bahrain.
Although the candidates were issued with approved Medical Certificate (MC) from JDWNRH, however, they were diagnosed with the medical conditions during medical screening for a residential work permit in the host countries. To make sure that the report is accurate, they were rescreened up to three times, agents shared.
In one case of hepatitis, after returning, the candidate did the screening twice in JDWNRH and the report was normal. However, since the candidate was again refused by the host country, on request, the sample of the candidate was sent to Delhi, whereby the report showed it to be positive.
In other returning cases, there were a few candidates who suffered from Tuberculosis (TB) in the past, but they got through the medical screening from the hospital.
A 22-year-old woman from Bumthang said that she cleared the medical screening (X-ray and blood) from Bhutan and went to Kuwait with the approved MC. But she did not clear the medical screening in Kuwait as she had a scar in her lung.
“In my first test, only my urine and blood test was done which was normal. Before I could even finish my probation period which was for 3 months I did my 2nd round of test, whereby I was detected with a scar in my lung,” she added.
The moment she was detected with the scar she was asked to return to Bhutan and no concrete documents were provided to her by the company there, she added. After returning she has undergone medical screening but the report was normal, to her surprise.
She said, “The agent was helpless as well, and until now, I did not get to see the medical report from Kuwait despite request to the agent.” The expenditure of her return home was borne by the company.
Likewise, a 22-year-old woman from Paro shared that she was sent back as a spot was detected in her lungs as well. “I did not get a Qatar ID even after a month when rest of my friends got. Back there, the company didn’t tell me about the scar, but the agent here had informed my parents about it,” she added.
She requested for a second screening but they didn’t allow it and she was instead asked to leave Qatar. “Once I reached here, I did a thorough screening twice, but the reports say I am physically fit and with no scar in my lungs,” she added.
She was made to pay 50 percent of the airfare and did not get her refund from the company (Nu 33, 000). “I want to try for another job but I will have to pay the fees again. Therefore, I didn’t try for second time. It was a loss for me and family,” she said.
Both of them wanted to go back but the companies have refused to take them back. They went there in 2018.
Meanwhile, a 25-year-old man was sent back in 2018 from Dubai after he was detected with left pleural reaction and no focal pulmonary lesion. When he went from here, his MC was normal. After coming back he did a medical screening in hospital but report states that everything was normal.
There were other cases where the candidates were sent back for indulging in burglary and drinking. In addition, there are also reports of a few cases of skin diseases; however they are under treatment for now in the host countries.
The Labour and Human Resources Minister, Lyonpo Ugyen Dorji, said that medical screening is important but it is not certain how strictly the hospital conducts the screening and if a person is vulnerable to certain diseases after the test.
He said, “It is something challenging and it would be difficult to eliminate the issue completely. However, what is possible has to be done and as a part of process we can only question, inform hospital to be stricter, if at all, they have been a little negligent.”
“We will ensure that things will be monitored at the places where it is required, at least when it comes to overseas employment, and we will always keep in mind when we implement,” Lyonpo added.
“The honesty is upon the candidate and their parents. This is moral responsibility that each of us must shoulder,” he added.
An official from Department of Medical Services (DMS), Ministry of Health (MoH) said that they do not have a stand on the need for MC as the requirement really depends upon the host countries.
If the requirement is an extensive test, the hospital would try to do all. However, he said that it is must to understand that this is burden on the hospital as it is taking the resources away.
He also said, “Issuing MC is very different from treating a sick person, and for that matter, the accusation that is made against the health workers of not being concerned over the issue is unfounded”.
In addition, he said that they are not aware about the host countries conducting medical screenings once candidates reach the said countries. He said, “If a person is subjected to further medical screenings upon reaching, then we won’t be asked to provide the MC from here.”
“I do not know the circumstances for people who have returned home, and therefore, I won’t be able to talk on that. In terms of monitoring, the doctor who certifies the MC is responsible for it because everything has to be checked and balanced before issuing the MC,” he said.
He said that they are not aware of any future plan to make medical screening mandatory, however, they would provide health advisories before travelling, especially on disease prevention, vaccination requirements, etc.
Ugyen Tshomo, proprietor of EBOEA said that the medical screening is done by the hospital to know if a person is physically fit to work. Candidates go there to work but they do not get to work (not even a month) as they are sent back due to certain medical issues.
She said, “After their return, they undergo screening here in hospital and they come to us requesting to go back, however, the companies do not want to take them back.”
Therefore, she said that these things cause expenses to the company and loss to the candidates. Some companies are generous enough to bear the cost to send the candidates back home while there are some who ask for cost sharing.
“No one is at fault and before sending the candidates abroad to work, they are briefed on such matter. It is our responsibility to bring them back home safe but we cannot refund their amount as we charge them only with a month salary,” she added.
In addition, she also said that to those who have come back, they suggest them to refrain from travelling to any other countries as the procedure is going to be the same everywhere.
“We have raised this issue to the ministry, and later we were informed that the validity of the medical certificate has been brought down to three months from six months. If the validity of the MC is above 3 months then the Kuwait embassy will not (issue a) stamp,” she added.
Medical issue is something challenging to handle when one is far from home, also it can pose threat on someone’s life, she futher said.
Similarly, Kalpana Sunwar, principal of BISHT shared that they have encountered a few return cases though their MC where approved from here, and companies in host countries are particular about health issues.
Since it is not a fault of the agent or the candidates, they bear 50 percent of the flight tickets for them, she said.
She said, “When such issue pops up, it doesn’t look good on candidate, government and the agents here. We have raised this issue to the ministry. Number may be few right now, but it may grow in future if the relevant agencies do not take the required measures.”
Finance Director of iED jobs, Tshewang Dorji, said that the ministry and hospital has to do thorough and compulsory check up of the candidates regardless of which country they are going to, and when such checks are not done, this becomes double work for the agent as well for the candidates.
He said, “This issue is sometime an indirect harassment to the candidate who went to work with an approved MC, and a loss to the country in some ways. If these things are not taken care at the earliest, there is every chance of serious issues in future.”
In addition, he also said that at the end of the day, agencies are being blamed for being irresponsible. “I feel that it is mandate to create awareness program including hospitals, MoH, agencies, MoHCA, etc., because it can curb down such issues in the future,” he said.
Dr Tshewang Tobgay, JDWNRH, said that they conduct the medical screening strictly and as per the requirement set by the host countries. He said, “If they find anything in X-Ray they refer to the chest specialist and to pulmonologist, and until we get the approval from them we do not sign the MC.”
In terms of TB patients, if they have no active infection then usually the host country will accept the person and also they approve the MC, he added.
He said that the duration of MC for overseas is 3 months, and there is a window period to every disease. If a candidate has a clean report today, they may get any diseases tomorrow and this is why it is quite challenging.
With regard to the psychological and mental issues, he said, “There is no particular screening for that. However, if a person has a history of bipolar, depression and anxiety disorder then we mention in the paper. But if a person looks normal, we do not do the mental screening separately.”
A scar in the lungs does not only mean a person has or had TB, it can also mean a candidate is having calcification, viral infection, Chronic Obstructive Pulmonary diseases (COPD), previous infection which is healing, etc.
“As far as I know, we did not come across any person who has come to us requesting for proper medical screening after their return due to medical failure. If they have then we would have done a screening to cross check,” he added.
There is no delay in services because the screenings are conducted the same day when they come for MC and they have a lab technician working the same hour (4pm to 7 pm). The report has to be collected the next day and visit doctor the same evening, he said.
In a day, each doctor is supposed to attend to 60 people for the issuance of MC. However, when number exceeds 100, they then call for additional doctors. One doctor a day is assigned for the said purpose and on a rotation wise basis.
Though Bhutan Overseas Jinzai is still operating, the agent did not want to comment on the issue.
This story was made possible with the help from Bhutan Media Foundation (BMF).