Long working hours, coupled with improper diet and living conditions are the main causes of students contracting Tuberculosis (TB), according to students who are in Japan under the Learn and Earn Programme (LEP).
In an earlier interview (13 April 2019), The Bhutanese reported 30 cases of TB among the students in Japan. It is suspected that of the 30 students who got TB, 60 percent of them got infected through one Bhutanese in the same school due to cramped living conditions and other factors.
The students said they were sharing rooms which were already congested, were not getting enough sleep and depending mostly on instant noodles for sustenance.
In order to cover their expenses, including loans and school tuition fees, they had to sacrifice their weekends and their vacations. They also shared that few of their friends were deported back as they were caught working two jobs at a time.
“But it is difficult to get the required amount with one job,” one student said, adding that students were aware they had to work hard, but did not realize it would be this challenging. No matter how hard they work, they could hardly pay their tuition fees, forget about paying loans and sending money home.
The medical record of Sonam Tamang, 27 years, who is in coma for past one year show she is diagnosed with Tuberculosis meningitis (multi-drug resistance). She was admitted in a Japanese hospital in September 2018.
As per her mother Dhan Maya, Sonam Tamang did not have any illness before leaving for Japan. “If I knew that my daughter has any disease while in Bhutan, I would not have let her go. She did not complain of any illness,” she added.
According to Sonam Tamang’s friends in Japan, she was hardworking and would skip meals to earn extra money. This way, Sonam Tamang was able to pay her monthly loan without fail and was also sending money home to her family. “Maybe that is why she got TB, since she couldn’t take better care of her health,” said a friend.
Another 30-year-old TB patient who is a student in Japan under LEP said he slept only few hours. “It is difficult to attend classes and work,” he said. “I worked in a factory and I woke up at 4 AM as my work starts at 5 AM.”
He attended classes after work and usually skipped lunch which was the one hour break to work on assignments. He has completed his language studies, however, and is waiting for his working visa.
The 30-year-old said that during their summer vacations they had to work from early morning till night to cover up their tuition fees, phone bill, electric bill, rent, water bill, food, health insurance and loan.
“If we skip a single day then we fail to pay those bills. I worked hard sacrificing most of my meals and sleep. I lost weight drastically and may be that is why I got TB. However, I have completed my medication and I am hoping that I could do better if I get my working visa,” he added.
Another 27-year-old, Dorji said that he contracted TB when he was in Japan and he has now completed the medication course in Japan. He said he shared a single room with three others. The apartment had one toilet and a kitchen.
Another student, a 28-year-old, contracted TB from her friend. “Some of us, including some Japanese students and teachers got TB from him,” she said, adding that she had completed her six-month medication course after which was supposed to screen for TB again. She has not done her screening and is back in the country.
Yet another student who got TB said patients were given the choice to undergo the six-month TB medication course or stop it before the course is completed. “I stopped medication after few months,” she said. “I stopped thinking that complications would arise in future, since I am anemic.”
Students said that no proper medical screenings were carried out in Bhutan. They were issued a pink Medical Certificate (MC) which was meant for employment purpose in Bhutan and not Japan.
One of the students said that doctor on duty asked him the purpose for MC whereby he said it is for Japan LEP program.
“The doctor asked me to get different form for MC (for Japan) from the counter but I told him the same thing which was shared to me by the agent. The agent (BEO) had said that it is okay to have the normal pink MC for the program. The doctor then issued me the MC without further enquiry,” he added.
He said that the Bhutan Employment Overseas (BEO) agent in the beginning told them that the agent will carry out a throughout medical screening of the students whereby they will be disqualified if found with any diseases.
In addition, he said, “They asked us to remove any tattoos on our body and thereby some of them did. The agent also said that they will do drugs test. However, at the end nothing was done and we went to Japan with the pink MC.”
Students have shared that after reaching Japan they were made to undergo compulsory medical screening and if diagnosed with any diseases, the students had to undergo the treatment.
The Medical Superintendent (MS) of JDWNRH, Doctor Gosar Pemba said the requirement for Japan is blood, urine and X-ray test which is to detect TB and HIV among others.
“We usually get blamed saying we did not check the person well before issuing the MC,” he said. “TB can be negative while he or she undergoes the screening and it can get activated after reaching the destination countries due to various factors,” he said.
“Not only in Japan, but there are people who got TB in Australia due to various reasons,” he added.
He said that in Bhutan most of the people already have TB in their body whereby it may become active when one’s body gets very weak.
He said a person can catch TB due to harsh working conditions, no proper diet, weight loss, depression and more. “Of all, it depends upon the person’s immune system and they cannot guarantee 100 percent that a person won’t get TB in a lifetime,” he said. “If a person with low immune system sits next to the TB positive person, the TB will then get transferred.”
“Hospital alone cannot take the responsibility,” he said adding that people should be honest.
He said, “Students who went to Japan must have gone to see the doctor with the pink form which is why they must have approved the MC thinking that it is for employment for in-country purpose. Otherwise they would have done the screening as per the requirements by the Japanese.”
The students, however, says that they did inform about them going to Japan.
The experience of the Bhutanese students in not a unique case as the LEP program students from other countries like Vietnam, Nepal, Philippines and others show similar examples of students falling sick, dying and even killing themselves in some cases.
The very program was found to be fundamentally flawed but what made it worse was unethical practices by agents and language schools.
Of around 700 students in the LEP program in Japan two died (one was a suicide), one was a coma cases, two were paralysis cases, 30 were TB cases, two were mental breakdown cases and there were other trauma cases too.
This story was made possible with support from Bhutan Media Foundation (BMF).