| Poverty and Illness: A Vicious Cycle | ||||||||
Refugees dread being unwell. If they are sick, they put off going to the doctor because they are too poor. In 2005, the Tzu Chi Kuala Lumpur and Selangor branch and the United Nations High Commissioner for Refugees signed a memorandum of understanding to provide free medical services to refugees in order to keep them from being hit by the double whammy of poverty and illness. One day in Kuala Lumpur, Ellyas Biri Soyad, a Burmese refugee, was weeding a garden when a stomachache forced him to stop. He had been bothered by this ailment for quite some time and had gone to public hospitals several times for treatment. The hospital visits and various tests cost him a lot, but to no avail—the doctors could not identify what was wrong with him.
As a result, he was not very motivated to make another visit to the doctor for the pain. He wanted to tough it out despite the fact that the ache had now also reached his waist and back. Money, to be sure, played a part in his reluctance. He had to keep working because his wife and children back in Burma were waiting for him to save enough money to get them out of the country. The thought of making money for their future reunion strengthened his desire to work through the pain. He wiped off his cold sweat, picked up the hoe, bit the bullet, and went back to work.
From Burma to Malaysia Ellyas used to live in Rakhine State, Burma. Though he worked hard, his Rohingya ethnicity often prevented him from getting paid. He could hardly feed or clothe his four children. His eldest son even died from a skin condition at the age of eight. He pondered the unjust treatments he had been subjected to in his homeland and longed for a better future. When he heard about job opportunities in Malaysia, he weighed his options and made up his mind. He asked relatives to look after his family, and he left for Malaysia in 2005, at the age of 23.
With the help of a human smuggling outfit, seven people, including Ellyas, walked or rode automobiles and took whatever routes necessary to avoid law enforcement personnel on their journey to Malaysia. They went through India, China, and Thailand before eventually setting foot on Malaysian soil. Ellyas had no choice but to work as a laborer in this new land. He spoke not a word of English, and he had no marketable skills. He did yard chores or cleaning work in exchange for a small income. He spent his hard-earned money only when he absolutely had to, and he saved everything else. He called his family just once a year. He had to pinch every penny so he could speed up the day when they would be able to come to Malaysia. He worked and saved the best he could, year after year, and yet still he did not have enough. During his sixth year in Malaysia, his stomachaches often prevented him from working. No work meant no income, and that really worried him. He was afraid he wouldn’t live to see his family again. He continued to work whenever he could, and finally, in July 2013, he paid 14,000 ringgits (US$3,630) to human traffickers to get his family out of Burma and into Malaysia. That amount included 7,000 ringgits that he had saved in eight years. He borrowed the rest of the money from friends. His wife and their children took the same tortuous route to Malaysia as he had. Their third daughter got sick en route, and her fever raged unabated. But they could not see a doctor, and she died before reaching Malaysia. In September 2014, Ellyas was finally diagnosed with appendicitis and underwent an appendectomy. What was usually a routine operation was followed by an infection and hospitalization. A large area of his skin and muscle was removed. “The doctor told me that I had to have the wound cleaned every day,” Ellyas said. After he was discharged, he went every day to a clinic near where he lived to have his wound cared for, at a cost of seven ringgits per visit. Without any income, even seven ringgits was a great expense for him. He would have loved to skip those daily clinic visits, but he could not risk the wound worsening or becoming infected. He could not afford to die. His family needed him.
Sick, now what? The hardships that Ellyas and his family experience in Malaysia are quite typical for refugee families there, most of whom come from Burma. It is hard enough for them to make ends meet on a good day. On a not-so-good day, such as when a family member falls ill, it is just about beyond their ability to manage. A sick person can plunge a poor family into an endless vicious cycle of poverty and illness. To address the refugee problem in Malaysia, the UNHCR convened a meeting of international NGOs near the end of 2004. The organization pointed out that refugees in Malaysia had unseated Indians as the third largest group of people in the country. Though refugees had become a primary source of labor in Malaysia, they were otherwise ignored and were not being accorded with just wages. They worked for low pay and were forced to live in dilapidated housing. They generally suffered from malnutrition. When they got sick, they often had nowhere to go for treatment. In refugee detention camps, 40 to 50 people shared a room. It was very easy for diseases to pass from one person to the next. When the refugees got sick, they did not usually have the freedom to leave the camp to obtain medical help. Therefore in 2005, Tzu Chi volunteers, with permission from camp managers, started to provide on-site medical care once a month at three detention camps: Lenggeng in Negeri Sembilan, Semenyih in Selangor, and Bukit Jalil south of Kuala Lumpur. Sometimes volunteers brought food to the refugees as well. In 2006, Tzu Chi volunteers extended those services to refugees living outside the camps in the bottom echelon of society.
Jobs were abundant around Jalan Imbi, a major road in Kuala Lumpur. Many refugees worked and lived in the area, so volunteers rented a place there and started providing refugees with free medical services in internal medicine, surgery, and dentistry. There was even a pharmacy. The UNHCR helped recruit refugees who spoke Malay to interpret for patients and care providers. Non-medical Tzu Chi volunteers ensured that the refugees felt at home and that things ran as smoothly as possible. The free medical services were very well received, and the news quickly spread by word of mouth. Soon even refugees from Penang in the north and Johor in the south would travel to Kuala Lumpur, spend the night with a friend or at a refugee association, and go to the free clinic first thing the next morning. This mode of providing medical care won over the UNHCR. Since 2007, it has funded the free clinics operated by Tzu Chi. The Buddhist Tzu Chi Free Clinic located on Jalan Pudu, another major road in Kuala Lumpur, is a permanent, well-equipped facility that occupies the top two floors of a five-story building. It was established to provide medical care for the needy in Malaysia. In March 2010, after a great deal of work, volunteers finally obtained permission for the clinic to provide care for refugees as well. Many refugees live in the communities that surround this free clinic, which is also within walking distance of Jalan Imbi and is easily accessed by public transportation. Consequently, the medical services on Jalan Imbi came to an end.
Companionship Medical care providers must have a way to communicate with their patients. With the help of refugee associations and the UNHCR, Tzu Chi volunteers have employed some refugees to act as interpreters. Dr. Foo Seay Liang (٢إ$'(}), one of the physicians at the clinic, even arranged for them to attend fundamental nursing courses so they could better assist doctors.
Alice, 44, is one of these assistants. She arrives at the clinic early each morning to get the consulting rooms ready and to tend to the people who are waiting in line for service. She left Burma for Malaysia in 2010 with her mother and younger brother. He broke his leg at work one day and was operated on at the clinic, but he still lost some mobility. He became deeply depressed as a result. Tzu Chi volunteers frequently encouraged him to accept his life’s new reality, and he gradually turned the corner. Alice is glad that she can now confer with volunteers and colleagues at the clinic whenever she runs into problems. “I feel my life is more settled now,” she said. Lee Mun Yeng ('چ٠ز<v), a Tzu Chi volunteer, is a constant fixture at the clinic. She often invites Burmese medical assistants to meals when they get off work at the clinic. She asks how they are and offers them help. “They’re all outlanders,” she said. “Though they’re here for different reasons, they all face the same predicaments. I just want to help them feel a little more at home.” She knows that she cannot help every refugee, but she also knows that if she helps the ones around her to stand on their own, they can in turn help others. She continued: “A few earlier assistants moved to other countries where they were granted asylum, but they all stay in touch.”
Health first By October 2014, Ellyas Biri Soyad, who had had the appendectomy in September 2014, was no longer able to afford his daily visits to a clinic to have his wound cleaned. That clinic referred him to the Tzu Chi Free Clinic. Dr. Foo examined Ellyas, and he saw a wound that spanned a large area of his abdomen, a nasty-looking sight. He quickly got another physician to take a look too. The doctors were certain that the wound could not be sutured, so they could only let it heal itself. Dr. Foo removed the stitches that had remained there since the surgery, and he told Ellyas to return to the clinic to clean the lesion every day to stave off infection. Ellyas seemed bothered by that request. After inquiry, volunteers found out that Ellyas had been out of work for a while and had used up all his money. He was two months behind on his rent of 600 ringgits a month, and he was not sure if he and his family could continue to live there. Volunteers made an appointment to visit his home. On a sunny day, they arrived at a serene residential area located in Pandan Indah, a Kuala Lumpur suburb. Mature trees cast their cool shade. The volunteers entered a building that was unusually run-down for that neighborhood. Inside, they were greeted by an abhorrent smell of decaying garbage. The walls were heavily stained and the elevator was so rusty that it gave off an air of menace. The building had never been completed. Construction had been halted more than a decade ago for lack of funds. Some time ago, Burmese refugees found their way into it and began living there. Then a purported landlord appeared, claimed that he owned the place, and started collecting rent from them. Some refugees subleased their units to reduce the burden of their rent. The building, a place that most people shunned, became a home away from home to many refugees. The volunteers went up to the second floor, where Ellyas and his family were waiting. His youngest son, Mufizur Rahman, came to the iron gate at the front door but did not unlock it. He looked out at the visitors, turned back to look at his father for permission, and then reached his hand through the bars to open the padlock and let the volunteers in. The walls inside the apartment, as stained as elsewhere in the building, encircled a stark interior. A worn sofa was flush against a wall. The kitchen was behind a hanging cloth that served as a partition. Ellyas and his wife, Shajan Begum, both looked melancholy. Witnessing her husband lose heart in the wake of the surgery had grieved her heart and worried her. Volunteers decided to help defray the cost of Ellyas’s daily commute to the clinic. They also gave the family enough cash to last them about a month. Ellyas thus went to the clinic every day for treatment. A month later, the lesion had gradually healed and no longer looked so grisly. Despite the scars, he was able to return to work. When volunteers visited their home again in March 2015, they found a much more cheerful Shajan Begum. Their second son, Azizur Rahman, 13, was learning English from a neighbor, and Mufizur Rahman was attending a refugee school. Things were looking up, and their home, though still as bare as ever, was beginning to feel more homey.
Guardian angel On Sunday mornings, the dental service at the clinic is reserved for refugees. There must be a serious, unmet need for the service because there are often long lines of people waiting outside the building on those mornings. On this Sunday morning, a father and his two daughters were the first in line, leaning against the wall to rest. The older of the girls, 17, said with a smile, “My sister’s not feeling well. In order to be seen sooner, we left home at five o’clock, changed buses a couple of times, and got here at 6:10.” A young mother was behind them in the line. She was holding her daughter in her arms, who was wriggling restlessly because of her toothache and fever. The mother soothed her and checked frequently to see if the clinic had opened. Not far from them, a mother and her son and daughter were walking hand in hand towards the clinic. They lived nearby. This daughter had a toothache, too. Like guardian angels for sick needy people, the volunteers at the Tzu Chi clinic help the underprivileged in society become healthier. With their health, refugees are better able to strive for their goals and improve their lives.
What Would I Do?Narrated by Dr. Foo Seay Liang Compiled by Qiu Ru-lian
I first got involved with Tzu Chi when I was studying medicine in Taiwan. I even joined the Tzu Chi Collegiate Association there. Then I came back to Malaysia to practice in a public hospital. I was too busy at that time and did not have time to spare for Tzu Chi.
When I was in the process of moving to a private hospital, I reconnected with Tzu Chi at a Jing Si Books & Café store. Volunteer Lee Mun Yeng knew that I was a physician, so she invited me to volunteer at the Tzu Chi Free Clinic. I started there in early 2013. Soon I found that many patients with chronic conditions would forget to come back for follow-up visits. Therefore, I initiated a change. Now such patients leave our clinic only after the appointments for their next visits have been made. This has improved the situation. As follow-ups improve, so does their health. The clinic does not have a regular physician staff. Instead, doctors from the Tzu Chi International Medical Association fill its schedule slots. I started with one day a week, which gradually crept up to two days and then three days. Now I come here four days a week. My job at the private hospital seems more like a part-time thing now. I have tried to stand in refugees’ shoes. I think, “What would I do if, like a refugee, I didn’t have a legal identity, couldn’t work legally, and couldn’t go to school? Would I be able to carry on?” I don’t dare to think very far down that line, nor do I have an answer to that question. I have been with the clinic for more than two years now. During this time, I have often thought not of what I’ve given to my patients but of what they have taught me. A young woman once brought two elderly people to the clinic. I referred them to a public hospital because their conditions were quite serious. A couple of weeks later, she returned with two more sick persons. For the same reason I referred those patients, but this time she cried. It turned out that none of those people were related to her. She had picked them up in a marketplace or on the roadside because they were from Burma, her own homeland. They were all infirm, and they had nowhere to live. She took them home and sheltered them. The six people in her own family lived with close to 20 such fellow Burmese. They all lived on one salary, the 900 ringgits that her husband brought home every month. Refugees had to pay their own way at public hospitals, so she cried when she saw the referrals again in my hand. After learning her story, I asked myself: If I were in her place, would I do the same thing? Would I take an unknown countryman home because he or she was sick on the roadside? I didn’t have an answer. Whenever I feel agitated or tired, I recall this story, and it keeps me going. I admire the woman’s spirit: Even though she can barely scrape along, she shares what little she has with other needy people. I tell myself that if I help a patient regain his or her health, I can perhaps help a family get a chance to survive in a strange country. |
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