SINGAPORE: "Mr Zhang", a construction worker in his twenties, recalled how a doctor at a private hospital refused to give him more than one day of medical leave for fracturing his finger about five months after arriving in Singapore. The doctor's blunt explanation was that it was because he was a migrant worker.
"He said: 'You've been here for less than a year, so you don't understand the situation. If I give you medical leave, you might be forcefully repatriated by your employer'."
"Think carefully, I just don't want you to do anything foolish and get yourself in trouble," the doctor advised.
"I believed him, because in my hometown the medical profession is a sacred one. I respected the profession from the bottom of my heart," the Chinese national said.
According to Mr Zhang, the hospital even "guaranteed" that his company would pay him, whether or not he could actually work during the two weeks of "light duty" prescribed following the day of his surgery. However, he has yet to see a cent of this compensation.
Mr Zhang shared his predicament with Channel NewsAsia, while sitting in the office of non-governmental organisation HealthServe, which provides subsidised healthcare and other support for migrant workers.
Three other migrant workers nodded somberly as Mr Zhang told his story. They too, had similar tales and agreed to share them with Channel NewsAsia on the condition of anonymity for fear of hurting their cases against their employers or their future employment opportunities.
"Mr Li" said he was given two days of medical leave for a shattered knee, while "Mr He" and "Mr Huang", who both work for the same company, told Channel NewsAsia they were given one day medical leave each, just for the day of their surgeries, after suffering fractures for an arm and a leg respectively.
Staying in Singapore on Special Passes from the Ministry of Manpower (MOM) while they are treated for their injuries, the workers said they are no longer receiving salaries and go to HealthServe daily to meet their basic needs: Food, medicine and companionship.
"IT HAPPENS SO OFTEN, WE SOMETIMES DON'T BOTHER ASKING": NGOS
The issue of migrant workers given inadequate medical leave came under the spotlight last week when Raffles Hospital doctor Dr Wong Him Choon was suspended for certifying a foreign construction worker with a fractured hand was fit to return to work the day after his surgery.
While the case may have grabbed headlines, there are more like it that have yet to be resolved, NGOs focusing on migrant worker rights told Channel NewsAsia.
The Humanitarian Organisation for Migration Economics (HOME), which initiated the complaint against Dr Wong, estimates that it sees between 15 to 30 cases of migrant workers given inadequate days of medical leave in a year. HOME's executive director Jolovan Wham said this was a problem he had observed since 2007.
Another rights group, Transient Workers Count Too (TWC2), executive committee member Debbie Fordyce said that of more than 100 injured workers that approach TWC2 every month, most of them would have had been given inadequate medical leave.
"I would say that it happens so often that we sometimes don't even bother asking about it," she said.
Ms Fordyce also pointed out that the workers that would approach TWC2 for assistance would mostly have already lodged a work injury claim.
"We can assume that there are many more people that haven't been able to lodge a work injury claim because they've been given very short medical leave, or they may well have been repatriated before they could do anything about it."
She suggested that the underestimation of medical leave required affected not just the injured workers' chances of recuperation, but could also have financial repercussions.
"All of the people that we see have left their dormitories because of a variety of reasons resulting from the lack of goodwill from their employers – maybe attempted repatriation or forcing them out of the dorm – and they will depend on their medical leave wages for support."
HealthServe sees about 60 to 70 workers every year that had been previously treated by doctors but given inadequate medical leave, casework manager Jeffrey Chua said. This is about a third of 200 to 250 workplace injury cases the group sees in a year, he added.
The NGO's communications manager, Nhaca Le Shulze, said the cases usually involve "a fracture or an operation, and the workers are usually given zero to one or two days of medical leave".
According to MOM guidelines, it is a must for employers to report workplace accidents if the medical leave given is more than three days, whether consecutive or not, or if the worker is hospitalised for at least 24 hours.
A volunteer doctor at the HealthServe clinic, Dr Shawn Vasoo, noted that the length of medical leave given was a "judgement call", but said certain cases seen at the NGO's clinics did make some doctors wonder if it had anything to do with helping employers avoid reporting workplace injuries.
The associate consultant at Tan Tock Seng Hospital (TTSH) added: "Some of the medical certificates might be legitimate, but we do see, anecdotally, conditions that in our experience should ordinarily warrant a longer period."
WE'RE NOT AFTER ANYTHING , JUST OUR BASIC RIGHTS: WORKERS
HealthServe has three clinics that provide subsidised healthcare for migrant workers, staffed by 80 volunteer doctors each on duty an average of once a month. It also has 200 active volunteers including pharmacists, nurses, housewives and teachers that provide a range of support services for foreign workers, according to chairman and co-founder Dr Goh Wei Leong.
When Channel NewsAsia visited the main clinic at Geylang on a rainy Wednesday evening (May 18), there were already about 15 to 20 workers milling outside at 7pm, opening time. At the reception area, some volunteers manned the pharmacy while others helped workers fill in registration forms or took their temperature. Two doctors were available for consultation.
The four workers Channel NewsAsia spoke to were initially treated by private doctors, but have since stopped working while being treated at restructured hospitals, which they approached for second opinions on the advice of case workers and friends.
When Mr Zhang went to the Singapore General Hospital (SGH) for a second opinion, the doctor told him that his finger could be infected so badly he might have to amputate it. He got 75 days of medical leave in total for the injury, a world apart from the one day he was initially given.
Mr Li, a stout, spirited man with a crew cut, showed Channel NewsAsia two round scars on his knee, where surgeons from TTSH had drilled holes for an operation to fix his shattered knee.
He fell down a ladder at a construction site last December, and five months later, still needs a crutch to walk.
"When I was first injured, my boss told me: 'Singapore's healthcare system is too lousy. You better go back to China to get it treated, it'll get better faster.'"
But he refused, and his employer took him to a private hospital where he was given two days of medical leave.
In desperation after numerous delays in getting treatment, he called the police on his employers. After this, his employers immediately took him to TTSH. This was three weeks after he fell, Mr Li said.
Mr He said he hurt both his arm and head in a fall at work last September, but the private hospital his employer brought him to gave him only one day of medical leave after surgery on his arm. He was also told his head was "fine".
When the pain became unbearable, Mr He went to SGH on his own to get checked, and doctors immediately gave him seven days of medical leave for his fractured arm. They later advised him to stay in hospital for observation after he complained of continuing head pains, more than a week after the accident. However his employers refused to pay for the treatment of his head ailment, saying that it had not been reported as a work injury and the company had no obligation to cover it.
Mr Huang, who had fractured his leg, said his manager went as far as threatening that if he stayed in the hospital beyond the day of his surgery, the company would make him pay a penalty of S$1,000.
"I was too scared to stay, even though the nurses said I should be hospitalised when my leg kept hurting even after painkillers and injections. But I'm injured and they still want to make me pay. I was scared."
When asked if they would go back to their employers if they had recovered enough to go back to work, the workers unanimously said "no way". "They are too evil as human beings," Mr Huang said. Mr Zhang added that he had heard of cases where after getting injured, workers who had gone back to work were repatriated soon after.
"You may have recovered but there might still be complications ... So the employers make up reasons like saying 'You're lazy, you're bad at your job' to send you back," said Mr Zhang.
But they said they had no thoughts of bringing the matter to court because it would take too long and the cases ultimately might not be resolved.
"I read the case about Dr Wong and it's very similar to mine," said Mr Zhang. "But we're not after anything. We just want our basic rights to be respected, to get back what we're owed so we can survive."
Mr Huang added: "We're looking at the most basic levels of needs as people here. If they would provide for our most basic needs, we wouldn't even want to say anything."
WORKERS OFTEN DON'T HAVE ACCESS TO OWN MEDICAL INFORMATION: NGOs
The NGOs said one major problem in obtaining a just outcome for workers was that many were not given full access to information about their own medical conditions and the medical leave they had been given.
"The doctors don't issue the medical certificates to them," HOME's Mr Wham said. "They are given to employers and when the workers ask the employers, the employers don't tell them anything, so they are also left in the dark."
This happened to Mr Zhang who was under the impression that he was on 15 days' paid medical leave after his surgery, and did not show up for work for a week after he was discharged.
He only found out this was not the case when a supervisor told him to go to the office to give a statement on how the accident happened for company records and a colleague helped translate the attached medical report from English.
HealthServe's Mr Chua said the workers are usually accompanied by their employers, during which time they are often not allowed to say anything. The account of the accident comes from the employer. "Sometimes they even tell the worker to shut up," he said.
According to Mr Wham, the doctors in many of these cases were not only from hospitals but were also often private practitioners.
Ms Fordyce agreed, adding that many of the workers were taken to company clinics within the shipyards they worked at or small private clinics where employers could dictate the number of days of medical leave; tell the doctors not to give medical certificates, or insist they give the workers light duty instead.
These clinics that serve almost entirely migrant workers, are "well aware of the system and ... of the benefit to the employer to give fewer days", she said.
"MAKING A LOT OF NOISE" TO MAKE PROGRESS
At the time that HOME started pursuing the case against Dr Wong in 2011, it had seen a "surge" in the number of such cases. This was what spurred the NGO to "fight tooth and nail" to push to take up the issue, Mr Wham said.
However, a key challenge in such cases is finding doctors who are willing to testify. To get around this, HOME has contemplated civil claims but found itself in a bind as its lawyers advised that it was difficult to get independent witnesses.
Asked why he thought that the case against Dr Wong succeeded when others failed, Mr Wham said: "We started to make a lot of noise about it, and we just filed complaint after complaint ... I was just telling my colleagues: 'Let's just file until they scream!'"
"I had almost given up, I thought they weren't going to do anything. On the SMC website it says it takes six to nine months, but this took five years. When I finally got the lawyers, I could hardly remember the case anymore."
He added that coverage in the media could also have caused the issue to be taken more seriously.
However, when asked about why action was only taken on Dr Wong's case this year, the SMC told Channel NewsAsia that the cases that take a longer time are "not straightforward".
A spokesperson explained the process that takes place after a complaint is lodged: An independent complaints committee is formed to investigate the complaint, and will gather evidence, including getting expert opinions where appropriate, before making a decision. Time is needed for this, SMC said.
Furthermore, if the committee refers the matter to a formal inquiry by a disciplinary tribunal, parties will instruct lawyers, and the various parties will review all the documents and prepare for the hearing, which will again take time, the Council added.
As to why this case was taken up in particular when HOME said it has lodged other complaints to no avail, SMC said each case is assessed on its own merits.
"Some cases may be dismissed for lack of strong evidence of wrongdoing and others may be given a warning. However if the case is considered by the independent complaints committee to be serious enough to merit disciplinary action in a formal inquiry as in this instance, it will be referred to a disciplinary tribunal," it said.
HOME said it is currently pursuing other similar cases with the SMC and had secured tribunal hearings against two other doctors, but declined to disclose details so as to avoid compromising proceedings.
NOT PAINTING ALL DOCTORS WITH THE SAME BRUSH
HealthServe chairman, Dr Goh, a private practitioner himself, said he believed that most doctors try to give medical leave that is appropriate. "We trust the judgment of the first doctor that sees the patient. We honour that. That's why we write in to the doctors to seek clarification ... Usually they're quite helpful."
In some cases, after HealthServe reached out to them, the doctors even revised the days of "light duty" given to full medical leave, Dr Goh added.
TWC2's Ms Fordyce also stressed that by speaking out against errant doctors, the NGOs were not trying to "paint all doctors by the same brush".
The long-term Singapore resident said there should be greater attention and scrutiny placed on "a small number of clinics and hospitals that are guilty of this".
And in cases where TWC2 suspects workers are given an unfair number of days of medical leave, it often directs the workers to restructured hospitals.
"I would say that the doctors at restructured hospitals understand that 'This person is not able to work', and they are less likely to listen to what the employer says or follow the employers' instructions about issuing medical leave ... My personal feeling is that the doctors in those hospitals are very professional and very attentive to the needs of their patients."
She added: "Migrant workers being such a large population within Singapore, and suffering injuries at a much higher rate than the average Singaporean, should really receive greater consideration."