On the Run June 5, 2012Posted by Nazneen Uddin in Luce, Malaysia.
Tags: healthcare, Kuala Lumpur, refugees, UNHCR
Never judge a book by a cover. And never judge a country by its looks.
The several, newly built skyscrapers that glitter amidst lush greenery and the well-paved roads, high speed public train lines, and clean streets makes Kuala Lumpur seem too pristine to be true.
Malaysia prides itself on being a middle-class country, and upon seeing the skyline at first glance, I thought it would be difficult to find a medically related placement that would satisfy my intended goal of serving the undeserved population.
However, I quickly came to learn that amidst all this glitter, there were gaps that needed to be filled.
One such gap is the rising population of refugees, with estimates from the United Nations High Commissioner for Refugees nearing 100,000, primarily from Myanmar, but also Sri Lanka, Somalia, and Afghanistan. What makes the situation especially delicate is that Malaysia is not a signatory to the 1951 UN convention for refugees, and as such, their presence in the country is a delicate one. Many of them are assaulted and robbed by locals, face harassment from cab drivers, or are put in detention centers by police authorities, even if they hold a UNHCR card.
I joined one of the NGOs that runs a clinic for the refugees and every day, I am astounded by the cases that come through the clinic. Designed to be a family medicine primary care clinic focusing on preventive health, it is more or less like an emergency room or urgent care center. Because of the language barrier, the high cost of medical care, or fear of being caught by authorities, the patients are often scared to seek medical attention in the local hospitals. So by the time they come to the clinic, their clinical presentation is often very advanced. I’ll never forget one Burmese man in his mid 20s who presented to the clinic with fatigue. On further questioning, he had diarrhea and chills and on physical exam, he was in acute distress with a high pulse rate and respiratory rate. He also had a rash distributed throughout both arms and oral thrush. Suspecting HIV, we did a rapid test which was positive, and immediately sent him to the hospital for further work-up.
Occupational injuries are also very common. Many of the refugees work in very challenging, high-stress environments such as plantations, factories, or restaurants. They work long shifts, have extremely low wages, and little, if any benefits. I never would have thought to do this at first, but now I examine every patient’s hands, as many of them have missing digits from being cut in a machine, or have rashes from washing dishes or cleaning with bleach without the use of gloves as it will “slow down” their work.
Moreover, many of them have a past medical history, such as a congenital heart condition, TB, or a fracture that was neglected in their country of origin because of the lack of adequate healthcare or loss of follow-up given the unpredictability of their life. I remember seeing one man in a mobile clinic we ran in a rural farm who was walking crookedly because of a childhood accident–it had resulted in a tibia fracture that never healed properly. Despite all the pain, he continued to work in the plantations.
Given that many of the refugees live in pocketed areas, cannot open bank accounts, and cannot speak the local language, they are especially vulnerable to assault. I’ve seen everything from deep head lacerations, black eyes, lost teeth, and knife wounds for what amounts to a mere 15 USD or a cell phone. One young man lost his sight, voice, and has both hands disfigured from a severe burn because an official, at a detention center he was held at for not having a UNHCR card, asked him to change a light bulb but did not turn off the fuse first.
Mental illness is also quite common. We were astounded to find one of our long-term patients experiencing uncontrollable convulsions from ingesting insecticide as a suicide attempt. A Sri Lankan native, the suffering this man faced in his country and the continuous stream of struggles he faces in Malaysia were more than what he could bear.
Interestingly, the word for refugee in Malay is perlarian, which literally means “a person on the run.” I will be forever indebted to each of the patients. Not only did they teach me more about their medical condition, but they taught me how brave and resilient the human spirit can be when running away from oppression and injustice.