Written by Shao-Yun Chang (張韶韻) and Hang-Tang Chen (陳翰堂).
“Tell them, Lily! Tell them about the time you called at midnight and talked my ear off about seeing Jesus.” Lily laughed nervously as her Taiwanese friend AJ pressed on about converting from Islam to Christianity. Lily first came to Taiwan from Indonesia more than five years ago as a domestic caregiver. She soon met her then-boyfriend (now husband), who was a devoted Christian from Thailand. Lily denied that her husband influenced her decision to convert. “We went to church on our dates! I didn’t believe what the pastor was saying.” When her initial contract ended two years ago, she decided to transition to a manufacturing position. On average, manufacturing positions not only pay better than domestic care work, but their work schedules are also slightly more flexible than caregivers who live with their employers 24/7. Lily was also frustrated with having to urge her client to do home exercises per doctor’s order, which her client was reluctant to follow.
Migrant workers like Lily emigrate from Southeast Asian nations to fill many positions in Taiwan. Since their labour was first viewed as a supplement to the domestic labour market, Southeast Asian migrants have become indispensable to the manufacturing, agricultural, fishing, and care industries over the last three decades. While the initial foreign population was primarily Thai and Filipino workers, Vietnamese and Indonesian workers are now taking over factory jobs, farm work, and caring for seniors and the disabled.
Before emigrating, brokering agencies in home countries assign migrants to employment positions based on their gender, physical fitness, and level of education to undertake different jobs. Migrants are then charged a brokering fee, often more than 4000 US Dollars, and given basic language lessons and training programs prior to departure. Migrants in Taiwan are required by law to sign a three-year contract with their respective employers. Should migrants decide to quit due to adverse working conditions or personal health issues, they are given little time to find new employers or risk deportation. To legally change jobs, migrants must wait until the end of their three-year contract and then work with their brokering agency to seek out new positions.
No Time and Space for Care
After her initial contract ended, Lily’s brokering agency was able to relocate her to a factory that manufactured wood pallets. While the factory paid better and she was living much closer to her husband, making pallets was extremely laborious. Lily was a little over 5’ tall but was put in charge of moving deck boards and hand-assembling using air nail guns. “There was this older lady at work, and she worked so fast with nail guns. She said I should work faster but the equipment was really heavy,” said Lily. A few months into the position, Lily began to develop wrist pain in both hands. “The pain gets worse at night. It feels as if a thousand needles were poking my palm. I can barely sleep and go to work feeling exhausted. I worry that I would make mistakes and hurt myself.” While there were no visible injuries on her hand, Lily held up her palm and pointed where the pain was. When asked if she sought medical advice, Lily said her brokering agency had been taking her to acupuncture appointments, but their treatments were not effective. She explained that they also went to a “big” hospital and the doctor advised surgery. “Can you imagine surgery on my hand? How would I be able to work? What would my employer think of me?” Lily exclaimed as she showed me her chat history with the doctor on her phone.
While migrant workers like Lily are eligible for universal healthcare in Taiwan, healthcare resources are not always accessible or viable. As migrant workers enter contracts with their Taiwanese employers, their labour rights are governed by Labour Standard Acts, much like those of Taiwanese workers. Workers are required by law to work no more than eight hours a day and to be compensated by their employers in the advent of occupational diseases.
Despite legal safeguards, migrants remain vulnerable because of their working conditions and relationship with employers. On weekdays, factory workers like Lily shuttle between factories and their dormitories. Some even work overtime to pay off brokering fees and send remittances to family members back home. Sundays are their only day off, but almost all clinics are closed. Unless their ailments severely hinder their ability to work, most workers endure physical discomforts. Healthcare is even more inaccessible for domestic caregivers and foreign fishermen since both work in isolated locations. Caregivers are confined to their employers’ houses, while fishermen spend long hours on fishing vessels. Leaving their work sites is extremely difficult. Since migrants are tied down by contracts, negotiating with their employers is often fruitless and may even jeopardise their ability to safely work and stay in Taiwan.
When migrants do find time for healthcare, medical institutions often fail to meet their needs. In Taiwan, clinics, pharmacies, and hospitals are still oriented toward the Mandarin-speaking mass. For migrant workers with a limited understanding of Mandarin, the thought of seeing a doctor is extremely daunting. Making an appointment over the phone is hard, let alone explaining their symptoms to a doctor. How does one talk about pain? Would the doctor take their pain seriously? Ideally, brokering agencies assist workers with accessing healthcare as detailed in their service package.
In reality, agencies lack incentives to follow up on workers’ medical conditions, and they are not penalised for ignoring workers’ requests. Some may even add a surcharge for transporting workers to medical institutions. In severe cases, such as workers contracting fatal diseases or revealing pregnancy in their third trimester, migrant organisations and faith-based organisations may step in to provide help and care. In addition, organisations can sometimes offer temporary shelter should workers decide to leave their employers. However, resources from organisations are insufficient to make up for the lack of access to everyday healthcare.
Finding Health beyond Healthcare
During one of her sleepless nights, Lily suddenly had a vision of Jesus. “I was tossing and turning in bed. Suddenly I saw a hole emerge on the wall next to me. Light shone through the wall and lit up the whole room. I thought this must be it.” She immediately called her husband and her friend AJ about the surreal experience. Lily also became proactive about going to church on off days and would even tell her family in Indonesia about her new religion. “If anything, I think I became less temperamental and was able to work through the pain.” Lily said her wrist pain comes and goes, but surgery was not an option.
Challenges in accessing healthcare do not render migrants helpless. The purpose of outlining struggles is to make sense of how, despite legal safeguards, healthcare is at a premium for Southeast Asian migrant workers. Moreover, one might ask if health is to be obtained beyond healthcare. If that’s the case, what does health look like for migrants? Can others, especially migrant organisations and medical professionals who intend to intervene, recognise and empathise with these understandings of health?
During the authors’ conversation with Lily, another colleague suggested that she follow up with a CT scan and not rely too much on prayers. While the colleague volunteered to put her in touch with a medical professional, Lily never reached out for more medical advice. Medical scans were not a means to an end for workers like Lily since there was no end in sight in navigating the healthcare system. On the other hand, Faith communities offered solace that was more mobile and flexible – not only did Lily bring prayers to work and bed, but she could also seek care from church on Sundays.
In addition to religion, workers find creative means to care for their health, such as purchasing over-the-counter medications at unauthorised Southeast Asian shops. Rather than evaluating their effectiveness in healing or curing, the authors underscore how these approaches might challenge imaginations of health. Is it possible to perceive plural means of health beyond healthcare, especially among non-citizens? For the academic audience, the experiences of migrant workers invite an in-depth understanding of how state-based healthcare systems shape (un)healthy migrant bodies. Activists might also take stock and evaluate how intervention plans work with, not against, migrants’ own creative approaches.
Shao-Yun Chang (張韶韻) is a PhD candidate in Anthropology at Tulane University. Her research looks at the racialisation of Southeast Asian migrants and addresses alternative ideas of migrant advocacy. She is also the co-founder of Listener, a collaborative project in Chiayi that provides Southeast Asian migrants with legal, medical, and mental health resources.
Hang-Tang Chen (陳翰堂) is a PhD candidate in international politics at National Chung Hsing University. His research interests are transnational migration and management of Southeast Asian workers in Taiwan. He also works at 1095 Cultural Studio in Taichung, focusing on human rights education and promoting multicultural understandings.
This article is published as part of a special issue on Health Justice in Diversity.