Approximately, 272 million international migrants are living away from their homeland, accounting for 3.5% of the world population. Migrants are prone to experience hardship in settling permanently into their new land, including employment, culture, language, education, government policies and new healthcare systems (Wechkunanukul, Grantham, & Clark, 2014). Interestingly, about two-third of migrants (over 90 million) are working in skilled jobs and may not be adequately insured for healthcare (International Organization for Migration, 2019). Uninsured migrants have to pay their medical bills which is likely to be an excessive cost and lead to financial insecurity (World Health Organization, 2020). To address this health agenda, the World Health Organization has released the Promoting the Health of Refugees and Migrants: the Draft Global Action Plan 2019-2023 with its Priority 2 to “Promote continuity and quality of essential health care, while developing, reinforcing and implementing occupational health and safety measures” (World Health Organization, 2019).
In 2019, more than 7.5 million migrants (30% of Australian population) reside in Australia and about 65% of these migrants are holding temporary visas (Australian Bureau of Statistics, 2020).
In 2017, Jai a 59-year-old man, was working as a chef in a large Asian restaurant in a large city in Australia. He was a qualified chef in his home country and had been offered a temporary working visa to work lawfully in Australia with his boss Mr Tony since 2005. Jai has two daughters, 10 and 15 with his wife who were living back in his home country. He decided to leave his homeland alone to work and send money back to support his family. He had dreamed of a better future for his family in Australia. He thought if he was permanently settled, he would be able to bring his family to live together.
Jai worked with Tony for 12 years on a temporary working visa. His salary met the Fair Work Australia Award Rates (Hospitality); however his working hours were much more than a standard full-time working week. Jai worked from 9.00 -21.30 from Tuesday to Saturday and 17.00 -23.00 on Sunday. The restaurant closed every Monday and that was his day off. He never complained about long hours of work and never thought about it as unfair. He did not mind working hard as it enabled him to keep supporting his family.
Jai was living in a shared house with three friends who came from the same hometown and worked as chefs at the same restaurant. There were six chefs at his restaurant, another two were Asian from different countries. They shared the same life routine, starting work at 9.00am until 10.30pm, smoking during the breaks and drinking 1-2 bottles of beer at the end of the day. On his day off, Jai usually had a lazy day at home to ease the stress and tiredness from his heavy workload throughout the week. He and his friends would normally spend the day on the couch with cigarettes and snacks. Sometimes, they watched movies in their language to entertain their life away from home. Jai rarely went out for shopping or socialised with the community because he wanted to save money for his family, particularly for his daughters. Jai could only afford a ticket to visit his family every two years. It made him feel lonely and he missed his family a lot.
After working in this restaurant for five years, Jai felt like his dream would never come true because his boss renewed his temporary visa and did not discuss the permanent one. Jai and the other chefs talked about their feelings, burned out and emotionally drained from long hours of work and an insecure future. However, they had no choice but to keep working hard for the sake of their families and their dreams.
Jai did not seek professional medical advice or go to the doctor’s if he felt unwell since he moved to Australia because his English was very limited, and he did not know how to communicate with health workers. Additionally, he held only an essential health insurance policy which covered only basic services that made Jai concerned about costs of care and medication. He smoked more often when he had headaches or when he felt feverish because he believed something in cigarettes could help relax and reduce the fever. He sometimes took his friend’s medications or traditional herbs.
In 2017, his temporary working visa was expiring in March of that year and he could not apply for another temporary visa due to the rules of the immigration department. However, his boss agreed to apply for a permanent working visa for him. The decision made Jai feel over the moon as he could see his dream coming true soon. His visa application was lodged in February 2017 and everything went well except for the English language requirement. He was on a bridging visa after his temporary visa expired and he had to pass the English test to get the permanent residence status. Jai felt completely stressed and hopeless with his English as he had very limited English which was basic and got him through simple communication at work He had no time to study or train to improve his English nor the means to afford paying for language school.
While he was fully stressed with visa and work issues, his wife called him to discuss their younger daughter’s behavioural problems. Jai faced a heavy burden in his life , and it made him feel down, sad and hopeless. He smoked more often and drank 4-5 beers each night to comfort himself.
It was in early April that Jai woke up and felt a little funny on his left arm and leg. He went to work as usual, but he made many mistakes and could not focus well on his duties. His friends noticed Jai was a little slow and looked unwell, and they suggested for him to go home. Although Jai felt something wrong in his body, but he kept working to impress his boss that he was fit for work. Also, he was afraid to pay expensive medical costs and thought it may be due to too much beer from the previous night. He finished work at 10.30pm and went home with his friends as usual. At 11.30pm before going to bed, Jai suddenly felt numb on the left side of his body from head to toe, he was completely shocked with the sudden weakness of his body. He could not see anything properly and tried to call his friends for help. He could not control his lips and his voice was very soft and sounded strange. Luckily, his friends walked pass and grabbed him before Jai reached the ground. His friends thought Jai had a serious condition and drove Jai to the hospital nearby. They did not call an ambulance because they believed using their car was the fastest option and they were also concerned about the high cost of ambulance services.
Jai arrived at the Emergency Department of a large public hospital where full health services and specialist care are available. Jai was diagnosed with a stroke because he had a blockage of blood flow in his brain. He was sent to the operating theatre for urgent brain surgery to save his life. Nurses and staff were unable to acquire the necessary health and social information from his housemates nor gain all the required consent to offer health services. Unfortunately, there was a language barrier and differing attitudes to health care between two cultures created ineffective communication. Special treatment and appropriate health services were provided nonetheless based on the ethical principle of health care.
While Jai was in the operating room, his friends and colleagues were gathering in the waiting area with many concerns and high levels of stress. They discussed how much the treatment costs would be and how Jai could afford it. They wanted to share his burden, but they were also migrants with small amounts of savings. Even if they collated all their savings, it would not be enough for the costs. They knew that Jai was uninsured because he was in the gap between visa processes. They felt deeply sorry for Jai and also for themselves. As migrants they felt like they had less value, less power and were living below the locals.
They were worried about the outcome of the brain surgery and whether Jai would survive. If he became permanently disabled, how would he pay for living costs and who would look after him. In the worst case, if he did not survive the operation, how would they organise a funeral for Jai and how would they send him (Ashes) home and how much would it cost? They felt deeply for Jai but were also thinking about themselves if something should happen to their life.
Tony (the restaurant manager/owner) was contacted by the hospital to consult about costs of care, but he said the cost was too high for him to support. Jai’s situation would not be covered by his work as it happened outside the workplace and work hours and was due to a non-work-related health issue.
Jai was facing the situation where he did not have health insurance, and he was not covered by the Medicare system because of his visa status. His access to his superannuation (retirement fund) was restricted due to his age.