A few weeks ago, the 300th episode of BBC SajhaSawal, an open discussion program, exposed how government-authorized medical clinics in Nepal are issuing fake medical reports by charging Rs 2,625 from each migrant worker.

 

In the program, the owner of one such clinic admitted that they are unable to do a proper checkup as the 2,625 rupees have to be distributed among various groups, including manpower companies that get almost 50 percent of the total amount in commission. 

 

Nepal Health Professional Federation (NHPF), which provides them government-authorized hologram stickers, gets 20 percent; five percent is paid in taxes while the rest pays for salary, rent and doctor charges. 

 

He also admitted that they are permitted to “sign” as doctors who are paid Rs 3,000-Rs 4,000 per month for the use of their signature stamp. The doctor present at the program admitted that his signature had been misused time and again. He also disclosed that the stamps of radiologists were also kept in such clinics, although radiologists never visit the clinics. 

 

The wrongdoers were forced to own up their deeds after a ‘fit’ medical report was produced in the program, which was obtained without any medical tests—the blood and urine tests, as well as the chest X-ray, were fake. Yet the government and other concerned authorities including the chief of the Department of Foreign Employment (DoFE) and the Chairman of NHPF seemed helpless. In the program, they committed to take action against the culprits. But there has been no action so far. 

 

In the preparation for the program, several manpower operators admitted that in many cases they issue fake medical certificates for pre-visa purposes themselves. In the past three months, almost 500 migrant workers have been compensated according to NHPF rules. But there is an equal number who run away in the country they go to work in, after failing their medical tests. Others don’t get compensation as “there might have been an error in diagnosis abroad.” 

 

Dambar Bhandari, 32, of Urlabari in Morang and Krishna Bahadur Karki of Gulmi district are among the victims. They both had a dream of earning a decent livelihood for their families, but their dreams were shattered after they were sent back to Nepal after failing their medical tests in Malaysia and Qatar respectively. Bhandari had spent Rs 120,000 to go to Malaysia and Karki Rs 70,000 to fly to Qatar. They had undergone medical checkups three times in Nepal and were given a ‘fit’ medical report each time. 

 

Karki was sent back to Nepal after 110 days, after the expiry of NHPF’s 105 days time limit to claim compensation; Bhandari was sent back after three days without being given any medical test ‘fail’ certificate. If they are at all compensated, they get only fifty to sixty percent of the total amount. It does not help them much since most migrants would have collected money at 36-40 percent interest from local landlords. 

 

Nepal has sent a record number of workers in the past few years. On average, around 1,500 leave the country every day to work in the Gulf, Malaysia and South Korea. The money sent home by more than 2.5 million Nepali migrant workers is the largest foreign exchange earner for the country. As the country slowly emerges from ten years of civil war, domestic employment opportunities are limited. Finding a job overseas has become a dream for many young Nepalis.

 

More than 400,000 people come into the job market every year; ninety percent of them find employment overseas. Money sent home by workers makes up a big chunk of the Nepali economy. Last year, remittances were worth roughly US $3.5 billion, almost a quarter of GDP.

 

But the government hasn’t taken the issue seriously, even though it has time and again encountered such fraud cases. Last year DoFE exposed at least 301 fake medical reports from around 32 clinics. 

 

In 36 of those reports, only people’s names and photos were changed, all else remaining the same. Some reports also had unusual features like the “not applicable” label on the reports of lady migrant workers and “hemoglobin 2” (which does not exist). But, no one was booked in this connection. 

 

Jobs at DoFE have become the most attractive, like custom and revenue departments. It is assumed that almost Rs 2 million worth of corruption takes place there every day. The recent crackdown of the Commission for the Investigation of Abuse of Authority (CIAA) has hindered corrupt officials a little, but by and large, DoFE is considered safe haven.

 

Even government-authorised clinics lack proper manpower. A few years ago, a study done by Nepal Health Professionals Council, a government body to monitor paramedical doctors, revealed that almost 90 percent of radiologists and lab technicians working in such government-authorised clinics are quakes. They do not have permission to do any medical check-ups.

 

It’s also because Nepal lacks proper manpower. Nepal hardly has 400 trained radiologists to serve almost 1,500 clinics and hospitals across the country. Interestingly, the X-Ray association claims that out of 400 trained radiologists not everyone has a job. Clinics and hospitals are hiring “untrained” medical practitioners who are ready to work for nominal amounts. In addition, there are several government authorised clinics without proper equipments. 

 

The major problem is the lack of a proper government monitoring system. According to Foreign Employment Act 2064, there is a provision for an expert committee led by a senior health ministry official to regulate and monitor government registered clinics. However, it has been almost a year since they last monitored any hospital. The transfer of the committee chief from one place to another has also created problems. 

 

Rather than checking clinics without informing them, surprisingly the committee announces any future check a month in advance. Last month the government plans to monitor and list new clinics went in vain because few clinic operators spoke out against it. The plan has since been scrapped. 

 

There are two groups that conduct medical tests in 205 government permitted clinics—Nepal Foreign Employment Medical Association (NHPF) and Golf Medical Council approved Medical Association (GAMCA). While NHPF charges Rs 2,625 for medical tests, GAMCA charges Rs 4,000, much more than the government-set amount. 

 

The Ministry of Health has issued a clear directive that they can only charge Rs 2,950 for men and Rs 3,125 for women, who have to undergo pregnancy tests as well. GAMCA doesn’t adhere to government law. But the government has been unable to do anything. 

 

Apart from this, in the absence of proper medical checkups, migrant workers are having a hard time overseas. A doctor whom I met in Qatar a few months back claimed that those who had died in sleep in all likelihood had some heart diseases before landing there. 

 

Any preexisting situation gets worse as people have to work in intense heat. Recently the government revealed that at least 726 workers died in last one year in East Asian and Gulf countries, one of the major reasons being heart-related ailments. The government ‘test list’ for migrant workers doesn’t include heart tests. 

 

Until and unless fraudulent doctors and clinics operators are punished and government monitoring strengthened, the problem of poor migrant workers will remain. The government shouldn’t only concentrate on remittance but also think of proper ways to manage it. 

 

The author is an in-depth reporter with BBC’s Sajha Sawal