Afzal first came to the attention of Transient Workers Count Too on 22 March 2013, six days after being assaulted by a Thai worker wielding a beer bottle. Just looking at Afzal, you wouldn’t know that anything was seriously wrong. You’d spot a black eye, with a little blood in the white of the eye, and you might think it was nothing more than that.

Afzal and his friend Homayon happened to cross paths with the inebriated Thai worker as they walked along the Kallang Riverside Park, perhaps inadvertently provoking him by looking in his direction.

The police report dated 18 Mar 2013 tells the story like this:

“…we saw 1 unknown male subject believed to be Thai national drinking beer and seated before the underpass. As we were walking near him, he suddenly walked towards us and said in English, ‘Looking what’ and he just swing the beer bottle which he was holding in his right hand… and it hit me on my face and I lost consciousness.”

That perceived goading resulted in the fracture of numerous facial bones in Afzal’s face. The medical jargon of the 17 March report from the Emergency Department at Tan Tock Seng Hospital describes it like this:

Eyes: Left injected, periorbital swelling noted, difficulty opening eyes, direct tenderness on cheeks.

Nose: noted bilatereal nostril bleeding, obvious deviation of nasal bridge to Rt, septum not well appreciated due to bleeding. Traumatic mydriasis Lt eye/nasal bone fracture

Plan to admit to EDTC (Emergency Department Trauma Centre)- head injury path after seen by eye (specialist)

Orbital bone fracture, plan to do orbital CT in addition to head CT

The radiology report of 19 March looks deeper:

“Blowout fracture of the floor of the left orbit with herniation of extraconal fat. No herniation or entrapment of inferior rectus muscle seen. Multiple other facial fractures as described above mainly left-sided.”

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Employer refuses to pay for treatment

When Afzal came to the Cuff Road Project six days later, his employer was threatening to send him back. This was a fight, the boss Gary said, and he shouldn’t have to pay to treat an injury resulting from a drunken brawl. Although the injuries were not the result of a workplace accident, according to Work Permit conditions, the employer is still responsible to pay for medical treatment if the treating doctor declares it to be urgent. The Ministry of Manpower (MOM) requires employers to take up an insurance package of $15,000 for accidents and illnesses that may not be work-related.

afzal_hossen_xrayTransient Workers Count Too’s first intervention was to give Afzal $100 from our Care Fund to attend his next appointment at Tan Tock Seng. Dr. Jack Lee called Debbie Fordyce, TWC2 executive committee member, three times on Monday 25 March to discuss the operation and payment. He explained Afzal’s injury as a complex nasal orbital fracture best treated with surgery within 2 weeks of the injury. Without the operation, Afzal would be able to breathe only through one nostril, the nose would remain askew, the eyeball would retreat without the support of the orbital bone, affecting his vision and distorting the side of his face. Dr Lee had also heard from the employer that he (the employer) was refusing to pay, saying that he need only pay for workplace accidents, and not injuries resulting from fights.

Afzal is a young man, single, the oldest of three siblings, not bad looking. Tan Tock Seng required a deposit of $7,210 before the operation could take place. This was just before the Good Friday weekend, and the doctor was planning to be away for a few days. The doctor stressed the urgency of the surgery before the bones began to fuse in unattractive ways, and he could reserve a slot for Afzal on Thursday morning, the day before Good Friday.

Given the urgency, TWC2 was willing to place the deposit, but would have depleted the CareFund by doing so.

Various opinions within TWC2 were raised:

  • According to MOM, the $15,000 insurance coverage was meant for urgent treatments such as this case, which was reiterated by Kandha (Director Joint Ops Directorate) and Darren (Senior Assistant Director, Claims Management) themselves.
  • We shouldn’t deplete our funds where the employer has a clear responsibility.
  • Pay for the surgery and press the employer to refund the amount.
  • Explore more options; find another donor and we’ll go halves.
  • Find another donor to front the full amount and deal with the employer later.

TWC2 can hardly be expected to step in to arrange for payment whenever the employer fails to fulfil their responsibility. Funds are hard enough to come by for the running of our small operation. We expect that the employers should not be released from their obligation to pay for medical treatment should the doctor declare it to be urgent.
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Checked with MOM

We attempted to confirm that the employer is responsible for these payments by writing to the Ministry of Manpower. Their response confirmed our understanding of the ruling, but did not result in compliance by the employer. MOM’s reply was:

“An employer is required to purchase medical insurance providing at least $15,000 coverage per year for hospitalization and day surgery expenses. This medical insurance will cover non-work related injuries or illnesses as well as work-related injuries.

“We will need more details from the worker before we can make any assessment and follow-ups with his employer. Please inform the worker to report his case at our counter.”

 

Afzal did visit the MOM twice for assistance and was told that the boss must pay for treatment. If the MOM contacted the employer, he wasn’t aware of it. All he knew was that the employer made repeated efforts to repatriate him and continued to threaten him with repatriation.

Fortuitously, an anonymous donor stepped forward to provide the $7,210, and this cheque was presented to the hospital so that the six-hour surgery could proceed, restoring the facial bones with small titanium plates and screws. Afzal was admitted at 7am on 28 March 2013, and discharged the following day.
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Repatriation company at the ready

Debbie was in conversation with the employer, Gary, throughout this episode. Gary had contacted UTR Repatriation Services soon after the accident, leaving Afzal in a panic about his future. Even the day before the operation, knowing that TWC2 had sourced funds for the deposit, Gary was threatening Afzal with repatriation. Afzal had worked for this company less than three months, and had earlier suffered a small injury to his hand that resulted in three days medical leave. Two injuries already, with one resulting from a drunken brawl, was how Gary saw it. This was not a worker worth keeping. Better send him back.

That’s where UTR Repatriation Services is willing to offer their services. The employer had alerted and requested them to locate Afzal and arrange his flight home on the day before the scheduled operation. We briefed Afzal on how to deal with airport immigration should he taken suddenly and forcibly to the airport (contact the airport police before passing through passport control, explain that the injury has not been treated and that an operation is scheduled and paid for.) Debbie also visited the UTR office to explain Afzal’s injury, and request that Afzal be allowed to undergo the surgery and remain in Singapore long enough for the doctor to review the results. The UTR staff agreed to keep hands off until treatment was completed and reviewed by the doctor.
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Surgery went well

After the surgery, you could only see the plastic support to protect and align the nose. The X-rays showed a different picture with six or seven small supports fixing the bones in place, a result of six hours of painstakingly aligning, drilling, fixing and stitching. The doctor had gone through the nose and mouth to reach the bones, leaving Afzal with a painful face and eating difficulties.

The ENT doctor reviewed Afzal on 3 April, and the eye doctor saw him on 4 April. Both were pleased with the surgery and the healing process. The doctors advised him to take care and not engage in any potentially dangerous work for the next few months.

This injury would not result in compensation, as it did not arise out of a workplace accident. The employer would not be able to provide him with light duties in construction that would guarantee no damage to the face. Knowing this, Afzal agreed to be sent home, his last night in Singapore spent in the rooms of UTR Repatriation Services, to ensure his safe passage to the airport on 10 April.

He had been working for this employer barely three months, with debt still owing at home. Like nearly all foreign workers, he had to raise thousands of dollars to get the job in the first place.
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Please help with a donation to our Care Fund

TWC2 depends on the CareFund (click here for more info) for emergencies that are not covered elsewhere in the government regulations. Even though this was clearly the responsibility of the employer, the company refused to pay. MOM might have been able to persuade the company to pay, and the doctor would certainly have penned a note about the urgency of the operation, but that would have run into the holiday weekend. The delay would have meant the facial bones joining in all the wrong places and surgery later would cost more and take longer than the doctor was willing to allow.

Delay would also mean a a greater risk that Afzal might be sent home before receiving treatment, which would be extremely unfair to him.

Having sufficient funds in our CareFund gives TWC2 important resources and flexibility to manage medical treatment that can save a future.