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This is a speech given by Nicholas Harrigan, a member of TWC2’s research subcommittee, at the ‘Health of Migrants and Refugees Workshop’ in Kuala Lumpur, Malaysia on 10 November 2017. This workshop was hosted by United Nations University – International Institute for Global Health. Attendees and speakers came from across South East Asia and included academics, civil society representatives, government officials, and officials from international organisations such as the Iinternational Labour Organisation and the International Organisation for Migration.
By Nicholas Harrigan
I want to start by thanking Dr Nicola Pocock and the organisers and funders of this conference. It has been a tremendous opportunity for sharing, learning, and networking.
I hold two positions of relevance to this conference: Assistant Professor of Sociology at Singapore Management University – soon to be moving to Macquarie University in Sydney – and I am one of three research coordinators for the research subcommittee of Transient Workers Count Too – TWC2 – a migrant worker NGO in Singapore.
However, what I say today is in my personal capacity, and are not the views of any of these organisations.Singapore, as most of your know, has a population of about 1 million low waged migrant workers from the developing world – nearly 30% of its entire workforce. The major countries of origin are Malaysia, China, Bangladesh, India, Philippines, and Indonesia.
Over the last 4 and a half years I’ve lead studies that have conducted quantitative surveys of over 2000 migrant workers, and qualitative interviews of over 300 workers, and these have been published in several policy reports and academic papers dealing with mental health, workplace injuries, and generally the working and living conditions of low wage migrant workers in Singapore.
The question for this talk is “How can we best bridge the academia – NGO divide in migrant health research?”
I want to suggest four answers to this problem:
I think we need to start by being honest about the different cultures which academics and NGOs have – both in general and around research.
For many academics, there is – if we can generalise and stereotype – a perception of NGOs as staffed by people who want to shout and who appeal to emotion before facts and logical argument. There is a frustration that NGOs are not meticulous about all their research. And there is a fear that NGOs are focused on results and social justice, not necessarily the truth. There is often a feeling that NGOs can ask academics to take on lost causes. There is a sense that NGOs don’t understand how much an academic might be sacrificing by associating themselves with an NGO, and also a sense that NGOs are not respectful of boundaries academics set – putting key relationships with other policy players in jeopardy.
Conversely, for many NGOs people, their perception and lived experience of academics as people who are often too detached from very pressing social issues. There is a sense that academics lack empathy with the immense and immediate suffering of migrant workers. They are seen as parachuting in, behaving like experts, talking down to officials and unpaid volunteers. They are often seen as taking a lot from migrant workers and their NGOs, and not giving migrant workers or NGOs much in return. NGOs often see academics as people who want to keep up good relations with government officials, even if it means sacrificing the truth. The desire of academics to be objective and avoid advocacy is often seen as a delusion academics tell themselves so as to not get off side with the powers that be. And when the issues involved are immediate suffering of migrant workers, and issues for which NGOs see a clear right and wrong side, such equivocating is seen as complicity, if not outright betrayal.
With respect to this clash of cultures, I think the main thing we need to do is simply to acknowledge them. Acknowledge that there are many truths in both perspectives. That many of these perspectives are born from real experiences and real wounds from bad collaborations or disillusionment from watching at a distance.
I see culture as something which is largely stereotypes and prejudice, and it is something that can only be overcome through positive contact – on the basis of equality and mutual respect.
However, differences in interests in relation to research is something that can’t just be overcome through contact.
Difference in interests need to acknowledged, and negotiated.
For NGOs, they want research to move forward advocacy and policy change. This impetus often comes from the desire to stop the raw injustices that they experience everyday.
For NGOs, research is judged by being timely, communicable to the public and policy makers, being newsworthy, speaking to central policy and political debates, and crucially changing policy or raising public awareness.
For academics, research needs to meet our high standards, and the needs of our institutions. Our high standards mean that we want our methods to be thorough, conclusions to be circumspect, our limitations to be made prominent, our research to speak to an often arcane academic literature.
Our institutions also impose requirements on our research. We need publishing in high impact academic journals – or perish. We need to contributing to generalisable knowledge – applied knowledge is disdained. We need to win external grants. And need shouldn’t cause political problems for our management.
In my experience, the solution to this clash of culture and clash of interests is firstly, acknowledgment – awareness and self-consciousness is to a certain extent curative.
Secondly, I think we should try to operate with explicit agreements, and generally simple rules.
I emphasise simplicity because most NGOs are not rich or highly resourced.
In the case of TWC2, some of these rules are:
Why? Conflict of research collaborations isn’t worth it. It’s either yours or ours. We have enough trouble negotiating the politics of authoritarian society within TWC2.
Why? First, they take unbelievable resources, the benefits to participants are minimal, and we have burnt out multiple volunteers with IRB processes and they can take 6 months. And secondly, they also a route for censorship of research – IRBs flag.controversial research for ‘institutional risk’.
I want to suggest that the third solution to this clash of cultures and interests is for us to engage in a deep discussion about what are the most effective research questions and research methods to help us achieve justice for migrant workers.
While it is beyond my scope to answer that, I think an answer will focus on:
1. Use successful past research as models
Firstly, I think we should look for models of research from the past has actually helped migrant workers – and imitate them.
Value policy change
And when assessing value – assessing what has helped – value at least three things: Value policy change – because it improves people’s lives. Because it is a demonstration of the universal values and laws of our society.
Don’t just value policy change
But we can’t just value policy change. In my experience the argument that we should ONLY value policy change is the last refuge of scoundrels. This is because as people working for social justice we can’t be expected to see our change happen over night – and to expect that you can say to a researcher or NGO volunteer “What policy change have you achieved in the last 2, 5, or 10 years?” Is to hold them to an impossible, ridiculous standard. What would be a similar question anti-slavery activists in the 1700s or most of the 1800s. What policy change did you achieve in the last decade? It is a terrible question. The question shows a failure to understand how social improvement happens. Social problems are rocks, and we are the rain. We have only a small impact individually, but gradually we wear down the rock. And it is true that some changes happen quickly, but it is the rain that lays the basis in consciousness and organisation for these leaps in social justice.
Value public awareness. Value movement building.
So how can we value this slow progress that lays the basis for policy change? We can value other products of research and campaigns for social justice. Two of these things are public awareness, and movement building. How much has public understanding of these problems and issues improved because of your work? How many new volunteers have got involved? How many people are meeting, working, researching, organizing for migrant worker health and health justice.
2. Generate evidence of the experiences of the powerless
The second focus i would suggest – for any research that aims to help migrant workers – is a focus on generating evidence – facts – which surface the experiences and priorities of migrant workers.
Bertrand Russell wrote that the two main ways that authority in modern society controls the population is through sacking people – denying dissidents the right to employment, or at least well paid employment – and through the biased generation of evidence . The beliefs and prejudices of the powerful appear to us as everyday truths, repeated and freely available everywhere. But for the powerless, their facts, their truths, their perspective on life can only be discovered with deep, hard study, and a search for inconvenient facts.
I think the role of research for migrant health should be dedicated to transforming into facts the experiences and priorities of migrant workers.
3. Expose myths of the powerful
The third focus i would suggest is a focus on exposing myths of the powerful – delusion and myths – that the system is fair, that there are no problems, and that nothing can be done.
One of the key things that I think has not really come up at this conference is how much policy is formulated in an intellectual environment characterised by vastly differing belief systems, dramatic differences in the conception of basic facts and social processes. For those in power these take the form of convenient delusions and myths.
I think the goal of migrant health research should be – to the extent that these are delusions and myths – to collect evidence to disprove them in the public mind and the mind of policy makers.
I want to illustrate these points with a story about the first migrant worker study I was involved in in Singapore. The irony is that I can say that – by most measures – I achieved more for migrant workers in Singapore in my first three days of research than I did in my next five years combined.
In Singapore there is active and explicit collusion between private doctors and employers. The motive is simple, for a company to maintain a good safety record you need to not report injuries to the ministry of manpower, but there is a requirement to report all injuries that result in more than 3 days of medical leave.
Private doctors collude – mostly from market pressure – by providing workers with serious injuries with ‘2 day mcs’.
TWC2 feeds about 400-500 injured migrant workers each night – about 1500-2000 individual workers a year – of whom about 80% have run away from their employers after a workplace injury.
TWC2 wanted to expose the collusion of private doctors and so surveyed 150 injured workers in one Friday night at their food program. They asked five questions on their survey – the shortest I have ever participated in – it was a survey the size of two business cards. Were you injured? Did you go to public hospital or private doctor first? How many days at private doctor? How many at public hospital?
We collated the survey that night, and gave to a Straits Times journalist. It was on the front page of the Sunday Times that Sunday. 1 in 3 workers surveyed got 4 days or less Medical Leave. When those workers went to a public hospital they got, on average 94 days medical leave.
Over the next three years I met with both the ministry of manpower and with employers, and in meetings with both they showed me that Straits Times article. They were furious about it. It clearly had an impact and honestly it is the most impact I think I have had in my five years as a researcher and assistant to NGO advocacy in Singapore.
 “Legal penalties are, however, in the modern world, the least of the obstacles to freedom of thoughts. The two great obstacles are economic penalties and distortion of evidence. It is clear that thought is not free if the profession of certain opinions makes it impossible to earn a living. It is clear also that thought is not free if all the arguments on one side of a controversy are perpetually presented as attractively as possible, while the arguments on the other side can only be discovered by diligent search. Both these obstacles exist in every large country known to me…” Bertrand Russell, 1922, Free Thought and Official Propaganda. Conway memorial lecture, 24 March. Kindle edition.
 see for example MOM circulars warning doctors against collision with employers over medical leave https://www.wshc.sg/files/wshc/upload/cms/file/2014%20Uploads/Issuance_of_Medical_Certificates_to_Injured_Workers(For_Medical_Practitioners).pdf l
 Radha Basu, 2013. Doctors told to give injured workers enough leave, 07 Jul 2013. p.1
Radha Basu, 2013. TWC2’s check with 150 injured workers finds nearly 1 in 3 got less leave than warranted. Sunday Times, 07 Jul 2013. p.7
TWC2 is an organization that is dedicated to assisting low-wage migrant workers when they are in difficulty. We are motivated by a sense of fairness and humanity, though our caseload often exceeds our