By Alston Ng, based on an interview in March 2018
It has been 18 years since Ganapathi Alaguraja first arrived in Singapore as a foreign worker, but his impeccable record of accident-free workdays came to an end when a spinning drill-bit crushed a finger on 1 March. Despite the years of experience living and working in Singapore, he was now in rough ocean. Alaguraja has never had to navigate the shark-infested waters of employer-controlled medical care.
Most Singaporeans have the autonomy, when they feel ill, to make their own way to a doctor of their choice. Even if their employer has a pre-arranged medical plan with a chain of general practitioners and employees are required to visit a doctor from this chain, the Singaporean would generally be seeing the doctor privately. The employer or his representative would not be in the consultation room.
It’s a luxury foreign workers hardly ever enjoy. Because of their low salaries, they do not have the disposable income to pay for their own visits to doctors — even if reimbursements from the company might be a possibility later on. So, the usual practice is for a worker to depend on his employer to take him to a doctor. The employer would typically send someone trusted to accompany the patient. This someone would be responsible for payment, but might also have certain instructions to convey to the doctor.
With this in mind, let’s hear Alaguraja’s story:
The severity of his injury notwithstanding, Alaguraja was only brought to his “company clinic” in Lavender. Oddly enough, Alaguraja was not consulted on the cause and nature of his injury, despite his first-hand knowledge thereof. Instead, he found himself an unwitting specimen for a cursory examination and a spectator to the discussion between the physician and his supervisor. In the end, he was prescribed just one day of medical leave (usually referred to in Singapore-speak as “1-day MC”) followed by a day of “light duty”.
“Light duty” is a strange Singapore beast. There’s nothing quite equivalent in most other countries. “Light duty” simply means that the worker should go back to work, but the employer should not be assigning him heavy physical labour. However, it’s hard to imagine what other kinds of labour there can be at a construction site.
As for medication, Alaguraja was issued some painkillers. It goes without saying that Alaguraja returned to work the next day in poor shape. His finger continued to hurt and, by his recounting, the manual labour he was obliged to perform was hardly light.
The untreated injury continued to assail Alaguraja with sharp bouts of stinging pain. He requested for another visit to the doctor’s a few days after his light-duty expired, hoping for a proper diagnosis and treatment. He was brought to a different clinic, this time round a small establishment in Little India. At the clinic, the doctor recommended that he undergo an X-ray scan at a hospital, a fact which Alaguraja belabours to explain to me, as though determined to justify his distress. His consultation, however, proved fruitless — he was given “light duty” yet again, a sticking-plaster label fundamentally contradictory to the kind of work required in the construction industry. According to Alaguraja, he was denied an answer by both the doctor and his employer when he sought an account of why he was only granted “light duty”.
With his patience wearing thin, Alaguraja requested for another examination about a week later. Like clockwork, he was brought to a clinic in Holland Village, and “light duty” was duly dispensed to the hapless patient. Desperate for a lasting solution, Alaguraja finally resolved to seek treatment on his own terms — he went to the Singapore General Hospital (SGH) by himself on March 19, almost three weeks after his accident. His hand was placed in a cast and he received a week-long MC, though his treatment did not come cheap. “One hundred, twenty-four dollars, sixty cents,” he emphasized, making sure that I had the figure right down to the last decimal place.
Embittered by his experience with the three clinics, Alaguraja categorically charged that they were all “useless” in treating his injury. But unbeknownst to Alaguraja, the doctors are similarly up in arms about the MC issue and the absence of policy guidelines. Indeed, a TODAY article dated 29 March 2017 (Doctors seek clearer rules on MCs for foreign workers) states that as doctors compete to meet the employer’s interest, the former is incentivised to grant employers “undue influence… in deciding the duration of medical leave for work-related injuries”.
Under the existing regulatory regime, employers are required to submit an incident report to the Ministry of Manpower for work-related injuries or diseases that result in at least 24 hours of hospitalization and/or 3 days’ worth of MC (computed cumulatively, not consecutively). This creates a perverse incentive for employers to exercise their bargaining power, as Alaguraja’s employer appears to have done, driving down the length of medical leave granted to their workers. Alaguraja, for instance, only received one day of MC in total prior to his decision to pay for his own treatment at SGH. Given that workers like him are rarely able to seek medical treatment with their personal savings, employers may exploit the workers’ lack of financial independence to hedge the risk of injury reporting. Even if that should prove insufficient, the threat of repatriation is always close at hand.
According to the 2017 Workplace Safety and Health Report, the construction industry’s workplace injury rate has seen a general decline over the past decade, falling from 796 injuries per 100,000 employees in 2008 to 417 in 2017. Alaguraja’s predicament, however, challenges the reliability of these figures and demonstrates the ingenuity of employers in circumventing injury reporting. His situation underscores the problems of institutional design and the contradictions between regulations and operations. More poignantly, that even the Singapore Medical Association has sounded the alarm on the MC issue raises two critical questions: Whose interests do low workplace injury rates truly serve, and is this system set up to fail the very people it claims to protect?