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Table 3 summarizes the main themes and subthemes identified. There were four main themes: difficulty understanding and using medical services, obtaining necessary health and safety information, the impact of COVID-19, and protecting oneself from becoming infected with COVID-19. Each quote included in the text below is presented with a participant study code and the location of the quote for the participant’s interview transcript.
Theme 1: Difficulty understanding and using medical services
Interview participants had significant barriers to understanding how the South Korean health care system works and how to access necessary health care. We identified four relevant subthemes: limited Korean proficiency, lack of knowledge about the South Korean health care system, insufficient time, and concern about hospital fees.
Limited Korean proficiency was a common barrier to health care access. As per the national policy, migrant workers have to pass the Test of Proficiency in Korean (TOPIK) to be eligible for a job in South Korea. The TOPIK includes a basic Korean learning program as part of the TOPIK registration and test-taking processes. Some migrant workers chose to learn Korean through the TOPIK just to “get by” rather than spending money and time to learn the language. One worker described, “Through the TOPIK, I only learned the basic [health-related] words […], such as ‘hands,’ ‘feet,’ ‘headache,’ or ‘abdominal pain.’ [Participant N, 1].” After passing the Korean exam, most workers had to wait, per their description, an “indefinite” amount of time (at least 6 months) before entering South Korea; by the time they arrived in the country, they forgot the Korean vocabulary they used to know. A migrant worker expressed the challenges faced in communicating with a doctor: “When I visited a clinic alone in South Korea, there was no one with whom I could communicate. I had to use gestures and only said, ‘I, pain’. [Participant E, 6]” Language barriers resulted in unsatisfactory and poor patient-provider communication. Some workers reported that they did not receive sufficient information from health providers and consequently avoided them. One worker said: “[The doctor] just said, ‘I know,’ although I do not think [the doctor] really understood. This made it uncomfortable for both the doctor and me [Participant 0, 7].”
Lack of knowledge about the South Korean health care system made it even more challenging for the participants to use medical services. In South Korea, patients need to choose a primary or specialty doctor based on their signs and symptoms (as opposed to primary physician referrals to specialty doctors). Interview participants noted that the requirement to choose a doctor was confusing. One worker explained: “It is hard for me to find the appropriate clinic or doctor by myself. I go to any clinic on the street, regardless of my problem. If it is the wrong clinic, they tell me where I must go [Participant A, 12].” Another worker said, “Generally, clinics provide a broad level of care. However, South Korean hospitals are too big and complicated; therefore, I need help from someone—going through the reception counter, picking up the prescription, and so on.. [Participant I, 10].” As a result, many workers used complementary and alternative medicine, in accordance with their traditional cultures. One worker said “Sometimes, we ask for medicine or purchase it from newly arrived friends or other migrant workers in South Korea [Participant R, 6].”
Other significant challenges included lack of time and worries about service fees. Migrant workers preferred working extra hours to receive overtime pay; however, since most of the participants worked in small-sized businesses, their overtime or off-duty work was often unplanned and unpredictable. This resulted in a limited time window to schedule a doctor’s appointment for their health problems. Migrant workers felt more comfortable to make a clinic visit on weekends or at night than being excused during their work hours. Nonetheless, they were burdened by the higher cost of after-hour appointments: “I must go to the nearest hospital because I need to make it quick. Our South Korean coworkers conveniently visit [hospitals], although we need to be sort of tactful in doing so. This is why I go see a doctor after hours or on weekends, although I need to pay more money for these visits [Participant T, 5].”
After the COVID-19 outbreak in South Korea, migrant workers were dismissed from their work or had to take unpaid leave; hence, any cost related to medical service was perceived as a significant burden. One worker complained, “Ever since the pandemic, few or no jobs have been available. I do not know when I will work. [However], I will be available when my boss clocks me in because I need money. Although the work has been sparse, I must [be on call and] wait until I am told to come in for work [Participant U, 15].” All participants noted health insurance as an important determining factor to use health services. Migrant workers who were legally admitted to the country had health insurance; however, when their visas expired, they became undocumented and lost health insurance. Without health insurance, migrant workers avoided seeing a doctor, as it was simply too expensive. Even when workers had health insurance, returning to a home country was a better option for some who had to receive a surgery. One worker stated: “I know that there is a long waiting time for surgery in my country. Health services in South Korea are good, although those in my own country are free or cheaper than here [Participant D, 12].” Recently, most free health clinics for low-income migrant workers were closed due to the COVID-19 pandemic. One worker complained, “I used to receive a free medical check-up. Ever since the pandemic, this service was all suspended; therefore, I do not have any place to go even when I get sick [Participant B, 22].”
Theme 2: Obtaining necessary health and safety information
Obtaining necessary health and safety information was another main theme, and it included three subthemes: limited health information in one’s native language, seeking opportunities or resources to learn Korean, and using technology to overcome limited language skills.
The participants had limited opportunities to acquire health information in South Korea. In particular, in the early stages of the COVID-19 pandemic (February–March 2020), the local government in Daegu provided real-time updates on COVID-19 cases, although the information was not available in a foreign language. One worker said, “Every morning, a public safety alert message delivers on my phone, in Korean. Because the main target of these messages is South Koreans, people like us [foreign workers] cannot understand anything [Participant A, 7].” Instead, migrant workers often relied on health information from family members, friends, and social networking services (SNS) back in their home countries. One worker reported: “There is a famous and reliable family health encyclopedia in my home country [country name removed for confidentiality reasons]. When we have health problems in South Korea, we often access the encyclopedia by [calling home using] free internet calls [Participant S, 10].”
Some workers were determined to learn Korean to better serve themselves. They searched for language-learning assistance from various sources, including foreign-worker support centers and senior migrant workers who could speak Korean well. One worker said, “The Center offers a Korean language program, and many [friends] take classes there. It is free, too.” Another worker said, “I like it [the Korean class]. If one is absent too many times, the course requirement is not fulfilled. …before COVID-19, I used to work a lot on the weekends and I kept missing classes; therefore, I ended up dropping out of it [Korean class] [Participant 0, 28].”
Participants discussed the use of technology to overcome the limited language skills. They heavily relied on translation or messenger apps on their smartphones. Before meeting with a doctor, some participants prepared what they would ask using a translation app: “…I translate [what I want to say] before I go see my doctor, just to prepare myself [Participant F, 10].” Another worker noted, “I use a popular messenger app [Kakao Talk] to ask what I want to know. When I use the app widely used by South Koreans, it is easier to find someone who can give me a hand since many friends of friends [in Korea] also use the app.[Participant T, 16].” Using the app, some Koreans even provided a simplified visual aid and migrant workers appreciated it: “Oral pills, injection… such straightforward visuals help me understand what I should do [Participant J, 17].”
Theme 3: Impact of COVID-19
Four subthemes were identified in relation to the theme of the impact of COVID-19: changes in daily life, witnessing discrimination, psychological distress, and self-reflection. All participants experienced small or big changes in daily life ranging from limited or no social activities to economic precarity. One participant said: “Since February 2020, my manager has completely banned us from going out on weekends. Over the last few months, I have spent my time in my dorm room, alone [Participant A, 26].” Some noted reduced work hours and were worried about their ability to send money to their families. One worker said, “The factory runs, although only few work there. …Fortunately, the factory has not closed. There have been days when I work only 2 h … The primary change for me is that the income has gone downward [Participant K, 15].” In some cases, concerns were related to the fact that the pandemic made things more difficult for workers to adjust to the Korean society. For example, the centers for migrant workers were either closed or had changed the format of their education programs, including those for learning Korean and computer skills, from face-to-face to online. However, migrant workers rarely owned a computer and had to rely on their phones. Yet, a cellphone was not an appropriate learning device to engage in a 3-month course that required 3 h of study a day: “…online education causes challenges for migrants […]; my friends gave up. I would prefer studying with other workers in a classroom [Participant U, 18].”
Discrimination against migrant workers was also discussed. Participants mentioned feeling excluded from care as they did not receive timely information and care from the South Korean government. The majority of the participants reported feeling alienated as a result of being excluded from the Korean government’s COVID-19 emergency relief funds provided to its citizens. One worker said, “The Korean government provides for its citizens. However, my country is poor and I am a foreigner. I do not feel that we are being taken care of…[Participant B, 9].” They felt further discouraged by the Korean government’s decision to declare foreign workers as a “risk group” for the COVID-19 infection. One worker complained vigorously, stating: “Why are we regarded as being confirmed cases? I even got a test [Participant M, 13].” Another worker noted, “I got the foreigner [COVID-19] test. None of my South Korean coworkers were tested. We work together; why was I the only one tested? Am I suspected of having [COVID-19] just because I am a foreigner? [Participant C, 5].”
When participants discussed the impact of COVID-19, they mentioned that, during the initial outbreak of the virus in Daegu, they felt anxious and distressed because of the uncertain future. One worker reported, “In February [2020], when [COVID-19] had just appeared, I wanted to return to my country. I was scared at that time. I could not go because there was no airline available [Participant S, 3].” Another worker added that he felt like he might become depressed as a result of disconnection from the outside world: “I was worried if I would contact COVID-19 back in February [2020]. I did not go outside often and even avoided taking the bus. I stayed away from other people as much as possible. I did not meet friends either. I rarely went grocery shopping [Participant I, 11].”
Despite these negative emotions, some participants described engaging in self-reflection. The pandemic provided them a chance to think about what they were planning to do with their lives and how they can cope with distress from the pandemic. While money was of primary importance for migrant workers before the COVID-19 outbreak, the pandemic changed their perspectives. They recognized that their health and dream are most important. One worker, who had tested positive for COVID-19 and had stayed in a residential treatment center, said: “The first quarantine facility was like a prison. I was confined in a room alone. I was intimidated and worried to be alone after the positive COVID-19 result… I prayed to Allah every day. I felt that I was being protected… I realized that I have put off countless important decisions in life. …It is a short life we live; I believe going after dreams even if one may fail is worthier than worrying and not giving it a try [Participant M, 18].” Another worker said, “I came to South Korea because I like K-pop. …These days, I realize that my life will not change other than earning more money with the current visa. I will take a [school] qualification exam when I go back to my country. I want to study at a South Korean college. Would not my life turn from a toilsome laborer to an engineer then? I want to become an engineer and live the rest of my life with confidence [Participant C, 20].”
Theme 4: Protecting oneself from becoming infected with COVID-19
The two subthemes related to the theme of protection from COVID-19 were: adhering to preventive behaviors and learning about the disease. Participants were worried about being exposed to the COVID-19 virus in their living and working environments. They tried to comply with the protective guidelines. One worker said, “Our factory at first did not make any change when COVID-19 spread. …My boss said not to go around outside. Lately, there are hand sanitizers where we work and screen fences in the cafeteria. …My friends who work at different factories say there has been close care for COVID-19 prevention at their workplaces [Participant B, 13].” Still, some were concerned about their workplace not necessarily implementing thorough protective measures: “Every morning, my boss asks the foreign workers, including me, ‘Do you have a fever?’ But I do not have a thermometer, because of which I say ‘no.’ My boss never checks our temperature or prepares a thermometer for workers.” Another participant said, “I was never given a COVID-19 protection guide in my factory [Participant W, 6].”
Participants said that learning about the disease was a way to prevent COVID-19. However, it was difficult for migrant workers to access rapidly changing new information about the pandemic because of the language barrier. At the time of our interviews, the Korean government had provided a free tracking app as a means to prevent further viral infection spread. However, this service was only provided in Korean. Consequently, the participants chose to consult Facebook to track positive cases: “There are people on SNS who call themselves ‘reporters’ [Participant C, 21].” They translate the reports from Korean to other languages in real time. “We obtain information through them [Participant C, 21].” In fact, most migrant workers sought information about COVID-19 from SNS, including Facebook and Twitter, and they believed the information they obtained from anonymous users—“reporters”—to be accurate and reliable. Collected information on COVID-19 was then shared with fellow migrant workers through SNS. Participants noted that posting translated reports on COVID-19 was almost occurring on a real-time basis (i.e., as soon as these reports become available) and that sharing information acquired through SNS was a way to express their concerns and care for one another.
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