Globalization and the health and well-being of migrant domestic workers in Malaysia | Globalization and Health

Departure and the stress of leaving home

Unsurprisingly given the socio-political context in which they were situated, three quarters of our informants cited economic difficulties as their primary reason for leaving their homeland to work in Malaysian homes. Sixty-one percent emphasized that their labour trajectory was undertaken to aid family members primarily with subsistence, education, health, and business. Just over 10% joined family members in the country and an additional 5% each specified that the global economic crisis and securing money for specific business ventures were their primary motivators for migration. Additional reasons for migration shared included martial problems, joining other friends in Malaysia, wanting independence, and searching for more work and life experience.

The information they had about Malaysia prior to their departure was spotty and conflicting. Many were aware of highly publicized abuse cases involving migrant domestic workers, yet they also heard that the country was peaceful and safe. Importantly, most had heard of others who had succeeded in meeting their financial goals by working as domestic workers in Malaysia. Limited in their ability to access labour rights, residency, and social support, our interlocutors often turned to individual strategies to help them cope with their working and living conditions. For example, respondents often spoke of the importance of prayer in helping them handle migratory stress. Praying for a good employer whom they could please also helped both to mitigate their fears of moving into a home filled with strangers in an unknown country, and to dispel any lingering media image they may have had of abused migrant domestic workers in Malaysia. HalmaFootnote 3, a middle-aged Indonesian widow with five children, summed up the sentiments of many other migrant domestic workers: “I imagined it like this. If my luck is like the husk, I’ll float, if my luck is like the stone, I’ll sink.”

Despite the financial hardship, the decision to work abroad was not easy to make. A married Sumatran woman in her mid 30s, Ani had to negotiate and persuade her father who disagreed with her desire to work abroad. Linda, an Indonesian mother of seven, simply disobeyed her husband, while Candy’s husband compelled this Filipina mother of three to leave and take a job overseas. On the other hand, Irda, an Indonesian in her early 20s, told acquaintances she was moving to Medan on the island of Sumatra in Indonesia instead of Malaysia while Maya, also from Indonesia, refrained from informing anyone about her departure. The Filipino respondents noted that migrant domestic workers were viewed respectfully in the Philippines for their industriousness and support for their families. Indonesian informants, however, reported more diversity of attitudes towards migrant domestic workers in their country; hence, some opted for a surreptitious departure. Seventy-two percent of the Indonesian and 81% of Filipino respondents remarked that there were many women and men in their home communities who had gone to work overseas, thus normalizing the option of labour migration. Halma offered another salient adage: “It rains gold in someone else’s country; it rains stones in one’s own country.” Being away from home and family especially for those who have left home for the first time can be very stressful.

Migration process and cost: influence on well being

Respondents were asked why they selected Malaysia as a destination country. Three women indicated that they opted for Malaysia because their low levels of education would have made them ineligible to enter some other countries. Nine informants said that the recruitment agency directed them to this country offering no other option. For many, Malaysia was geographically close—and for the Indonesian respondents, culturally, linguistically, and religiously similar—to their homelands that they deemed working in Malaysia a less frightening prospect than traveling further afield. Eight informants came to Malaysia through chain migration where a sibling or other relation arranged for an employer to sponsor them.

Working abroad requires an initial financial outlay for costs of training, travel documents, medical screening, transportation, and other fees. Thirty-six respondents relied on recruitment agencies to finance their trip to Malaysia. Fifteen had their expenses covered by their employers, while six workers were aided by family members, and five paid their own way. Those who received assistance from recruitment agencies or their employers sustained salary deductions for three to seven months to reimburse their sponsor. Jen recalled her trip from Indonesia five years ago:

…The expenditure of the journey to Malaysia. The first, from the village to Jakarta, my old folk were given 1 million rupiah for the expenditure for the time in Jakarta and then to Malaysia. After that in Malaysia the agent is responsible for everything. Then I was sent to the employer, but for five and a half months I was without pay because of the deductions for the agency.

It is clear that the first few months upon arrival, they were without any income and this caused stress if family members requested funds unaware that migrant domestic workers had to wait a few months before being paid.

Employment conditions and well being

Employers of migrant domestic workers are required to provide suitable accommodation and meals free of charge and are also responsible for the worker’s medical expenses in the event of illness or injury. Furthermore, special protection is afforded to Muslim workers in terms of their rights to religious practices, which remain paramount and as such that they cannot be directed to undertake activities contrary to Islam or that would interfere with religious observances.

Some of the unique features of paid domestic labour include the private nature of the workplace, the close proximity of one’s employer and the lack of separation of work and leisure [27, 55, 56]. Previous studies suggest that living with one’s employer is the least desired option for migrant domestic workers who are employed in countries where live-out migrant domestic workers may be legally employed [56]. In this study, informants reported that they often shared rooms with their primary care recipients, generally children; however, the majority asserted that they had sufficient privacy. Rina, a widowed Indonesian and mother of four shared how lack of privacy to have her own room interrupted with religious obligations.

The children are naughty, really. The little one sleeps with me, too. That has been my set-back. I wish…wish I told my employer so that I can carry out the prayers of five times. For that I haven’t been given the time.. .. What else when there’s so many children, can we concentrate if we want to pray? … If I cannot, yeah, already cannot, I’m sure to go to hell.

Most of our informants declared they had positive relationships with care recipients. While a small minority preferred more formal relations with their employers, most migrant domestic workers favoured warm relations and indeed many felt they were treated like a member of the family. Communication was seen as key to developing and maintaining good rapport with employers; however, the incipient power relations that underpin the social hierarchies that are replicated in the household are evident regardless of the quality of employer-domestic worker relationships. Rina, whose religious observances have been disrupted by her young charges, feared discussing the situation with her employer as she was unsure whether her employer would sympathize with her predicament and would be willing to take action to remedy it. Lhet, a Filipino domestic worker who has resided in Malaysia for more than a decade said of her employer who likes to treat her as a friend: “She wants you to smile even if you are tired, angry. You must smile.”

The social hierarchy is further evidenced by responses to our queries regarding social interactions with other household members. For instance, 46% of our informants shared meals and leisure activities with their employers—although a small number would have preferred not to do so. Thirteen percent would like to engage in these activities with their employers, but do not while 39% did not share meals and had no expectations to do so themselves.

Sixty-one percent of our respondents stated that they are constrained in their use of space when their employers were home, although some reported receiving warnings against using certain space or items such as the telephone when the employer was not home. The close proximity to their employers however means that they either feel under surveillance or place themselves under further self-surveillance. Linda, a Christian Indonesian mother of seven said:

When the employer is here, I too don’t watch TV. If the children were watching cartoons, yeah, I go along. I’m afraid, if…didn’t say, but what if [the employer thinks], ‘Oh like that’s what she does at home. Watching TV all the time ya right?’ Aa…because the employer doesn’t look for the good of the maid, but always the faults. I have observed my employer, always regarding my work, the part she takes note of are my faults.

The power of observation also appeared to be key to maintaining their jobs as respondents described watching employers closely to ensure they were following instructions and anticipating their needs. Informants were generally assigned similar duties including housecleaning, laundry, childcare and/or eldercare, cooking, cleaning cars and gardening. Interestingly, pet care has also become increasingly common, and informants cared for a host of animals—fish, tortoises, rabbits, and hamsters as well as cats and dogs. The days’ activities are generally structured around the comings and goings of household members. Rosanda, a young, single Filipino woman, describes a typical day:

I get up in the morning about 5:30, then I take all the clothes to put in the washing machine, then cooking for my Mem’s lunch to bring to the office, then… after that I am going outside cleaning the car, then mopping the floor there, and then after I’m making breakfast for my boss then after making breakfast, I am going out again and wash the other car outside. Then after doing work in the outside, I’m having a breakfast, then washing the hand wash clothes then after that start cleaning already. Then after 11:00, I cook for lunch for the kid, then… after that [I] continue cleaning, then after cleaning ironing, then after ironing preparing for dinner and then until nine. Because my Mem also she came back late. . So, since 10:00 then I can go (sic.) inside my room.

Since the completion of our data collection, the Government of Malaysia has mandated a single day of rest for migrant domestic workers to be determined by the employer [28, 29]. At the time we conducted interviews, migrant domestic workers were to be allotted one rest day per week described on the Department of Immigration website as a continuous period not exceeding 24 h—although in the Malay version, it is defined as “sufficient rest including at least 8 hours of sleep per day” [57]. Of our sample, 45% already received leave each week although 22% reportedly never received a day off. Among this group, Candy, a Filipino mother in her late 30s, had not had a day off in four years while for her compatriot, Lhet, it has been two years. Over 11% were granted one day off per month while 8.5% were granted two per month. A few other arrangements were uncovered; 3% of the sample were given three days per month; another 3% were off work for two days every two months; an equivalent number had three to five rest days every three months or were just granted rest days on an irregular basis. For some informants, the definition of rest day was called into question. For Elsa, a 40-year-old Filipino domestic worker who has lived in Malaysia for more than 12 years, her rest day consisted of two hours every Sunday. Peni, a policymaker, spoke about another common issue that emerges from negotiating the boundaries between employer-employee and friendship.

I have friends that have maids. … This one is, I think, a good employer; like if my friend sends the family go for vacation. So, this maid, if she wants, if she wants to go with them for vacation then they’re allowed. If not, ok we want to go on vacation this day, you must stay home. Then she can go wherever she want. That one is the one side of story—the good side of story, the other side then you need to go with the family. You don’t, actually even the family go for vacation, for holiday, the maid is still doing the work. Taking care of the children and then the family go for shopping, picking up the [groceries].

Like Peni’s friend, some employers are cognizant of the difficulty of extracting oneself from an employee or employer roles resulting in the enactment of these roles even on holidays. Twenty-percent of respondents also received overtime pay in recognition of workload increases. The employment condition and work environment, therefore, is inextricably related to the well-being of the domestic worker.

The denunciation of desires and dreams: influence on well being

In recent decades, the demand for migrant domestic workers, particularly women, has burgeoned. Gender ideologies modulated by culture, class, religion, place, and other factors, are embedded in social interactions, expectations, decisions, and structures that shape women’s gender roles and the performance of certain gendered dispositions (e.g., docility, pleasant demeanour) reflect the desires of recruitment agencies and employers. Many of our informants learned to abnegate their desires and dreams to allow male and/or younger siblings to prosper. As one of seven children in a poor household, Cristy, a Filipino mother of one, shared that her family opted to only educate her brothers. As a girl in the Philippines, Kathy had hoped to become an engineer, but instead she was set to work to put her younger sisters through school. Now that they are married, as the eldest sister she is expected to continue to sacrifice her own aspirations and provide ongoing support for her sister’s family that continues to be in need. To this end, she has been working in Malaysia since 1988 and, at the time of our interview, was in her mid 40s. Kathy, therefore, saw no chance to either study or marry and start a family of her own.

Some migrant domestic workers migrate to work to escape domestic violence and they continue to carry the pain of violence in their memory, which impacts their well-being while they are in Malaysia. Linda, a Christian Indonesian woman in her mid 40s, articulated how globalization, gender, work, and health are embodied in her lived experience:

I wanted to be a defender of women, but because of the economic factor, I couldn’t. Because I see in Indonesia, we are, we women are given less attention, ya right? So, there are many women who are suffering because of their husbands. Those who came here too had problems from their husbands, right? So since last time, if I observe, I have been hurt by my husband. I asked God: “God don’t have anymore Indonesian women like me.” Always tortured by husbands. It’s not just bad, worse than bad. He drinks, womanizes, hits. [back to crying] That’s why for only three years I was married to him. How God, our government. I always pray, asking God: “God bless our government. Bless our country. So that we no longer need to go to Malaysia.”

Health status and access to health services

Overall, two thirds of both Indonesian and Filipino informants reported no change in their health status since moving to and residing in Malaysia. Eighteen percent of Indonesian and 22% of Filipino migrant domestic workers claimed their health was better in Malaysia than in their home countries while 14% of Indonesian and 11% of Filipino workers felt that their health status had declined. Headaches were the most reported complaints. Hypertension and menstrual problems were the next most common conditions while some mentioned having diarrhea and others had problems with their eyesight.

Except for two informants who reported having difficulty accessing health services because their employers would not allow them to leave the workplace to seek help; the rest of the respondents were satisfied both with their access to, and with the quality of, health care in Malaysia. Employers played a vital role in helping workers navigate the health care system, ensuring they received appropriate and timely care. According to government regulations at the time, employers were required to cover the costs of health care services for their employees unless they are still under the auspices of the recruitment agency who were then responsible for those expenses. Approximately half of respondents had health insurance coverage paid for by their employers. Among the half who did not receive health insurance coverage, 17 reported that their employers still paid or reimbursed their health bills. Twelve respondents paid for health services themselves—a few stating that they were “too shy” to approach their employer to reimburse their health expenditures.

Women also recounted their interactions with FOMEMA the organization that manages the health screening of migrant domestic workers in Malaysia. Foreign workers, depending upon their occupational status, are as previously mentioned, required to undergo annual and then more infrequent health examination for a variety of primarily infectious or chronic conditions that might impede the worker’s ability to complete her duties. The Department of Immigration receive the judgment of physicians who are in essence agents of FOMEMA as to whether the individual is deemed fit or unfit. Respondents were generally satisfied with the health examination process although there were some disparities in the way in which the results were distributed; some say they were sent directly to their employers; others received them directly. Although there were also differences as to the number and type of tests that they underwent with FOMEMA, the comparisons between the medical examination screening they had in their home country prior to departure generally found favour with the Malaysian system which was viewed as more efficient, orderly, and respectful. Indonesian informants in particular were more satisfied with the Malaysian medical examination as compared to the medical examination they underwent in their home country; however, a small number of Filipino informants felt that the examinations they underwent in their homeland were complete and more compassionate. For some, the thoroughness of the examinations, both pre-departure and in Malaysia, meant that patients were asked to disrobe, enhancing their stress and hesitancy to undergo subsequent routine exams. Some respondents shared how these examinations were unpleasant experiences for them. For example, three Filipino respondents reported they were asked to fully undress for their pre-departure medical examination in the Philippines. Kathy queried the physician’s request that she take all her clothes off and bend down; the doctor responded, “This is a medical check-up. This is the one you need.” Candy noted that medical examination protocols appear to have changed when she returned to Malaysia for a second time.

In the Philippines, [the physician said] all the way take out, lah. It’s like naked already because they are going to check the whole body. … First time I came here, I never experience about that, must be naked.. . but now when I second time came here already, the FOMEMA ask me to be naked. Yeah, I’m naked together, the doctor is there…together with the nurse.

Promoting health and well-being

Being surrounded by people who make one happy, trying to not think too much, practicing patience, and refraining from anger or unpleasant thoughts were amongst the most cited contributions to good health status. In addition, one had to attend to the body through exercise, proper rest, healthy foods, drinking clean water, and eating and sleeping in accordance with nature’s daily rhythms. Some of the Indonesian informants also maintained their health by consuming jamu, traditional medicine of Indonesia. The converse of these activities contributes to poor health including most saliently overwork, over-thinking, and stress, particularly when one is pining for one’s family. Kathy, a middle-aged domestic worker from the Philippines, described how she used self-care activities to distract her from missing her family:

[I am] drinking a lot of water. Little bit exercise. But now I exercise every morning. Really exercise because washing the car is one exercise, mopping the floor. Not really exercise that one, right? And I am not thinking about problem, but you cannot also avoid the problem, right, if you thinking every time the problem, you so fast become old. . Every morning I wake up, I sing the praising song for distraction. . If you have a lot of problems, if you thinking because if you’re mind thinking, your mind [is] not feeling well. That’s why I never think. Yeah, I never.

While these modalities of self-care are individualized methods of health promotion, interlocuters also strove to leverage social support, another vital determinant of health that can in fact be highly problematic to access for migrant domestic workers due to their isolation in private households [37, 54]. The Filipino informants who, at the time of data collection, had more regular days off than their Indonesian counterparts become involved in a variety of community organizations, from Philippine associations, church groups, sports clubs, to arts and crafts organizations and church choirs. For many informants who had limited social interaction, employers became the primary source of social support followed by family at home and for those who have them, family members in Malaysia. Five informants said they turned to the agents who recruited them for assistance: one utilized formal support services. Most respondents felt they had sufficient social support even though they did not often try to mobilize their support networks. Seventeen participants, however, described how they had to cope with a paucity of social support. For example, Liza, an Indonesian mother of two, relied on her own inner strength. She shared that: “No one supporting; it’s from my own thoughts.” Many drew strength from prayer and spiritual practice for solace and support. Candy, a Filipino mother of three whose husband compelled her to become a migrant domestic worker said:

If I have a problem, I never think about that lah. Just… because I’m here in Malaysia, of course a lot of friends but if for example, you have a problem also, sometimes the friends cannot help you also, lah. So… I always think positive. I pray to God, I’m here in Malaysia to work. Then, I’ll pray to God that he doesn’t give me an illness lah. Hor? I don’t want, I don’t want to become sick here in Malaysia because I’m working here. Not only for myself, but for my family.

Halma, a 56-year-old widow who had worked in Malaysia for 15 years, shared her lament for her husband and how she copes:

[I] think about… why did you leave all your children to me? Like that lah… Why did you go so soon, like that? [Interviewer: So to reduce the stress, what does ibuFootnote 4do? Or even prevent, so as not to be stressed what does ibu do?] I get up in the middle of the night, pray. Pray, asking God for patience and strength in my heart. Get up in the middle of night so its calmer.

Prayer was mentioned by many informants to give them a sense of calm and it was used as a self-care strategy to help them relax and cope with stress.

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