SINGAPORE: As the authorities seek to fend off a resurgence of tuberculosis (TB) here, non—government organisations (NGOs) have backed the medical fraternity’s call for more comprehensive screening for foreigners.
The NGOs also proposed that the authorities rethink the repatriation policy for work permit applicants diagnosed with active TB.
Earlier in May, Today reported that two experts — Dr Cynthia Chee and Dr Wang Yee Tang, who are both from the TB Control Unit at Tan Tock Seng Hospital (TTSH) — had called on the authorities not to underestimate these foreigners’ "potential to spread TB to the community" even though they do not stay here for long.
They also argued that a repatriation policy "has not only potentially devastating consequences for the patient, but would also not serve the greater good of the global community, including our own".
The Ministry of Health (MOH) is currently reviewing its TB elimination programme.
Under the Manpower Ministry’s work permit regime, foreign workers who are unable to pass a medical examination, which includes those who have been diagnosed with active pulmonary TB, will have to be repatriated.
For foreign workers already working here and are found to have TB, it is up to their employers whether they want to keep them here, Today understands.
Ms Debbie Fordyce, an exco member of Transient Workers Count Too, cited the case of a construction worker who was diagnosed with TB after working here for three months. While the worker began treatment, "he was often asked to work 24 hours at a stretch and was not able to visit the polyclinic during opening hours to collect the medicine", she said.
Dr Thein Than Win, who volunteers with the Humanitarian Organisation for Migration Economics, added: "If they cannot seek and complete treatment in their home countries, there is a risk of a further spread."
And if the authorities repatriate such foreigners, MOH should "work actively with the governments of (the foreigners’) countries and NGOs to provide possible sources of treatment and care services ... so that follow up treatment and social support is provided", Dr Thein said.
Doctors here also suggested more comprehensive screening for foreigners.
In a letter to Today published earlier this month, Dr Vincent Chia pointed out that a chest X—ray "has poor sensitivity, specificity and reproductibility".
Responding to Dr Chia’s letter, MOH Communicable Diseases Division Director Jeffery Cutter noted that the "vast majority of lung TB cases will have abnormalities in their chest X—rays and will thus be picked up during screening".
Dr Cutter said: "Cases with lung TB are required to undergo treatment under strict programmatic conditions." He also noted that the Republic’s screening policy is consistent with "the United States Centre for Disease Control’s recommendation for diagnosis of lung TB". Nevertheless, he added: "We urge employers to be supportive of TB treatment for their workers, by granting them the flexibility to go for treatment, when necessary."
Dr Thein pointed out that, to the companies, "TB—stricken workers are perceived as a liability". Employers that TODAY spoke to said they handle the cases on a case—by—case basis.
Mr Alan Chew, director of Chew Hock Seng Construction, said: "If he’s a good worker, I don’t mind giving him sick leave until he’s well again, but if he causes me a lot of problems, and TB is added (to the mix), then I will have to think extra—hard about it before taking the necessary steps."
Mr Chew pointed out that sometimes, the TB—stricken worker prefers to return home for treatment. He had a case when an Indian worker wanted to do so, after he was suspected of having TB. Said Mr Chew: "He said that treatment (back home) was cheaper and faster. He told me that TB is more common over there, and doctors know how to treat (it) faster and better."
While he has not had to handle such a situation, Jian Huang group executive director Lee Chong Chin said he will send TB—stricken workers home if their work permit is expiring soon. Otherwise, he would assign them to light duties, he said.
Association of Small and Medium Enterprises president Chan Chong Beng urged employers to take responsibility for their foreign workers. "The moment the employee is employed, it’s part of your responsibility (as an employer) to make sure they are healthy or are receiving treatment in the course of working with you," said Mr Chan, who also felt a "more thorough screening process" for foreigners is necessary.
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