In the minds of Nepal’s migrant workers

Illustration: SAMBHRANT BISTA

There was a collective, albeit cautious, sigh of relief in Nepal when overseas remittances defied prediction and did not decrease dramatically this fiscal year. However, rarely is the social cost of migration including mental health, given the attention it deserves. 

Of the 801 migrant deaths in 2018, 132 were suicides. In 2019, 730 Nepali overseas migrants died abroad, and of them 111 were suicides. These figures may be even more shocking if Nepali migrants in India are included.

There has not been enough effort to address the drivers of suicides among migrant workers, or access to mental health care that could have prevented them. We celebrate remittances and the resilience of workers abroad during the worst crises, but do not give those who shed blood, sweat and tears the attention they deserve.

Deaths, however, are extreme cases. Countless cases of returnees coming home after facing unfavourable experiences go unnoticed, perhaps because of their scattered, isolated nature. The ramifications last for a long time, even after return. 

Santosh Sapkota was beaten up while working as a security guard in Malaysia, and three years later is still on medication for psychological trauma. His story went viral on social media, but thousands of such stories go unnoticed. The trauma lasts a long time, even after return to Nepal. Sapkota has been suffering silently, until the viral video acted as a trigger and made him come out with his experience.

Now, with signs that the Covid-19 crisis will be protracted and affect migrants en masse, their emotional and mental health should be an urgent policy priority for the state. In addition to concerns about the health and economy, uncertainty about the ability to return home has caused much psychological discomfort. 

Exposure to the virus is also constant fear among migrants. Physical distancing was never an option in the cramped living quarters. One Nepali working in a Malaysian glove factory that meets the global demand for personal protective equipment during the pandemic says he has stayed in his dormitories for months. But there are other local workers who commute, and there is fear of exposure. Those working in ‘essential services’ like security guards, retail workers, airport handlers and food deliverers are often in close proximity to others. 

But compared to the earlier days, migrants report that their perception of the virus has evolved. Hari, who works in Qatar says, “Initially, we thought Covid meant certain death, and that Nepal was somehow cushioned from the virus. When two of my roommates tested positive, my world came crashing down. We had been cooking and eating together. I remember the fear before and after I got myself tested when my Ehteraz app had a yellow signal as I waited for my results. When I finally saw the green in the app indicating negative results, it was a huge relief. I am now less scared of Covid because I have closely watched my friends recover.” 

Anxiety is especially high among migrants who want to return but have not been able to. The Government’s flip-flopping regarding who, when and how many get to come home and the related protocols adds to the stress.  

Says a Nepali worker in UAE who tested positive: “At such times you realise no one is really there for you. Not the embassy. Not the Nepali community groups. Not your employer.” 

Sitting in a shared space that houses a dozen other migrants and unemployed for months without any pay, Ram from Saudi Arabia tells me on the phone how the ordeal has taken a toll on his emotional and mental health. 

“I can’t say I am not alive because I am breathing. But really, sometimes I question what kind of life this is? Crammed in a room for months, eating distasteful food, waking up multiple times in the night, with no certainty about when I will meet my aging parents and my wife. I have never felt this anxious before,” he says. 

Separation and crossborder parenting was already difficult for many migrants, but the pandemic worsened it. A Nepali domestic worker in Lebanon finds it ironic that her workload has increased because of the pandemic. 

“The school-going children are at home at all times, but I also worry for my own children back home who require more attention now that they are at home,” she says. “As a single mother, I chose to come here so they got a good education.”

Thanks to social media, migrant workers, their colleagues and families are in constant touch, and that has helped. Krishna is based in the UAE and says after working for 11 hours every day for a decade it is strange now to be without any work. Furloughed and waiting for his employer’s situation to improve, Krishna has found solace in speaking to his family multiple times a day in an otherwise dreary and uncertain period. 

“For one hour every day I play online games with my daughter. She likes to win, and cries whenever she loses, so I have to try to lose, but it is still the highlight of my day,” he says. 

Others who face mental tension from work and worry, have taken to prayer as a recourse. Pramila in Beirut says praying helps her deal with health and economic difficulties. “I go to the church every week even though the service is held in Hindi,” she says. “I pray every day and it helps calm me because my faith makes me hold on to the belief that sooner or later, I will see my husband and my son.”

She firmly believes that things could have been worse, and she could have died in the massive explosion in Beirut in July. 

Nitesh Aryal

While they have found different ways to cope with the crisis, most Nepali migrant workers do not have access to counselling or formal mental health services.

Nitesh Aryal, a physician based in Qatar remembers that there was much panic among migrants in the initial days who tested positive and were kept in isolation. They called him frequently, worried why they were not getting medical attention.

“I used to counsel them that unless they had severe symptoms, there was no need for emergency care,” he adds. “Patients always imagine the worst and many went into depression so they had to be counselled. Things are more stable now.”

While not a substitute for one-on-one counselling sessions, online mental health and wellness videos also present an opportunity to help migrants deal with their problems as they wait idly amid the uncertainty, at their camps in the destination country or in quarantine centres in Nepal.

To equip them with practical problem-solving skills, Bibhav Acharya, Associate Professor at University of California, San Francisco and mental health adviser and co-founder of the non-profit Possible, has created a series of videos made in simple conversational Nepali targeting migrant workers to reduce stress and to self-manage problems in life.

The series covers a range of topics in problem solving, including defining a problem in a way that increases the person’s ability to solve them, generating solutions and implementing them, using examples relevant to migrant workers. 

 “When we face problems in life, we often lack a systematic approach to solve or manage them. I made these videos with principles of mindfulness meditation and problem-solving therapy so that people in distress have a way to reduce their stress and manage their problems. The videos require no literacy," says Acharya.

Bibhav Acharya

There are other similar videos and radio programs made by civil society groups working in the mental health arena. Circulation of such resources by the government, especially via embassies and the Foreign Employment Board, and their inclusion in the government's reintegration package, could potentially ensure a wider reach among the migrant community. 

Aryal says mental health issues have been overlooked for far too long despite being rampant. He says, “Young men, often with no prior work experience, come with a lot of expectations about the foreign dream. The daily grind, the heat and the homesickness makes it difficult for many to cope especially during the first few months. There is therefore a need to ensure they have access to counseling services, whether it is via telemedicine or hotline services that link migrants to mental health professionals in Nepal.” 

Kalim Miya, a Nepali worker who has returned from the UAE, says his family in Gorkha saw videos of his dire living conditions with no employer support, and were worried. 

“My wife and my parents are not on social media but the neighbours would show them the live videos we posted,” Miya recalls. “My attempts to downplay the situation over the phone so they would not worry would therefore fail. There were constant tears and worry.” 

It is a dilemma for workers like Miya who need to publicise their working or living conditions in order to force the authorities to take action, but it meant exposing families back home to the difficult reality of work abroad.

“A few words of comfort from a local leader, whom the family trusted, that their relative abroad would be taken care of would have helped reduce the stress,” Miya adds.

When Ishwor Thapaliya’s parents learnt that he was feeling unwell prior to the pandemic, they wanted him to return home immediately. He had to submit a one month resignation request, but was stuck there when all flights were suspended.

Thapaliya’s father in Nepal says, “We wanted him to come home. The virus was spreading and I was scared that he would catch it before he could return. We were told about his attempts to draw attention to his problem via online social media videos. We are his guardians, but we trusted the government to be his guardian also, but in vain. We did not have any option but to cry and wait for his return, and it was God’s grace that finally brought him home.”

Pashupati Mahat at the non-profit Centre for Mental Health and Counselling (CMC Nepal) has adapted its work for Covid-19 needs and started providing tele-counseling to families of migrants left behind with support from initiatives like the Swiss supported Safer Migration (SAMI) project.

“We have to counsel them on how to handle themselves while also being a source of strength and support to the migrant in distress abroad,” Mahat says. 

CMC also provides counselling to returnee migrants in quarantine centres. When cases are severe, they coordinate with the local governments to either provide counseling in person or to transfer the patient to hospitals. This is especially true in case of mourning family members who need special attention. Since the pandemic began, over 492 bodies of Nepali overseas workers have been brought home, and 167 have been cremated abroad with permission of families.

Pashupati Mahat
Sapana Bashyal in Malaysia is part of a church where she along with other community leaders are trained to provide weekly counseling sessions to migrants in distress. Photo: SAPANA BASHYAL

CMC Nepal has averaged over 30,000 returnees a month in the last few months, and the prolonged uncertainty of the pandemic has created economic stress, concerns about family members abroad and about the worsening Covid-19 situation in Nepal. Common complaints include lack of appetite, loss of willpower to carry out daily activities as caregivers or taking care of livestock, erratic sleep and, in some cases, even suicidal thoughts. 

Mahat acknowledges that mental health care has improved in Nepal, but the country has a long way to go. “When our psychosocial counsellors need to travel, sick patients have to be taken to hospitals, or patients are out of medicine amid the lockdown, local governments have been helpful,” he says. “But we still lack trained human resources including clinical psychologists, mental health facilities are not in the proximity and there is a shortage of medicines.” 

Recognising mental health as a policy priority, Prime Minister Oli recently met with Ministry of Health officials and psychiatrists, and urged that mental health issues be addressed in the Covid-19 response. If implemented, this is a welcome move and should be inclusive of all Nepalis, including those across borders.

Some migrant workers have found comfort in art or poetry. Bhim Rasaili Biswokorma has been in Bahrain for 12 years, and is a gifted artist. As a caregiver, he finds time to draw whenever his employer is resting. He uses pencil art, rather than paint on canvas, because it is easier to pick up where he has left off. 

Apart from the initial fear of the virus, his work as a live-in caregiver has not been affected much, but he has postponed his return for Dasain until the situation normalises in Nepal. He admired poet laureate Madhav Prasad Ghimire who died in August, and that is one of his latest sketches. 

Tirtha Sangam Rai is an avid poet who spent four months in his room in Qatar without work, and found solace in verse. He is now back at work.

“I have spent two decades in Qatar, and my daughter is now 14. I have missed all important milestones in her life, and the pandemic posed the possibility that I would never see her again,” says Rai who wrote a poem dedicated to his daughter, which will be published soon: 

क्वारेन्टाईनबाट छोरीलाई सम्झिदा 

बाहिर मृत्युको जुलुस चलिरहेछ

 बन्द कोठाको सानो झ्यालबाट                               

तिम्रो बाल्यकाल  एकाध सम्झनाहरु

मस्तिष्कमा संग्रहित गरिरहेकोछु 

हरेक दिन सपनाहरुको मलामि निस्कन्छ

हरेक प्रहर भय  त्रासको सुनामी आउछ

ओठबाट मुस्कान अचानक हराएको 

फूलबाट रंगहरुले बिदा लिएको 

 जीवनको किनारामा उभिएर

तिम्रो रुमानी मुस्कान सम्झिरहेको छु

कामना गरि रहेको छु

तिम्रो सुश्वास्थ्य  दीर्घायूको 

छोरी !

थाहा छैन हाम्रो भेट हुन्छ या हुन्न

तिम्रो सपनाको सहर कस्तो होला ?

जो हरेक संवादमा सुनाउने गर्छौ

तिम्रो स्कुलको प्रगती बिबरणमा

तिम्रो नाम  तस्बिर प्रकाशित हुन्छ या हुन्न

जुन तिमी सधै चाहान्छौ

सायद यतिबेला तिम्रो मस्तिष्कले

केके सोचिरहेको होला ?

 भने क्वारेन्टाईनको सुन्य कोठाबाट

तिम्रो बर्तमान  भबिस्य सोचिरहेको छु 

आजभोलि अरबियन सागर

लय विहिन सुसाई रहेकोछ

मरुभुमीमा चलेको छैन बतास

मौन  सहर  मजराहरु

सायद मृत्युले पर्खिरहेको होला

मानिसहरुको लाखौं सपना

तिम्रो  मेरो वियोगको कथा 

For My Daughter from Quarantine.

There is a parade of death outside

Through a window in a closed room,

I watch 

Your childhood, relive memories

I attend funerals of my dreams,

Confront tsunamis of fear and panic.

Smiles are wiped off my face

Colour are gone from the flowers.

I stand on the shores of my life

Replaying your smile, and

Wishing you health and a long life,

My daughter.

Maybe we will meet, maybe not

What are your dreams like,

What are your thoughts,

You would share with me 

Your progress in school today

And an award with your name and photograph 

Me? I’m in my quarantine room.

Planning your present and future

Near a joyless Arabian Sea  

A windless desert

And soundless cities.

Maybe death is waiting 

To end millions of dreams

Our social distance. 

(Some names have been changed.)

Upasana Khadka writes the regular column Labour Mobility every month in Nepali Times, analysing trends affecting Nepal’s workers abroad.

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