Dying to work overseas

Sagar Tamang first met Laxmi Tamang in video calls between Malaysia and Pokhara. He was working as a security guard in Malaysia, and had sent her a Facebook request.

Before long, between messages and calls, they were in love and planning a future together. Laxmi could see it clearly: after six years Sagar would return home to Sankuwasabha, they would get married and have children, live in the home that Sagar had built, and she would open up her tailoring shop with Sagar’s savings from abroad.

But Sagar revealed that he was experiencing shortness of breath and his legs had begun to swell. She pleaded with him to come back, but he would only return after his roadside property back home was built. Sagar’s parents had already built a new house with his income and were planning another nearby.

The symptoms worsened over time, prompting Sagar to eventually consult a doctor. Both his kidneys had completely failed. A seemingly healthy, energetic 28-year-old suddenly turned into a dialysis patient.

Sagar lived with his mother, father, five sisters and four brothers in Sankuwasabha, and the family depended entirely on a piece of land they farmed. An older brother left home to seek work elsewhere but that was not enough. So, after just finishing Grade 10 Sagar decided on an overseas job.

He arrived in Malaysia at just 20, saddled with loans, and an immense pressure to raise the economic status of his family. But upon arrival, he found that he would be working in agriculture, not as a security guard as per his contract.

Toiling for 11 hours in the sun every day, he felt worn down and disillusioned with the promise of life abroad. His living situation, made up of a tightly regulated, crowded compound with other migrant workers, was no better. Only when he heard the distorted voice of his mother through his flip phone did Sagar find a sense of solace.

Over the next two years, Sagar developed friendships with other Nepalis working with him, and eventually accepted that his life abroad was nearly permanent. He planned to stay aboard at least 10 years.

And after writing a letter to his company, he was able to successfully switch to security guard work. Although the hours were longer, it beat the difficult manual labour Sagar was previously forced to complete for a meagre salary.

Sagar fell into a routine he thought he would follow for the next eight years: get ready, go to work, return to the compound, and call Laxmi before going to sleep. But two years ago, his health reached a breaking point, and he had to return to Nepal for dialysis.

Upon his arrival, he was rushed to Bir Hospital for immediate treatment. To this day, Sagar has never stepped foot inside the houses his family built with his overseas earnings.

Read also: Dirty, Dangerous, Difficult ... and Dehydrating, Pinki Sris Rana

Dialectics of dialysis

It is estimated that one in four Nepali kidney patients is a returnee migrant. Factors such as excessive heat, dehydration, and unhealthy diets can lead to chronic kidney disease, including kidney failure. Many returnees head straight to a dialysis bed in Kathmandu instead of taking the first bus home.

In dialysis wards across the country, scores of young men under 40 sit in hospital beds, unable to work or earn for their families anymore. Many remain in debt for treatment, or have had to relocate to seek care.

For patients with no source of reliable income, even finding a willing landlord to rent out a room in the capital can be almost impossible without the right connections. However, Sagar’s cousin, who had also developed chronic kidney disease while working abroad and had moved to Kathmandu from Sankhuwasaba for dialysis, took him in.

Laxmi finally met Sagar two months later. She found it hard to hold back tears whenever she saw his face. She was able to stay with her brother in Bhaktapur for some time, but eventually the couple decided to marry.

Laxmi’s mother and sisters urged her to put off the marriage until Sagar had completed a kidney transplant. The couple eloped. Two days after their marriage, Laxmi’s family called them to come to their home in Nagarkot to celebrate.

Now, the couple lives in a rented house near the National Kidney Centre with other dialysis patients and their families. Sagar walks to his dialysis session three times a week.

In this house, there is a sense of solidarity among patients, and Laxmi especially feels a comfort knowing that her neighbours understand her position as the wife and caretaker of a dialysis patient. Members of the house cook for each other, help with transport to the hospital, and sometimes even lend money.

So far, Sagar has used his savings from abroad to pay for the direct and indirect costs of his treatment. However, the money is running out as the couple grapples with the city’s cost of living and medical bills.

The government offers free lifetime haemodialysis for patients, but the Rs5,000 monthly allowance does not come consistently, in full, or just never comes at all despite repeated requests to the patient’s municipal office.

Those receiving treatment in the Kathmandu Valley also access medicine through Bhaktapur’s Shahid Dharmabhakta National Transplant Centre (SDNTC), but under the hospital’s insurance are required to pay for 10% of the cost.

Once his family’s primary earner, Sagar can no longer make or send money due to his condition. His family runs a goat and poultry farm, but has been forced to take loans to stay afloat and cannot send money for Sagar’s treatment. Until recently, Laxmi worked 12 hours a day as a tailor and house cleaner.

Sagar, his mother and Laxmi, have been making trips to SDNTC in preparation for his transplant. In Nepal, only relatives or the spouse of the patient are allowed to be donors for their kidney transplant.

This can be debilitating for patients whose families are unwilling or unable to donate due to pre-existing health issues such as hypertension or diabetes. Wives and mothers are the most likely demographic to donate to a male patient.

Due to Sagar’s inability to come home and officiate his marriage it is yet to be recognised by the municipality, making Laxmi an ineligible donor. After finding out his father’s blood type did not match and refusing his younger sister’s offer to give her kidney, he and his mother decided that they could start the transplant process together.

Even Nepal’s prime minister K P Oli has had a double kidney transplant, but for those who cannot find a donor within the family, the remaining years of life is measured by the humming and erratic beeps of a dialysis machine three times a week.

It is going to be a lengthy and expensive process, but it is the only hope for Sagar. And what are his immediate plans after a successful transplant? To return home, to finally see his siblings, father, neighbours and friends, he tells us.

He has seen his father once since his return to Nepal, but has not seen his siblings since he left for Malaysia. They have not visited him in Kathmandu yet, but he hopes that they will before his transplant.

The couple believes that after his transplant, anything is possible: finally getting their marriage recognised, opening up a tailoring shop, having children, building a life in Sankuwashaba.

Laxmi strongly objects to Sagar ever leaving Nepal again, but he remains open to the idea.