IAR Journal of Medical Sciences ISSN Online: 2708-3594 Frequency: Monthly Language: English Origin : Kenya Website : https://www.iarconsortium.org/journal-info/iarjms View point

Health Needs of Migrant Workers in during COVID-19 Pandemic and Associated Medical Observations

Article History Abstract: Kerala, an Indian state sets an example for rest of the world with its exceptional treatment of 'guest workers'. After lockdown, Kerala had 18,912 Received: 25.11.2020 camps that housed over 3 lakhs migrant workers who were addressed by Revision: 19.12.2020 administration as Guest workers. The government departments were looking Accepted: 21.12.2020 into the needs of them. However, individual medical checkup and dispensing Published: 25.12.2020 medicines to the entire members of a camp community was not envisaged by the Author Details government system. This tertiary care centre provided mobile medical services Nimisha Soloman1, P R Varghese2 and Praveenlal through 81camps for 17 days at 33 locations under 10 police stations areas in *3 Kuttichira district of Kerala with the help of State police department. Almost Authors Affiliations 90% of migrant workers knew Hindi and 5 % were Tamil speaking. Remaining 5% (from Assam and Bengal) could converse only in their language. The health 1Quality Lead, Quality Dept, Jubilee Mission team managed essential communication with them in their language using Medical College & Research Institute.Thrissur- Google Translator. This medical camp covered 3021 migrant workers using 94 680005, Kerala, man days including 57 doctor days. Out of this 34 were diagnosed with Upper 2Research Coordinator, Jubilee Centre for Medical Respiratory tract Infection (URTI) and one case was Herpes. Three had TB and Research, Jubilee Mission Medical College & one had HIV. In all the visited camps, barring one in coastal region skin diseases Research Institute. Thrissur-680005, Kerala, India were common. A few of them complained empty feeling, sadness, and

3 sleeplessness and muscle aches especially of calf muscles. They were known to Prof of Psychiatry & Principal, Jubilee Mission be workaholics doing overtime work. A workaholic in workless times can Medical College & Research Institute, Thrissur- experience Work Withdrawal Syndrome (WWS) which is an offshoot of 680005, Kerala, India workaholism.This study may be an eye opener to heath administrators to the Corresponding Author need for medical care, follow up, extreme care to the diagnosed cases and such Dr. Praveenlal Kuttichira facilities even after lockdown among the guest workers.

How to Cite the Article Keywords: COVID-19, migrant workers, health needs, medical camp, withdrawal

Nimisha Soloman, P R Varghese and Praveenlal symptoms, workaholism, public health system. Kuttichira (2020); Health Needs of Migrant Workers in Kerala during COVID-19 Pandemic and Associated Medical Observations. IAR J Med Sci, 1(7); 328-331. THE SCENARIO Copyright @ 2020: This is an open-access article COVID-19 response model of Kerala (an Indian state) is well distributed under the terms of the Creative Commons acclaimed. One of its components is the care for migrant workers. After Attribution license which permits unrestricted use, th distribution, and reproduction in any medium for non Indian government declared lock down from 25 March 2020, Kerala had commercial use (NonCommercial, or CC-BY-NC) 18,912 camps that housed over 3 lakhs migrant workers, as per the home th provided the original author and source are credited. ministry report on 8 April to the Supreme Court of India. They were addressed by the administration as Guest workers.

The state-wise percentage of migrant laborers residing in Kerala, according to Gulati Institute of Finance and Taxation (GIFT) is: West Bengal (20), Bihar (18.10), Assam (17.28), Uttar Pradesh (14.83), Odisha (6.67) and the rest of the states (23.13). Poor economic conditions in their respective native places and high wage rate and better employment opportunities in Kerala have been the main reasons of migration to Kerala (Saikia, D. 2015). Apart from that, Kerala provides better social security to migrant employees than in other Indian states. Under the insurance scheme started in 2010, migrant workers are eligible to buy medicines worth INR 15,000 in a year, get inpatient treatment worth INR 25,000 in empanelled hospitals and can claim up to INR 5, 00,000 for accidents and disabilities. Their children are encouraged to join Government School and considered at par with Kerala children with free education up to level 10th standard.

In spite of these facilities, hundreds of migrant laborers were on the streets of a small town in southern Kerala demanding exemption from lockdown and arrangements for journey back home (Arnimesh, S. 2020). Following this, Government had revised the strategies. Instead of free supply of cooked rice from Kudumbashree (Government supported women self-help groups) kitchen, different menu suiting the workers for North and East Indian states were provided all free of cost. Counseling services were provided (24 x 7) in five languages- Hindi, Bengali, Odia, Assamese and Garwahli. Health care programmes were started. Apart from essential supplies, television, indoor games like carom board and chess for entertainment and even free recharge for mobile phones were some other facilities provided to them (Arnimesh, S. 2020). The revised approaches showed positive results, as there was prevention of flare up and spread of unrest in other parts of the state.

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Nimisha Soloman et al., IAR J Med Sci; Vol-1, Iss-7 (Dec, 2020): 328-330

The officials from Labour and Health departments appreciated as humane and supportive, unlike the carried out checks in migrant workers‟ camps and sites, traditional image of rough and harsh. with awareness campaigns in multiple languages. Accredited Social Health Activists (ASHA) and Almost 90% of migrant workers knew Hindi the National Health Mission (NHM) officials were working National language and 5% were Tamil speaking of as a link between guest workers and government health neighboring districts of Tamil Nadu. Remaining 5% department. They were providing help to the sick (from Assam and Bengal) could converse only in their (COVID-19 scare in Kerala. 2020), conducting language. The health team managed essential campaign to maintain personal safety measures and communication with them in their language using contact tracing if any. However, individual medical Google Translate. checkup and care for the ailments to the members of a community was not envisaged by the government Health inspectors in the team working in system. Hence our hospital provided mobile medical corresponding areas identified camp sites and fever services with the help of police department. cases with IR thermometer. Social workers in the team provided mask to every worker and ensured hand rub PPROACH hygiene procedure before the clinical examination. A Those with signs of infection on clinical examination This tertiary care centre provided mobile medical were given antibiotics. A few cases were suggested services to guest workers through 81 camps for 17 days rd th quarantine and the formal order were issued then and from 3 April to 25 April 2020 at 33 locations. This there by authorities and arrangements were made at the was provided at their place of residence as the policy of place of their stay itself. Their follow up were ensured the government with the help of police department. by Health and Police. These locations come under 10 police stations areas of Thrissur City and Kunnamkualam Rural police Out of 3021 workers, 34 were diagnosed as Upper superintendent jurisdiction of of Kerala Respiratory tract Infection (URTI) and one case was state. Medical team moving in an ambulance provided Herpes. Three had TB and one had HIV. All TB and services including disbursement of medicines at every HIV cases were diagnosed early and were on current camp site. These services were provided to 3021 treatment. In all the visited camps, barring one in migrant workers. Police taking stock of living coastal region skin diseases were common (Table 1). conditions and heading the welfare programs did None was diagnosed as COVID-19. contribute to their own attitude and approach which was

Table 1: Details of camps conducted Medical Team Clinical observations Number No Locations No of camps Skin of workers Total Doctors URTI Other diseases 1 1 130 6 4 2 + Puthur 2 3 201 6 4 2 ++ 3 Marathakkara 5 145 7 5 2 + 4 1 204 7 5 2 + 5 Valakkavu, Moorkanikkara 3 139 6 3 2 + 6 Thiroor 7 355 6 4 2 + 7 Aanakallu 3 213 6 4 2 + Pattikad 8 Kannara 5 183 5 3 2 TB ART-HIV ++ Peechi 9 Vaniyamapara Chuvannumannu Pattikad 9 214 5 3 2 ++ 10 Kuttanellur 3 163 4 2 2 + Aswini 11 Museum road 11 228 4 3 2 TB + Mar Aprem church 12 Padavarad Ponnukara 5 159 5 3 2 + 13 Myliapadam 5 113 6 3 2 + Kottapuram 14 4 120 5 2 2 Herpes + Kerala varma 15 Vadakkekad Chavakkad 2 121 6 3 2 0 16 Chavakkad 8 209 6 3 2 TB-2 + 17 Chavakkad 6 124 4 2 2 + 3 TB, Total days 17 Total locations 33 81 3021 94 57 34 1 HIV, 1Herpes Legends: TB: Tuberculosis; ATR-HIV: Antiretroviral Therapy for HIV; Skin diseases frequency: + ~ 10%, ++~20%

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Nimisha Soloman et al., IAR J Med Sci; Vol-1, Iss-7 (Dec, 2020): 328-330

Information gathered Alcohol and tobacco use among migrant workers In one camp, a migrant worker with cough was were not uncommon. Withdrawal symptoms of some remaining unattended, being excluded by everyone. He and illicit liquor distilling were hence expected. was a long term sufferer of bronchial asthma. Patient Excessive use of intoxicants during Pandemic is was reluctant to take prescribed medicines till he and highlighted as a matter of concern (Clay, J. M., & others were assured it was not COVID-19. There were Parker, M. O. 2020). But withdrawal syndrome was not few cases trying to avoid or quicken the screening due considered with the seriousness it deserves. A to the fear of possible quarantine and further checkup. workaholic in workless times can experience There were a few cases of alcohol withdrawal in the withdrawal symptoms. Thoughts like „dread over camp. Tremors, anxiety and depressions were looming time off, guilt over not doing anything encountered by them. A few tried to prepare homemade “productive”, inability to stop thinking about work, liquor with their own recipe and techniques. They were compulsive checking of work-related matters, counseled by police authorities and kept under watch, restlessness, irritability, and difficulty relaxing, and no legal case was charged against them. A few of obsessing over cramming leisure time with structured them complained empty feeling, sadness, and activities, depression etc. sleeplessness and muscle aches especially of calf muscles. They were known to be workaholics doing Work Withdrawal Syndrome (WWS) is an offshoot overtime work most of the days when they were of workaholism (Hoffman, R. 2014). Symptoms and working. Reversal of sleep wakefulness cycle was signs of WWS were seen in some. Their anxiety about observed in some, who suffered insomnia due to families at home place, limited amenities at their excessive day time sleeping. Nothing to do made them normal place of stay and crowed sleeping areas has not sleepy during the day. They complained of suffering minimized their dedication for hard work. They were from head ache. working well to the value of the wages received; perhaps these wages are beyond imagination at their Members of medical team also suffer travel sickness home place. and some developed symptoms of heat stroke. They were also under the pressure of procedures for personal The diagnosis of TB, HIV and Herpes demands a protection. Among the team members behavior at camp periodical and effective health check up and follow up site varied. Most of them were compassionate and policy among guest workers. This should be an eye professional in their dealings. But one person was opener to heath administrators. The widespread noticed to be keeping social distancing at a much longer occurrence of skin disease should also attract attention distance than advised, negatively affecting of health care workers since many may be contagious. communication. A consultant who was anxious about pandemic was noticed to be behaving unpredictably. Since the health workers are the frontline warriors in Another doctor was noticed to be disposing cases very this fight their apprehensions and over protective fast in an unreasonable haste. behaviors are not matching to their profession which they adorn. It is worth to note that majority of the HE IEWPOINT medical team were working hard and restlessly to T V provide healthcare to the lockdown stranded fellow men In spite of providing all essentials and possible of our country, This study highlights the need for recreations free, most of the migrant workers were keen repeated such camps, follow up programmes, extreme to return to their village and unite with family. Urge to care to the diagnosed cases and similar medical camps return to place of familiarity and comfort of family of even after lockdown among the guest workers. origin appears to be innate and universally seen. Perhaps at least a generation of stay may be required to assimilate to a novel and foreign culture and SUMMARY OF VIEW POINTS environment.  The guest workers were keen to return to their village and unite with family. Urge to return to After lockdown of the Nation, there was daily place of familiarity and comfort of family of origin briefing by Chief Minister of Kerala in visual media. appears to be innate and universally seen. The Thrust in campaign was for wearing masks, hand facilities provided at their work place were not washing and keeping social distance. The camp enough to think them stay back. observations showed that the messages reached even  After lockdown of the Nation, thrust in campaign migrant workers who are living in remote areas and by the government was for wearing masks, hand speak different languages. This shows the efficiency of washing and keeping social distance. The camp public health system and commitment of grass root observations showed that the messages reached level workers. even migrant workers who are living in remote areas and speak different languages.

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Nimisha Soloman et al., IAR J Med Sci; Vol-1, Iss-7 (Dec, 2020): 328-330 here-but-do-you-suffer-from-wws-work-  The diagnosis of TB, HIV Herpes and skin diseases withdrawal-syndrome/. Accessed: 15 August 2014 demands a periodical and effective health policy 2. Clay, J. M., & Parker, M. O. (2020). Alcohol use for guest workers. This study highlights the need and misuse during the COVID-19 pandemic: a for repeated such camps, follow up programmes, potential public health crisis?. The Lancet Public extreme care to the diagnosed cases and even such Health, 5(5), e259. medical camps even after lockdown among the 3. COVID-19 scare in Kerala. (2020). Migrants to aid guest workers. health service delivery - Times of India. 18 March, 2020. Available at: EFERENCES http://timesofindia.indiatimes.com/articleshow/746 R 06930.cms?utm_source=contentofinterest&utm_m 1. Arnimesh, S. (2020). Rotis, mobile recharges, edium=text&utm_campaign=cppst. Accessed: 29 carom boards- how Kerala fixed its migrant worker April 2020 anger. New Delhi. 18 April, 2020 1:29 pm IST. 4. Hoffman, R. (2014). Vacation time is here – but do The Print. Available at: you suffer from WWS (Work Withdrawal ttps://theprint.in/india/rotis-mobile-recharges- Syndrome)? carrom-boards-how-kerala-fixed-its-migrant- 5. Saikia, D. (2015). Migrant Workers in Kerala: A worker-anger/403937/. Accessed: 29 April 2020 Study on Their Socio-Economic Available at: Conditions. Journal of Economic and Social https://drhoffman.com/article/vacation-time-is- Development, 11(2), 29-43.

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