Background
Methods
Data collection
Interview Questions | |
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What are all the challenges that domestic workers in this community experience? | |
How would you know if a domestic worker in the community is doing well? Describe this person. | |
How would you know if a domestic worker in the community is not doing well? Describe this person. | |
What are all the ways domestic workers in your community rely on one another? | |
Name all of the people that members of the domestic worker community rely on for assistance. | |
What are all the challenges that domestic workers in this community experience regarding health? | |
What are all the challenges that domestic workers in this community experience in their relationships? | |
Additional Questions for Key informants:
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Where do domestic workers go to receive healthcare and mental healthcare? | |
What challenges do domestic workers face in accessing healthcare? | |
What kinds of health-related programs might benefit this community? |
Analysis
Participant characteristics
Results
Key health problems identified
One domestic worker stated: “Your sleep is also lacking. I’m one of them. I get dizzy as well. That’s why they say, if you’re an OFW, everything’s inadequate. Inadequate food, inadequate sleep.”
Four themes associated with mental health problems were identified. First, stress and burnout were associated with the following reported symptoms/idioms: mind flies, inability to concentrate on job, lazy to work, difficulty sleeping, self-pity, feeling down, feeling angry, heart palpitations, thinking too much, and feeling nervous.One of the key informants from an NGO observed this as well: “Yes, because they don’t have any, you know, vitamins in their body already. They are very weak, and they have been working and working for so many years.”
Second, a depression-like syndrome was noted, that include the following signs and symptoms: gloomy face, looking haggard, always sad, social withdrawal, feeling lazy or lazy to work, inability to do tasks, becoming slow, and thinking of suicide. One domestic worker described a person with these problems as: “Frowning. Carries the weight of the world. Gloomy face. Face always looks sour.” A key informant who was a member of the Church shared that a person who shows these symptoms could not seem to feel better, “even during prayers, she doesn’t become happy … it’s difficult to, for her to unload her problems … it’s so difficult for her to drop them.”One domestic worker stated: “My first employer, because it was my first time, in 2009, the effect [on me], I couldn’t sleep at night. Then I really feel pity for myself. You know that. So it’s not good, because the whole year like, I was really down, it’s not good.”
One domestic worker stated: “You can’t talk to her sensibly.”Another domestic worker stated: “Even if you talk to her, it’s like she [heard] nothing. Like nothing, like you didn’t say anything, like she didn’t hear anything, things like that.”
A key informant from the consulate recalled: “..she was really just blank and then she was really dazed.”
One domestic worker recalled: “She learned how to gamble, that’s why she used the money to buy things at the market to gamble. So she didn’t have anything to cook in her employer’s [house]. What she did was to go to our boarding house then, she took the rice grains there so that she has rice to cook in her employer’s [house]. The budget, she just gets eggs from the boarding house.”
Table 2 provides a summary of key determinants of health, which are detailed below.Another domestic worker said: “They sell their bodies for sex to the foreigners”
Social determinant | Theme | Sub-themes |
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Social and community networks | ||
Social relationships: Family | Physical separation, broken families and infidelity, problems with children, financial, and familial misconceptions. | |
Social relationships: peers | Gossips and intrigues, fighting, money issues, stealing, being inconsiderate, and poor conflict management. | |
Work and living conditions | ||
Work Environment | Strict and unreasonable standards, unpredictable and poor mood, misunderstanding due to culture and language, being treated without dignity, and controlling behavior. | |
Healthcare services | Barriers to healthcare access emerged including lack of medical insurance, low trust, and language difficulties. | |
Housing | Expensive housing and overcrowding. | |
Cultural and policy environment | ||
Problems with employment agencies | High agency fees and agency exploitation. | |
Inadequate labor protections | Not following labor laws, and unreasonable, unlawful terminations. | |
Perceived discrimination for being a domestic worker | Discriminated by the local Chinese and by fellow Filipinos who are not employed as domestic workers. | |
Geopolitical concerns | Political issues between The Philppines and China. |
Determinants of health: Social and community networks
Social Relationships
One domestic worker shared: “Of course, you’re used to, with the things you do every day they’re [family] with you. And then taking care of your child and then when you arrive here, you take care of someone else.”
“Sometimes when you feel, you feel many things, life’s difficulties, that’s when you, like you need your family more. That, and especially when you hear about a family member who gets sick, that’s when homesickness sets in.”
“And the children sometimes because the mother, there, usually when she arrives here, the children left in the Philippines are neglected by the father.”
These relationship challenges with children are also related to showing discipline and maintaining their position as a parent. For example, a domestic worker shared:Relationships with children can be strained,A domestic worker said:“Yes and then they will make you feel guilty, like, you were not around when they needed you, none, they are used to not having a mother. It’s so painful.”
Financial disagreements also strain family relationships. Remittances sent home are the embodiment of sacrifice for domestic workers. Once the money is sent home, domestic workers have little control over how that money is spent, and disagreements about expenditures are not easily resolved. Feelings of resentment and lack of appreciation for their sacrifice was shared by one domestic worker:“Lose their way. That’s when you like lose, like that’s when you’re a failure, that’s your failure.”
Others noted that family members might ask often for money and the amount of remittances never seems adequate. This strains the roles as noted by one domestic worker and a key informant from the consulate, respectively:“Like you just pick up money [from the ground], they think money comes easily (laughs) They don’t know life is difficult. My God! They really don’t know.”
“Sometimes I feel like an ATM machine, like that.”
“….the others don’t work, they just wait, right? There are those.”
Misconceptions may fuel these issues. Macao is a relatively richer environment, and the perception of people is that in Macao, people live a luxurious lifestyle. This is partially cultivated by domestic workers who attempt to appear as though they are living a good life aboard, motivated by protecting family members from the reality of their suffering, and to maintain their own dignity. As a result, some family members may believe they are living a “rich life,” the “good life,” “just relaxing and having fun,” and that they have a “new family.”"But then, he [the husband] would appease me because he has needs, right? He will appease me. “Ah he keeps on,” I said, “Ah he keeps on sending text [messages]. And like he has changed already.” Turns out, it’s followed by, “Send me some money.”
Further, these problems can lead to sullying the reputation of a domestic worker. For example, one domestic worker raised this issue: “Sometimes when there are fights, she will go to your employer and will ask her to remove you from your job.” A key informant from the consulate also shared: “So like the aggrieved party said her name got destroyed with her employer, so when she came back, she didn’t have a job anymore. She just went on a vacation, then when she came back, she didn’t have a job anymore.”“Because, because there are people who are, yes, they will listen to you, but they will gossip about you. Right? There are people you sometimes really trust that you tell your problems to them. But despite that, you think they sympathize with you, helping you but, the, you know how they just make up stories about you?”
“Sometimes, there’s only one guy. So they will fight [over him], pull each other’s hair.”
Issues with money were centered on borrowing and lack of repayment and non-payment of rent:“Then when you ask for your money back, you’re the bad guy. They curse you outside.”“If you’re a member of an organization, don’t join other organizations because if you neglect one [of the organizations], they will sulk. And you’re not the only one they are enemies with, but the entire group is their enemy because they took you away from them (laughs).”
Poor conflict management was also a salient theme. For example, a domestic worker talked about her housemate: “She hasn’t even understood the situation, there’s a reaction, reaction, negative reaction right away. She hasn’t even understood the topic, the problem. Her reaction, it’s different right away, her reaction’s aggressive right away.”“Sometimes, you did your laundry already, then someone would cook ‘tuyo’ [a type of smelly fish]… then [the one who did her laundry] gets really angry.”
Determinants of health: Living and working conditions
Work Environment
“Like, like your every minute is paid. Like you don’t have freedom anymore, right, right?”
“Because like me during the interview, she told me my work is only very easy, just attend to the child, just clean. So, I didn’t expect that, it’s really, they didn’t say that I have [to work on] two houses. So I’m shocked… when I signed already.”
“….because they have so many comments, that I smell, you complain a lot, you are never contented, your house is already clean, you want 100%.”
“Just a little from your employer, shout, you tremble already.”
“But when she promised she will increase [the salary], she will increase my [pay], up to now it’s not”
Unpredictable and poor mood sets the tone for uncomfortable and precarious working conditions. This leads some domestic worker to report:“When you give my salary delayed, you don’t hear anything from me. 9-10 days after the supposed day of compensation, that’s when you give my salary.”
Cultural and language issues. Most Filipino domestic workers know little about Macao’s official languages, Chinese and Portuguese. This presents problems communicating with their employers. A key informant from the consulate mentioned: “When you make a mistake, I think, with the accent … the meaning is different, like that. So they don’t understand each other. Maybe, the understanding of instructions is wrong, of course the employer will get mad.”“You know, when they make you absorber of their stress.”
“When they heard about a Filipina who stole something, you know, whenever they leave, the kungkong [grandfather] is there … so whenever they leave [before], they did not lock their master bedroom. But since they heard about that, they locked it already. Plus there’s a kungkong to check.”
And employers may treat the domestic worker as only employees, and not as people with their own needs, as described by one domestic worker: “Because when you’re a helper, you’re a helper to them.”“They don’t accept their mistakes, there are employers like that. When, when, uh like my first employers. “Don’t reason out.” But I reasoned out. She said, “Don’t argue with me!,” she’d say that.”
Controlling behavior is manifested through limited access to technology, restricted movement in the home, through food offered, allowing them to show emotions, and physical abuse.“You know the feeling that you’re losing your humanity. But you will just swallow your saliva.”
Dietary freedoms are also limited, especially for domestic workers who live with their employers. For example, one domestic worker stated:“Seven days, 16 hours, inside the house of the employer. Cannot use the phone. Cannot go out. If they go out, they go with their employer, taking the car. Cannot go out by herself.”
“If the food is chicken, you get the neck, you get the feet. If the food is fish, you get the tail.”
“Quiet. You can’t, when you’re frowning, “What’s wrong? Have a problem?” While you’re tired, you’re pissed. They want you to smile, but you’re pissed.”
“Yes, then you’ll get scorched with an iron. Right, what they are holding, yes.”
“There are employers who will make you drink soap. My friend, before, oh my, she was really made to drink soap.”
Healthcare services
One key informant who was an NGO worker said: “If they have rather big [physical health] issues in Macao, they may need to pay much, and they might not be able to afford.”
A key informant from the Church commented: “Expensive. They are actually very scared to get sick. Actually, they are scared to get sick to the extent that even if they’re already getting sick, they don’t want to see themselves as getting sick. Until they’re at the point when they couldn’t… rehabilitate or recover, what do you call that, recuperate. And then their bodies just collapse.”
Another barrier identified was pervasive lack of trust for local medical treatment. For example, one domestic worker stated “From the local hospital. It’s rare to come out alive. The next [stop] is really the morgue, straight [to the morgue].” A key informant from the Church recounted a domestic worker who went to the local hospital, “Isn’t it, there was one who went to us, [she] asked for help because she had stomachache? To know about the stomachache, she needed to have an operation [in the hospital]. Of course, you’ll be scared.” This lack of trust was associated with unwillingness to undergo treatment and a feeling that no one is available to help when illness occurs.“It’s like that with me as well, she reimburses. For the others, they don’t. It’s up to you to undergo treatment. But, which is right, you should, you should have insurance, right?”
Housing
“Yes, it’s hard to imagine. Three or four hundred square feet…it’s unbelievable for over 10 people to live within.”
“Because sometimes their houses are congested so they have to go out. They have to go out. Because when they arrive at their houses, their houses are congested. You really cannot take a rest.”
Social determinants of health: General policy and cultural environment
Problems with employment agencies
For example, one domestic worker stated: “If you have money, then you’re the one who’ll get an employer (laughs).”
A key informant from an NGO shared: “Maybe you have heard of it somehow. Like more than 10,000 [MOP], they might [be] charge[d]…So they come to work a few months for nothing, after that, they start to really earn money.”
Inadequate labor protections
For some domestic workers, the salary indicated in labor contracts are not honored. For example, one domestic worker shared: “My friend only gets 1,900 [MOP]. 1,900 only but the contract states 4,010 [MOP]. It’s not given to her, it goes straight to her family in The Philippines, that’s why she doesn’t hold anything.”The problem is it’s not in the form of rewards. If the deal is, “If you do this, you will get that,” but it’s not like that. It’s more like, “You must not have day off if they want to work at his place.”
“Because you’re scared that when your boss learns about it, you’ll get terminated. Of course, they are scared that someone’s sick.”
“….for us if we resign, we get banned in Macao. We will get banned.”
“And if you’re prettier than them, there, they will also ask you to leave (laughs).”
“That’s why the child, s/he will say, “Auntie, do, can you do, can you do my homework?” Like that. But then the mother’s there, s/he won’t ask the mother to do [the homework] because the child said the English of the mother is all wrong, like that.”
A key informant from an NGO also shared: “Even one’s Filipino, they won’t communicate with them, talk to them. “Oh, you are a domestic helper. I am an engineer,” like that. The sense of hierarchy is quite strong.”For example, a domestic worker recalled: “If they know you are tailing after your employer, you have with you the children, the employer’s children, the Filipinos, will they smile at you? No. … They will not pay attention to you if you are a domestic worker.”
“Especially when there were those who were [taken] hostage. When there were people from Hong Kong who died in Manila. There were those [Filipina domestic workers] who got terminated.”