Sandep Chaudhary (26) from Dang was busy welding in the workshop of a metal processing company called KK Metal Processing Company in Malaysia, cleaning the welded parts with a grinder.

While he was working, another employee from the company came and told him to go to the office. Sandep got a little nervous when he was suddenly asked to go to the office. Then, taking an older Nepali worker who was also working in the same company with him, he followed the employee to the office.

Sandep, who had arrived in Malaysia for the first time, didn't understand a word of what the staff in the office said to him in the local language. It was only after the older Nepali worker who had accompanied him translated that Sandep felt like he had fallen into a whirlpool of problems. "I don't know if they were the company manager or the in-charge, but they said, 'There's something wrong with your blood, you can't work, you have to go home now,' and then I got nervous," Sandep explained.

Sandep had only been in Malaysia for a little over two-and-a-half months. He was confused by what the company head said. The employee gestured him towards their computer and showed Sandep a photo. As he approached the computer to look at the photo, the employee told him not to get too close. Sandep said, "I went near, and the employee moved away."

Sandep said that after that, the employee told him, "This kind of disease has been found in your blood, medicine for it isn't available here, and you also can't work. Go home and get treatment there (in Nepal)."

Sandep, who had gone to Malaysia after taking out a loan, shared his plight with the employee. "When I told him that nothing like this had ever happened to me and that I could work, he didn't listen at all.  When he said, 'This is a contagious disease, you can't stay here,' I had no choice," Sandep explained about his forced return.

What was that photo that the company employee showed on the computer?

"It was a photo of a swollen leg, it was of elephantiasis," Sandep says, expressing surprise and asking, "I went there (Malaysia) after passing a medical test here (Nepal), how could I fail there?"

Sandep's leg was not swollen, and it is still not swollen. After returning from Malaysia, Sandep went to Sukraraj Tropical and Infectious Disease Hospital in Teku, Kathmandu and got tested for elephantiasis, but the hospital could not confirm that he had the disease.

According to the Epidemiology and Disease Control Division under the Department of Health Services, Teku, elephantiasis is caused by filarial parasites, and these parasites are transmitted from one person to another through mosquito bites.

How can the same disease report be different in Nepal and Malaysia?

Sandep's health checkup before going to Malaysia did not show any problems. The doctor wrote that he was ‘fit for work’ and ‘able to go for employment’. The report does not have the clear name, address, phone number, website, or email of the health checkup institution.

The report's header states ‘Malaysia Medical Report for Foreign Worker’ and mentions MC Reference Number 85854. At the end, it states the doctor's name, Binaya Thapa, signature, and ‘powered by bestinet’.

His medical report, dated February 11, 2024, stated 'He is fit to work' and in another section, 'Recommended that he be considered for employment.' The report's validity was for three months from the date of the checkup, meaning it was valid until May 11, 2024.

According to the Department of Foreign Employment, there are 223 institutions that conduct health checkups, among which 36 are authorized to conduct health checkups for workers going to Malaysia. These institutions have obtained permission to conduct health checkups for workers before they go abroad for employment.

Sandep returned to Nepal and underwent a 'Circulating Filariasis Antigen' test at Sukraraj Tropical and Infectious Disease Hospital, Teku on July 1, 2024 (Shrawan 17, 2081) to determine if he had elephantiasis. The report, which came out the same day, showed no signs of elephantiasis. This suggests that any worker who passes a health checkup in Nepal and goes abroad for employment may fail the health checkup in Malaysia and have to return home.

"The difference in results may be due to differences in testing methods and equipment," said Dr. Sher Bahadur Pun, an infectious disease specialist at the hospital. "Sometimes, the symptoms may not be visible during the test, which could also be the reason for the different results in the two locations."

According to Ram Kumar Mahato, Senior Public Health Officer at the NTD and Vector Borne Disease Control Branch under the Department of Health Services, government hospitals in Nepal conduct antigen and microfilaria tests for elephantiasis, but he is not aware of any such tests being conducted by medical institutions related to foreign employment.

He also stated that these institutions do not have the kits to perform these tests. Antigen tests look at the nature of the elephantiasis disease, while microfilaria tests look at the current state of the disease. "If the antigen test is positive, it may or may not be contagious to others, but if the microfilaria test is positive, it is contagious to others."

According to Mahato, Malaysia does not conduct these types of tests; instead, they perform non-specific and group tests, which are different from the methods used in Nepal. "Malaysia does not provide a report detailing what tests were conducted on the worker, making it impossible for us to know what happened there without conducting tests here," Mahato said.

The company that sent Sandep back from Malaysia did not provide any documents stating which health checkups were conducted and what the results were. According to him, he had two health checkups in Malaysia. In Malaysia, the report given by FOMEMA, the agency responsible for health checkups of foreign workers on behalf of the Ministry of Health there, only states ‘Medically Unfit’.

On September 10, 2024 (Bhadra 25, 2081), we inquired with FOMEMA in Malaysia about the health checkups of Sandep and other Nepali workers who had gone there. On September 18 (Ashoj 2), FOMEMA replied in a letter stating that they could not disclose Sandep's health information but provided a two-page document with information about the health conditions of Nepali workers working in Malaysia.

According to tests conducted from 2020 to June 2024, FOMEMA reported that Nepali workers in Malaysia were found to have contracted infectious diseases such as TB, Hepatitis B, Syphilis (a type of sexually transmitted disease), Hepatitis C, and Elephantiasis.

According to FOMEMA, the health checkup reports from 2020 to 2024 show that the most common diseases found in Nepali workers are TB, Hepatitis B, and Syphilis. FOMEMA clarified that these diseases are contagious, and workers who are found to have contracted these diseases are declared ineligible (to work).

FOMEMA's data shows that in the seven-month period from December 2023 to June 2024, 90 Nepali workers were found to have Hepatitis C and 550 Nepali workers were found to have Elephantiasis in the health checkups conducted.

As per FOMEMA, non-communicable diseases such as diabetes and hypertension (high blood pressure) were also found. These issues were found in 3,000 people in 2023 and in 2,490 people by June 2024.

Workers with non-communicable diseases like diabetes and hypertension should adopt a healthy lifestyle, and those with chronic illnesses should regularly take the medicines prescribed by their doctor.

According to FOMEMA, workers with chronic illnesses that are under control will be eligible to work in Malaysia. Emphasizing the importance of an active health management system, FOMEMA has clarified that foreign workers with controlled diseases are eligible for employment.

The list of infectious diseases updated by the Nepal government in the Gazette on July 4, 2024 (Ashadh 20, 2081) contains 52 diseases. Among them, TB is number 2 and Hepatitis B is number 19. Syphilis is not mentioned in that list. Similarly, Hepatitis C is number 25 and Elephantiasis (Lymphatic Filariasis) is number 33 on the list.

The latest data from the Malaysian health agency 'FOMEMA' over the past three-and-a-half years shows that the major infectious diseases found in Nepali workers include TB, Hepatitis B, Syphilis, Hepatitis C, and Elephantiasis.

Sandep is not the only one to return after failing a medical checkup, nor is it the only case of Elephantiasis found in returning Nepalese. Sanjay Urau (26) from Duhabi, Sunsari, who went to Malaysia on December 12, 2022 (Mangsir 27, 2079), returned in February 2023 (Falgun, 2079) after failing a medical checkup.

His mother, Chandra Kumari, said that the company sent her son back because they found a mark on his chest, and he is now working in India. He had a medical checkup at Universal Diagnostic Center in Nepal before leaving, but he failed the health checkup in Malaysia. According to his mother, Sanjay had pneumonia as a child.

According to FOMEMA's data from the past five years, at least 2,900 and at most 5,260 Nepali workers are declared unfit for work annually due to health reasons. Malaysia sends back the unfit workers.

People Forum, an organization that advocates for the rights of migrant workers, said that last financial year, they provided legal assistance to 26 workers, including two women, who returned after failing medical checkups. Among them, the highest number of 15 returned from Malaysia, while others were from Kuwait and the UAE.

Kritu Chaudhary from Tulsipur-10, Dang, recounted his experience of being sent back from Malaysia 10 years ago after failing a medical checkup, saying he didn't receive any information about what to do at that time. "I didn't know where to file a complaint, what compensation I could get, and no one told me," said Kritu, who was in Kathmandu to help his relative Sandep Chaudhary, "My money was simply wasted."

Reconciliation of Discrepancies at the Department of Foreign Employment

Sandep went to Malaysia on May 19, 2024 (Jestha 6, 2081) for grill welding work with a monthly salary of 1,500 Malaysian Ringgit (45,000 Rupees). He returned home from Malaysia on July 30, 2024 (Shrawan 15, 2081), barely managing to arrange the travel expenses.

Sandep said that he had paid 405,000 rupees in cash to Manoj Chaudhary from Dang to go to Malaysia. "I had taken a loan of 400,000 rupees at 3% interest per hundred rupees, and I had some other money with me. Now, how will I repay that loan?" Sandep is worried.

Manoj said that he took 400,000 rupees from Sandep, kept 15,000 for himself, and gave the rest to Sanyog Overseas Pvt. Ltd. in Tinkune, Kathmandu. Sandep had gone to Malaysia through Sanyog Overseas. His health checkup was done by A Quality Health Care and Diagnostic Pvt. Ltd. He had paid 10,000 rupees for the health checkup.

On June 10, 2015 (Jestha 26, 2072), the government decided to implement a free visa and free ticket policy for Malaysia and six Gulf countries, effective from July 5, 2015 (Ashad 21, 2072). According to this decision, workers should not have to pay more than 10,000 rupees to manpower companies for service charges. However, the manpower company and its agents took more than 400,000 rupees from Sandep, instead of just 10,000 rupees.

Similarly, according to the labor agreement between Nepal and Malaysia, the employer is required to reimburse the cost of the health checkup conducted in Nepal for workers going to Malaysia. The Nepal government has set the health checkup fee for Malaysia at 6,500 rupees. However, Sandep, who paid 10,000 rupees, did not receive a reimbursement.

After returning from Malaysia due to failing the medical checkup, Sandep filed a complaint with the Department of Foreign Employment on August 15 (Shrawan 30) against the medical institution, manpower agent Manoj, and manpower company Sanyog Overseas, along with evidence of expenses amounting to 451,000 rupees.

Sandep demanded compensation of 451,000 rupees, which included the 405,000 rupees he gave to agent Manoj while going to Malaysia and the 1,650 Ringgit (46,200 rupees) he spent on his return air ticket from Malaysia.

"As the company sent me back to my country after conducting a health checkup three months after I arrived in Malaysia, saying I failed the medical test, and as I was not taken care of by the concerned manpower company after returning and contacting them, I was compelled to seek refuge in the esteemed department for justice," he wrote in the complaint he filed with the department.

After his complaint, the Department of Foreign Employment sent a letter with a seven-day ultimatum to the manpower company on August 16 (Shrawan 31), asking them to appear with a written response, stating that the workers in Malaysia did not receive work, salary, and benefits as per the contract agreement. Sandep said that after this, the manpower company and agent Manoj, claiming that he had filed a false complaint, threatened him and his relative Kritu Chaudhary, pressuring them to settle the matter.

He said that he was forced to settle the matter on September 20, 2024 (Bhadra 6, 2081) after receiving 100,000 rupees in compensation due to the pressure. "They started threatening to file another case, and I was afraid of what they might do, so I settled," Sandep said after the settlement, "There was no one here (in Kathmandu) to fight for me, and it would only cost me to travel back and forth from Dang, so I agreed."

The 100,000 rupees he received in compensation is not even a quarter of his expenses, whereas, according to the Foreign Employment Act, 2064, he should have received compensation for all his expenses. The Act states that workers who return home after failing medical checkups should be reimbursed for the expenses incurred while going to and returning from foreign employment.

Similarly, Sanjay Urau from Sunsari, who flew to Malaysia through Sherpa International Manpower Consultancy Pvt. Ltd. after giving 310,000 rupees in cash to agent Binod Kumar Urau of Duhabi, Sunsari, has also not received a refund of the expenses incurred.

After returning from Malaysia, he (Sanjay Urau) filed a case of foreign employment fraud against Binod Kumar at the District Administration Office, Sunsari, on March 31, 2023 (Chaitra 19, 2079), alleging that he had undergone a fake medical checkup and was sent abroad without insurance.

The mother and son came to Kathmandu and also filed a complaint against the manpower company and agent Binod Kumar at the Department of Foreign Employment.

In the complaint filed by the mother, Chandra Kumari, with the department on October 29, 2023 (Kartik 13, 2080), she demanded compensation of 465,000 rupees, which included the 310,000 rupees spent while going to Malaysia and 155,000 rupees in damages.

Chandra Kumari said that the manpower company returned 75,000 rupees in two installments after the complaint was filed, and the remaining amount was supposed to be given by the agent. "But the agent didn't give a single rupee," she said. "The mother and son spent 40,000 rupees just traveling to Kathmandu four times for the complaint." Although Chandra Kumari demanded the harshest possible action against agent Binod Kumar, no action has been taken.

Binod Kumar, on the other hand, said that he did not do any fraudulent work to send Sanjay abroad and that out of the money he received from him, he only kept 15,000 rupees and gave the rest to the manpower company. "When I offered to return 40,000 rupees by adding 25,000 rupees to the 15,000 rupees I received as commission, they didn't agree," Binod said. "They want all the expenses incurred, but this is a case of medical failure, it's not my fault, I can't give anything more."

Although Sandep received 100,000 rupees, the settlement agreement between him and the manpower company does not mention the amount of money that was exchanged.

Rabin Ghimire, an official at Sanyog Overseas, claimed that they fulfilled Sandep's demands through mutual understanding. "We fulfilled the demands he made," Ghimire added, "We don't want to victimize anyone. Everyone earns a little when things are good. We fulfilled the demands he made."

He declined to disclose the amount the manpower company took from Sandep and the amount they compensated him. When asked how much they gave him to settle the matter, Ghimire said, "I won't say anything about that."

Nisha Baniya, a member (judge) of the Labor Court, says that the amount must be disclosed when facilitating a settlement. "Settlements cannot be done without disclosing the amount," she said. "It must be mentioned how much money will be given and how much money will be received. When facilitating a settlement at the Department of Foreign Employment, it should be done in the presence of the department's employees."

Loknath Bhusal, the director of the department, said that they have been letting the parties settle on their own, but from now on, they will make them mention the amount in the settlement agreement. "We let the two parties settle on their own, and in 90% of the cases, settlements have been reached. In cases where they don't settle, we proceed with further legal action," Bhusal said. "This settlement did not have the amount of the transaction mentioned, but we will make them do it from now on."

Admitting that manpower companies have taken more money from workers than the actual cost, he also pointed out that there are legal issues involved. He said, "We have not been able to connect the agents and the manpower companies, and this is where the legal gap lies."

According to Gurudatta Subedi, the spokesperson for the department, medical failure cases have been coming to the department sporadically. "The rate is not enough for a proper medical checkup, and the businessmen cheat," Subedi said. "If the medical checkup was done properly, this problem would not have arisen."

Sudeep Devkota, former coordinator of the free legal aid program at People Forum, said that workers cannot go to a medical institution of their choice for a health checkup and are forced to go to the institution designated by the agent or manpower company. "That's why in cases of medical failure, both the medical institution and the manpower company have to be complained against," Devkota said.

What is the solution?

According to the Foreign Employment Act, 2064, and the Foreign Employment Regulations, 2064, workers who fail medical checkups abroad can file an application within 90 days of returning home to the Ministry of Labor, Employment and Social Security, the Department of Foreign Employment, the Foreign Employment Promotion Board, or the authorized Labor and Employment Office that handles foreign employment affairs.

The government has also designated a separate health expert committee to hear the complaints of those who return after failing medical checkups. This committee is under the ministry in Singha Durbar, where it is not easy for workers to get a gate pass to reach, file a complaint, and get a hearing.

The report of the task force formed to improve the health examination of workers going for foreign employment, 2081, has pointed out that most health institutions related to foreign employment have not met the standards.

It has suggested that these institutions be compulsorily operated according to the standards and that quality monitoring be ensured by the committee. The task force, chaired by additional health secretary of the Ministry of Health and Population Dr. Dipendra Raman Singh submitted the report to the Minister of Labor, Employment and Social Security, Sharat Singh Bhandari, on November 26, 2024 (Mangsir 11, 2081). The report prepared by 30 experts states that the government should effectively and strictly monitor migrant workers' health testing institutions to ensure quality as per international standards, and also create an environment for health testing in the presence of a doctor.

On the one hand, the health institutions in Nepal do not meet the standards, and on the other hand, Malaysia uses different methods and technologies for health checkups. This is also one of the reasons why Nepali workers fail the health checkups.

Gokarna Dahal, the head of the NTD and Vector Borne Disease Control Branch under the Epidemiology and Disease Control Division, said that there have been other similar incidents like Sandep's. "We have also received 10-11 cases of elephantiasis from there," Dahal said. "We have also had verbal discussions with the health department there about how to standardize the tests in Nepal and Malaysia."

I took 400,000 rupees and kept 15,000: Manoj Chaudhary

When Sandep said he was going to Malaysia, I took 400,000 rupees from him and kept 15,000 rupees. He returned, and this matter has now been resolved. Why is it coming up again? I have already deposited the money into his account through a check, telling him to wait for a day or two. I gave him 100,000 rupees later. I told him that I would send him if he wanted to go somewhere else, but I found out that he had already gone somewhere else on his own.

This is not my fault, nor is it his fault. He came back after failing the medical checkup. Instead, he filed an application with the Department of Foreign Employment saying that he didn't receive his salary, didn't receive it on time, and so on. The salary was paid on time. He would have saved 80,000 rupees at the company.

I had told them before leaving for Malaysia that if they had to return, the labor permit and ticket money would be deducted. They said okay at that time. Now, what can I do if they send them back from there? They worked for the same company. The report came back saying they had elephantiasis.

I haven't sent many people abroad. Sandep is the only one who went through me and came back after failing the medical checkup. Others haven't returned.

(Based on a conversation with Manoj, who sent Sandep to Malaysia.)

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