Vous êtes sur la page 1sur 148

Women and Migration:

THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Filipino Women Migrant Domestic Workers

Action for Health Initiatives (ACHIEVE), Inc. Vrije Universiteit Medical Center Metamedica / Health Care and Culture (VUMC-MHCC)

Women and Migration: The Mental Health Nexus

A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Filipino Women Migrant Domestic Workers
Published by Action for Health Initiatives (ACHIEVE), Inc. and Vrije Universiteit Medical Center Metamedica/ Health Care and Culture (VUMC-MHCC) with funding from the European Union through the EC-UN Joint Migration and Development Initiative.

Principal writer: Prof. Maria Theresa Ujano-Batangan Additional write-up: Prof. Ivan Wolffers, Lia van der Ham, Raquel Ignacio Content Editor: Maria Lourdes S. Marin Statistical Analysts: Michelle Ong and Alvin Mejorada Editor: Dino A.E. Subingsubing Layout & Design: Chriss J. Capili and Joy Q. Mauricio All rights reserved. Copyright 2011 ISBN: 978 971 0466 09 2 Project Title: Developing Interventions to Address Stress and Mental Health Problems among Women Migrant Workers Action for Health Initiatives (ACHIEVE), Inc. 162-A Scout Fuentebella Ext., Kamuning, Quezon City 1103 Philippines Tel (+63 2) 414 6130 Telefax (+63 2) 426 6147 E-mail: achieve_caram@yahoo.com Website: www.achieve.org.ph
This publication has been produced with the assistance of the European Union through the EC-UN Joint Migration and Development Initiative. The contents of this publication can in no way be taken to reflect the views of the European Union, IOM or the United Nations, including UNDP, UNFPA, UNHCR and ILO, or those of their member states. Website: www.migration4development.org.

Table of Contents
4 5 6 7 8 10 21 23 45 49 98 103 106
Acknowledgments Foreword: Action for Health Initiatives (ACHIEVE) Foreword: Vrije Universiteit Medical Center Metamedica/ Health Care and Culture (VUMC / MHCC) Message: International Organization for Migration (IOM) Abbreviations and Acronyms Executive Summary Introduction Section 1: Review of Related Literature Section 2: Research Methodology Section 3: Research Results and Discussion Conclusions and Recommendations References Annexes

Acknowledgments
Action for Health Initiatives (ACHIEVE), Inc. andVrije Universiteit Medical Center / Health Care and Culture (VUMC-MHCC) would like to recognize and convey gratitude to the people and agencies for their generosity and willingness to share their time, experiences and expertise, which enriched this research project. Their valuable support has made this endeavor fruitful and has resulted in possibilities for partnerships and collaboration in promoting and protecting the rights of women migrant domestic workers. We would like to extend our gratitude to the following: Ms. Jennifer Manalili, the former Administrator of the Philippine Overseas Employment Administration (POEA), including the staff of Central Office, and its regional offices: Regional Office for Northern Luzon led by Chief Nonette Legaspi-Villanueva, Regional Office for Visayas led by Chief Evelia M. Durato and Regional Office for Mindanao led by Chief Carolina B. Agdamag; Ms. Marvi Ador of the Overseas Workers Welfare Administration (OWWA) and OWWA Regional Welfare Offices (RWO): OWWA RWO I led by Chief Esperanza Cobarrubias, RWO XI led by Chief Zenobia L. Caro and RWO VII led by Chief Mae Codilla; Undersecretary Florita Villar of the Department of Social Welfare and Development (DSWD) Central Office and its field offices: DSWD FOI led by Director Leonardo Reynoso, DSWD FO XI led by Director Ester Versoza and DSWD VII led by Director Evelyn B. Macapobre; Atty. Enrico Fos of the Office of the Undersecretary for Migrant Workers Affairs (OUMWA) of the Department of Foreign Affairs (DFA); Dr. Eduardo Janairo of the National Center for Disease Prevention and Control (NCDPC) of the Department of Health (DOH); Dr. Venus Arain of the National Center for Mental Health (NCMH); Ms. Rose Bayan of Kanlungan La Union; Members and officers of Bannuar Ti La Union and Timpuyog Ti Agkabsat; Ms. Jean Goulbourn of the Natasha Goulbourn Foundation; ACHIEVEs Administrative staff, Rafael Alberto, Anafe Luna, and Elena Bejar, for their support; And most especially, to all the women migrant domestic workers, who were involved in every stage of the research and have been very generous in sharing their experiences, stories and time with us.

Foreword
In recent years, various international as well as regional development and human rights organizations have voiced their concern about the increase in documented cases of work-related mental health problems. They have noted the many negative impacts of these issues on the social-cultural life and economic productivity especially of vulnerable groups like women migrant domestic workers, indigenous peoples and poor farmers in developing countries. The World Health Organization in its Mental Health Policy and Service Guidance Package (2005) for workplace related policies and programmes notes that mental health problems are the result of a complex interplay between biology, psychological, social and environmental factors. Although work-related stress is not usually classified as a mental disorder, it can precipitate or eventually lead to depression, chronic anxiety, poor concentration and other psychosocial and emotional as well as physical health problems. Among the key factors cited by WHO that contribute to work-related stress are excessive workload and poor working conditions, conflicting demands of work and family / household life as well as the lack of participation and control over income and work policies. Over the years, the Action for Health Initiatives (ACHIEVE) has produced numerous policy action studies that aimed to contribute to a better understanding of the labor conditions of overseas migrant workers, including the factors that make them most vulnerable to physical health problems. These studies have amply documented how the human rights of migrant workers have often been compromised, if not violated, due to the inability of state parties and service providers, both in sending and receiving countries, to provide acceptable, affordable and appropriate measures to protect them from abuse and harm. Problems of overseas and mobile workers are also rooted in their lack of awareness of the causes of health risks and vulnerabilities as well as their lack of access to enabling information and services. This study is a pioneering effort to further enrich our knowledge of the psycho-social dimensions of overseas domestic work. Through use of quantitative and qualitative research techniques, the study team looked into the stressors of women migrant domestic workers, the manifestations of stress and its impacts on their personal, interpersonal, family and economic life. The recommendations generated by this study can hopefully be used to strengthen current policies, programs and services to promote the emotional and physical health of our women migrant domestic workers and their families. Again, as previous literature argues, the right to health its protection, promotion and fulfillment can only be fully realized through the concerted effort of all stakeholders. The recommendations put forward by the research team call for measures to strengthen current policy and program initiatives to address employment and related sources of stress of migrant workers, while simultaneously creating an enabling environment for them to develop life skills and culturally sensitive self-empowerment strategies to promote personal health and well-being.

Carolyn I. Sobritchea, Ph.D. ACHIEVE, Inc.

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Foreword
We lack sufficient knowledge about the health of migrants. In the past, international health-care focused on the containment of infectious disease transmission. From their perspective, employers have been interested in migrants health as an aspect of the quality of labor the migrant will be able to provide. Emphasis was on testing the health of migrants. Of late, politicians in rich countries began discussing control of migration and have brought up the issue of the cost of migration through more use of the social system. The general health and well-being of migrants itself however, was not the focus of attention. Receiving countries have not been investing in proper monitoring of health, let alone mental health of migrants. Some countries have even used their access to health care as a means to control migration. Sending countries can only organize information sessions for leaving migrants and services for returning migrants with health problems. What is needed, however, is solid knowledge about whether migrants are really more vulnerable, as many health advocates claim; which factors of migration impact on their health and well-being; and, the relationship between these health threats and the conditions that made them leave their countries. It is the role of health research to make the lived realities of people visible and provide insight into the interrelations among factors that impact health. With regard to migrants health there is a lot of catching up to do. Mental health of migrants suffers even more from underexposure. In the framework of the Joint Migration and Development Initiatives (JMDI) and supported by the European Commission-United Nations (EC-UN), the Action for Health Initiatives (ACHIEVE), Inc., in partnership with the Vrije Universiteit Medical Center Metamedica / Health Care and Culture (VUMC-MHCC) carried out this participatory research to shed light on the mental health of women migrant domestic workers. The data produced is rich and gives good insight on the realities of their lives. But it is not enough. A lot more has to be done. This research provides us with a solid background for testing potentially successful interventions. If we are content with what we made visible now, we fail in the very core of the need of this kind of research. This is just a beginning.

Professor Ivan Wolffers, Ph.D. Vrije Universiteit Medical Center Metamedica / Health Care and Culture (VUMC-MHCC)

Message
This study, Women and Migration: The Mental Health Nexus addresses the critical gap in migration research as it looks at the mental health of Filipino women migrant domestic workers. In 2009 alone, the Philippines deployed 69,669 female domestic workers (new hires) roughly about 39 percent of all the new hires deployed (POEA 2009). By the nature of their work and workplace, and the factors that drive them to work in this occupation, domestic workers have come to be among the most vulnerable among our migrant workers. Often however, only the physical abuses that occur are documented and responded to, isolated from the fact that mental anguish and stress can often be a daily struggle for many, if not for most migrant domestic workers. Through the European Commission funded Joint Migration and Development Initiative (JMDI), the joint UN Country Team paid particular interest to this project among many good proposals, in view of its compelling perspective in contributing to the knowledge base needed in accounting for an often neglected issue relative to the welfare of vulnerable women domestic workers. Concern for mental health is not just about prevention of its worst traumatic outcomes. The recent turmoil in the Middle East and North Africa (MENA) region resulted in a wave of employment displacement which has affected many OFWs, notably domestic workers, health workers and other migrant laborers. One may only have to place themselves in the positions of these migrants in order to understand how they must drop the thought of employment when it poses a clear threat to their lives and safety. As action oriented research, the Action for Health Initiatives (ACHIEVE) and the Vrije UniversiteitMetamedica / Health Care and Culture (VU-MHCC) have utilized the research findings and a participatory process of validation to design rights-based, gender responsive interventions for frontline service providers at all stages of migration (pre-departure, during and post-migration). This study is timely as the community of nations, in particular labour origin countries, has come to raise concern as to who comes quickly to the rescue of domestic workers trapped in conflicts. The Philippines government, certainly, can benefit from this research contribution in its efforts to champion the cause of domestic workers in a number of regional and international fora, notably the Colombo Process and the deliberations on the breakthrough draft ILO Convention on Domestic Work. While countries of origin must be prepared to further support the physical and mental health of returnees, there is the larger challenge of how such goal can be shared by receiving country authorities. Research like this provides critical insights and information to form a deeper understanding of issues like migrant mental health, which can consequently guide the design and implementation of key programmes. The IOM congratulates ACHIEVE and UV-MHCC for consistently focusing on a field of concern specifically migration and health, which has relatively lagged behind to capture due level of attention of stakeholders and interest groups. International Organization for Migration (IOM) Manila

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Abbreviations & Acronyms


ACHIEVE AE AIDS BH BN CARAM CEDAW CY DFA DILG DOH DOLE DSWD EENT ES FADS FGD HIV HK IL ILO IOM IT JO KD KII KW LB LGU MO Action for Health Initiatives, Inc. United Arab Emirates Acquired Immune Deficiency Syndrome Bahrain Brunei Darussalam Coordination of Action Research on AIDS and Mobility Convention on the Elimination of All Forms of Discrimination Against Women Cyprus Department of Foreign Affairs Department of the Interior and Local Government Department of Health Department of Labor and Employment Department of Social Welfare and Development Eye, ear, nose, throat Spain Filipino Anxiety and Depression Scale Focus group discussion Human Immunodeficiency Virus Hong Kong Israel International Labor Organization International Organization for Migration Italy Jordan Kuwaiti dinar Key informant interview Kuwait Lebanon Local government unit Macau

NCR NGO NRCO OFW OM OUMWA OWWA PDOS PEME POEA QA SA SG STI SRRS SSS TB TW

National Capital Region Non-government organization National Reintegration Center for OFWs Overseas Filipino Workers Oman Office of the Undersecretary for Migrant Workers Affairs Overseas Workers Welfare Administration Pre-Departure Orientation Seminar Pre-employment medical examination Philippine Overseas Employment Administration Qatar Saudi Arabia Singapore Sexually transmitted infection Social Readjustment Rating Scale Social Security System Tuberculosis Taiwan, Republic of China

VUMC-MHCC Vrije Universiteit Medical Center Metamedica/Health Care and Culture

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Executive Summary
Background of the Research In 2010, an estimated 214 million or 3.1 percent of the worlds population are currently living, permanently or temporarily, outside their country of birth or citizenship. More than one third of migrants are hosted in Europe (32.6 percent), while others are hosted in Asia (28.7 percent), North America (23.4 percent), Africa (nine percent), Latin America and the Carribean (3.5 percent), and Oceania (2.8 percent). In the last ten years, there was an increase in number of women migrants; women currently represent about 48 percent of the 214 million worldwide migrants. The increasing proportion of women migrants is most evident in Asia, where hundreds of thousands of women both low-skilled and skilled emigrate each year. Recent statistics show that the main origin countries are Indonesia, the Philippines, Sri Lanka and Thailand and the main destination countries and regions are Hong Kong (China), Malaysia, the Middle East and Singapore. Given the significant numbers of women migrating as domestic workers, there is concern regarding their health and general well-being. The new transnational face of domestic workers generates important questions about the even greater vulnerability of this invisible community. Their daily interaction with the state, the host society, and their employers can be marked by discrimination on the intersecting basis of their ethnicity, nationality, class and gender. How do developments concerning global migrant flows influence the health and well-being of these domestic workers? Studies have shown that stressful experiences increase ones vulnerability to diseases and mental health problems. This is because sustained stress has a negative impact on a persons immune system, generates passivity and hopeless resignation. Individual factors such as age and gender influence the experience of imbalance. Stress may also have positive effects (that of transformation) and stress and crisis may also trigger growth. Coping styles of Filipinos, nested in collectivist culture, may not always work in other settings. Specifically, the emergence of the pseudo- family comprised of compatriots may also impede adjustments necessary in cultures that are task oriented and impersonal. Prayer is also one of the tools used to cope. This is attributed to the Filipinos strong and positive sense of spirituality, which is considered to be a source of strength in the individual. The latter has been considered as a major coping mechanism in times of crises among Filipino women migrant domestic workers.

10

Given the aforementioned, the following analytical framework was proposed for this research, which takes into account the different stages of migration (i.e. pre- migration, on site and upon return/ reintegration) and socio demographic characteristics of migrant domestic workers (i.e. age, civil status, educational background, place of origin and type of work) as contexts in identifying mental health needs of female migrant domestic workers. Due consideration should be directed to sociocultural contexts in the countries of origin and destination, existing laws and mandates for the development of mental health programs for the identified population, and important standards of ethics and care in the development of mental health services and programs. Recommendations in addressing mental health needs of women migrant domestic workers will be drawn from the outcome of the research. Research Management and Methodology There were two major phases in the conduct of the action research. The first entailed the conduct of preparatory activities, while the second included the data gathering, collation and analysis processes. The preparation phase involved the following sub-steps: (1) review of related literature, scoping of existing mental health services and conduct of focus group discussions (FGD); (2) finalization of the study design; (3) planning for data organization and management; (4) formation and training of the datagathering teams; (5) field manual development; and, (6) translation, pre-testing and finalization of datagathering tools. The data gathering, collation and analysis phase included: (1) social preparation for data gathering; (2) data gathering in the study sites; (3) data editing, encoding, and collation; (4) data reduction and presentation; (5) finalization of the case studies; (6) data analysis; and, (7) writing of the research report. Three research methods were utilized in the conduct of this action research: (1) survey research; (2) key informant interviews; and, (3) case studies. Four research sites were identified for the study: La Union and National Capital Region (NCR) in Luzon, Davao City in Mindanao and Cebu City in the Visayas. These were selected to represent differing populations from the three main island groups of the Philippines (i.e. Luzon, Visayas and Mindanao).

11

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

With regard to the respondents, inclusion criteria were: adult female individuals (18 to 60 years old) who have finished at least one contract as an overseas domestic worker. The participants came from different life stages (i.e. young adulthood and middle adulthood), different types of domestic work (e.g. child minder, cook, all around, etc.) and places of destinations (e.g. Asia, Europe, Middle East). A total of 500 respondents were interviewed. To conduct the research, research teams were organized thus: The national coordinating team, which was composed of the following: (a) project coordinator; (b) principal investigator; and, (c) project assistant. The local coordinating team in the different study sites included: (a) team leader; and, (b) field researchers/ interviewers. Research Results Among the key research findings were: Participant / respondent socio-demographic characteristics

Most participants identified trade as the primary source of income of their barangay (36 percent), led by retail sales (34 percent), and followed by wholesale trading (5.1 percent). Agriculture as a main income source came second, followed by manufacturing. For the primarily agricultural communities, farming of crops to be sold was the top means of livelihood (17.9 percent), followed by livestock raising for sale (5.6 percent), farming for personal needs (4.1 percent), and raising livestock for personal needs (one percent). The mean age of those surveyed from the four research sites is 35.09 years, with a range of 18 to 60 years. Most survey participants are married (51.2 percent), some are single (32 percent) while others are separated (nine percent), widowed (four percent) and cohabiting (four percent). Most of those who are single came from the young adult group (20.20 percent). Majority of the respondents have reached high school or college (with 35.2 percent having completed high school, another 32.4 percent reached college and 18.8 percent completed college), particularly for those in the young and middle adult categories. In terms of religious affiliation, majority are Roman Catholics (76.6 percent), with a smaller number being Born Again Christian (6.6 percent) and Muslim (6.4 percent).

12

Majority of survey participants are currently unemployed (67.4 percent), while a few work for their own income (20.8 percent) and a number receive regular pay from work (7.4 percent). For those who are working, most are primarily involved in trade (28 percent), particularly in retail selling (49 percent). Some provide private services (13 percent), like doing laundry and sewing clothes (as a dressmaker or tailor). Some are employed (four percent). For those who have current sources of income, the mean income per month is PhP5,421 (US$120.46). Most study participants had completed one to two contracts as overseas domestic workers (67 percent). Some finished three to four contracts (18 percent) and five to six contracts (5.4 percent). A smaller percentage had completed seven to eight contracts (1.2 percent), nine to 10 contracts (1.2 percent) and more than 10 contracts (4 percent). The top five reasons for working abroad were: (1) to save for the future; (2) to be able to send children to school (3) poverty; (4) no jobs available in the Philippines; and, (5) to help parents and siblings.

Pre-migration status and requirements

A large number of survey participants reported that they left as domestic workers (86 percent) while one in ten left as tourists (10 percent). Some of those who left as tourists were able to get work permits on site. Others left as caretakers, factory workers, nursing aides, or dressmakers. While majority of the participants said their job title is consistent with their contract (92 percent); some noticed different job titles stated in their contracts (e.g. babysitter, caregiver, tutor, tailor / dressmaker or factory worker). Significantly, eight percent (8.1 percent) did not read their contract and another three percent did not have any contract when they left to work abroad. The top five most frequent pre-employment medical examinations (PEME) that the survey participants had undergone were: x-rays (84.2 percent); urinalysis (82.8 percent); blood workups (82.4 percent); stool examination or fecalysis (79.4 percent) and general physical examinations (79.4 percent). Half (57.4 percent) reported they went through a psychometric test while (39.4 percent) underwent neurological test. Ninety-two per cent said their informed consent was secured but only 86 percent were informed of the result of their medical examinations.

13

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Majority of the respondents (78.6 percent) said they attended the Pre-Departure Orientation Seminar or PDOS. The PDOS providers included: recruitment agencies (39.7 percent); the Philippine Overseas Employment Administration or POEA (25.7 percent); the Overseas Workers Welfare Administration or OWWA (24.2 percent) and non-government organizations (4.3 percent). The survey participants recalled these top five topics from the PDOS: (1) travel rules and procedures (17.6 percent); (2) information on culture and laws of the host country (14 percent); (3) how to adapt to a different culture (14 percent); (4) information on how to remit money (14 percent); and, (5) how to adapt to a different language (12 percent).

Working conditions abroad

Living arrangements: Majority of the survey participants lived with their employers (94.8 percent). In terms of the amount of time spent working and living arrangements, majority (58 percent) of those who live out work nine to 12 hours; almost a quarter (23 percent) worked 13 to 16 hours; and, one out of ten respondents (11.6 percent) worked 17 to 20 hours. Of those who lived with their employers, 27 percent work from 17 to 20 hours, almost a fourth (23 percent) worked for 20 to 24 hours. A fifth (22 percent) worked for 9 to 12 hours; and another fifth (20 percent) work for 13 to 16 hours. Working hours: A quarter of the participants work for 13-16 hours (26 percent) while almost another quarter work from five to eight hours (23.8 percent), 17 to 20 hours (22.2 percent) and nine to 12 hours (20.2 percent). Others also noted working for an unlimited number of hours or for as long as they have work (7.2 percent). Survey participants identified the following tasks they performed in their employers household: cleaning house (87.6 percent); cooking meals (77.4 percent); doing laundry (74.4 percent); taking care of employers child/children (62.2 percent); and washing the car (25.4 percent). Though considered illegal and a violation of contract, some reported cleaning the house of their employers relative(s) / friend(s) and taking care of their employers friends child. Half (58.6 percent) of the participants said that they are entitled to regular days off. Of these, 70.5 percent avail of the benefit. The frequency of their regular days off varies, however, with most having them once a week (48 percent), followed by once (17 percent) or twice a month (8

14

percent). An even smaller portion (7.5 percent) have a day off only during Christmas Day (when the employer goes out), or twice a week, or once every three months, to cite some examples. The five most cited activities they engage in during their day off are: (a) go out, take a stroll, shop, and eat out (31.4 percent); (b) meet / spend time with friends (24.6 percent); (c) attend church / hear mass / attend Bible study sessions (24.6 percent); (d) do part-time work (10.2 percent); and, (e) stay at home (9.6 percent).

Individual income and expenditures: The mean income for all respondents is PhP17,027.80 (US$378.39) per month. A minority (2.8 percent) working in developed countries such as the United States, Canada, Spain, Italy,and other European countries earned salaries ranging from US$1,000 to US$3,000 or higher. Sixty percent of respondents earned below US$400; about 20 percent received US$400 to US$500 a month. The lowest salary stated per month was PhP 5,500 (US$122.22). Sixty-eight percent of respondents, their reported salary is consistent with their contract. Majority of survey participants (98.4 percent) said they send remittances to their family. The percentage of their income which they send home varies. Most of them send a big chunk of their earnings to the Philippines: 41 to 50 percent of their income (18.3 percent); 71 to 80 percent of their income (16. 8 percent); and 91 to100 percent of their income (15.2 percent). Social protection and safety nets: More than a third (35 percent) reported they do not have any form of insurance while they were in the Philippines. Some have social security (31.8 percent), national health insurance (29.8 percent) or government social security insurance (.8 percent). Most of those who were insured noted that their coverage included health insurance (37 percent); life insurance (16.8 percent) and coverage for illness, sickness, or injury (15.3 percent). While working overseas, 54 percent had insurance coverage which included health insurance (48 percent), illness / sickness / injury (19.4 percent) and life / death insurance (17.5 percent). Majority of those who reported having insurance while working abroad worked in Hong Kong, the UAE, and Singapore. Most of those working in Saudi Arabia and Kuwait were not provided with insurance.

15

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Migration related health concerns and issues (health conditions, stressors, coping with stress, sexual and reproductive health, health services availed of)

Most respondents (56.50 percent) of the study did not experience any illness while working abroad. Those who fell ill (43.5 percent), reported experiencing the following most frequently cited symptoms: fever (33 percent); cough (28 percent); colds (12 percent); flu-like symptoms (12 percent); and, headache (nine percent). Very few respondents sustained injuries while working overseas (17.8 percent). Majority of these experienced cuts and abrasions and were from Hong Kong and the UAE. Amputation or loss of body part was reported by two respondents from Saudi Arabia. Most of those who reported dislocation, fractures and sprains worked in Saudi Arabia and the UAE. Most of those who sustained burns, contusions, bruises and hematoma were from Saudi Arabia. Some other conditions where injuries were sustained included being bitten by a dog; falling while handling persons because of the weight of the elderly person she was taking care of; and, slipping and falling. One of the sources of stress of migrant workers based on the FGDs is the difficulty in balancing the demands of work abroad and family life back home. Results of the survey shows that such condition is considered to be somewhat difficult by 38 percent of respondents; very difficult by 27.7 percent; not very difficult by 27 percent; and not at all difficult by a minority (7 percent). Furthermore, the greatest source of stress while abroad is stress at work (43 percent), while others identified stress from both work and home (26 percent); and stress at home (25 percent). Only 5.6 percent stated that neither is considered to be stressful. A little more than half (55 percent) of respondents experienced stressful life events while employed overseas such the death of a close family member (19 percent); diagnosis of a serious illness of a close family member (12.4 percent); break up of a long term relationship (9.6 percent); respondent diagnosed with a serious medical problem (6.12 percent); loss of employment for more than two months (3.06 percent); and transfer from former home (3.06 percent). The most frequently identified physical manifestations of stress while overseas were: fatigue (64.6 percent); headache (60.4 percent); muscular tension (49.8 percent); upset stomach / indigestion (36.4 percent); feeling faint or dizzy (36.2 percent); and, inability to sleep (36 percent). On the other hand, while in the Philippines, they experienced: headache (48 percent);

16

oversleeping (2.2 percent); upset stomach / indigestion (23.8 percent); fatigue (19.8 percent); inability to sleep (18.2 percent); and, muscular tension (17.4 percent).

Significantly, the number of psycho-emotional symptoms reported by the participants decreased while in the Philippines compared to when they were abroad. The same trend was observed among the reported psychological manifestations of stress. While overseas, the following were experienced: loneliness (68.2 percent); desire to cry (66 percent); sadness (66 percent); feeling nervous (36.8 percent); and irritability (32.4 percent). While in the Philippines, they reported irritability (24.4 percent) anger (23.6 percent); sadness (22.8 percent); desire to cry (19.6 percent) and loneliness (15.8 percent). Food is one of the sources of stress identified by FGD participants. This may be due to the absence, inadequacy, and unpalatability of food provided by their employers. Missed meals further add to this. Majority of the participants (74.6 percent) reported that they never missed a meal in a weeks time, but some missed meal/s in a week, specifically: one meal (7.2 percent), two to three meals (nine percent), four to seven meals (2.6 percent) and eight or more meals (4.2 percent). This trend is seen among respondents coming from both the young and middle adulthood stages. When asked about their sources of joy and happiness while abroad, the categories of their responses included: talking to / sending text messages to ones family (14.8 percent); receiving ones salary (seven percent); having a good and generous employer (6.6 percent); thinking of ones family (five percent); playing with / taking care of her employers child/child(ren) (4.8 percent); sending money to ones family in the Philippines (3.8 percent); receiving gifts from employer (3.6 percent); strolling / going to the mall / shopping (3.2 percent); helping ones family (three percent); having a high salary (2.8 percent); seeing other Filipinas (2.6 percent); chatting with friends (2.4 percent); saving money (2.4 percent); and, being inspired by ones family (two percent) In terms of the necessity of engaging in a romantic relationship while working abroad, only 11.7 percent answered positively. Majority of these had a male partner (91.4 percent), while some had a female partner (seven percent). Less than half (41.6 percent) reported that they had sex with their partners. A small number (3.6 percent) had sex with someone not their spouse. Their sexual partners include male friends (39.1 percent); boyfriends (21.7 percent), and casual

17

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

acquaintances (17.4 percent). Other partners included co-worker, female friend, commercial sex worker, employer or customer or client (for those engaged in paid sex). It is important to note that some women migrant domestic workers need contraceptive counseling and services, as well as prenatal care, as some of them get pregnant while working overseas.

When asked if the respondents ever consulted a counselor or a mental health professional, three percent answered in the affirmative. Of this number, 43 percent reported that they sought the services of a pastoral counselor. Others reported seeing a psychiatrist (21.4 percent), counselor (14.3 percent) and a psychologist (14.3 percent). With regard to their family members, two percent have family members consulted mental health professionals, specifically psychiatrists and substance abuse counselors The leading sources of support of migrant domestic workers are: Filipino friend (26.2 percent); female employer (11.2 percent); mother (5.5 percent); relative (5.2 percent) and co-worker (4.9 percent). It is important to note that a fifth (20.3 percent) of the respondents reported that they do not have any source of support. A few of the respondents experienced seeking assistance from the Philippine Consulate in the country where they are working (8.6 percent). The services they availed of from the agency included the following: renewal of workers documents (e.g. passport, contract) [23.3 percent]; advice regarding refund of placement fee, dealing with conflicts with employer, and the deportation process (23.3 percent); provision of temporary shelter (20.9 percent); and, facilitated return to the Philippines / deportation (18.6 percent). Others identified being assisted in filing complaints, counseling, financial and legal assistance (9.3 percent) while 4.6 percent of those who went to the embassy reported that they did not avail of any service.

Recommendations Recommendations are drawn along three areas-policy, research and program development and intervention. Specifically, these are:

18

On policy development and implementation

Enforce policies protecting the rights and welfare of women migrant domestic workers [such as, for example, the Migrant Workers Act (RA 8504) and the Amended Migrant Workers Act (RA 10022), POEA guidelines and other most strategic policies] Review current policies in relation to health and migration, specifically the Philippine Mental Health Policy Framework, and support the call for the enactment of a National Mental Health Act that would incorporate the issues and concerns of migrant workers

On research

Conduct cross-cultural research on migration and mental health (i.e., on-site research that will look at the relationship of culture / context / condition in the host countries and mental health of migrant workers) Conduct research on the mental health status and needs of children (family) of women migrant domestic workers

On programme development Pre-departure

Integrate mental health in programming of relevant government agencies such as the Department of Education (Dep Ed) and Department of Social Welfare and Development (DSWD), among others Incorporate mental health topics in the module of the Pre-Departure Orientation Seminar (PDOS) Training of PDOS providers on mental health topics and concerns Integration of counseling / psychosocial intervention in the training of foreign service personnel Participation of family members in PDOS and other training such as financial literacy

19

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Assessment of mechanisms being used to identify mental health needs of OFWs and how they are being responded to (in relation to the conduct of psychiatric tests that if an applicant fails the test, s/he will not be able to work abroad because of being unfit to work)

On site

Setting up of referral mechanisms that will respond to the mental health needs of women migrant domestic workers Making services available for women migrant domestic workers Mapping of services Provision of continuing support to families of women migrant domestic workers through organizing, training, counseling, among others

Upon return

Provision of services to women migrant domestic workers and their families (livelihood, counseling, among others)

20

Introduction
The Commission on Filipinos Overseas (CFO)1 reports that the estimated number of Filipinos outside the country reached 8,579,378 in December 2009. Of this figure, 3,864,068 (45 percent) are contract workers; and 658,370 (7.67 percent) are irregularly documented migrants.2 In 2009, the total number of new contracts (both new hires and rehires) processed for landbased Overseas Filipino Workers (OFWs) reached 1,092,162. A total of 175,298 women migrated to work as newly-hired workers in 2009; 40 percent of these were household service workers.3 Such figures do not represent the total stock of female migrants abroad, as these exclude rehires, those who still have ongoing work contracts, and those who are undocumented. Women migrant domestic workers experience various forms of discrimination due to their gender, race and class. Many are isolated and subjected to exploitation, physical abuse, sexual violence, maltreatment and labor rights violations, such as contract substitution and non-payment of wages.4 Because domestic work is not recognized as work in most destination countries, women working in this sector often do not have access to social and legal protection. They also have the least access to health services and information, including sexual, reproductive and mental health. Mental health has been defined by the World Health Organization (WHO) as the state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. Mental health also encompasses a persons emotional stability to handle pressures and other stressors.5 In the case of women migrant domestic workers, they are clearly placed in situations where there are additional stressors brought about by their working and living conditions and also by the distance and separation from their families and social networks. While there are existing data and interventions concerning labor rights violations, and physical and sexual abuses of women migrant workers, there are very few researches and services addressing health, specifically their mental health concerns. Such absence or gap is likely to be a function of the absence of collated, updated and relevant data. Likewise, there is often no linkage being made in various reports on abuses, violence and problems faced by women migrant workers to their state of mental health. This research will endeavor to establish the links between the living and working conditions of women migrant workers and their mental health. Apart from looking at living conditions of women migrant workers, the research will also look at the impact of separation and distance from their families and social networks, as this also impacts on their mental health and well-being. A research that was

1 2

A government commission mandated to uphold and promote the interests and well-being of overseas Filipinos Commission on Filipinos Overseas Stock Estimate of overseas Filipinos as of December 2009. http://cfo.gov.ph/pdf/statistics/ stock%202009.pdf 3 Philippine Overseas Employment Administration, 2009 4 Quesada, A and M. Marin. 2009 Unveiling HIV Vulnerabilities. Filipino Women Migrant Workers in the Arab States. ACHIEVE, Inc. 5 Mayor, R. 2008. Untangling the Mental Haywire. Health Alert Asia Pacific edition

21

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

done in Japan among Filipino migrant workers showed that migrants more frequently experience familybased life strains compared with life strains resulting from working and living conditions.6 In 1990, the Philippine Embassy in Singapore reported that within a six-month period, there were six (6) deaths due to suicide among Filipina domestic workers.7 A research in Kuwait back in the early 80s also showed that the rate of first admission in psychiatric hospitals were five times higher among female migrant workers than among the local Kuwaiti women.8 Ten years later, another study in Kuwait found that the most common psychiatric diagnoses among foreign domestic workers were acute stress reaction, acute adjustment disorder, manic episode, depressive episode, and acute and transient psychotic episode.9 Media reports in the last few years regularly feature stories and accounts of returning OFWs in situations of distress such that in 2008, the Office of the Undersecretary for Migrant Workers Affairs (OUMWA) of the Department of Foreign Affairs (DFA) proposed the conduct of mandatory psychiatric screening of all outgoing migrant domestic workers. While this call was promptly rejected by various organizations and even the recruitment agencies, it gave evidence to the urgency of addressing mental health issues among migrant workers, albeit it meant addressing more the structural factors and conditions that lead to mental health problems among women migrant domestic workers. Existing pre-departure programs for female migrant domestic workers do not include services related to mental health. Neither does it provide realistic and comprehensive information on working and living conditions in the country of employment. While services of the Philippine Embassies and Consulates in the destination countries include counseling, domestic workers are mostly isolated or have only one day off a week, thus, this service is not very accessible to them. Returning migrant workers, especially those who underwent distress and abuse, are often brought back to their families and communities, without adequate and sustained psycho-social support. Government agencies and CSO service providers also speak of their inadequate capacity to address mental health issues. This research is envisaged to provide evidence in the formulation of appropriate rights-based and genderresponsive policies and programs addressing mental health issues of women migrants. In addition to generating information, the project entails development of a package of interventions and conduct of a pilot training course on psychosocial assistance for women migrant workers, specifically targeting frontline personnel from service provider institutions from both government and CSOs. It is hoped that the findings of this research can further inform the advocacy agenda on women migrants rights and health, in national, regional and international spaces.

6 7 8

Ohara-Hirano, Y. Cognitive life strains and family relationships of Filipino migrant workers in Japan CARAM Asia citing Gulati, L. 2005. Domestic Workers and Health. Ibid, citing el-Hilu, et. al. (1990). 9 Ibid citing Zahid, et. al. (2003).

22

Section 1: Review of Related Literature


This review is a modest attempt to present a comprehensive view of the international and local literature concerning health issues of migrant domestic workers, with particular focus on their mental health. In the review, both primary and secondary data were utilized, which led to a vast body of data of different classes both epidemiological studies and small-scale qualitative studies, and of different levels of evidence from findings based on well-designed research projects to anecdotal knowledge. Relevant literature is presented with examples from different countries, if available. By analysing these issues, this review attempts to establish an understanding of the vulnerability and risk factors affecting migrant domestic workers. In 2010, an estimated 214 million or 3.1 percent of the worlds population are currently living, permanently or temporarily, outside their country of birth or citizenship10. More than one third of migrants are hosted in Europe (32.6 percent), while others are hosted in Asia (28.7 percent), North America (23.4 percent), Africa (nine percent), Latin America and the Carribean (3.5 percent), and Oceania (2.8 percent)11. There are multiple pull and push factors contributing to global migration. Poverty is commonly cited as the predominant reason why people migrate. Other factors include increasing differences between countries, decent work and human security in certain parts of the world, the growing demand for high and low-skilled workers in destination countries and the geographical proximity and historical linkages between origin and destination countries12. Migration is a process of social change, whereby an individual moves from one cultural setting to another for the purposes of settling down either permanently or for a prolonged period13. Migration for overseas employment involves three stages: pre-departure; post-arrival and onsite; and return / reintegration. Pre-departure begins when a person has made a decision to apply for overseas employment. This period covers the actual application process, medical testing, contract signing and compliance with the legal pre-departure requirements. Onsite or post-arrival covers the period of arrival of the migrant worker in the country of destination and the entire duration of his or her employment. Reintegration involves the period of return of the migrant worker to his or her country of origin and the corresponding adjustment and assimilation period. When conditions permit, such as the absence of legal prohibitions, a migrant worker may decide to settle permanently in the destination country. The process of migration is oftentimes characterized by circularity that is the movement back and forth from the country of origin and the country of destination.

10 11 12

Human Development Report 2009. Overcoming barriers: Human mobility and development; UNDP; 2009 p. 21 International labour migration: a rights-based approach. International Labour Organization, 2010, p.17 Martin P / Widgren J, International Migration: Facing the Challenge, Population Reference Bureau 2002. 13 Bhugra and Jones, 2001, p. 216

23

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Migrant work has always been part of the process of migration. Regionally, 15 million Asians work in countries other than their own14. In the Philippines, an estimated number of 8,579,378 Filipinos are overseas, 4,056,940 are immigrants, 3,864,068 are are contract workers while 658,370 are irregularly documented migrants.15 Two patterns govern migrant work, specifically regular (i.e. legal entry to the country of destination) and irregular (i.e. migration without proper documentation from sending country) migratory patterns (CARAM Asia, 2002). These patterns are not mutually exclusive, there are cases when regular migrants become irregular due to changes in their legal status, as a result of various reasons such as non- possession of travel documents, escape from abuse or exploitation, failing mandatory testing, or being undocumented free lancers. These two patterns lead to harm or no- harm situations16 at different stages of the migration process. A Women and Migration

In the last ten years, there was an increase in number of women migrants; women currently represent about 48 percent of the 214 million worldwide migrants17. The increasing proportion of women migrants is most evident in Asia, where hundreds of thousands of women, both low-skilled and skilled, emigrate each year. Recent statistics show that the main origin countries are Indonesia, the Philippines, Sri Lanka and Thailand and the main destination countries and regions are Hong Kong (China), Malaysia, the Middle East and Singapore18. Women are believed to be pulled to migration due to the preference and demand for them in genderstereotyped work such as domestic work, care-giving and entertainment. Such work are outside the coverage of social and labor laws, thereby putting women at risk of abuse , violence, exploitation by recruiters, employers and state functionaries19. In the Philippines, women account for around 50 percent of legal migrant workers (United Nations, 2008). In 2009, the total number of new contracts (both new hires and rehires) processed for landbased Overseas Filipino Workers (OFWs) reached 1,092,162. A total of 175,298 women migrated to work as newly-hired workers in 2009; 40 percent of these were household service workers. According to Hanochi (2007), migration of women in the Philippines is primarily driven by poverty thus the need to explore other sources of livelihood. Working abroad has been the solution to address a

14

8th Regional Conference on Migration, 2002 Commission on Filipinos Overseas Stock Estimate of overseas Filipinos as of December 2009 . http://cfo.gov.ph/pdf/statistics/ stock%202009.pdf 16 IOM, cited in CARAM Asia, 2002 17 Human Development Report 2009. Overcoming barriers: Human mobility and development; UNDP 18 ILO 2010: International Labor Organization: A Rights-based Approach , p 28 19 th 8 Regional Conference on Migration, 2002
15

24

variety of economic woes. It is therefore not surprising when in 2005, the POEA recorded that among migrant domestic workers alone remittances were pegged at US$255,689,000. Almost half of the women migrant domestic workers are college graduates (43 percent) and half have at least a high school education20. Majority of these women (52.5 percent) have taken loans from relatives and less than a fourth (15 percent) from money lenders, to be able to pay for the costs of applying for domestic work abroad. 1. Women and Domestic Work Women domestic workers constitute a unique working population. They are predominantly females, and ethnically different from their employers. The live-in nature of their work isolates them and makes them especially vulnerable to abusive working conditions20. Migrant domestic workers are adult women who voluntary migrate from one country to another to find work in the domestic service sector. The International Labor Organization (ILO) defines domestic work as a wage- earner working in a (private) household, under whatever method and period of remuneration, who may be employed by one or more several employers who receive no pecuniary gain from their work21 Based on the definition, the following characteristics of domestic work were derived: . Box 1: Characteristics of domestic work 22

The work site is a private home. The work performed is of a domestic nature: cleaning, cooking, laundry, childcare and personal care and may include other home-based tasks such as gardening, driving or patrolling. The work is carried out under the authority, direction and supervision of the householder. The worker is remunerated in cash and/or in kind. The employer derives no pecuniary gain from the work performed.

20 21 22

The Womens Foundation, 2006, p.63 ILO 2009, Moving towards Decent Work for Domestic Workers: An Overview of the ILOs work, p.9 ILO 2009

25

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

In many countries of destination, domestic work is not considered part of formal work (CARAM Asia, 2002). In a study of national laws conducted by ILO in 2004, only 19 out of 65 countries have specific laws or regulations dealing with domestic work23. This perspective ties in closely with the view that this type of work is womens work, which consequently leads to the discourse on the division of the productive and reproductive domains. Domestic work is often considered as unproductive work and as economically invisible...it assumes that domestic work does not create value because the immediate products are used for direct consumption within the same unit of production, i.e. the household.24 The work conditions of migrant domestic workers are replete with problems, specifically wage differentials, contract violations, poor working relations, physical and sexual violence (The Women Foundation, 2006). The absence of legal protection further exacerbates the condition of migrant domestic workers. The following statistics drawn from the study conducted by the European Union in five European cities reflects the situation of live-in domestic workers (cited in CARAM Asia, 2002): Average daily working hours: 17.2 Average monthly wage: 162.75 euro Psychological abuse (threats, shouting, insults) : 88% Physical abuse (striking, kicking): 38% Sexual abuse and rape: 11% Irregular access to food (leftovers, deprivation) : 61% No room of ones own (forced to sleep in hall, kitchen, etc.): 51% Confinement (forbidden to leave household unaccompanied) : 34% Confiscation of passport by employer: 63% Irregular payment: 55% Pay lower than agreed: 58% Free time not respected: 91%

These realities impact on the physical, social and health conditions of migrant workers. Gender differences were also identified in the conditions faced by female and male migrant workers that further disadvantage women migrant domestic workers. In Hong Kong for example, women migrant domestic workers are paid an average monthly income of HK$3,619 which is less than the HK$4,758 that men receive for the same type of employment. The nature of work varies too, as men are assigned to driving and gardening jobs, while women are tasked with childcare, cooking and cleaning. In terms of days off, women are

23 24

Ramirez-Mechado J, Domestic Work, Conditions of Work and Employment: A Legal Perspective, ILO, 2003 CARAM Asia, 2002, p. 98

26

given an average of 3.5 rest days per month compared to males (3.9 days per month). Despite contract rights, 50 percent of domestic workers do not claim sick leave or consult a doctor for illness and 85 percent pay for their own medical expenses. The study also cited a research (AMC, cited in The Women Foundation, 2006) that 26 percent of female respondents experience at least one form of physical abuse. Verbal abuse was noted to be prevalent. Five percent reported that they experienced various types of sexual abuse (such as obscene language, exposure to pornographic material, and rape). Filipino women migrant domestic workers reported that they have been kissed, touched and were the subject of sexual advances by their male employers. Gender intersects with ethnicity, as seen from a review of research on women migrant domestic workers. Globally, Asian migrant domestic workers are preferred not only because they are cheap but also because they are considered to be hardworking and malleable (CARAM Asia, 2002). Within Asia, Indonesian women domestic workers are paid less than Filipinos and Thais in Hong Kong (The Womens Foundation, 2006). Gender also intersects with existing social hierarchies in destination countries with migrant workers being considered to be at the lower rungs of the occupational hierarchy. Religion also serves as a factor in the migration pattern of female domestic workers. For example, Middle East countries prefer workers with similar religious backgrounds (CARAM Asia, 2002). This explains the migration pattern of women migrant domestic workers from Mindanao. Due to these interrelated factors, womens work is further undervalued, resulting in limited access to resources and services, social exclusion, discrimination and violence in host countries (8th Conference on Migration, 2002). B Migration and Well-being

Given the significant numbers of women migrating as domestic workers, there is concern regarding their health and general well-being. The new transnational face of domestic workers generates important questions about the even greater vulnerability of this invisible community. Their daily interaction with the state, the host society, and their employers can be marked by discrimination on the intersecting basis of their ethnicity, nationality, class and gender. How do developments concerning global migrant flows influence the health and well-being of these domestic workers? Among women migrant workers, specifically Asian migrant workers, studies have shown high incidence of mental illness and job-related accidents due to employers failure to comply with safety standards resulting in workers disability and death (8th Regional Conference on Migration, 2002). Unsafe work conditions, long hours of work and strenuous activities, have also resulted in lifelong disabilities such as Stevens Johnson syndrome, enlargement of the heart, and hypertension. Their vulnerability to

27

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

contracting sexually-transmitted infections, including HIV, is also present (ACHIEVE, 2009). Violence against female domestic workers has also been reported (The Womens Foundation, 2006). There is no existing literature that specifically targets migrant domestic workers and their health on a global level. Whenever we read about health problems in relation to domestic workers, usually the excesses are depicted by the media: cases of abuse, rape and torture. However, focusing only on excesses has at least two drawbacks. First of all, the media can give the implicit message that migration in itself is the root of all problems. Indeed, in May 1995 Philippine president Fidel Ramos called for initiatives to keep migrant mothers at home (Parreas, 2001). Secondly, the attention is directed away from less obvious and more hidden health problems faced by domestic workers: work-related accidents, clandestine abortions, low access to health care, as well as loneliness and depression, to only mention a few. 1. Migration and health Migration health (Migration Health Annual Report, 2005, p.2) is defined as the complete physical, mental and social well-being of migrants and mobile populations and not merely the absence of disease and infirmity. Determinants of migrant health could be divided into environmental, behavioral, socioeconomic and genetic-biological factors. Some determinants of migrant health along the different stages of migration have been identified (Annual Report Migration Health, 2005; CARAM Asia, 2002; Bhugra and Jones, 2001) and are shown in table 1.
Table 1. Determinants of migrant health
Pre-migration/ Pre-departure
Health determinants of migrants country Travel related conditions Process of migration Migration policies Disparities in the health determinants in host country Accessibility, availability, and affordability of health and social services Economic costs

Migration process/ Post-arrival


Access to health in host country Conditions in the process of migration Acceptance of host country Vulnerabilities of migrant Accessibility of health care and services Support systems

Post migration
Access to health in country of origin Economic, social, cultural and political reintegration Issues pertaining to return and visitation Social costs of migration

28

According to Carballo (2007), some emerging health concerns among the migrant population are chronic stress, poor dietary adaptation, rapidly changing lifestyles, Type 2 diabetes and cardiovascular problems such as hypertension and stroke. The risk of sexual abuse and exploitation is a reality for women migrant domestic workers. Difficulties in managing these conditions were observed as migrant individuals have to shoulder socio-economic burdens, are oftentimes alone and unable to access and use local health and social services. 2. Migration and mental health Mental health has been defined by the World health Organization (WHO) as the state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make contribution to his or her community. Given this definition, one can surmise that mental health is not just the absence of mental illness. Positive mental health involves a sense of psychological well- being which goes hand in hand with a healthy sense of self25. Some of the factors that affect well-being include emotionality and life satisfaction. Emotionality pertains to both positive and negative emotions and the capacity to regulate these feelings. Among adults, well-being is associated with a decrease in negative emotions such as anger, fear and anxiety; and an increase in cheerfulness. The latter has been correlated positively with education and marital status. Life satisfaction on the other hand, entails an assessment of ones subjective wellbeing. This includes good coping skills and capacity to adapt. Important contributors to this are social support and spirituality. It has been said that counting ones blessings increases life satisfaction. Generally well-being has been associated with physical health, capacity of enjoying life, positive feelings about self and serenity in looking at life events26. Ryff and colleagues27 further developed a model of well-being, which is comprised of six dimensions, specifically, self-acceptance, positive relations with others, autonomy, environmental mastery, purpose in life and personal growth. These are collectively associated with social well-being, defined as the quality of a persons self reported relationship with other people, the neighborhood and the community28 - an essential aspect of wellness and are a relatively unexplored area of mental health. Keyes and Shapiro (cited in Papalia, Olds and Feldman, 2007, p. 601) identified five dimensions of this construct: social actualization, social coherence, social integration, social acceptance and social contribution.

25 26 27

Keyes and Shapiro, 2004 cited in Papalia, Olds and Feldman, 2007, p. 598 Papalia, Olds and Feldman, 2007, p. 599 Cited in Papalia, Olds and Feldman, 2007, p. 600 28 Papalia, Olds and Feldman, 2007, p.601

29

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Migration, whether forced or voluntary, creates a strain on individuals and families. The process is typically associated with uprooting, leaving some family members behind and breaking with social customs and values that have provided a sense of continuity29. Undoubtedly the process of migration puts a lot of strain on individuals and the people they leave behind and may contribute to migrant health issues (Bhugra and Jones, 2001). Specifically in the realm of mental health, the responses of migrants to the demands of the new environment, have been characterized as a mix of culture shock, language problems, homesickness, difficulties staying in touch with families left behind, anxiety about work insecurity, and in case of clandestine migrants...the constant fear of deportation (Carballo, 2007). Bhugra and Jones (2001) purported that the different stages of migration may create vulnerabilities and stresses that accompany the process of assimilation, acculturation and deculturation which are necessary in adapting to a new socio-cultural environment. The same study forwarded that the high rates of psychological problems and disorders are related to migration. For example, it has been observed that the incidence of schizophrenia is related to stresses produced by migration. In the same vein, Lerner, Kanevsky and Witztum (2008, p. 291) posited that immigration is acknowledged to be a major stress which may increase the emotional distress of an immigrant and in some cases may lead to pathological reactions. Most commonly recorded mental psychiatric disorders due to migration are: anxiety disorders, depression, dysthemia and adjustment disorders. These are primarily due to acculturation problems, immigration stresses and social isolation, exacerbated by low health seeking behaviour, as immigrants do not seek medical attention until their mental health status compels them to be hospitalized. A study done among Filipinos migrating to the United States show that migrants use less mental health care than other groups, regardless of age, gender and geographic locations; drop out of treatment prematurely; tend to use services only in crises; have somatic expressions of mental issues; and refuse treatment because of severe stigma associated with mental illness30. Murakami (2009) further enthused that cultural changes affect mental health. Working in a different culture creates conflicts due to differences in language, lifestyle, and values; as well as the feeling of isolation from ones network. The changes in global movements in more recent years, with females moving as much as if not more than males, draws attention to the differential characteristics and experiences of female migrants (Carballo, 2007). Oftentimes, women are moving alone as a consequence of which they find themselves with minimal social support. Research has shown this is true among female domestic workers, as they are excluded from mainstream society (The Womens Foundation, 2007). They also experience violation of contracts and are subjected to subservient and dependent positions. Their relationship with their employers is ambivalent, as they are considered as helpers and

29 30

Carballo, 2007, p.1 Sanchez and Gaw, 2007

30

competitors to their children. Women workers who left their families behind have to provide economically for them and may experience problems in maintaining their relationships with family members because of the distance and time away from them. A reality faced by migrant female workers is informalization of labor. This may be due to disasters or untimely termination of contracts (Hirochi, 2007). When this happens, informal communities are formed at the fringes of society making them vulnerable. 3. Migration and stress Studies have shown that stressful experiences increase ones vulnerability to diseases and mental health problems (Meyer, 2002). This is because sustained stress has a negative impact on a persons immune system, generates passivity and hopeless resignation. Individual factors such as age and gender influence the experience of imbalance. Stress may also have positive effects (that of transformation) and stress and crisis may also trigger growth (Bee and Bjorklund, 2004). Stress is defined as a physical or mental response to demands from the environment (Bee and Bjorklund, 2004). One type of response is physiological, where the body reacts to the condition of stress. The second response to stress is psychological, which include cognitive defence and behavioural responses (Marks et al, 2004). This recognizes the perspective that psychological stress as a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being31. In understanding stress further, it is also imperative to look into the different triggers of stress which are collectively known as stressors. According to Pearlin, stress (Meyer, 2003) is a condition where the individual becomes active in the process of adaptation. Thomas Holmes and Richard Rahe developed the Social Readjustment Rating Scale (SRRS) which consist of 43 life-change events which require adaptation. The top ten sources of stress in the scale are (Bee and Bjorklund, 2004): (1) death of a spouse; (2) divorce; (3) marital separation from mate; (4) detention in jail and other institution; (5) death of a close family member; (6) major personal injury or illness; (7) marriage; (8) being fired from work; (9) marital reconciliation with mate; and, (10) retirement from work. The abovementioned scale was further improved by succeeding researches along such lines. One such development was that of Pearlin (Meyer, 2003), who made a distinction between scheduled life changes and unscheduled life changes, the latter being more stressful than the former. The value of the individuals appraisal of the life event is also worth considering in the process, as stressors vary depending on the individuals assessment of the phenomenon.

31

Marks et al, 2004, p. 263

31

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Another type of stress identified in the literature is minority stress, which concerns individuals belonging to minority groups. This is said to be a result of the stigmatized social category the person is a part of32. The foundations of minority stress are structures and institutions in society, including societal processes which challenge the capacity of the individual to control (Szymaski, 2009). It goes beyond what one individually feels and experiences. According to Meyer (2003), societies can trigger stress because they stimulate the values that lead to conflicts in structures, mirrored by differing values of dominant cultures and minority groups. Meyer further established the assumptions of minority stress, which those who are not members of minority groups do not experience: (1) it is an additional source of stress among stigmatized individuals; (2) it is chronic; and, (3) it is socially-based. Alcid (2007) noted Theodore Esmans perspective of migrant groups as minority groups. These groups never get assimilated into the whole society and develop a diasporic consciousness maintaining sentimental and material links to the land of origin either because of social exclusion or internal cohesion. This creates a destabilizing effect on transition and movement of the individuals cultural characteristics and the changes that takes place in all social contexts. Racial discrimination is considered a chronic stressor that can elevate blood pressure and increase the risk of stroke33. There are also researches pointing out to stress resulting from gender discrimination. Haslette and Lipman in 199734 observed that even small gender inequities on the job were a significant source of stress among women. Sexism also directly impacts womens health. In domestic work, another source of stress is the workers ambivalent identity as a family member and an outsider (The Womens Foundation, 2006). Migrant domestic workers attribute the discrimination they experience in their host country to the nature of their work (60 percent), their foreign status (22 percent), gender (five percent) and age (four percent)35. Discrimination comes in different forms, including very subtle ones, specifically in stereotypical perceptions of migrant workers. The experiences of Filipino domestic workers in Hong Kong attest to this: In particular, it has been observed that the sexuality of Filipino domestic workers in Hong Kong are subject to social commentary and control... media representations of Filipino domestic workers in Hong Kong recognise a stereotypical image of promiscuity...such an image may be rooted in historical links between domestic service and sexual services (p.67).

32 33 34

Rotosky et al, 2007 Guyll, Matthews and Bromberger, 2001, cited in Bee and Bjorklund, 2004 Cited in Bee and Bjrorlund, 2004 35 AMC, cited in The Womens Foundation, 2006

32

Stress factors identified by Murakami (2009, p.60) among migrant workers include: Adapting to an unfamiliar culture and lifestyle which may deprive them of the ability to cope Heavy workload Communication problems Values and way of thinking Less social support Conflicts between sending country and host country Lack of understanding of local situation

Married women domestic workers also have to contend with changes in their family structure and dynamics while they are abroad and after their return36. The new role of the wife as a breadwinner creates transitions in gender roles and expectations in the family which sometimes strains relationships. Studies show an increase in behavioral and social problems among children of overseas workers and drunkenness and infidelity among male spouses left behind. More often than not, female migrant domestic workers carry the brunt of blame and guilt of such consequences. The following table illustrates the connection of problems experienced by the migrant workers and the consequences for their wellbeing37.
Table 2. Problems experienced by migrant workers
Problems Poor working conditions including long working hours, no safety measures Low wages limited to minimum living cost No access to health information Difficulties in communication at medical institutions No maternity protection Mandatory medical testing for pregnancy, HIV, among others No health insurance for undocumented migrantsHigh medical cost Sexual, mental and physical abuse Different social status, exploitation, working in 3D jobs Consequences Industrial accidents, work related illnesses Ill balanced nutrition/ malnutrition No proper treatment Cannot explain health state or disease Bad health conditions of women and children Forcible deportation Self medication, development of diseases Emotional and psychological trauma Loss of dignity, self respect
(Source: Choi, cited in the 8th Regional Conference on Migration, 2002)

36 37

CARAM Asia, 2002; Pingol, 2002 Choi, cited in the 8th Conference on Migration, 2002

33

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Studies have shown that stressful experiences increase ones vulnerability to diseases and mental health problems (Meyer, 2002). This is because sustained stress has a negative impact on a persons immune system, generates passivity and hopeless resignation. Individual factors such as age and gender influence the experience of imbalance. Stress may also have positive effects (that of transformation) and stress and crisis may also trigger growth38. Stress is defined as a physical or mental response to demands from the environment39. One type of response is physiological, where the body reacts to the condition of stress. The second response to stress is psychological, which include cognitive defence and behavioural responses40. This recognizes the perspective that psychological stress as a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being41. C Coping with Stress 1. Coping: definitions and concepts An important buffer from stress is the sense of personal control, evident in the ability to cope. Coping is characterized by awareness of ones feelings, cognitions, behaviors and physiology42. Lazarus43 identified the following types of coping: Confrontative coping: I expressed my anger to the person who caused the problem. Distancing: I made light of the situation; I refused to get too serious about it. Self-control: I tried to keep my feelings to myself. Seeking social support: I talked to someone to find out more about the situation. Accepting responsibility: I realized that I brought the problem on myself. Escape / Avoidance. I hoped a miracle would happen. Deliberate problem solving: I made a plan of action and I followed it. Positive reappraisal: I came out of the experience better than when I went in.

Not all responses to stressors could be classified as coping (Miller, 2001). Responses to stress can be categorized as voluntary and involuntary only voluntary responses are considered to be coping responses (Compas et al, 2001). According to Carver et al (1989), there are three major categories of coping strategies: (a) problem focused (focused on what needed to be changed); (b) emotion-focused (addressing
38 39

Bee and Bjorklund, 2004 Bee and Bjorklund, 2004 40 Marks et al, 2004 41 Marks et al, 2004, p. 263 42 Compas et al, 2001; Lazarus and Folkman, 1984 43 1993, cited in Bee and Bjorklund, 2004, p.350

34

emotional disturbance); and, (c) dysfunctional (avoidance of the problem). According to Gutierrez et al (2007), a more appropriate way of differentiating types of coping would be discriminating between engagement coping and disengagement coping. Problem-focused and emotion- focused strategies belong to the first while dysfunctional coping belong to the second category. Miller (2001) purported that engagement coping entails changing the situation and is characterized by control of ones self and ones condition, associated with problem focused and problem-solving strategies44. Involvement in a political struggle is also classified under this. Disengagement, on the other hand, is a strategy in which the attention and action of the individual entails avoidance of the stressor. Under this are mental disengagement, denial and behavioral disengagement. Part of mental disengagement is behavior that does not directly relate to the stressor, such as sleeping (Carver, Scheier and Weintraub, 1989). A person may be aware of the stress but decides to divert her attention to something else. Denial entails distortion of reality and changing the meaning of reality. Behavioral disengagement includes helplessness, surrender and avoidance of objectives that may necessitate confronting the source of stress. Help-seeking implies directing ones attention, thoughts and behaviours to society and engaging society and individuals in the process of responding to the source of stress. Social support plays a critical role in the process. 2. Coping among migrant workers Among migrant workers, coping with difficulties may include tobacco and alcohol abuse (Carballo, 2007). Some address issues by challenging subservient roles at a discursive level of individual or collective engagement45. Filipino domestic workers are observed to come together to be part of group activities such as playing cards, eating Filipino food, dancing and attending mass. Apart from these, they are also active in directing their reactions and outrage to negative images created of them, such was the case when the helper doll was issued in 1986. This doll embodied the image of Filipino domestic workers as docile and hardworking. Activism of Filipino women migrant domestic workers is observable in Hong Kong, despite limitations, this contributed to strengthening protection of domestic workers rights (The Womens Foundation, 2006). Coping styles of Filipinos, nested in collectivist culture, may not always work in other settings. Specifically, the emergence of the pseudo- family comprised of compatriots may also impede adjustments necessary in cultures that are task oriented and impersonal46. Prayer is also one of the tools used to cope. This is attributed to the Filipinos strong and positive sense of spirituality, which is considered to be a source

44 45

Gutierez et al 2007; Fuster, 2002 Lowe, cited in The Womens Foundation, 2006, p. 67 46 Sanchez and Gaw, 2007

35

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

of strength in the individual47. The latter has been considered as a major coping mechanism in times of crises among Filipino migrant domestic workers. 3. Social support as a coping strategy Through time, researchers proposed that well-being requires the fulfillment of various support needs that are provided through relationships with intimate others48. These needs include attachment, social integration, reassurance of worth, guidance, reliable alliance and the opportunity to provide nurturing49. Support is more effective when it comes from those who are similar in values and characteristics, and who are facing or have faced similar stressors somewhat more successfully. Spouses, children, relatives and peers are likely sources of social support. Empirical studies on social support substantiate the contention that support provided by a spouse and family members may take precedence over other sources of support (Meyer, 2002). Gender factors also play a role here, women who contribute more to household work and supportive nurturing might draw more positive emotion from the presence of companionship. Studies50 showed that women are generally more family-oriented, child-centered and relationship-oriented than men. These characteristics make them experience being away from home doubly stressful. Social support, according to MacArthur and MacArthur (1998), is considered assisting someone in terms of emotional and instrumental help. Respectively, these are acts that show affection and encourage a persons self worth, as well as the provision of tangible or material aid. In general, these behaviours have been found to have positive influence on the health and well-being of recipients of support51. From the social cognitive perspective, social support influences health by influencing self-esteem and selfregulation. Since the experience of self is closely related to how one is viewed by others, social support operates by influencing evaluations of self and others. Consequently, perceived social support indirectly leads to well-being, by promoting self esteem first before enhancing ones sense of wellness. Gilbert (2000) and Uchino et al (1996) surmised in their researches that social support brings forth the capacity of directly addressing problems and stressors, which also lead to physical health. Meyer (2002, p. 587) claimed that those who enjoy close relationships eat better, exercise more, and smoke and drink less. He related the demonstration of such healthy behaviours to self-esteem, which is related to having close relationships that allow an individual to evaluate and address the source of stress. Confiding painful feelings to someone is also correlated with lesser health problems. Negative effects of stress on health and happiness decrease when one has adequate social support compared to
47 48 49

Conde, 2004, p. 160 Meyer, 2002; Weis, 1974 Dehle and Landers, 2005 50 Cited in Jiang and Winfree, 2006, p.36 51 Cohen, 2001; Helbrun, 2008; Lazarus and Folkman, 1984

36

those with weak social support (Bee and Bjroklund, 2004). Women, who portray multiple social roles as wife, parent, caregiver and worker, suffer from stress when they do not have adequate social support. People are generally happier when surrounded by family and friends. Cultural factors also impact on this, as shown in researches documenting the differences on the impact of support in collectivist and individualistic cultures52. Sanchez and Gaw (2007) highlighted the collectivist characteristic of the Filipino culture, which is associated with family, regional affiliation and peer group in the achievement of mental health. Reciprocity and mutual caring, which characterize these relationships, have been noted to impact on health seeking behaviours, as assistance from family members and friends are sought before mental health professionals. Treatment is oftentimes in consultation with family members. Despite the proven buffering effect of social support, there are also negative effects of social support. When interactions are characterised by anger, dislike, criticism or undermining, these relationships will have substantial effect on an individuals sense of well- being and mental health53. D Addressing the Healthcare Needs of Women Migrant Workers 1. Access to health care Carballo (2007) confirms that even in host countries providing universal healthcare coverage, migrants still fail to benefit from the services available. This is due to how migrants perceive their illness and what they can do about it. Language barriers and poor communication between migrants and health personnel contributes to the problem, as well as misperceptions of migrants on the local health care systems. Migrant workers are also tied to their work and may not be able to take time off to avail of health services. The status of the migrant further complicates the issue, as illegal migrants tend to fall outside the parameters of organized health care and end up resorting to emergency services when they are unable to address their illness. In order to deal with these access barriers to health care, migrant women may indeed prefer to go to the doctor when in their home countries, on their rare holidays. In the study by Holroyd et al. (2003), this definitely seems to be a frequent practice; 44 percent of the women reported a general practitioner in the Philippines to be a regular source of medical care, as compared to only 26 percent who reported a general practitioner in Hong Kong. The migrant domestic workers low health care utilization reflects shortages of time, a lack of economic resources and/or different prioritisation, cultural, communicational and discriminatory problems in addition to a lack of freedom to seek health care if she needs medical care.
52 53

Bettencourt and Dorr, 1997, cited in Meyer, 2002 Bee and Bjorklund, 2004

37

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

2. Concerted Global Efforts Participants in the 7th Regional Conference on Migration (2001) proposed an advocacy framework in combating problems experienced by migrant workers and to protect their rights, nested in international labor and human rights standards such as the UN Migrants Convention, CEDAW and ILO migration conventions. They recognized that the problem with advocacy in migration is the reality of the need to engage different countries and stakeholders, which involve confronting issues on race, gender and class discrimination as well as changes in roles, jobs and contexts of individuals. Other basic migrants rights included in the discussion were rights to social services and social security, health and safety, including medical and retirement benefits. The process of addressing migrant workers health needs to be a concerted effort by origin and destination countries. The process of addressing migrants health necessitates the process of bridging national health systems and international systems. There is a need to look into the social determinants of health at all phases of migration. Multidisciplinary approach and cross- country perspectives needed to be employed in the process54. Services for migrant workers therefore should not only include services for communicable diseases and acute health care, but also the provision of appropriate preventive measures, as well as health services for chronic conditions, care for older migrants, and special needs of women. All these should be integrated in the existing systems available to migrant workers. Migration research points out to the need to determine migrant needs and access to health services, evaluation of public health interventions and the development of culturally sensitive, acceptable and affordable services55. In 2008, the 61st World Health Assesmbly convened by the World Health Organization passed a resolution on the Health of Migrants. The resolution called on the member states to address the issue of health of migrants by adopting policies and programmes that enable migrants to have better access to health information and services. This resolution led to the development of an Operational Framework on Migrants Health, which was presented in the 63rd World Health Assembly in 2010. The operational framework addressed four key areas, namely: monitoring migrants health; policy and legal frameworks; migrant sensitive health systems; partnerships, networks and multi-country frameworks. 3. Addressing health needs of Filipino migrants Among Filipinos migrants, there is an identified need for culturally and linguistically competent providers56. The following guidelines for culturally sensitive approach to treatment of Filipino migrants in the United States were drawn from the research of Sanchez and Gaw (2007, p. 814): (a) Pay attention to immigration

54 55 56

Migration Health Annual Report, 2005 Migrant Health Annual Report, 2005 Sanchez and Gaw, 2007

38

history and regional orientations; (b) Determine the underlying reason for treatment; (c) Ensure adequate understanding of the diagnosis and treatment plan, bearing in mind that social inhibitions and nonverbal cues can mislead; (d) Use visual cues and communicate in a collaborative manner; (e) Facilitate dialogue, inquiring about physical, as well as mental health complaints; (f) Utilize the family and identify the patients power hierarchy; (g) Allow the patient time to process any information given; (h) Respect personal space; (i) Note mannerisms without making assumptions about their meanings; (j) Do not be misled by the presenting affect; (k) Maintain judicious use of medication; and, (l) Engage patient by actively focusing in the individual symptoms. Deducing from the above, a comprehensive cross cultural assessment needs to be done in the development of psychosocial interventions, taking into account the following: (a) Immigration history; (b) Socio-economic beginnings; (C) Regional orientation; (d) Tracing the chronology of events prior to the visit; (e) Considering the familys conceptualization of the condition and course of treatment; (f) Ascertaining health practices and fears for implications of treatment; (g) Identifying the people of influence; and, (i) Motivations and actions that contribute to family welfare. 4. Protection of migrant workers The 1990 International Convention on the Protection of the Rights of all Migrant workers and Members of their Families provide a broad range of protection for migrant workers and their families. Some of the important provisions of the Convention include the protection of human rights of migrant workers and their families; freedom from slavery or servitude; protection from violence, physical injury, threats and intimidation; provision of services/assistance e.g. health, education, housing, among others57. ILOs Decent Work Agenda, on the other hand, focuses on creating opportunities for all men and women of working age, including migrant workers, to obtain decent work in conditions of freedom, equity, security and human dignity.58 In 1995, the Migrant Workers and Overseas Filipino Act was enacted that puts together the national policies on overseas employment and establishes a higher standard of protection and promotion of the welfare of migrant workers, their families and distressed Filipinos overseas. The law was amended in 2009 and is currently known as Republic Act (RA) 10022. The laws guiding principles include upholding the dignity of citizens whether in the country or overseas; full protection to labor; full employment and equality of employment opportunities; adequate and timely social, economic and legal services;

57 58

ILO, International Labor Migration: A Rights-based Approach, 2010, p133 ILO, International Labor Migration: A Rights-based Approach, 2010, p 71

39

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

fundamental equality before the law of women and men; the significant role of women in nation building (gender sensitivity is a necessary component of programs); and the right to participation in democratic decision-making processes of migrant workers and overseas Filipinos59. Concretely, the law defines the roles of different agencies such as the Department of Foreign Affairs (DFA) to issue travel advisory /information dissemination; the Labor Department (DOLE) and its attached agencies to attend to all travel and work deployment needs of overseas workers, such as accreditation and regulation of recruitment agencies, among others. The OWWAs National Reintegration Center for OFWs (NRCO) has been tasked to develop reintegration programs for returning Filipino migrant workers. Another important provision of the law is the establishment of Migrant Workers and Other Overseas Filipinos Resource Centers in countries where there is a large concentration of OFWs. The center is expected to provide services such as medical care, social counseling, community outreach, temporary shelter, welfare benefits and airport assistance when needed. 5. Promoting mental health among migrant workers Murakami (2009) noted that based on their evaluation of Japanese working overseas, the presence of the following are crucial in promoting mental health of migrant workers: self-care; industrial physician; care by higher ranking members of organization; and, care by outside resources such as medical clinics, counseling facilities and other public services. She added that it is the role of the employers to support prevention of problems at an early stage, introducing program treatments and promoting smooth re-adaptation and adaptation to the workplace. One study purported that mental health adjustment among Filipino domestic workers needed to be addressed and one method to deal with such concern is through Sunday gatherings60. These gatherings serve as group counseling sessions where domestic workers find a venue to seek comfort and release emotional tension. In the Philippines, the Department of Health (DOH) implements the National Program for Mental Health. Premised on the policy shift from mental hospitalbased psychiatric treatment to community-based mental health care, the program entails integration of mental health care in general health services61. It aims to promote mental health in the general population, to reduce the risks and prevalence of mental disorders, and to improve the quality of life of those who are affected. Currently, six priority areas of concern have been identified, specifically, (1) mental disorders; (2) substance abuse; (3) disaster and

59 Sobritchea C. et al 2010, Health of our Heroes: Access to Sexual and Reproductive Health Services and Information of Women Migrant Domestic Workers. p.22 60 The Womens Foundation, 2006 61 Conde, 2004

40

crisis management; women, children and other vulnerable groups; epilepsy and overseas workers62. Mental health programs for OFWs mentioned in the program are those run by OWWA, such as the predeparture policy to have overseas contract workers undergo neuropsychiatric screening. A pre-departure seminar is compulsory, where lectures should include the culture of the country of destination, expected stresses and coping strategies. Assessments of the PDOS conducted by various entities point out to the inadequacy of a one-day seminar to fully prepare migrant workers for overseas work. In 2002, a joint initiative by the DOH, DOLE and DSWD was rolled out involving social welfare officers and medical officers in Philippine consulates who can provide counseling and social welfare assistance. While this was implemented during the first two years of the effectivity of the MOA, there are concerns about the sustainability and continuity of the programme. Physicians in consulates have been reported to have been trained by DOH to identify mental disorders. Another attempt to address mental health concerns of migrant domestic workers, albeit replete with controversies, was the suggestion of the Office of the Undersecretary for Migrant Workers Affairs (OUMWA) of the Department of Foreign Affairs, to require psychiatric screening of all outgoing migrant domestic workers. Opposition to this recommendation has been raised by various sectors migrant workers, recruitment agencies, and overseas workers organizations. The DFA justified the proposal requiring departing Filipino household service workers to take psychiatric tests by saying that seven of every ten domestics in death row have a history of insanity63. Undersecretary for Migrant Workers Affairs Esteban Conejos further reported that In these [death conviction] cases, the only defense that weve had was insanityIm not a medical expert, but I have talked to them and they say they have done what theyve done because it was a message from God, or theyre still getting a message from the ground. E Mental Health and Well-being In Filipino Culture 1. Filipino concepts of mental health and well-being Among Filipinos, health and happiness are considered to be intertwined and should be balanced to achieve wellness64. Positive characteristics such as tiyaga (hard work), patience and endurance; and lakas ng loob (inner strength) and hardiness are related to capacity of individuals to be happy. The experience of wellness is also related to an individuals mental health.

62 63

Conde, 2004 http://globalnation.inquirer.net/news/breakingnews/view/20080821-156020/DFA-defends-psychiatric-tests-for-departing-domestics 64 Sanchez and Gaw, 2007

41

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

In the Philippines, the sense of wellness, well-being and positive mental health, is tied in to the achievement of ginhawa (comfort). According to Salazar (1982), ginhawa is an aspect of ones personhood (pagkatao) that is related to the individuals state of physical, mental and social health. It is considered to be a condition or state which is, though related to the external realm (labas), significantly rooted in the inner core (loob) of ones being. The experience of ginhawa is related to kaluluwa (soul) which is the core of an individuals being that is immortal and is the foundation of morality. Kaluluwa is not associated with a persons religiosity but to ones spirituality which characterizes an individual (tao) as essentially mabuti or good. This is the wellspring of buhay (life) and sigla (roughly translated to a combination of flow and positive affect), which allows one to attain ginhawa. The latter is typically described using the following phrases: gaan ng buhay, aliwan ng buhay, kaibsan ng hirap, mabuting pamumuhay, paggaling sa sakit, and pahinga. Attaining this state therefore entails experiencing total health or wellness in all realms physical, psychological and social. The non-achievement of ginhawa may be due to and may lead to the experience of siphayo or pains of the soul (rough translation), which is associated with incidence of illness, including mental health problems. 2. Social support and coping in Filipino culture The system of social support among Filipino migrants depicts the relationships in their country of origin characterized by kapwa (shared identity) and the distinction between the ibang tao ang hindi ibang tao65. Enriquez (1989) forwarded the assertion that social relationships and interactions among Filipinos are categorised into ibang tao (outsider category) and hindi ibang tao (one of us category). The local language provides a conceptual distinction in several levels and types of interaction between the two66: Ibang tao or Outsider category - Pakikitungo (level of amenities / civility); Pakikisalamuha (level of mixing); Pakikilahok (level of joining / participating); Pakikibagay (level of conforming); and, Pakikisama (level of adjusting) Hindi ibang to or One of us category - Pakikipagpalagayang loob (level of mutual trust / rapport); Pakikisangkot (level of getting involved); and, Pakikiisa (level of fusion, oneness and full trust)

These levels of interaction define the nature of relationships individuals have and constitute the core interpersonal behavior of pakikipag-kapwa, which comprise the super- ordinate concept of kapwa. According to Maggay (2002), these levels are correlated to the level of disclosure in an interaction the higher the level of pakikipagkapwa, the higher the level of disclosure. The quality of perceived social support may also be related to this, there is greater likelihood to perceive social support in the context

65 66

Sanchez and Gaw, 2007 Enriquez, 1989, p. 31; Santiago and Enriquez, 1976

42

of relationships that are characterized as hindi ibang tao. Traditionally, people who are considered to be one of us are family members and friends. This may be the reason why the family serves as a critical source of support, and when this is absent, an informal definition of family which may constitute friends, neighbors and other members of the community are established67. This is seen among female migrant domestic workers, when they form groups and create spaces for these groups as a way of addressing and coping with the demands of overseas work68. 3. Views on mental illness among migrant Filipinos According to Tsai et al69, there are commonalities in migrant Filipino views of mental illness, which are identified and summarized in Table 2. Sanchez and Gaw (2007) further noted that among Filipino migrants, there is a prevalence of depression, but low suicide rate. They also coined the term smiling depression which characterized the behaviour of Filipinos with depression. Clinical depression for said population is most often due to separation from family and financial difficulties. The low suicide rate is attributed to the presence of extended family and social support. Barriers to treatment include dealing with family hierarchy and regulation; fatalistic attitude and religious fanaticism; lack of belief in the capacity to changes; communication barriers, externalization of complaints and lack of culturally competent services.
Table 3. Similarities in migrant Filipino views of mental illness Topics Nature of mental illness Viewpoint Perceived ridicule encourages hesitance in accepting having mental illness and avoidance of services Family and peer groups, indigenous healers and dependence on religion, reduce perceived need of services Prioritization of economic and environmental needs over mental health services Limited awareness of services limits access Adult family members work making it difficult to use services during usual hours Mental illness reflect weak spirit, adverse reckoning and consequences to personal and ancestral transgression Lack of culturally appropriate relevant services; language barriers
(Source : Tsai, in Sanchez and Gaw, 2007, p. 811)
67 68 69

Alternative coping measures

Cost Knowledge of mental health services Operating hours Belief systems

Limitation of services

Conde, 2004; Medina, 2001 The Womens Foundation, 2006; CARAM- Asia, 2002 Cited in Sanchez and Gaw, 2007, p. 811

43

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Analytical Framework

Given the aforementioned results of studies in the area, the following analytical framework is proposed for this research, which takes into account the different stages of migration (i.e. pre- migration, migration process and post migration) and socio demographic characteristics of migrant domestic workers (i.e. age, civil status, educational background, place of origin and type of work) as contexts in identifying mental health needs of female migrant domestic workers. Due consideration will also be directed to socio- cultural contexts in the countries of origin and destination, existing laws and mandates for the development of mental health programs for the identified population, and important standards of ethics and care in the development of mental health services and programs. Recommendations in addressing mental health needs of female migrant domestic workers and development of the training design for service providers will be drawn from the outcome of the research. Diagram 1. Analytical Framework
Stages and Contexts of Migration Pre-migration Examples Economic Hiring/placement conditions Preparations Migration Process Examples Economic Cultural context Social support Experience of abuse Post-migration Examples Return Mental Health Needs According to Socio-Demographic Characteristics of Women Migrant Domestic Workers Age/life stage Civil status Place of origin (urban/rural) Educational background Type of work Enabling Laws/ Policies International mandates, laws and policies Local mandates, laws and policies National laws Recommendations: Policy development/ reforms Training and capacity building for service providers Improvement of services Research and documentation Other prevention and intervention measures

Existing Programs & Services (Local and on-site) Psychological (Individual e.g. debriefing, medical care, counseling, education) Psychosocial (Relational e.g. family counseling, couple interventions, training) Societal (Community e.g. law enforcement, community theatre)

Training Program Framework Design Policy mandates Referrals Case management protocols Care for service providers Others

Standards Ethics Practice

44

Section 2: Research Methodology


A. Overview of Research Activities The action research consisted of two phases. The first consisted of preparatory activities, while the second included the data gathering, collation and analysis processes. 1. Phase 1 - Preparatory Activities This phase involved the following sub-steps: (a) review of related literature, scoping of existing mental health services, and conduct of focus group discussions (FGDs); (b) finalization of the study design; (c) crafting of the data organization and management plan; (d) formation and training of the data-gathering teams; (e) translation, pre-testing and finalization of the data-gathering tools; and, (f) development of the field manual. 2. Phase 2 - Data Gathering, Collation and Analysis This stage covered: (a) social preparation for data gathering, which included an orientation on the study for local government leaders, host institutions, gatekeepers and stakeholders in the research sites, identification of potential research respondents and participants, and logistical preparations for the research team; (b) data gathering in the study sites using the survey forms and key informant interview schedule, as well as conduct of the case studies; (c) data coding, encoding and collation, including data quality checks and transcription of the results of the FGDs and key informant interviews (KII); (d) data reduction and presentation in tables, graphs, and other forms of data presentation; (e) finalization of the case studies; (f) data analysis; (g) validation of the results; and, (h) writing up the research report. B. Research Methods Three research methods were used in the conduct of this action research: (1) survey research; (2) key informant interviews; and, (3) case studies. The survey was used to determine the mental health needs of Filipino women migrant domestic workers. For this particular study, the survey involved structured interviews to determine the mental health attitudes, beliefs, practices and perceptions of Filipino women migrant domestic workers. Pre-testing was done with participants coming from the same population where the study participants would be drawn (i.e. women migrant domestic workers). The key informant interview (KII) entailed the conduct of a semi-structured interview focusing on key aspects of the research problem. Programme implementers were interviewed to determine their perceptions and practices in promoting the well-being of women migrant domestic workers. Also interviewed were informants from regional and national agencies and migrant support organizations

45

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

involved in various capacities in the development, implementation, monitoring and evaluation of policies and programs geared toward addressing the mental health needs of women migrant domestic workers. The KII guide covered these areas of inquiry: description of current policies / programmes / projects; assessment of gaps and gains in the implementation of policies / programs / projects; assessment of existing referral mechanisms; identification of challenges and lessons learned; and, suggested ways / mechanisms of addressing the challenges identified. The case studies documented the lives of selected women migrant domestic workers and included an analysis of their experiences. The research process was characterized by the following values and perspectives: Observance of ethical standards in the research process. Observance of ethical principles governing the research cycle was given utmost importance in the data gathering and analysis process. Informed consent was secured from the research participants before the data gathering process. Furthermore, the participants were made aware of their rights as respondents, especially of the right not to disclose any information they are not comfortable disclosing and their right to withdraw at any point of the research process. The ethics of confidentiality and respect for privacy were strictly enforced in the research process, which meant that no personal information which can lead to the identification of the research participants was included in the research documents and report. All data generated in the study were coded based on the variables considered in the process of research. In addition to this, no information on the participants were released without the consent of the individuals involved. Context-based and process-oriented research process. The whole research process was contextand process-based; that is, the process of data gathering and analysis took into consideration the socio-cultural realities of the participants. The data gathering tools and procedures were also subjected to the evaluation of the research participants. The research tools were pretested, translated and back-translated from English to Filipino, and back to English. Culturally sensitive and gender sensitive research process. The various methods employed and the process of data gathering and analysis were based on the cultural variations that characterized the population studied. The process of data gathering and interpretation took into consideration the values, practices, relations, needs, beliefs, preferences, resources, and other aspects of subcultures defined by gender.

46

Rigor in the research process. The development of the research framework, data gathering tools, and procedures were guided by the review of literature, established methods of data generation, consultation and pre-testing of instruments to ensure the reliability and validity of the research findings. Participatory process. Former migrant domestic workers were involved in the project, from the development and implementation of the survey (as field interviewers) and in the validation phase.

C. Sampling Design 1. Study sites Four research sites have been identified for the study: La Union and the National Capital Region in Luzon, Davao in Mindanao and Cebu in the Visayas. These were selected to represent differing populations from the three main island groups of the Philippines (i.e. Luzon, Visayas and Mindanao). The survey was conducted in the barangay where women migrant domestic workers live and in agencies such as POEA, recruitment agencies where they process their application. Selection of research participants Since there are no harmonized national and local statistics on the number of female individuals working overseas as domestic workers, non-probability sampling was used in the survey. The identification of respondents at the barangay (village) level was done purposively, based on the information provided by gatekeepers in the research sites. Snowball sampling was employed in the process. The inclusion criteria for the sample are: adult female individuals (18 years old and above) who have finished at least one contract as a migrant domestic worker. The participants came from different life stages (i.e. young adulthood and middle adulthood), different types of domestic work (e.g. child minder, cook, all around ) and countries of destinations (e.g. Asia, Europe, Middle East). A total of 500 respondents were interviewed (200 from NCR, 100 from Davao, 100 from Cebu and 100 from La Union).

47

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

The participants in the key informant interview were also identified purposively. The selection criteria are: Involvement in programs geared toward addressing the mental health needs of women migrant domestic workers at different levels of intervention (i.e. international, national, regional, provincial and municipal) and foci of intervention (e.g. individual, family, peer group, community). At least two years of hands-on experience in the implementation of such programs.

The identification and selection of individuals who will take part in the case study was based on the result of the survey. The sampling of participants entailed maximum variation to capture differing experiences and perspectives. Five case studies (two from the Philippines and three from Holland) were included in this study.

48

Section 3: Research Results & Discussion


This section of the report discusses the main findings of the survey conducted among 500 women migrant domestic workers who participated in the study. Though the outcome of the survey is the focal point of the write-up, the case studies of selected women migrant domestic workers, results of focus group discussions and post survey consultations among women migrant domestic workers, and the data from interviews conducted with key informants from governmental and nongovernmental organizations were also included to provide context and additional information to better understand and analyze the main findings generated by the survey. A. Socio- demographic profile of participants barangay (village) The following tables show the socio-demographic profile of the barangays where the participants surveyed came from. Most participants identified trade as the primary source of income of their barangay (36 percent), led by retail sales (34 percent), and followed by wholesale trading (5.15 percent). Agriculture as a main income source came second, followed by manufacturing. For the primarily agricultural communities, farming of crops to be sold was the top form of livelihood (17.9 percent), followed by livestock raising for sale (5.6 percent), farming for personal needs (4.1 percent), and raising livestock for personal needs (one percent).

Table 1. Primary source of livelihood in the barangay (village) Trade 36% Retail business (33.8%) Whole sale business (5.1%) Agriculture 23.2% Farming crops to be sold (17.9%) Raising livestock to be sold (5.6%) Farming for personal needs (4.1%) Raising livestock for personal needs (1%) Manufacturing 16.2% Varied Wood / furniture(4.1%) Food manufacturing(2.5%) Leather (2.1%) Mat weaving(1.4%) Factory worker (1.2%)

49

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Manufacturing activities in the barangay include woodworking / furniture making, food manufacturing, leather tanning, mat weaving, and factory work. Secondary income sources include: transport, private services, and trade. In terms of accessibility of their village to the nearest town center, the respondents noted that if they walk to the town center from their village hall, it will take those about 51 minutes to arrive. Using local transport, the travel time is nearly halved to 22 minutes. A combination of walking and taking transportation takes them about 33 minutes. From these, it could be said the participants communities are generally accessible. The respondents also described their communities as being peaceful (10 percent), progressive (eight percent), and clean and well-kept (six percent). Post survey consultation workshops conducted in NCR and La Union show a trend of unemployment among returning women migrant domestic workers. The workshop participants said they had difficulty getting jobs or finding sources of income when they come back in the Philippines. This is the reason why most of them would like to save money to start their own business so they could stay in the country for good. Some participants told of success stories of women migrant domestic workers who were able to set up their own business. However, they had also heard of negative experiences among fellow women mirgrant domestic workers, some of who came home only to find out that their families had not invested their hard earned money wisely or had not saved enough for their future. According to the workshop participants, running out of resources is one of the reasons why most women migrant domestic workers decide to leave the country and their families again. B. Socio- demographic profile of participants The mean age of those surveyed from the four research sites is 35.09 years, with a range of 18 to 60 years. Mean age of the young adults (18 to 30 years old) is 27.86 years, while those in middle adulthood (31 to 60 years old) is 39.88 years. The average age of those who are having their papers processed is 34.34 years and those on vacation is 35.87 years.

50

1. Civil status, educational background and religious affiliation

51

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Most survey participants are married (51.2 percent), some are single (32.2 percent) while others are separated (nine percent), widowed (four percent) and cohabiting (four percent). Most of those who are single came from the young adult group (20.2 percent). Majority of the respondents have reached high school or college (with 35.2 percent having completed high school, another 32.4 percent reached college and 18.8 percent completed college), particularly for those in the young and middle adult categories. In terms of religious affiliation, majority are Roman Catholics (76.6 percent), with a smaller number being Born Again Christian (6.6 percent) and Muslim (6.4 percent).

In terms of membership in and size of their nuclear family, 27 percent of respondents said they had four members, 20 percent had five members, 19 percent had three members, 13.4 percent had six members and 8.6 percent had two members. The mean number of individuals in families is 4.5, while the number of family members ranged from 2 to 13 individuals. Number of participants with children. The mean number of living children (among those who have children) is 2.43, with a range from one to seven. The mean number of male children is 1.52, with a range of one to five, while the mean number of female children is 1.58, with a range of one to four.

52

2. Current work status Majority of survey participants are currently unemployed (67.4 percent), while a few work for their own income (20.8 percent), and a number receive regular pay from work (7.4 percent). For those who are working, most are primarily involved in trade (28 percent), particularly in retail selling (49 percent). Some provide private services (13 percent), like doing laundry and sewing clothes (as a dressmaker or tailor). Some are employed (four percent).

For those who have current sources of income, the mean income per month is PhP5,421 (US$120.46). The approximate income distribution of the participants is as follows:

53

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

3. Overseas work experience of participants a Contract Most study participants had completed one to two contracts as migrant domestic workers (67 percent). Some finished three to four contracts (18 percent), five to six contracts (5.4 percent), and seven to eight contracts (1.2 percent). A smaller percentage had completed nine to 10 contracts (1.2 percent) and more than 10 contracts (.4 percent). The usual length of contract is two years, but this may vary based on the country of destination, legal status of the worker and living arrangement.

For those with unfinished contracts (189), 96.8 percent were not able to finish one to two contracts. Most of these individuals came from those who are currently on vacation. FGD participants cited reasons why contracts are terminated, which include: incidences of abuse; early termination of contract; breach of contract by the employer; differences with employers; and, domestic workers desire to go home because of illness or homesickness. The contract signed in the Philippines may change once the worker arrives at the country of destination, according to post survey workshop participants. Some experienced signing a different contract upon entry in the destination country. Breach of contract stipulations also occur, as seen in the following comments: ...sa akin two years gagawin ang household chores, cleaning, cooking, washing, linis ng kotse. Nakalagay may sariling banyo, kwarto, gaano kalawak ang bahay, ilang kwarto ang lilinisin, ilang tao ang aalagaan...yung lang ang nakalagay sa kontrata pero hindi sinunod, marami pang ibang pinapagawa... [in my contract, (it is stated) that within two years, tasks would include household chores, cleaning, cooking, washing, washing the car, and that I would have my own bathroom, room. (It is also stated) how large the house is, how many rooms have to be cleaned, how many persons to look afterThese are all in the contract, but these are not followed; there are other tasks actually performed. (post survey consultation workshop)

54

The story of Myra from Cebu (refer to Annex: Consolidated Case Studies) provides an example of how a documented migrant domestic worker dealt with changes in her status from being a documented migrant worker in Lebanon, to an undocumented one. This situation was brought about by the end of her contract and a change in employers. Since she wasnt ready to go back home because of financial obligations, Myra had to content herself with a tourist visa (renewed three times) provided by another employer in Romania. The absence of legitimate status as a MDW subjected her to psychological distress as well as physical abuse. Marita (refer to Annex: Consolidated Case Studies), a domestic worker in Holland left her first employer after finishing her one-year contract because of individual differences with her employer. She was subsequently hired without a contract by another employer for some time, until she again changed employers. The case of Naty on the other hand entailed a breach of contract. Before leaving the Philippines, she signed a contract stating that she will be working in Kuwait for two years and will be receiving a salary of US$300 (approximately PhP13,000) a month. These conditions were not implemented, as she was only given 45KD (Kuwaiti Dinar, or PhP8,100) and she went on to work with four employers under varying conditions. In the case of Gen, she experienced not having a contract while working as a cleaning lady for different households. She went abroad using a tourist visa and lived with a relative for a while. This subjected her to constant fear of being deported and difficulties in accessing services such as bank transactions and medical and dental services. These cases show that changes in contracts and absence of contracts make women migrant domestic workers vulnerable, as they are unable to protect themselves from exploitation and abuse, aside from being unable to access needed services.

55

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Reasons for working overseas

Majority of respondents (53 percent) said it was solely their decision to work abroad, while some were influenced by friends (12 percent), relatives (11 percent) or siblings (eight percent). Variations were noted regarding the reasons behind the decision to work overseas as domestic workers among participants. Most of the reasons given by the participants are economic in nature e.g. to save for the future, to be able to send children to school, poverty, no jobs available in the Philippines, to help parents and siblings, etc. However, it is also important to note that there are also participants who left to avoid conflict with family members and to escape an abusive relationship, as time away from the country provided them space to be away from abusive situation. In Maritas case, she saw leaving the country as a way to make a fresh start, after two incidents of attempted sexual abuse in the past. (It is one of the reasons that I want to go somewhere, because it happened in the province of my father and the other in the province of my mother, so where should I go?).

56

Destination countries and reasons for choosing particular countries

Table 8 shows the countries of destinations of women migrant domestic workers during their most recent contracts. The top five countries of destinations are Hong Kong (19.6 percent), Saudi Arabia (13.2 percent), United Arab Emirates (12.2 percent), Singapore (11.2 percent), and Kuwait (nine percent).

57

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Table 9 shows the reasons of survey participants for choosing to work in destination countries.

72 Country codes: BN Brunei; BH Bahrain; CY Cyprus; HK - Hong Kong; IL Israel; IT Italy; JO Jordan; KW Kuwait; LB Lebanon; MO Macau; OM Oman; QA Qatar; SA Saudi Arabia; SG Singapore; ES Spain; TW Taiwan, Republic of China; AE United Arab Emirates (Source: World Intellectual Property Organization, WIPO Standard ST.3)

58

Looking solely at the top five destination countries, it can be seen that the most frequently cited reason is economic, specifically poverty, the lack of jobs in the Philippines, and high salaries abroad, among others. Those who go to Hong Kong and Singapore said that they were influenced / persuaded / sponsored by their family members, relatives or friends who currently work there. Those who choose Saudi Arabia and Kuwait say these countries hire / accept women migrant domestic workers where there are job orders and available work visas. The United Arab Emirates is selected usually as a result of the recruitment agencies decision. The latter is reflected in the case of Naty. She heard over the radio that a recruitment agency was looking for domestic workers for Kuwait and they were not charging placement fees. Naty grabbed the opportunity and applied with the agency. In the case of Sandra, it was her siblings who did all the processing for her travel to Holland to work as an au pair. She only found out about this when she was called to get her passport and other travel documents.

59

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Regarding the length of stay working as migrant domestic workers during the last contract, majority of the respondents stayed abroad for two years (53.8 percent) while 35.4 percent stayed for less than two years. Pre-migration status and requirements A large number of survey participants reported that they left as domestic workers (86 percent) while one in ten left as tourists (10 percent). Some of those who left as tourists were able to get work permits on site. Others left as caretakers, factory workers, nursing aides, or dressmakers. While majority of the participants said their job title is consistent with their contract (92 percent); some noticed different job titles stated in their contracts (e.g. babysitter, caregiver, tutor, tailor / dressmaker or factory worker). Significantly, eight percent (8.1 percent) did not read their contract.

60

As part of the pre-departure medical examination (PEME) of applicants, survey participants said the five most frequent medical examinations they had undergone were: X-rays (84.2 percent); urinalysis (82.8 percent); blood workups (82.4 percent); stool examination or fecalysis (79.4 percent) and general physical examinations (79.4 percent). Half (57.4 percent) reported they went through a psychometric test while two out of five (39.4 percent) reported that they went through neurological testing. Nine out of ten (92 percent) said that their informed consent was secured prior to going through the medical tests. However, only 86 percent were informed of the results of their examinations.

Majority of the respondents (78.6 percent) said they attended the Pre-Departure Orientation Seminar or PDOS. The seminar providers included: recruitment agencies (39.7 percent); the Philippine Overseas Employment Administration or POEA (25.7 percent); the Overseas Workers Welfare Administration or OWWA (24.2 percent) and non-government organizations (4.3 percent). The survey participants recalled these top five topics from the PDOS: (1) travel rules and procedures (17.6 percent); (2) information on culture and laws of the host country (14 percent); (3) how to adapt to a different culture (14 percent); (4) information on how to remit money (14 percent); and, (5) how to adapt to a different language (12 percent). 4. Living arrangements

Majority of the survey participants lived with their employers (94.8 percent). In terms of the amount of time spent working and living arrangements, majority (58 percent ) of those who live out work nine to 12 hours; almost a quarter (23 percent) worked 13 to 16 hours; and, one in ten (11.6 percent) worked 17 to 20 hours. Of those who lived with their employers, 27 percent work from 17 to 20 hours, almost a fourth (23 percent) worked for 20 to 24 hours. A fifth (22 percent) worked for 9 to 12 hours; and another fifth (20 percent) work for 13 to 16 hours.

61

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Workshop participants from NCR observed the same trend when it comes to the conditions of work. They said there is a greater likelihood for live-in domestic workers to be exploited by their employers since they are always available and accessible to them. Some of them even have experiences of working non stop until the wee hours of the morning and waking up early the next day. In the case of one of the workshop participants: Ako halos isang oras lang ang tulog dahil sa dami ng trabaho, kailangang tapusin kundi matatambak ang trabaho. Kaya pumupunta ako sa CR, doon na ako natutulog. Sobrang istrikto ng amo ko, sinusunod ko lang. (I only sleep for one hour because of my workload. I need to finish my work, if not, my work will pile up. I usually go to the comfort room to sleep. My employer is very strict; I need to comply with her). 5. Work conditions a Working hours The average working hours of the participants vary as could be seen from the table below. A quarter of the participants work for 13-16 hours (26 percent) while almost another quarter work from five to eight hours (23.8 percent), 17 to 20 hours (22.2 percent) and nine to 12 hours (20.2 percent). Others also noted working for an unlimited number of hours or for as long as they have work to do (7.2 percent).

Long hours of work could be attributed to the bulk of work delegated to the domestic worker and requirements of employer. As shared by one of the workshop participants, madami talaga akong gawain, 12 ang inaasikasong bata, ako lang mag-isa. Sa umaga, magluluto ng pagkain nila, tapos gigisingin isa-isa. Tapos ihahanda ang uniform, 12 piraso. May isa akong alaga, 17 years old na, nagpamedyas pa sa akin. Dun talaga ako naluha, malaking babae eh. Kasi utos ng isa, hindi ka pa tapos, tawag na naman ang isa. Tapos pag nasa school sila, maglilinis ng bathroom, ng mga kwarto nila. Pagdating nila, nagkakagulo na naman ang bahay, kakalinis mo lang, gugulo na naman. Wala kang katulong eh, mag isa lang ako. (I take care of 12 children. In the morning, Ill prepare breakfast for them, then Ill wake them up. I will prepare their school uniform; 12 sets of uniform. One time, one of my wards, a 17 year old girl, asked me to put her socks on. I cried on that instance. They are demanding. One will request for something and Im not yet done with the first request, another one will call me for

62

something. While the kids are at school, Ill clean the bathroom and their rooms. When they come home from school, they will scatter their things; the house will become a mess again. I have no one to help me, Im alone.)

A look into the destination countries shows the variability in the number of hours required from female domestic workers in meeting the demands of their work. Most of those from Brunei, Jordan and Kuwait work from nine to 12 and 13 to 6 hours a day respectively; while those from Bahrain work from nine to 12 hours. Most of those employed in Singapore, Israel and the UAE work from 13 to 16 hours. In Taiwan, most would work from five to eight and 13 to 16 hours. Those who reported working for 17 to 20 hours work in Oman, Qatar and Saudi Arabia. In Hongkong, some would work for five to eight hours while others work for 13 to 16 hours. Half of those in Cyprus work for five to eight hours while others work from 13 to 16 and 17 to 20 hours. Majority of the participants working in Italy, Macau and Spain reported working for five to eight hours a day. One respondent each from Bahrain, Kuwait and Saudi Arabia reported that they work more than 24 hours, depending on the time required finishing their tasks. Oftentimes, such long working hours are not compensated fairly. A response from one of the post survey consultation workshop reflects this: ...four hours lang talagang oras ng pahinga, gigising ng 5

63

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

a.m. Tutulog madaling araw na...20 hours ang trabaho talaga. Merong overtime pay sa iba, sa akin wala. (I only sleep for four hours; I need to wake up at 5:00 a.m. I go to bed around dawn. I work for 20 hours. Others get overtime pay, but I dont) b Scope of household work

Survey participants identified the following tasks they performed in their employers household: cleaning house (87.6 percent); cooking meals (77.4 percent); doing laundry (74.4 percent); taking care of employers child(ren) (62.2 percent); and washing the car (25.4 percent). Though considered unacceptable and a breach of contract, some reported cleaning the house of their employers relative(s) / friend(s) and taking care of their employers friends child. Other tasks performed are shown in Table 15 above. The case studies of Myra, Naty, Marita and Gen also show the varieties of tasks they need to fulfill in the households where they work. Differences in the length of time spent on working in their employers home and the number of households they work in, also vary significantly. In Myras case, a 21-hour workday was normal in her employment in Lebanon and 22 hours in Romania; with, Natty, she was on call 24 hours, taking care of her Kuwaiti employers child. c Days off benefit and availment of days off Half (58.6 percent) of the participants said that they are entitled to regular days off. Of these, 70.5 percent avail of the benefit. The frequency of their regular days off varies, however, with most having them once a week (48 percent), followed by once (17 percent) or twice a month (eight percent). An even

64

smaller portion (7.5 percent) have a day off only during Christmas Day (when the employer goes out), or twice a week, or once every three months, to cite some examples. Table 16 shows the number of participants in the study who have reported enjoying a day off. In Table 16 though the sample is small, there are some countries where all the respondents stated that they have days off (such as Israel, Italy, Macau, and Spain).

FGD participants said some employers who hire them for multiple contracts, would not provide regular days off because the latter consider their domestic workers end of contract vacation in the Philippines as accumulated days off. Though the respondents find this unacceptable, they said they had no other choice but to abide by the decision of their employers. The five most cited activities they engage in during their day off are: (a) go out, take a stroll, shop, and eat out (31.4 percent); (b) meet / spend time with friends (24.6 percent); (c) attend church / hear mass / attend Bible study sessions (24.6 percent); (d) do part-time work (10.2 percent); and, (e) stay at home (9.6 percent).

65

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

The respondents also answered they are able to do the following during their free time or leisure time: (a) pray (95 percent); (b) talk to or text / SMS family (82.2 percent); (c) play music or listen to music (72.2 percent); (d) read (69 percent); (e) watch television (65.4 percent); (f) drink alcohol (58 percent); (g) take a nap (51 percent); (h) exercise of walk for more than 30 minutes (50 percent); (i) socialize with friends (47.4 percent); and, (j) go to church / attend religious services (44.8 percent) 6. Individual income and expenditures Their mean income is PhP17,027.80 (US$378.39) per month. A minority (2.8 percent) working in developed countries such as the United States, Canada, Spain, Italy,and other European countries earned salaries ranging from US$1,000 to US$3,000 or higher. Sixty percent of respondents earned below US$400; about 20 percent received US$400 to US$500 a month. The lowest salary stated per month was PhP 5,500 (US$122.22). Sixty-eight pecent of respondents reported that their salary is consistent with their contract. Majority of survey participants (98.4 percent) said they send remittances to their family. The percentage of their income which they send home varies. Most of them send a big chunk of their earnings to the Philippines: 41 to 50 percent of their income (18.3 percent); 71 to 80 percent of their income (16. 7 percent); and 91 to100 percent of their income (15.2 percent).

66

When asked about other sources of income, about one in ten (11.8 percent) answered that they had. More respondents from the middle adulthood category said they had other sources of income than those from the young adulthood category. Other sources of income mentioned were: doing part time jobs (84.7 percent), which includes cleaning houses (51.4 percent); baby sitting (8.3 percent); serving as caregiver (4.2 percent) and ironing clothes (4.2 percent). A smaller percentage (5.6 percent) sold cell phone loads. These responses show that even the part time work of migrant domestic workers focuses on household work associated with fulfilment of the ascribed caring and nurturing role of females. This despite the presence of laws that specifically states that migrant domestic workers are not allowed to take on part time work. FGD participants attributed this to the meager income some of them get from their full time jobs. As shown in Graph 1 (below), survey participants reported spending every month on the following: remittance to family (91.8 percent); communication (62.4 percent); food (60.8 percent); personal effects (48 percent) and toiletries (39 percent). Details of remittances to families show that majority of young adults would send 41 percent to 50 percent of their salaries to family members in the Philippines, while majority of those in middle adulthood (most of whom are married) would send from 71 percent to 80 percent and 91 percent to 100 percent. Majority of survey participants (98.4 percent) said they send remittances to their family. The percentage of their income which they send home varies. Most of them send a big chunk of their earnings to the Philippines: 41%-50% of their income (18.3 percent); 71%-80% of their income (16. 7 percent); and 91%-100% of their income (15.2 percent). Significantly, women migrant domestic workers coming from Metro Manila seem to receive a higher mean income, compared to participants from other sites. The lowest mean income per month was observed among those coming from Davao in Mindanao.

67

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Graph 1: Respondents expenditures

Only 10.6 percent of respondents said there are instances in their stay overseas where they did not have any income. In these situations, they relied on other sources of financial support, such as borrowing money from others (26 percent); using their own savings (24 percent); and borrowing money from a family member (10 percent). A minority (six percent) also said they received help from the Philippine embassy, while some (four percent) pawned personal items such as jewelry, and cell phones. Others (28 percent) resorted to not sending money home, asking help from their employer, getting a part time job, or even engaging in paid sex. 7. Family income and expenditures A significant number of the respondents (70 percent) said other family members are helping them to earn a living. These include their spouse (57.4 percent); parent/s (26.3 percent); siblings (19.1 percent) and children (2.6 percent).

68

Graph 2: Family expenditures

Families left in the home country spend monthly on the following: food (96 percent); electricity (77.4 percent); school expenses (73.2 percent); water (45 percent) and communication (34.8 percent). Households of young adults have the following reported monthly expenses: food, electricity, school expenses, water and payment of loans. 8. Social protection More than a third (35 percent) reported they do not have any form of insurance while they were in the Philippines. Some have Social Security or SSS (31.8 percent), national health insurance or PhilHealth (29.8 percent) or government social security insurance or GSIS (0.8 percent). Most of those who were insured noted that their coverage included health insurance (37 percent); life insurance (16.8 percent) and coverage for illness, sickness, or injury (15.3 percent). While working overseas, 54 percent had insurance coverage which included health insurance (48 percent), illness / sickness / injury (19.4 percent) and life / death insurance (17.5 percent). Majority of those who reported having insurance while working abroad worked in Hong Kong, the UAE, and Singapore. Most of those working in Saudi Arabia and Kuwait were not provided with insurance.

69

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Those who did not have any insurance gave the following reasons for not availing of this type of social protection: (a) insurance coverage benefits were not included in the contract (16.1 percent); (b) lack of knowledge about insurance (8.8 percent); and, (3) inability to afford insurance premium or contribution (seven percent). Participants who answered other reasons (28 percent), cited specifics as: having a thrifty employer; illegal / undocumented status; lack of need for insurance (because respondent just stayed home), among others. C. Migration- related health concerns and issues 1. Illnesses and injuries Most respondents (56.5 percent) of the study did not experience any illness while working abroad. Those who fell ill (43.5 percent), reported experiencing the following most frequently cited symptoms: fever (33 percent); cough (28 percent); colds (12 percent); flu-like symptoms (12 percent); and, headache (nine percent). Very few respondents sustained injuries while working overseas (17.8 percent). Majority of those who experienced cuts and abrasions were from Hong Kong and the UAE. Amputation or loss of body part was reported by two respondents from Saudi Arabia. Most of those who reported dislocation, fractures and sprains worked in Saudi Arabia and the UAE. Those who sustained burns, contusions, bruises and hematoma were mostly from Saudi Arabia. Some other conditions where injuries were sustained included being bitten by a dog; falling while handling persons because of the weight of the elderly person she was taking care of; and, slipping and falling.

70

2. Stress a Stressful life events experienced One of the sources of stress of migrant workers based on the FGDs is the difficulty in balancing the demands of work abroad and family life back home. Results of the survey shows that such condition is considered to be somewhat difficult by 38 percent of respondents; very difficult by 27.7 percent; not very difficult by 27 percent; and not at all difficult by a minority (seven percent). Furthermore, the greatest source of stress while abroad is stress at work (43 percent), while others identified stress from both work and home (26 percent); and stress at home (25 percent). Only 5.6 percent stated that neither is considered to be stressful. Other stress related health problems and conditions experienced abroad are depression (7.1 percent), hypertension (5.6 percent) and ulcer (5.6 percent). Majority (79.4 percent) did not report any stress induced physiological reactions.

A little more than half (55 percent) of respondents experienced stressful life events while employed overseas such the death of a close family member (19 percent); diagnosis of a serious illness of a close family member (12.4 percent); break up of a long term relationship (9.6 percent); respondent diagnosed with a serious medical problem (6.1 percent); loss of employment for more than two months (3.1 percent); and tra percent nsfer from former home (3.1 ). Comparing the experience of those from the young and middle adulthood groups, there were more stressful life events experienced by respondents from the latter than those in the former. This is plausible considering that most of those in middle adulthood are already married and have children (Table 21).

71

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Manifestations and sources of stress

72

The most frequently identified physical manifestations of stress while overseas were: fatigue (64.6 percent); headache (60.4 percent); muscular tension (49.8 percent); upset stomach / indigestion (36.4 percent); feeling faint or dizzy (36.2 percent); and, inability to sleep (36 percent). On the other hand, while in the Philippines, they experienced: headache (48 percent); oversleeping (2.2 percent); upset stomach / indigestion (23.8 percent); fatigue (19.8 percent); inability to sleep (18.2 percent); and, muscular tension (17.4 percent). Significantly, the number of psycho-emotional symptoms reported by the participants decreased while in the Philippines, compared to when they were abroad. The same trend was observed among the reported psychological manifestations of stress. While overseas, the following were experienced: loneliness (68.2 percent); desire to cry (66 percent); sadness (66 percent); feeling nervous (36.8 percent); and irritability (32.4 percent). While in the Philippines, they reported irritability (24.4 percent) anger (23.6 percent); sadness (22.8 percent); desire to cry (19.6 percent) and loneliness (15.8 percent). Some of the effects of stress were verbalized by the post survey consultation workshops participants thus: Ang epekto ng stress, nakakalimot ako. Nalilimutan ko magpainom ng gamot ng alaga. Nanlagas din ang buhok ko, pumayat ako, lumabas ang mga ugat ko. Pinauwi na ako, hindi na talaga kaya. Hindi ko natapos ang kontrata. (The effect of stress to me was I became forgetful. I forgot to give the child his medicine. I had hair fall, I lost weight, I had swollen varicose veins. They sent me home because I cannot carry on. I did not finish my contract.) Pumayat talaga ako noon, mukhang matanda. Tuyot na ang utak pati pa ang katawan, nalalagas ang buhok koSa pagkain, isang minute lang. Naghahang na talaga ang isip ko. Pagkatapos ng kontrata ko, hina-hire pa ako, hindi ko na tinanggap. Nung nakalabas na ako ng bahay nila, papunta na ako ng airport, para akong ibon na lumilipad. Nakalaya na ako. Pagkauwi ko dito parang nagkaano din ang isip ko, parang mild na naapektuhan. Tulala ako, hindi ako nakakausap. Wala na din akong lakas ng loob. (I lost weight then, I looked old. My mind and body got drained, I had hair fall After my contract, they wanted to rehire me but I declined. When I was on the way to the airport, I felt like a bird on flight. I was free. When I arrived home, it seemed like my brain was slightly affected. I stared blankly and they couldnt talk to me. I lost my inner strength.)

73

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

c Sources and levels of stress The significance of particular stressors as perceived by the respondents abroad and in the Philippines is summarized in Table 22. This also shows the manifestations and sources of stress of participants while abroad and while in the Philippines.

According to the post-survey consultation workshop participants, other contributing factors to the experience of stress were the lack of control and fear experienced by domestic workers in the context of their relationship with their employer. In the table, these can be inferred from such items as money (insofar as it related to the pay they actually received), personal safety, and the nature and scope of the work they did (including work hours). One participant said, Isa pa, kailangan lahat ng gagawin mo ipapalam mo sa amo mo. Matatakot kang magpahinga, matatakot kang magsabi sa amo mo kasi baka pauwiin ka nang bansa. Sabihin nandito ka para magtrabaho. (In addition to that, all the things that you do, need the permission of your employer. You cannot rest, and you will hesitate to ask for your employers permission, for fear that she / he might send you home. You are always told that you are here to work.) Food is one of the sources of stress identified by workshop participants. This may be due to the absence, inadequacy, and unpalatability of food provided by their employers. Missed meals further add to this. Majority of the participants (74.6 percent) reported that they never missed a meal in a weeks time, but some missed meal/s in a week, specifically: one meal (7.2 percent), two to three meals (nine percent), four to seven meals (2.6 percent) and eight or more meals (4.2 percent). This trend is seen among respondents coming from both the young and middle adulthood stages.

74

A workshop participant said her source of stress when she was working abroad was food. She got sick and was temporarily crippled, which according to her, was due to heavy workload and lack of food. Ang stress ko talaga sa gutom. Walang almusal, kape lang o kaya tubig kasi hindi naman daw nila sagutin ang magbigay ng pagkain Nagreklamo ako sa agency na kulang ang pagkain. Ang sagot daw ng employer ko, okay naman daw ang binibigay nila. Pero sa akin, hindi okay, kasi hindi rice e, noodles lang na tira-tira nila.(The source of my stress then was hunger [lack of food].There was no breakfast; I only had coffee or water. [My employer said that] its not their obligation to provide me with food. I went to my agency and complained that my employer does not give me enough food. According to the agency, my employer told them that they give me enough food. But for me, the food is not okay. There is no rice, its just leftover noodles. )

Majority of the participants said they are concerned with the level of stress in their everyday life, with two out of five being very concerned (46.1 percent) and a third being somewhat concerned (30.6 percent). Only eight percent said they are not at all concerned. In terms of their rating of stress experienced during the different phases of migrant work (on a scale of 1-5, 1 being the lowest and 5 being the highest), the mean ratings were: pre-migration, 2.97; migration, 3.47; and post migration, 2.62. The mean highest was when the respondents were on-site or abroad. Although few experienced injuries while working abroad, majority of those who did, reported experiencing high levels of stress (a 5 rating).

75

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

The level of stress experienced may be related to the number of unfinished contracts, with those not being able to finish one to two contracts experiencing high levels of stress. With this association, the trend shows that those who finished a lot of contracts seem to have less stress. This may be related to their greater ability to cope with the demands of work and being away from their families, which increases through time. It was also observed that participants who stayed less than two years have higher stress than those who stayed longer. Such trends however, needed to be verified further in future researches.

76

Manifestations of stress

77

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Table 25 shows the different manifestations of stress in different countries of destination. There are variations of the most often cited manifestations in the top five destination countries. In Hong Kong, it is feeling as though you want to cry; in Saudi Arabia, fatigue; in the UAE and Singapore, loneliness, and in Kuwait, fatigue, loneliness and feeling sad respectively. It is also important to highlight the fact that there are participants who had ideations of suicide (thought of ending ones life), even if the number is quite small (6.6 percent). The participants who reported this were employed in Saudi Arabia, the UAE, Singapore, Kuwait, Brunei, Hong Kong, Taiwan, Israel, Jordan, and Qatar. Table 26 below summarizes the levels of stress reported by the respondents in the different countries of destination. Seven of these countries (i.e. Bahrain, Hong Kong, Jordan, Kuwait, Macau, Qatar, and UAE) had the highest number of respondents stating a stress level of 3. Six of these (i.e. Cyprus, Israel, Lebanon, Oman, Saudi Arabia, and Singapore) have more respondents reporting a stress level of 5. Those working in Brunei have an equal number of respondents selecting stress levels of 1 and 5; from Italy, levels 1 and 2; Qatar, levels 2 and 3; and Taiwan, levels 3 and 4.

78

Factors affecting manifestations of stress (living arrangements, work hours, and days off)

Relating the participants selected stress levels onsite to their living arrangements, most of the participants in stay-in arrangements rated their stress as 3 (27.6 percent); 4 (17.4 percent) and 5 (23.4 percent). Most of those in live out arrangements selected ratings of 1 to 3 (1: 1.2 percent, 2: 1 percent, 3: 1.2 percent). This indicates that the increase in stress ratings may be associated with conditions related to living arrangements and living conditions. There are also differences in manifestations of stress between those in stay-in and live-out arrangements. For those in the former, the five most frequently identified manifestations of stress are: loneliness, feeling as though you would cry, feeling sad, fatigue and headache. Among those in live-out arrangements the manifestations are almost the same with the addition of change in appetite. Due to the small number of sample for the latter group, these results need to be further studied.

79

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

The stress level on site may also be related to the number of work hours a day, as shown in Table 28 which shows a general trend of having a high rating of stress with working less than or higher than five to eight hours a day. If the presence and absence of days off are charted vis- a-vis manifestations of stress one could surmise from Table 29 that individuals with days off have fewer manifestations of stress than those without.

80

Another source of stress identified in the post survey consultation workshops is the legal status of the domestic worker. Being undocumented or undergoing a change in the nature of work overseas could add to the problems of migrant domestic workers, as verbalized thus: ...ako kasi dapat waitress, hindi domestic. Kaya pagdating ng Abu Dhabi, mahabang proseso pa. Nakadagdag talaga sa alalahanin.(I was supposed to work as a waitress, not as domestic [worker]. When I arrived in Abu Dhabi, it was still a long process. Its an additional worry. Ako natagalan sa Singapore kasi tourist kami eh. Wala namang hinanap, gusto lang sabay- sabay kaming lalabas. Kinakabahan kami, nagutom na din sa tagal. Tapos kinakabahan ka sa papel mo, baka ma-hold. Baka mahuli ka at baka ma-A to A (airport to airport) ka. (We waited a long time at Singapore airport because were tourists. They [immigration officials] are not looking for anything; they just want us to leave together as a group. We were nervous. We were hungry because of the long wait. We were nervous because of our [insufficient / fake] documents; we anticipated that they will hold us [in the immigration]. We were thinking what if we get caught; what if we will be A-to-A (airport-toairport). The workshop results also pointed to possible differences in the experience of stress among younger and older domestic workers. The participants believe that mid-adults could handle stress better because of their experiences and their social networks: May diperensya. Kasi yung mga older doon, may mga experience na. Yung younger, wala ka pang masyadong experience abroad. Mas takot pa, hindi pa nagjojoin sa ibang recreational activities...pag bata ka hindi ka pa sigurado sa decision. Pag matanda ka na, base sa experience mo, mas kalmado ka... (Yes, there is a difference. The older [domestic workers] have more experience. The younger [domestic workers] dont have enough experience [of working] abroad. They are more cautious and they do not join recreational activities... if you are still young you are still not sure about your decision. If you are older, because of your experience, youre more calm.)

D.

Wellness and well- being 1. Positive and enjoyable experiences

Survey respondents cited positive experiences that helped cushion experiences of psychological stress while working abroad. These are shown in Table 30.

81

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

When asked what activities they enjoyed most while they are working abroad, the survey participants identified the following activities: continue working/doing household chores such as cooking, cleaning, etc., having day off and holidays, doing activities with employer; shopping/strolling/going out, doing activities with their employers child/children, etc.,. It is important to note that 8.78% of the survey participants said that they do not remember any activity they enjoyed doing while working abroad.

82

When asked about their sources of joy and happiness while abroad, the categories of their responses included: talking to / sending text messages to family (14.8 percent); receiving ones salary (seven percent); having a good and generous employer (6.6 percent); thinking of ones family (five percent); playing with / taking care of her employers child(ren) (4.8 percent); sending money to ones family in the Philippines (3.8 percent); receiving gifts from employer (3.6 percent); strolling / going to the mall / shopping (3.2 percent); helping ones family (three percent); having a high salary (2.8 percent); seeing other Filipinas (2.6 percent); chatting with friends (2.4 percent); saving money (2.4 percent); and, being inspired by ones family (two percent). The aforementioned sources of joy and happiness centered more on positive relationships with family members, employers, employers children, friends and fellow domestic workers. Though financial factors were considered important, these seem secondary to maintaining smooth relationships with other individuals in their lives. The FGD results affirm this finding, so even such an activity as shopping, is done to purchase things that they send home more than things that they need for themselves. The act of sending a Balikbayan Box to their loved ones back home is a source of joy and an affirmation of their ability to provide for the needs of their families, more than affirming solely their economic capacity. However, 3.5 percent of the respondents answered none when asked about their sources of joy and happiness. Apart from the aforementioned, the survey, narrative and post survey consultation workshop participants also identified some of their strengths, which allowed them to survive the demands of their work and being away from their families. One of their major sources of strength is their spirituality and religiosity which is exhibited by praying, going to church and maintaining a relationship with God. Another is their families. They reported that thinking of their families, communicating with them and receiving emotional support from them saw them through hard times. For those who had children, thinking about their welfare and their education motivated them further into working hard. The presence of supportive friends, romantic partners and other social networks served as links and connections while overseas. The participants also recognized individual characteristics that they possess which allowed them to cope, which include industry, fortitude, fighting spirit and determination, knowing how to save money, keeping oneself healthy, and patience. 2. Coping with stress Table 32 shows the mechanisms used by the participants to cope with problems and issues faced. Generally, the most frequently used strategies are: turning to religion (prayed/read the bible, went to

83

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

church, etc.); focusing on and venting emotions (cried); behavioral disengagement; mental disengagement; and, seeking social support.

In the case of Naty, who suffered physical, sexual and psychological abuse at the hands of her employers and was even jailed for leaving them, spirituality tided her through the difficult times. She would sing religious songs softly to calm her mind and lighten her feelings because she felt that God listened to her songs. Her experience of fear and helplessness made Naty cling to her faith firmly. Later, her faith and the thought of her family, gave her the strength to plan her escape. 3. Importance of social support The presence of social support is also associated with the stress ratings as seen from Table 33, which shows that the presence of support is related to lower ratings of stress. Most of those who reported that they do not have any sources of support rated their stress level from 3 to 5. This was confirmed by post survey consultation workshops results where the participants shared experiences when they felt the ameliorating effects of the presence of their families, friends and co-workers, when faced with stressful life events and problems. This is evident in the narratives of Marita and Gen.

84

In Maritas case, her sources of support are her current host family which encourages her to enjoy her weekend and days off; and her Filipina friends, to whom she confides her problems and struggles. In Gens case, her support network consists of Filipina friends who she regularly sees in church or in social gatherings; an organization to which she belongs (Trusted Migrants) and another to which she volunteers to help fellow Filipinos (Stichting Bayanihan); her family in the Philippines, with whom she regularly communicates through online chat rooms; and, her boyfriend who she says is very supportive of her. Other responses generated from the questionnaire and post survey consultation workshops point to positive thinking; assuring oneself that one can do it; and fighting back when the employer becomes unreasonable or abusive. Some just do not think about their problems by keeping themselves busy and concentrating on the work. In one of the workshops, a participant said it is important to assume that going overseas to work is stressful and one needs to accept this as a reality to be coped with. With this

85

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

in mind, the overseas domestic worker will be better prepared to meet the challenges of working abroad, as evidenced by this sentiment: Ako naman, natural lang na ma-stress ka. Dapat handa ka at alam mo ang dapat gawin doon, alam mo ang gagawin sa iyo ng amo mo, makikisama ka sa kanila. Iisipin mo talaga sa una dahil iba ang ibang bansa, iba ang Pilipinas. Pero nag-decide kang lumabas, kung anong mangayari sa iyo, tanggapin mo na lang. Bahagi ng decision na lumabas ng bansa ang stress. Coping mechanism yan, positive ang maidududlot at nakakatulong na isipin na bahagi talaga ito ng pag-aabroad. (My take on that, its only natural that youll be stressed out. You need to be ready and you should know what to do once youre there. You know what your employer could do so you better get along with them. The very first thing you need to think about is that [life] abroad is different compared to [life] in the Philippines. But because you decided to go abroad, whatever happens to you there, just accept it. Stress is part of working abroad. [Accepting that] is in itself, a coping mechanism. It could bring positive results to think that stress is part and parcel of going abroad.) E. Sexual and reproductive health In terms of the necessity of engaging in a romantic relationship while working abroad, only 11.7 percent answered positively. Majority of these had a male partner (91.4 percent), while some had a female partner (seven percent). Less than half (41.6 percent) reported that they had sex with their partners. A small number (3.6 percent) had sex with someone who was not their spouse. Their sexual partners include male friends (39.1 percent); boyfriends (21.7 percent), and casual acquaintances (17.4 percent). Other partners included co-worker, female friend, commercial sex worker, employer or customer or client. The latter applied to those who engaged in paid sex. The survey participants also cited other reproductive health concerns experienced by their fellow domestic workers. These are unwanted pregnancy, abortion, sexually transmitted infections, including HIV, myoma and cyst. It is important to note that majority of Filipino women migrant domestic workers belong to the reproductive ages thus, sexual and reproductive health services such as access to contraceptive counseling and services, pre-natal care, etc. should be available at various stages of migration.

86

1. Restrictions and abuse Table 34 summarizes the nature of restrictions and abuse experienced by the research participants, while Table 35 includes the types of restrictions and abuse experienced by other female domestic workers, as reported by the research participants.

87

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

The range of restrictions and abuses vary from the behavioral, psychological to the sexual. While some of the abuses are more serious, such as getting raped, slapped, cursed and being shouted at; some are very subtle, e.g., being prohibited from talking to neighbors, prohibited from leaving the employers house or being asked to wear only specific types of clothing. These types of abuses were also identified by post-survey consultation workshop participants and mirrored in the narratives of selected migrant domestic workers included in this report, as sampled below: Myra tells a story of how she was treated by her male employer in Romania at the time her tourist visa was about to end. It started when she accidentally damaged the glass frame in the living room. She admitted her mistake and told the male employer that she was willing to pay for the damages. But

88

without saying a word, he grabbed her hair forcefully and hit her strongly in the face with his fist, drawing blood as a result. Sinuntok ako, dumugo ang aking mukha, hinila niya ang buhok ko pataas hanggang sa fourth floor. Ang dahilan ng pananakit niya ay dahil nung naglilinis ako sa sala, natamaan ko yung frame, natanggal yung salamin. Sinabi ko sa kanya, sir, natanggal yung salamin, babayaran ko ito, magkano ba ang ipapabayad mo? Hindi siya umimik at yun na, hinila niya na yung buhok ko at sinuntok niya ang mukha ko. Dumugo ito at nung kinaumagahan, namaga. (I was punched till my face bled. Then he dragged me by the hair to the fourth floor. This was triggered when I accidentally dislodged a mirror from its frame while cleaning the living room. I had approached him and reported the incident, and asked how much was I liable for the mirrors breakage. Without a word, he pulled my hair and punched me in the face. The following day, my face was swollen.) Naty tells of how she was locked up in the ceiling of the toilet. Her first eight months were spent where the heater and airconditioning exhaust were located. She described it as being like in an airplane day and night from the noise. The flooring was sand so that she was like a dog covered with sand everytime she woke up. The room was very dark and she saw no light while inside. The space was only enough for her to sit up or lie down. She had no beddings and had to urinate where she was sitting. Naty also tells of an incident when her employer tried to sexually molest her. The employer would ask her to massage him while he wore only a face towel. If she refused to massage him, he threatened that he will rape her. When her employer became insistent, they would chase around the house. At times, she would slip on the stairs from running away. She would also grab the sleeping child and use him as her shield or she would cry then her employer would back away. When the Filipina cries, they take pity. He would then draw away, according to Naty. Sandra experienced how she was told at the beginning of her employment that her main task was to take care of the children and help a bit in the household chores. However, later on she had to do everything in the house, which included occasionally helping her host-mother71 in her catering business. Some of the respondents in the study also experienced forced sex or rape (2.6 percent), where the perpetrators include the male employer (68.7 percent) and co worker (12.5 percent). Other perpetrators include male friend, boyfriend, and the employers son. Box 1 shows the participants myriad responses who were raped.

71

Host-mother refers to female employer in the Netherlands

89

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Box 1. Responses to being raped (One respondent per answer)


Called mother for advice; kept silent Fought back; reminded her male employer that she is just a domestic worker Fought back; threatened rapist that she will kill him Fought back; told her female employer about the incident but she did not believe her Fought back; told her female employer of the incident. Male employer said sorry. She did not push through in filing complaint Begged him to stopReported the incident to authorities Got scared Shouted Lord help me!; rapist ran away

The cases above of Sandra, Myra, Marita, and Naty are clear evidence of the extent of restrictions and abuses that women migrant domestic work may entail. Women migrant domestic workers have minimal social support, are away from their home countries, and when they live in the homes of their employers, their work may not be recognized as work, making them vulnerable to such treatment. The experiences of abuse have far reaching effects, according to workshop and case study participants. Some still feel the emotional and psychological pain even after returning home, as seen from stories of flashbacks, numbness, sleeplessness, anxiety, and stigma. Some of these are mirrored in the following response: ...nung nandon ako, hindi ako ninenerbiyos. Ngayon naiiba, nagugulat na lang ako na may nararamdaman na akong ganito. Naging nerbiyoso ako simula nung nung bumalik ako ...Hindi ako nakatulog sa gabi. Sa tingin ko may nagbago sa akin mula nang nanggaling ako sa abroad (Before, while I was working abroad, I didnt use to feel anxious. Now its different. I easily get nervous ever since Im back. I cant sleep at night. I think something in me has changed since I came back from abroad.) It is not surprising therefore that key informant interviewees and survey participants have tales of other migrant domestic workers who just break free from reality or lose their mind (nababaliw) after being sent home from abroad.

90

F. Health services When asked if the respondents ever consulted a mental health professional or counselor, three percent answered in the affirmative. Of this number, 43 percent reported that they sought the services of a pastoral counselor. Others reported seeing a psychiatrist (21.4 percent), lay counselor (14.3 percent) and a psychologist (14.3 percent). With regard to their family members, two percent have family members who consulted a mental health professional, specifically a psychiatrist (80 percent) and a substance abuse counselor (20 percent). These were consulted for various reasons, as could be gleaned from the following box. Reason/s for consulting a mental health professional (1 respondent per answer, in alphabetical order)

Asked advice on how to fix relationship with her father Depressed and couldnt eat because she was swindled by the recruitment agency Depression Extreme homesickness Fear that she will not be allowed to go home she told them what happened (experience of abuse) Marriage counseling Spiritual guidance Did not know how to cope Felt like she would go crazy thinking about her family in the Philippines Thought of committing suicide because of too much work and anxiety Sister learned that she was abused To be relieved from physical and emotional problem To fix her relationship with husband

When it comes to sexual and reproductive health services availed, Graph 4 provides a summary of what the respondents have accessed. Majority (62.4 percent) however, never availed of these health services while working abroad.

91

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Sources of care and support When asked about the respondents sources of care and support when they are sick, most of them stated they rely on no one (52.3 percent). On the other hand, respondents identified their employer (31.94 percent), co-worker (8.8 percent) and friend (4.63 percent) as the people who took care of them while they were sick. The leading sources of support are: Filipino friend (26.2 percent); female employer (11.2 percent); mother (5.5 percent); relative (5.2 percent) and co-worker (4.9 percent). It is important to note that 20.3 percent of the respondents reported that they do not have any source of support. A few of the respondents experienced seeking assistance from the Philippine Consulate in the country where they are working (8.6 percent). The services they availed of included the following: renewal of workers documents (e.g. passport, contract) [23.3 percent]; advice regarding refund of placement fee, dealing with conflicts with employer, and the deportation process (23.3 percent); provision of temporary shelter (20.9 percent); and, facilitated return to the Philippines / deportation (18.6 percent). Others identified being assisted in filing complaints, counselling, financial and legal assistance (9.3 percent) while 4.6 percent of those who went to the embassy reported that they did not avail of any service. The cases of Myra and Naty show contrasting experiences of assistance from two Philippine embassies. While Myra was discouraged from pursuing her case and was not given sufficient assistance; Naty claimed she was provided the necessary support from the time she escaped from her employers to the time she was incarcerated and the time she went home. Different types of services were provided to her, specifically, legal, medical, and psychological. Yet, she also recognized the limitations of government agencies in responding to the needs of overseas workers with the same plight. G. Benefits of working abroad The female participants in the study identified a variety of perceived benefits of working abroad, foremost would be their capacity to send their children to school and meet their families needs. Securing ones

92

future by saving and establishing their own business, as well as having their own home, were also mentioned. It is not surprising therefore, that despite the issues and stress they went through while working abroad; they still hope to leave again in the future. All the narratives attest to the importance of being able to earn for and help their families, as a major advantage of working overseas. Some of them also recognize other benefits such as being able to travel to other places and learning more about other cultures. But apart from these, they also stayed on (or are planning to go back) because they feel that they have to prepare for their own future. They do not see their home country as having sufficient economic opportunities for them to be able to fulfill their dreams for their families and for themselves (even to the point of risking their well- being). Attitude toward overseas work The outcome of the post survey workshops and narratives conducted with the female domestic workers included in the study highlight the difficulties they encounter from the time they decided to work abroad, migrated for work and came back home. Generally, most of the groups of women migrant domestic workers who participated in the workshops still had plans of working overseas. Despite negative experiences (from restrictive to abusive conditions) they experienced in the past, they believe that they will have a better fate the next time they go abroad and that they just need to ensure that they do not go back to the countries they have been to before. The case studies show the resilience of women migrant domestic workers in the face of adversity. Yet one needs to recognize that such may also subject an individual to further exploitation. Unless the option of staying for good becomes attractive to them, it is likely that they will continue to perceive that overseas work is their sole practical choice to address their families and their own needs.

93

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

H. Program needs 1. Membership in Organizations Majority of the survey respondents expressed that they are not members of any organization while overseas (82.9 percent). Only 16.6 percent said they belong to one or more of the following groups: religious (50.6 percent); sectoral (overseas domestic workers, 25.3 percent); sectoral (women, 12.7 percent); cultural (3.8 percent); ethno-linguistic group (3.8 percent); volunteer group (2.5 percent); and, sexual identity (1.3 percent). The finding shows that religious organizations serve as the primary organization that many migrant workers identify with. This is due to a variety of reasons. Post-survey consultation workshops show that these groups are active in recruiting members; they are conveniently situated in the churches where migrant workers hear mass or pray; they provide emotional and social support; and they are nurturing especially to new comers in the country. It is usually in these contexts where some of the migrant domestic workers friendships are also formed and nested. The countries of destination where respondents reported that they are members of organizations come from Hong Kong, Singapore, Taiwan, Cyprus, Italy, Saudi Arabia, UAE, Israel, and Qatar. The five most frequently identified reasons why most survey participants never joined organizations based were: no time (24.3 percent); not allowed to go out (10.4 percent); no day off (9.2 percent); not interested (6.2 percent); and, does not know anything about organizations (3.8 percent). Such results were affirmed in the post-survey consultation workshops, with the additional reason of physical distance between their place of work and the church or parks where fellow Filipinos meet during their days off or on weekends. Some workshop participants also confessed to avoiding members of organized OFWs because of fear that they may just bring problems (e.g. being contacted when one flees her employer; being at the center of gossip, being asked for financial assistance, among other things). The respondents identified the following assistance that members of organized groups are provided with: spiritual/moral/emotional support (25.9 percent), financial assistance (11.1 percent), counseling / advice (8.6 percent) and information about labor migration (7.4 percent). In Sandras case, the presence of the Bayanihan support group helped her through trying times with her host-mother. A personal friend who was also a member of the organization linked her to possible employers when she was jobless and was looking for sources of income. Friends from the organization also helped her by providing shelter after she left her host-family. Meanwhile, Gen, who goes to church

94

and joins bible sharing sessions, shared that these activities strengthens her. Informal groups of women migrant domestic workers housed in embassies abroad also provide additional support to female victims of abuse, as in the case of Naty. 2. Issues, Concerns and Needs The respondents were asked to identify their problems and concerns, coping behaviors and resources needed in each of the three stages of migration. The most frequently reported ones along the different areas are shown in the succeeding tables.

95

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

The table above shows the problems encountered by the participants at different stages of migration. These table shows that though it would be financial concerns that would cut across the different stages of migration, there will be differences in terms of ranking vis--vis other factors, such as psychosocial ones. Psychological (i.e. homesickness / loneliness / stress) and relational issues (i.e. dealing with employer) have been dominantly identified in the migration phase, while financial need leads the concerns in the pre-migration and post-migration stage. These financial concerns vary depending on the stage of migration. In the pre-migration phase the concerns include not having financial resources to support the application process, while in the post migration, it is more an issue of their ability to support their needs due to the absence of employment and not having earned or saved enough money while working overseas. Issues pertaining to relationships with ones family are also salient at different phases. In the premigration stage, this involved apprehensions about the possible effects of being away from the family. In the migration phase, this evolved into homesickness and involved a lot of thinking about children and family members left in the Philippines. In the post-migration stage, this is characterized by positive emotions of being reunited with ones family, as well as the negative thought (or reality) of finding out that ones husband had extra marital affairs. The case studies also show the extent of stress; exploitation and abuse female migrant workers go through. Being in another country (especially if one is undocumented) limits ones access to social services. Being a minority makes one vulnerable to exploitation. Being a woman subjects one to discrimination and gender-based violence. The inability to understand the destination countries language and culture; absence of social networks and support; financial obligations back home; poor employeremployee interactions; insufficient assistance from the foreign posts exacerbate existing problems and issues. Extreme cases of being imprisoned and inhumane treatment of erring women migrant domestic workers further impinge on the already volatile mental health of female overseas workers. The issues identified in the survey and the narratives are nested in other problems besetting the general Philippine society. This was highlighted in the workshops: Agree ako na may kakulangan talaga ang gobyerno na mabigyan ng trabaho ang mga Pilipino. Kasi base dito lumabas man tayo ng bansa o bumalik, pera talaga ang problema natin. .. kasi sa Hongkong narinig naming may programa si Gloria, pero parang hindi lahat nakakauha nun. Tapos yung mga organisasyon, hindi kilala sa ibang bansa. Hindi mo alam kung saan ka hihingi ng tulong. (I agree with the [finding that says] that there are gaps and weaknesses in the governments ability to provide jobs for Filipinos. Because of this, whether we work abroad or here, [the lack] of money remains a

96

problem. There should be an organization that will help OFWs. While I was in Hong Kong, we heard that [President] Gloria [Arroyo] had a program, but it seems that not everybody benefited from it. The organizations are not known in the country of destination. You dont know where to ask for help.) 3. Services and Policies Needed The various services and policies recommended by the survey participants to address their identified needs and concerns along the different stages of migration are summarized in the succeeding tables. These were affirmed and validated by the inidviduals who partiicpated in the FGDs, narratives and key informant interviews. The five most frequently identified services and policies that should be in place to address the needs of migrants in the pre-migration stage are: (a) provision of financial assistance or support to applying women migrant domestic workers; (b) provision of information and orientation on migration realities, the host country, among other things; (c) enforcement of policies to protect the rights of women migrant domestic workers; (d) reduction or abolition of placement fees; and, (e) provision of services for women migrant domestic workers and their families. The need to review current policies in relation to health and migration, specifically the Philippine Mental Health Policy Framework, and support the call for the enactment of a National Mental Health Act that would incorporate the issues and concerns of migrant workers was also raised. On-site, the following are needed: (a) setting up of help / grievance / information desks for women migrant domestic workers; (b) provision of services on site; (c) ensuring that contracts are followed; (d) monitoring of women migrant domestic workers situation and provision of information; and, (e) skills training. Lastly, upon arrival in the Philippines, the following must be put in place : (a) provision of economic opportunities for returning women migrant domestic workers; (b) provision of skills training; (c) provision of services for women migrant domestic workers and their families; (d) conduct of reintegration seminars for women migrant domestic workers and their families; and, (e) assistance to women migrant domestic workers in their re-application process.

97

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Conclusions & Recommendations


Women constitute a significant number of individuals leaving the country for better economic opportunities. Their experience is influenced significantly by their gender identity, as they try to straddle the ascribed family role they left behind and their new role as female domestic workers in other countries. In the process, they not only confront economic and cultural problems, but also psychosocial issues, including mental health and well-being concerns. This reality therefore should serve as the basis of any research in understanding the positive and negative effects of migrant work. It should also be the assumption in any intervention work aimed at mitigating the costs of migration. In understanding the mental health status, needs and issues of migrant domestic workers, one needs to look into factors that may contribute to their well-being. One such factor is the stage of migration they are in and the issues and demands associated with each phase. The most frequently identified issue and resource needed during pre-migration center on finances needed in the application process, screening procedures, travel documents and others. During migration (being on site) the concerns shift to homesickness / loneliness, adjustments, work environment and workload. While majority stated that they did not encounter any issue during the post migration phase (upon returning home to the Philippines); some still identified financial issues, as well as strained relationships with family members, as prevalent problems. The aforementioned differences in the identified mental health needs and issues along the different stages of migration are also reflected in the variations in the manifestations of stress reactions when the participants are abroad and when they are in the Philippines. It is important to note that though some of the identified reactions were the same, the ranking of these physical manifestations changed. Additionally, the number of symptoms reported by the participants decrease while in the Philippines compared to when they are abroad. The same trend is also observed among the reported psychological manifestations of stress. One conclusion is that differences in the expressions of stress physical or psychological - may be related to the shifts in the primary context (work or home) of the migrant worker. These must be considered in the development of interventions for the mitigation of stress among members of the said population. The need to address competing demands of their work abroad and their families in the Philippines is another salient factor in understanding the mental health status of female migrant domestic workers. The participants reported that they find it difficult to balance these two aspects of their lives. This may be associated with the double burden faced by female domestic workers where despite their ability to contribute to the coffers of the family, they are still expected to fulfill their care-giving roles in their families even if they are overseas. Relating these two demands to the experience of stress, more

98

respondents reported that their greatest source of stress while abroad is still stress at work , while others identified stress from both work and home. The women migrant domestic workers living and work condition(s) may significantly influence their state of well-being. Very seldom does one focus on one single task; most of them are involved in multiple tasks. Though majority of the participants said that they work solely in their employers home, there are those who do work outside the household (such as for the employers parents or friends), performing the same tasks without additional compensation. Such tasks, associated with nurturing and sustaining families, are traditionally constructed as female roles. Thus the same roles that these women left in their homes in the Philippines, are replicated in their work abroad. Even among the very few respondents who reported that they have other sources of income abroad, most are engaged in part time work consistent with these female roles. Comparing the participants level of stress to their living arrangements with their employers, most of those in stay-in arrangements rated their stress level from 3 to 5 (on a scale where 1 is low and 5 is high). Though there were a small number of participants in live-out arrangements, it is interesting to note the trend of their ratings, which were from 1 to 3. This shows that it is possible that the increase in stress ratings may be associated with their living conditions. The stress level onsite may also be related to the number of work hours a day which shows a general trend of having a high rating of stress with working for longer periods a day. Though women migrant domestic workers may have the legal right to avail of days off, some still do not enjoy such a work benefit. There are also several ways of taking a day off once a week, once a month, once a year or accumulated days off used as vacation leave, among others. The latter shows how devalued domestic work is, as it is not considered as productive work, time off from work is not something that is considered to be essential in domestic work. Study participants responses show that having a day off allows them to enjoy activities individually or with friends which facilitate their adaptation to the demands of being away from home. Perceived personal capacities in terms of physical health, ability to cope with stress and state of wellbeing are factors that positively influence ones ability to address stress. Most of the participants in the study gave themselves high ratings which denote perceived positive state of health. Such could be considered as a critical buffer to daily hassles and critical life events. Positive experiences also cushion the negative impact of stress while working abroad. Among the participants, their stated sources of joy and happiness centered more on positive relationships with family members, employers, employers children, friends and fellow domestic workers. Though financial factors are also important, these seem secondary to maintaining smooth interpersonal relationships with other individuals in different spheres of their lives.

99

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Mitigating the effects of stressors are the perceived benefits of working abroad. The female participants in the study identified various advantages, foremost of which would be their capacity to send their children to school and meet their families needs. Securing ones future by saving and establishing their own business, as well as having their own home was also mentioned. It is not surprising therefore that despite the problems and stress encountered while working abroad, they still hope to leave again in the future. Another person-specific factor that affects the respondents experience of mental health issues and concerns is the type of coping strategies to deal with stress. The most frequently used strategies employed by the respondents in this research were: turning to religion, focusing and venting of emotions; behavioral disengagement; mental disengagement; and seeking social support. Other responses also include positive thinking, assuring oneself that one can do it, and fighting back when the employer becomes unreasonable or abusive. Some avoid thinking about their problems by keeping themselves busy and concentrating on work. Though the latter may not be an effective way of dealing with stressful situations, it may provide the individual with short-term respite from emotionally challenging situations. The appropriateness of the strategy employed depends on its impact in promoting positive mental health. If positive experiences mitigate the negative effects of stress on well-being, some negative experiences aggravate threats to wellness. One such threat includes restrictions and abuse. The range of restrictions and abuses reported by the participants vary from the behavioral and psychological to sexual. Some of these restrictions and abuses are overt while others are not. The experiences of abuse have far reaching effects according to the participants. Some respondents say they are still experiencing the resurgence of the emotional and psychological pain brought about by the abuse even after coming back to the Philippines. The presence of social support networks while working abroad must be considered as well. It was observed in the study that such networks were apparently related to lower ratings of stress. Most of those who reported that they do not have any source of support rated their stress level from 3 to 5. Participants noted the mitigating effects of the presence of their families, friends and co- workers, when they are faced with stressful life events and problemsLastly, access to healthcare and health seeking behavior are critical factors to consider. Many of the respondents reported that they have health insurance, yet most of those who experience getting sick did not avail of health services. Most rely on themselves, while some depended on friends and co- employees. Self- medication seems to be an acceptable practice in dealing with health problems. These health seeking behaviors may be due to cultural barriers, lack of information on health services, restrictions posed by employers in accessing services and participants own fear of getting terminated if they are found out to be ill or unwell.

100

One interesting observation in the study is the possibility that certain factors may affect or co-vary with female migrant workers experiences of stress and positive mental health. These include life stage, current work status, specific work conditions (such as days off and work duration) and country of destination. It would be important to pursue these in succeeding studies to determine the extent of their influence and impact in promoting positive mental health and well-being. Given these findings, recommendations are drawn along three areas: policy, research and program development and intervention. Specifically, these are: (see how they are aligned with the POI On policy development and implementation Enforce policies protecting the rights and welfare of women migrant domestic workers (such as the Migrant Workers Act of 1995 (RA 8042); the Amended Migrant Workers Act (RA 10022); POEA guidelines and other strategic policies) Review current policies in relation to health and migration, specifically the Philippine Mental Health Policy Framework, and support the call for the enactment of a National Mental Health Act that would incorporate the issues and concerns of migrant workers. On research Conduct of cross-cultural research on migration and mental health (i.e., on site research that will look at the relationship of culture / context / condition in the host countries and mental health of migrant workers) Conduct of research on the mental health status and needs of children (family) of women migrant domestic workers

On programme development Pre-departure Integration of mental health on programming of relevant government agencies such as the Department of Education (Dep Ed) and Department of Social Welfare and Development (DSWD), among others Incorporation of mental health topics in the modules of the Pre-Departure Orientation Seminar (PDOS) Training of PDOS providers on mental health topics and concerns Integration of counseling / psychosocial intervention in the training of foreign service personnel Participation of family members in the PDOS and other trainings such as financial literacy

101

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Assessment of mechanisms being used to identify mental health needs of OFWs and how they are being responded to (in relation to the conduct of psychiatric tests that if an applicant fails the test, s/he will not be able to work abroad because of being unfit to work)

On site Setting up of referral mechanisms that will respond to the mental health needs of women migrant domestic workers Making services available for women migrant domestic workers Mapping of services Provision of continuing support to families of women migrant domestic workers through organizing, training, counseling, among others

Upon return Provision of services to women migrant domestic workers and their families (livelihood, counseling, among others)

102

References
Alcid, M. (2007). Diaspora: Moving beyond minority status. Women in Action. No. 3, 2007. Isis International Bee, H.L. / Bjorklund, B.R (2004). The Journey of Adulthood, 5th edition. Upper Saddle River, NJ: Pearson Prentice Hall. Bhugra, D. and Jones, P. (2001) Migration and Mental Health. Advances in Psychiatric Treatment. CARAM Asia.(2002) Regional Summit on Foreign Migrant Workers: Report. Kuala Lumpur, Malaysia. CARAM Asia (2005). Domestic Workers and Health. Kuala Lumpur, Malaysia Carballo, M. (2007). The challenge of migration and health. International Centre for Migration and Health (ICMH). Carver, C.S. Scheier, M.F. and Weintraub, J.K. (1989). Assessing coping strategies: A theroretically based approach. Journal of Personality and Social Psychology, 56, 267-282. Commission on Filipinos Overseas. Stock Estimate of Overseas Filipinos (as of December 2009). http:/ /cfo.gov.ph/pdf/statistics/stock%202009.pdf. Conde, B. (2004). Philippines mental health country profile. International Review of Psychiatry, 16 (12), 159-166. Constable, N. (1997). Sexuality and discipline among Filipina domestic workers in Hong Kong. American Ethnologist 24 (3): 539- 58. Constable, N. (1999). At Home but Not at Home: Filipina Narratives of Ambivalent Returns. Cultural Anthropology 14 (2): 203- 28. Constable, N. (2002). Filipina Workers in Hong Kong Homes: Household Rules and Relations. In: Ehrenreich, B. & A.R. Hochschild (eds) (2002). Global Woman: Nannies, Maids, and Sex Workers in the New Economy. Granta Books, London. Dehle , C.; Larsen, D. and Landers J. (2001) Social Support in Marriage. The American Journal of Family Therapy, 29, 307-309.

103

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

DSouza, A (2010). Moving Towards Decent Work for Domestic Workers: An Overview of the ILOs Work . International Labor Organization. Geneva Enriquez, V. (1989). Indigenous Psychology and National Consciousness. Institute for the Study of Languages and Cultures of Asia and Africa (Tokyo). Fuster, JM (2002). Frontal lobe and cognitive development. J. Neurocytol. 31, 373-385 Gutierrez, F.; Peri, J.M.; Torres, X.; Carseras, X. and Valdes, M (2007). Three dimensions of coping and a look at theories of evolutionary origin. Journal of Research in Personality, 41, 1032-1053. Hanochi, S. (2007). Globalization and the hidden insecurity of women migrants. Women in Action, 3, 26-34. International Labor Organization (2010). International Labor Migration: A Rights-Based Approach. Geneva. International Organization on Migration (2005). Migration Health Report. Geneva Jiang, S. and Winfree, LT. (2006). Social support, gender and inmate adjustment to prison life: Insights from a national sample. The Prison Journal, 86 (1), 32-55. Lazarus, RS and Folkman, S. (1984). Stress, Appraisal and Coping. New York: Springer. Mayor, Ross. (2008) Untangling the Mental Haywire. Health Alert Asia Pacific edition (Manila: Health Action Information Network Murakami, Y. (2009) Cross cultural factors in workers mental health from the experiences of EAP services. World Cultural Psychiatry Review. January, 60-64. Ohara Hirano, Y (2000). Cognitive life strains and family relationships of Filipino migrant workers in Japan. Kyushu University. Papalia, D. / Olds, S / and Feldman, R. (2007) Human Development, McGraw-Hill Companies. Ramirez Mechado, J. (2003) Domestic Work, Conditions of Work and Employment: A Legal Perspective. International Labor Organization. Geneva.

104

Sanchez F. and Gaw A. (2007) Mental Health Care of Filipino Americans. Psychiatric Services. Vol. 58:810-815. Santiago, C.E. and Enriquez, V.E. (1976). Tungo sa MakaPilipinong Pananaliksik. Sikolohiyang Pilipino: Mga Piling Papel, 1 (4). Sobritchea, C. et al. (2010) Health of our Heroes: Qualitative Study on Access to Sexual and Reproductive Health Services and Information of Women Migrant Domestic Workers. Action for Health Initiatives Inc. (ACHIEVE). Manila. The Womens Foundation (2006). The Status of Women and Girls in Hong Kong 2006. Hong Kong: The Womens Foundation United Nations (2008). International Migrant Stock: The 2008 Revision. Accessed 19 November 2010 from: http://esa.un.org/migration United Nations Development Programme (UNDP 2009). Overcoming Barriers: Human Mobility and Development. Human Development Report. Wolffers, I. and T.M. Painter (2002). Programs for Mobile Populations and their Partners. In: P.R. Lamptey and H. Gayle (eds). HIV/AIDS prevention and care in resource-constrained settings: A handbook for the design and management of programs. Family Health International, Washington. 229-257. Zahid, M. Fido, A. Alowaish R. Abd El-Motaal Mohsen M. Abdul Razik M. (2003). Psychiatric morbidity among housemaids in Kuwait. III: Vulnerability factors. International Journal of Social Psychiatry 49 (2): 87-96. Conferences 8th Regional Conference on Migration (2002). Migration and Migrant Workers Health and Well- being. October 8 11, 2002. Dhaka, Bangladesh. 7th Regional Conference on Migration (2001) Devloping National and Regional Advocacy Agendas on Migrants Human Rights. June 13-16, 2001. Jakarta, Indonesia. On-line materials www.un.org/esa/population/publications/ittmig2002/WEB_migration_wallchart.xls Accessed Dec 2003

105

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Annexes: Case Studies


Myras Story (Cebu)
Myra (not her real name), is 28 years old, a Roman Catholic, and a high school graduate. She lives with her parents in Cebu City and is the youngest of six siblings. Myras parents are not engaged in any income-generating activity, while her unmarried siblings (a sister and a brother) have irregular incomes. Although unmarried, Myra has two children with a common-law husband. Myra got pregnant at age 19, prompting her and her boyfriend to live together, but the relationship lasted for only three years. He was unemployed and spent most of his time drinking with friends. The separation did not come easy for Myra because they have children, and the man was not supporting the family. This lack of support was one of the reasons why she decided to work abroad. She felt bad about what had happened, but the desire to move on for the sake of her children and family was greater. At the time of the interview, Myra worked as a contractual worker in a local company. She was earning PhP150 (about 2.50 euro) per day, amounting to roughly PhP3,000 (49 euro) a month. Despite the insufficient income, she claims it is a job that does not require college education. Her contract is renewed every six months, contingent upon the recommendation of her immediate supervisor. Myra has been working there for almost a year now. Seven years back, a female friend informed her of a notice posted by a recruitment agency recruiting domestic workers in Lebanon at the barangay hall, (Nangita kog trabaho pero wa koy masudlan, usa kaadlaw, ang among silingang amiga nakakita nga naay gi post sa barangay hall ang agency nga nangita og domestic helper para Lebanon). Interested, she went to the agency, was interviewed and was accepted. However, when it came to procuring the required documents and going through the procedures (such as passport, birth certificate, and medical examination), her money was not enough to defray the related expenses. Myra approached her parents and suggested that they borrow money (PhP6,000 /US$133.33) from a relatively well-off neighbour, with their house as collateral. For fear that Myra might not be able to repay the loan or redeem the house, her parents did not agree. Eventually, and after she made a promise that she will work hard abroad to settle the obligation, her parents approved. Myra recalls having undergone various medical examinations, such as tests for pregnancy, sexually transmitted infections (STI), HIV, hepatitis B and C, dental, eye / ear / nose / throat, urine, stool, blood, drugs, and was also subjected to X-ray and general physical examinations, and psychological evaluation. The results were made known to her by the agency. [Even during the migration stage, Myra recalls again undergoing pregnancy and urine tests.]

106

Upon completion of the requirements, Myra was given a two-year working visa as a domestic worker. Together with other applicants, she participated in a series of lectures reportedly initiated by the agency. These covered the following topics: health information, remittance of money, how to save money / earnings, the culture and laws of the host country, travel rules and procedure, cultural adaptation, language and coping mechanisms. She also claims having participated in the Pre-Departure Orientation and Seminar (PDOS), but could not say whether she underwent training with the Technical Education and Skills Development Authority, (TESDA). She stayed in Manila for three months, waiting for the agency to inform her that they have found an employer for her. Due to the high cost of living in the city, Myra asked her mother to borrow money (PhP2,000 / US$44.44) again from the same neighbor, bringing their debt to a total of PhP8,000 (US$177). Finally, the agency found her an employer in Lebanon, and Myra was scheduled to leave soon for Lebanon. It was stipulated in her first contract that she would be receiving a monthly salary of US$300 (roughly PhP13,000), and one day off from work. She knew however, that she would only be receiving US$150 / month (PhP6,900) because the agency informed her that the $300 was only on paper, to comply with immigration and POEA requirements, and not her actual salary. Myra accepted the arrangement because she was anxious to leave and work in another country. Myra recounts the sources of stress in the pre-migration stage: separation and lack of financial support from her partner; lack of resources to support parents and siblings needs; and, expenses for the working-permit requirements. Myra repeatedly cited her concern for the welfare of her two children and her love for her parents and siblings as the primary factors which gave her the courage to go through life despite the many emotional and financial difficulties). To cope, she listens to the radio and talks with her children. She also says the love and support obtained from her parents siblings, especially her sisters and friends have contributed to her well-being. Her family, she says, is the main reason why she decided to work abroad. In her words, I know how difficult it is to live in another country, but I have no choice because we are in need; what will we eat if we insist on the work we want? From 2005 to 2007, Myra, then aged 23, worked as a documented domestic worker in Lebanon earning a monthly income of US$150 (about PhP7,000). Her duties included washing and ironing clothes, cooking/preparing food, cleaning house, and taking care of the sick (the sister of her male employer).

107

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

When she first met her employers, she expressed gratitude for being chosen among all applicants. Myra said she appreciates how her female employer treated her. There were times when she would ask Myra about her life back in the Philippines, and they would laugh together. During the first few days of her stay in Lebanon, Myra was apprehensive, because of the ongoing war in the country. She said she was so scared; her body was always shaking from too much nervousness Her male employers sister, she claims, was also good to her, and advised Myra to drink a glass of water with sugar to ease the nervousness Apart from nervousness, Myra had to work 21 hours a day, leaving room for only three hours of sleep. Her employers did not go to bed, which also kept her up, for fear that she might be reprimanded. Although she claims she had never been sick in Lebanon, she admits she was always feeling very tired. Limited food and constant hunger was another concern in Lebanon, but she was able to find a way to address this. Oftentimes, she would secretly sneak in bread and a glass of milk inside the toilet.. In Lebanon, she was not given a day off from work, contrary to what was stipulated in the contract. However, she did not mind it since she was also afraid to go out When asked about source(s) of her strengths and why she was able to handle the difficult situations, Myra points to her children, family, and her obligation to repay her debts in the Philippines. Instead of thinking about the difficulties faced, she would listen to music (what she usually does in the Philippines) to ease fatigue or, just stay in bed to relax. To cope with loneliness, she would call and talk to her children and parents. This is what she had to say when asked why she did not complain, I needed the job. It was my decision to work abroad. Problems have solutions and I did not mind the heavy workload because the pay was good. Aside from her familys moral support, she says her lady employer and male employers sister were supportive of her financial needs. Myra concludes this part of her story by saying that in Lebanon (and even Romania) what made her forget about her loneliness was when she had sent money to the Philippines

108

Despite completing the two-year contract in Lebanon, Myras employer did not want her to leave the country thinking that she might not be able to come back. They had Myra extend her stay for four months and assured her that they will find a way to get her a tourist visa. When her employers brother from Romania came to visit them, he offered to get Myra a twomonth tourist visa so she could go to Romania temporarily to work for them as a domestic worker. The brother offered Myra higher pay (US$300 / PhP13,800). This was the primary reason she did not have second thoughts about accepting the offer. Her new employers were able to secure three consecutive two-month tourist visas, resulting in Myras six-month stay in Romania, Lebanon and again in Romania. She was grateful for the work because she needed the money, she was not ready to return home given the many financial obligations, and because she was assured that her employer would handle the needed papers. She admits that she also enjoyed the travel and the opportunity to see other places, including the experience of riding on a plane. A domestic worker with an expired visa is not easy, she continues. They are sent to another country, as a tourist, to avoid apprehension or deportation. They do not have any legal protection if they fall into the hands of a bad or abusive employer If an undocumented domestic worker experiences physical abuse, she would not find it easy to report the matter to the Philippine embassy. This is one reason why some women return home to the Philippines with physical injuries, or why they run away. Myra tells a story of how she was treated by her male employer in Romania at the time her tourist visa was about to end. It started when she accidentally damaged the glass frame in the living room. She admitted her mistake and told the male employer that she was willing to pay for the damages. But without saying a word, he grabbed her hair forcefully and hit her strongly in the face with his fist, drawing blood as a result. She says that, at that time, she was a willing victim because he obtained her a tourist visa and she was receiving a higher monthly salary The higher salary encouraged her to stay despite her being undocumented and maltreated. She did nothing because, at the back of her mind, she needed the work so she could save money Sometime in 2007, her employer in Romania decided to get Myra a two-year working permit. Again, it was the higher pay (US$300 / PhP13,800) that made her accept the offer.

109

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Document requirements were processed by the employer without Myra having to pay for expenses incurred. Her work covered house cleaning, fetching water, baby sitting a female child, cooking, washing, and ironing. Similar to her situation in Lebanon, Myra had to work 22 hours a day, something which she claims she already got used to. Caring for a child which included, bottle-feeding and changing diapers contributed to her lack of sleep. Food was strictly limited to bread, unlike in Lebanon where she had the chance to eat other kinds, albeit inadequate. To deal with this, Myra would, like before, secretly eat bread and milk in the toilet whenever she felt hungry. According to her, work in Romania as very tiring not only because she had to make sure that the needs of the employers child were properly attended to, but because she had to fetch water from the 2nd floor of the building (where the source of water is located) and bring it up to the 4th floor (where they live). The difficulties, however, did not prevent Myra from fulfilling her obligations. When loneliness crept up, listening to music and talking to her parents and children on the cellphone made her feel better. Morale boosting and other support in this case came from one of Myras married sisters. Whenever she is delayed in sending money, she would ask that sister to take care of her childrens needs. There were also times when she had asked money from her lady employer whom she describes as a good person (Ako, og magkaproblema kog kuwarta, makig-estorya gyud ko sa akong amo nga babaye sa Romania, dili gyud ko molimod niya og estorya kay maayo ra man siya nako, akong ingnong nga gusto ko magpadala og kuwarta sa Pilipinas kay nagkinahanglan sila, pero og dili sila mosugot, dili man sad ko mamugos). Aside from other Filipino female domestic workers she met at the playground, Myra claims she enjoyed the company of the child she was babysitting, which really made her happy. She also had the opportunity to meet other Filipino women when her employers family went to the beach. There they exchanged stories, including experiences as domestic workers. Looking back, Myra says that the worrying about how her family was doing created more anxiety than the difficulties she faced abroad (Pero di gyud nako malikayan nga mas kapoy huna-hunaon ang pamilya kaysa trabaho, mas bug-at ang problema sa pamilya). Eventually, Myra finished the second contract, but her employer extended her stay for another four months. Within this period, her male employer hit her again in the face, again causing bleeding. This time, she ran off and reported the incident to the Philippine Embassy (Iya

110

nasad kong gisumbag sa nawong nagkadugo lang gihapon ko, nilayas ko, niadto ko sa Philippine Embassy, ni reklamo ko sa akong nawong nga nahubag). To her dismay, she was discouraged from filing a case, and was told that processing of her departure documents will take a much longer time (Pero giingnan ko sa Philippine embassy nga kong mo file ko og kaso dugay pa ang pag process sa mga papeles.). Convinced that the Philippine Embassy could not do anything to help her, Myra decided to go home. Finally in 2009, Myra returned to the Philippines with only US$300 (Php13,000) in her pocket. She was frustrated to know that her parents were not able to save the monthly allowance she sent them. Her siblings were unemployed, and she was had no choice but pay the debts After all the years abroad, Myra said she lost weight as a result of lack of sleep and rest, both in Lebanon and Romania. The money she had was not enough to pay the debts, forcing Myra to pawn all the jewelry she bought in Lebanon and Romania To avoid dwelling too much on her negative experiences, Myra would just go for leisurely walks. Now that I am here, I have no master Her family is still her source of emotional support, including her married sister who has become the go-to-person whenever she needs money. When asked whether she has any plans of working abroad again, she replies not in Lebanon or Romania, maybe in some other place when given another opportunity. She complains about her inadequate income at the company which is not sufficient to make both ends meet. She does not however intend to reapply soon saying that she still wants to have more time with her children

111

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Natys Story (Davao)


A. I will have my own restaurant in the City. Naty (not her real name) is 42 years old, with four children from her first marriage. She now lives in a city in Mindanao with her partner, his daughter, and her daughter. Before going abroad, she lived and tilled a farm owned by her parents in North Cotabato. Aside from farming, she also worked in a rubber plantation, tapping rubber trees. As far as she could recall, she had been farming and tapping rubber trees with her family. It was a hard and back-breaking work, especially when the rains came and they had to rush to collect the rubber tree milk, lest the rain would wash it all away. One day, she learned that working abroad paid big. Thus, she vowed, I will go abroad and put up a restaurant in the City,. Not long after that, she heard on the radio an opportunity to fulfill her dreams. Greenfield Recruitment Agency (not its real name) announced that that they were looking for overseas contract workers to work in Kuwait and that no placement fees will be paid. For Naty, that would mean two hundred dollars a month - sufficient to start a new restaurant. She immediately went to the agency. It was March 14, 2005. Naty passed the interview and submitted the necessary documents (birth certificate, passport, NBI clearance, among others). On March 30, the agency asked her to go to Manila to undergo the Pre-departure Orientation Seminar (PDOS) and medical examination. She did not go through Overseas Workers Welfare Administration (OWWA) because, according to her, it was not required at that time. She left the country spending only a total amount of PhP6,000 (US$133.33) for the processing of the documents and air fare to Manila. Naty left the country on June 19, 2005 and arrived in Kuwait, received by an agency there. The contract she signed in the Philippines was for two years, entitling her to receive US$200 (about PhP10,000) a month. The agency in Kuwait, however, did not disclose the full terms of the contract. Instead, she had four employers and received a monthly salary of 45 Kuwaiti Dinar (KD) or PhP8,100 only. Her first employer paid the IQAMA (work permit), worth 350KD to the agency in Kuwait. The IQAMA was only good for six months. Her second employer took out IQAMA for one year and paid the amount of 400KD. The third employer did not pay for the IQAMA and she stayed for four (4) days before she was returned to the agency without any salary.

112

The fourth employer was her most horrid experience. In her entire stay of 14 months, her salary was never paid and she was beaten and locked up by her female employer. During the interview, Naty smiled during some phases of her story. Toward the end of her narration, she broke down and said, When I retell this story, it feels like it was happening again. I could feel the pain I felt then. This was how her story started. When she arrived in Kuwait, her first employer chose her from among the domestic workers in the agency. They paid the IQAMA of 350KD for six months of work. The family that Naty worked for was Kuwaiti and occupied the third floor of the house of the male employers mother. Her main task was to care for their two-year old son 24 hours a day; her other tasks were to wash and iron clothes and clean the three floors of the house. She did not need to cook as the household took their lunch in the unit of the employers mother. They ate a full meal during lunch only and had bread for breakfast and for dinner. Since there was only one full meal a day, Naty ate as much as she could during lunch so she had enough energy to do her tasks. Most of the time, she was left alone with her male employer because the wife was still studying. It was during these moments when her employer tried to sexually molest her. The employer would ask her to massage him while he wore only a face towel. If she refused to massage him, he threatened that he will rape her. When her employer became insistent, they would chase around the house. At times, she would slip on the stair in her efforts not to be cornered. She would also grab the sleeping child and use him as her shield or she would cry, and then her employer would back away. When the Filipina cries, they take pity. He would then draw away, according to Naty. These incidents started during her second month at work. She begged her employer to return her to her agency. But she was asked to pay the 350KD that they paid for her permit so she endured her situation because she could not pay the amount. She shared her situation with another Filipina domestic worker employed by the mother of her employer. She learned that no domestic worker stayed for a long time with her employer because of his behavior. She tried to tell the wife also but she said that she sided with her husband and did nothing about the situation. One good thing with her first employer, Naty says, was that she regularly got her salary for five months. The employer did not pay her first months salary - an agreement between her employer and the agency. She remitted all her salaries, except the last month, to her family in the Philippines.

113

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Since she was not allowed to go outside the house, her employer sent the money himself and paid the transfer fee of 2KD, but Naty was asked to keep this information from his wife or she would get angry. Her employer offered to make her his second wife because he really wanted to marry a Filipina. He wanted a Filipina wife because Filipinas are attentive and his wife was only 23 years old and was always out. At the end of her 6-month IQAMA, she was returned to her agency. Upon her return, her money, cell phone, and other belongings were taken by the agency. To be employed, she underwent the same process as with the first employer. Naty said, We were like piglets that they will select from. We sit (in a corner)then they will ask us to walk. When the employer has made a selection, they will then pay the IQAMA. This time, her second employer paid the IQAMA of 400KD and for one year. Each new IQAMA, her employer paid 100KD higher. Her situation was no different. The male employer also molested her. When asked if she was raped, she evaded the question. The male employer, also a Kuwaiti, worked for the boat industry and would be home for two weeks each month, while her female employer went to work everyday. Even though she had a separate sleeping quarter, and was able to lock it when she slept, her employer used a duplicate key and did whatever he wanted. At times, she would wake up with him touching her. Since the employers two-year old daughter slept with her, she would tightly embrace the child to stop her employer from what he was doing. Sometimes, her employer would also open the bathroom while she was taking her bath. At this point, Naty expressed what she thought of her employer, He is a pervert! During winter season, from November to March, he becomes more perverted. she added. On her ninth month, she begged her employer to return her to the agency. They did not want to let her go because nobody would take care of their daughter. She was also asked to pay the whole amount of the IQAMA before they released her. She again had to wait out the term of her work permit, when she was freely released. Meanwhile, to cope and to save her, I ran and ran. I ran and ran. Then I would grab her daughter whenever his perversion attacked again. Whenever I slept, I had three layers of clothing so he cannot easily touch me. One time, she hid under the TV shelf and he grabbed her feet. She kicked him and begged him saying, I came here to work only because I have to feed my children. He would usually withdraw and apologize, especially whenever she mentioned her family and children. Her employer was also afraid of his wife so he could not fully molest her whenever the wife was around.

114

At the end of the IQAMA with her second employer, she was returned to the agency. They allowed their daughter to hug her and they stayed for an hour in the agency so the child could fully bid her goodbye. Back at the agency, she stayed for another three days before the third employer came. However, it was not full-term employment. No contract was signed, and after three days she was returned to the agency. She was just made to clean the stock room without pay. This was apparently a common practice because Naty said, That was how it was. (They) will get you in the agency and observe you for five to nine days. If they dont like you, (they can return you). Some abuse this privilege (in order to get services for free). Naty complained this practice to the OWWA in Kuwait. Natys fourth employer was an Egyptian and his third wife. Very horrible sadists, was how Naty described them. The husband lived on the first floor with the first wife and on the second floor lived the second wife. Her employer had four children, aged 15, 12, eight and five years old respectively. From the time her employer took her from the agency, Naty was locked up in the ceiling of the toilet. Her first eight months were spent near the heater and exhaust airconditioning exhaust. She described it as being like in an airplane day and night from the noise. The flooring was sand so that she was like a dog covered with sand everytime she woke up. The room was very dark and she saw no light while inside. The space was only enough for her to sit up or lie down. She had no beddings and had to urinate where she was sitting. To get above the toilet, Naty had to use a table and when she was going up her employer poked her backside with a broom. For another six months, she was moved down and slept beside the toilet bowl without a mat and blanket. She was only allowed to go out for three hours whether the work was finished or not. Without any word she would do laundry, iron clothes, clean the house, and wash dishes. While she did her work, her employer sat by the door to guard her. While locked up, she talked to no one and was not seen by anyone. She did not even see the sun nor know the time and day. She would only learn the date when the children change into their uniforms in the bathroom. She was locked up to prevent her from escaping and to prevent her male employer to see signs of her maltreatment. Her employer feared her escape because they could not afford to give her

115

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

salary. They relied only on the monthly government subsidy for each of their children and the free food commodities they received. Not only was she locked up, her employer also severely maltreated her. According to Naty: I was physically maltreated. I was locked up...Scratched, slashed with a knife. My arms were pricked with a ballpen or fork. Pushed around. She would make me (clean the floor) and throw a strong powder soap and a gallon of acidic cleaning agent...I wrung the (rug). Then my face was pressed on the floor. I would be thrown grounded red chili, 1 jar, or ground pepper...my head and face felt hot. Thus, I cried and cried because it was very hot. I was like a child who was begging. I was like a two-year old. I was very thin because she did not let me eat. Then I was all bruised. Both arms were like an eggplant, very black. My head was burnt from the chlorox (acidic reagent). The chlorox trickled down my head. I just closed my eyes. She was happy when she saw me suffering with pain. She then sang. I was dipped (in the toilet [bowl]) then she pulled my hair and flushed it in the toilet. I got bald at that time. Then she would laugh, dance, and rejoice. My whole body ached. Painful, especially when she kicked my ribs when I was carrying seven carpets. I was very thin and bruised all over. I had no slippers. I did not change the uniform I wore for 14 months. It was threadbare. During that period, Natys meal would usually consist of only a piece of bread, which was slipped in the hole where she was locked up. No potable water was given and she drank the salty water from the faucet. She drank as much as she could that sometimes her stomach trembled when she hung the laundry. Then her employer would eat her meals in front of Naty, just for spite. There was a time when she did not eat anything for seven days. She became terrified of her employer that everytime she heard her voice she panicked and prayed for Gods help. She felt as if she was going crazy. Throughout all that she experienced, Naty said, But with Gods mercy, I did not get sick even a little...I just prayed to God. I was like a child. I prayed that He remove me from this house, this hell. I prayed all the time. She felt she was protected by God that she suffered no major injuries, even when her employer pushed her on the stairs. Her employer was also wary of her because no matter how Naty was hurt she would stand up. One time, her employer tried to stab her eye with a pen thinking she had the power of the Evil Eye.

116

Besides praying, Naty would sing religious songs softly. This calmed her mind and lightened her feeling because she felt that God listened to her songs. This is also her way to entertain herself. In the process, she would fall asleep and dream of delicious food and of places or of going home to the Philippines. When she woke up, her flesh felt like being electrocuted due to hunger. Finally, Naty had a chance to escape. Her employer was in deep sleep. She knew that the key to the door was tucked in the sleepers waist. Naty took a knife and was about to stab her sleeping employer. But the knife fell and her hands trembled. She realized she could not kill a person even if it meant freedom for her. Another opportunity came and, this time, she grabbed it without hesitation. It was two in the afternoon and the family was having lunch in the living room. Her employer ordered Naty to come outside and do the laundry. She went out to the living room and saw that the door in the first floor was open. She ran as fast as she could and flew down seven flights of stairs, out of the open door. She shouted to the husband that she could not take it anymore and would die in their house. They were shocked and were not able to move or say anything, especially when they saw her bloodied, bruised, and swollen flesh. Once outside the house, she immediately flagged a taxi and went straight to the Philippine Embassy. Once Naty saw the Philippine flag and stepped into the Embassy premises she felt as if she was already back in the Philippines. She felt relieved and joyful when she saw Filipino faces. She was very nervous when she arrived, and this lasted for a week. Although she had reached third year high school, she even forgot how to spell month while making her sworn statement at the Embassy. After the legal business was taken care of, the Embassy staff turned her over to the OWWA center, where she was dressed, fed, given first aid, and finally allowed to sleep. Rested, Naty afterward recounted her story with a staff who counselled her. Her medical examination was postponed while her more serious injuries head fracture, burns and intense fear were attended to. During the months she stayed with her last employer, her family in the Philippines sought the assistance of OWWA and POEA in Davao to find her. Flyers and TV missing person announcements were broadcast. When she arrived in OWWA-Kuwait she had to call home to assure them that she was still alive and safe. In her stay in OWWA-Kuwait, Naty found somebody whom she felt like a mother to everyone there. This person made them laugh, talked to them, gave them counsel, and provided physical therapy. She felt more comfortable because of this motherly figure.

117

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

After a months of stay in OWWA, she received a subpoena. Her employer filed a case of absconding against her. She was imprisoned for one month and transferred to about five different prisons, but she can only remember two (Sulay Biya and Talha). She stayed for two weeks in Sulay Biya. The last prison where she stayed most of her one month was Talha, which she compared to the National Penitentiary in the Philippines. When they arrived in each prison, they were led nude to three different sheds for thourough inspections. In jail, she cried and prayed a lot and preferred to be by herself because she did not want to join her inmates whose topic of conversations were mostly about their boyfriends. She did not feel any danger inside as long as she behaved formally. Otherwise, the prison guards would sexually abuse an inmate, which she knew happened to many of her inmates. Food was sufficient, with ample rice, chicken and a piece of fruit the usual meal. However, hygiene was a problem because all inmates in one cell shared one toothbrush and one underwear. About six Embassy and OWWA staff visited the Filipino inmates twice a month to bring them food, medicine, and toiletries. These provisions were shared by the Filipino inmates with those of other nationalities, especially Indonesians and Indians, who apparently were not visited by their embassies. During jail visitations, OWWA staff would ask them whether they wanted to continue working abroad or go home. Naty, for her part, asked what would happen if she decided to stay and file a case against her agency and her last employer. She was advised that she may stay longer in jail if she decided to take these actions. Given the situation and possibilities, Naty decided to go home. Fortuitously, a Filipino reporter in one of the major media networks in the Philippines came across her story and interviewed her while she was still in OWWA-Kuwait. The reporter gave her plane ticket back to the Philippines. Once she was released in prison, her belongings and passport were given to her. On the way to the airport, they were escorted by policemen. This was how Naty recalled that day, We were like pigs that were transported in a vehicle with barbed wire. What we went through was too much. Naty also saw a lot of OFWs who had been staying at the OWWA center for a long time, still waiting to be returned to the Philippines. Some had given birth and were raising their children in the shelter. OWWA provided milk and vitamins to the children and supported mothers with a livelihood program on rug making and selling blankets.

118

Naty arrived in the Philippines wearing the same uniform she wore for 14 months. She stayed at the OWWA center for a month until her wounds healed and was ready to go back to her family. This time, she did not call her family because she could not get herself to talk. Instead, she would constantly cry. Part of the healing process at the center was a daily check-up by a nurse every morning. During meal times, a staff would also sit with her and talk to her informally. All they had to do was to sleep and eat. The facilities were clean, so Naty was able to rest properly. She felt happy because now she could talk and was surrounded by fellow Filipinos instead of seeing only Arabs. But she eventually got bored because she was used to working instead of doing nothing and was glad to go home. Before finally going home to Mindanao, OWWA gave her a referral letter, endorsing her for assistance to its Mindanao branch. She went to the POEA and OWWA to avail of benefits due to OFWs. But, she could not get a PhP50,000 (810.92 euro) loan because she had no collateral. This did not diminish her determination. Naty went to the National Labor Relations Commission (NLRC) and asked advice on filing a case of unpaid salary against the local recruitment agency. NLRC told her that she needed to get her own lawyer to fight the case. She went to the Mayors Office, and presented her case. The Mayor sent her to the public attorneys office where she was provided legal counsel. In the process, Naty learned that it will be the agency in the Philippines who will have to pay for her. She can no longer file a case against her agency in Kuwait. At the time of the interview, Naty already won the case and the agency was asked to pay her P130,000 (2,108.39 euro). However, the agency closed down, for reasons not specified, and could no longer pay her. In the whole process of gaining what she lost, Naty spent her nights in Rizal Park and walked from office to office to save cost. During this time that Naty met her second husband who gave her support. She decided not to go back to her family and lived with her second husband. She missed her children and went to ask her only daughter to live with her in Davao City and to continue her studies even if only through the Department of Educations Alternative Learning System.

119

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

To help support her daughter and her new family, Naty worksed at a canteen, where she earned PhP120 (98 euro) a day working for nine hours, six days a week. Her daughter also worked in another canteen and went to class every Saturday. However, her daughter found the alternative learning system not enough to educate her and wanted to attend regular high school. With this, a new vision was planted in Naty. She now wants to work abroad again as a domestic worker but not anymore in the Middle East.

120

The Story of Gen

Gen (not her real name) grew up in Bacolod city, where she worked and studied at the same time. It was hard for her to combine the two, so she dropped out of college after the first two years. Seeking to improve her life, Gen decided to go to Manila in July 1993. She was 22 years old. Gen had little money left from her savings, but she did not want to inconvenience her parents. An aunt in Manila who had a small business helped her out. It was hard for her to find a job in Manila since she had no degree and spoke a local dialect. She knew few people and had little money. She had to ask her aunt for money which made her uncomfortable, and kept in contact with her parents through letters. Gen always told them that she was doing fine. For three months she stayed in different places, alternating with her aunt and with friends from the province. Gen eventually found a job in the kitchen of a fast-food restaurant through an agency. Everything there was new for her, because she did not have any experience with cooking and was unfamiliar with kitchen equipment and utensils. Her six-month contract ended, and the restaurant hired her as a regular employee, doing the kitchen inventory. She was later promoted to an office position, eventually becoming manager of one of the chain stores. Gen liked her job and learned a lot. She was very proud to have gotten where she was, despite the lack of a college degree. However she had difficulty dealing with her colleagues who sometimes complained about her, something she would cry over. However, she had a good relationship with her boss who supported and encouraged her, sometimes with financial incentives for doing a good job. According to Gen, one thing that could make her sad was if she did not accomplish her work for that day. She said she had the tendency to always say yes to orders from clients, even when they were too big to handle. This stressed her out. Gen sent some of the money she earned to her sister in Bacolod City to pay for the latters education. As time passed, hard times affected the restaurant she was working in, causing her to consider leaving to work abroad. Before she left, her boss asked her to assign someone to replace her.

121

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

This was a dilemma for Gen, because she found it hard to choose among her colleagues. As a result, her co-workers started to distrust her and tried to influence her decision. They also held her responsible for the replacement of five colleagues. Some would even threaten her. Looking back, however, Gen considers her time in Manila a good experience. She stayed in Manila for 10 years for the same employer and she had a satisfying social life.

When Gen decided to leave the company, she wanted to go to Canada or the Netherlands, where she had an aunt who had been living there for 14 years but regularly visited the Philippines. She wrote her aunt about her situation and asked whether her aunt and uncle could invite her to come to Holland. They agreed and sent her an invitation, so she could apply for a visa. She fulfilled all the requirements for the tourist visa and after it was approved she left for Holland. This was in 2003. When Gen arrived in Holland, she stayed with her aunt, who still spoke the same dialect (Ilongo), which made the culture transition easy for her to deal with. However, she says she did not feel like herself at that time, and experienced difficulty thinking straight, feeling like her brain was empty. Gen began to plan her next steps, since tourist visa was only valid for three months and staying with her aunts family began to cause relationship strains. She was not comfortable being around her uncle, who she said was always telling her what to do and watched her every move. He sometimes talked to her in an angry way and used harsh words in Dutch, which she could infer from the intonation. Her aunt apparently did not side with her and kept quiet when this happened. One of her coping behaviors was to go out of the house a lot. She met other Filipinas through her aunt. She would go to a Filipino church and attend social gatherings. She tried to stay positive and thought it was better to socialize and make friends. During that time her uncle wanted to know whether she would stay in Holland or go back to the Philippines. She decided to stay, because did not want to go home with no savings or earnings. People told her it would be easier for her to stay if she had a boyfriend to support her. Her uncle and other Filipinas suggested logging on to Internet chat rooms or putting out newspaper advertisements to form relationships. Although hesitant, she decided to go along with their advice.

122

Gen was convinced that in the end she would still be the one to decide if she liked somebody or not. After that there were a lot of calls for her from several men. She was not sure about what to do, because many Filipinas married men to get citizenship and residency documents. It was a difficult decision for her, because she was concerned about her future. After asking her mother for advice, she decided not to be with somebody she did not love. She would rather be independent and support herself. Gen decided to try and find a job. Because she did not have the necessary papers, the only job she could get was cleaning houses. She asked help from her friends and found a job with a family, which she liked a lot. They also referred her to their friends and colleagues, for whom she could work for as well. As a result, she was employed by eight families. Many of her employers are Americans temporarily working in the Netherlands for the same company. Eventually, her contacts expanded to include four other families, all of whom Gen described as nice families. Meanwhile she decided to live by herself. Gen has been in the Netherlands for the past seven years. In the beginning, the work was difficult for her, because it was heavy work, to which she was not accustomed. However, she wanted to be a good cleaning lady and tried her best. On reflection, Gen says accepting and loving your work makes the job easier. Other Filipinas come to her for help to find a job. For her this is difficult, because she does not have papers. Sometimes she asks a friend to help her with cleaning, so they can earn some extra money. She wonders why so many Filipinas have papers but do not have a job and do nothing. Not having papers creates many difficulties for Gen. For example, it is hard to access a bank. She carries an ATM card in the name of her aunt, but she cannot put a lot of money in the bank because her aunt has an uitkering (disbursement). She also has to watch out for the police and prays everyday that they dont come to her. It is not easy to go to the doctor or the dentist without papers; she always needs another person to organize this for her and set up an appointment. Because she has gum and dental problems, the dentist asks her to come back regularly, even if she does not have papers. She has a doctor and a dentist. Luckily she has a friend who offered to help her out in these cases. To have a working permit is one of Gens dreams. She is a member of the organization Trusted Migrants, involved in such advocacy. She sometimes worries about other Filipinas who do not have or make the time to take part in this or who prefer to stay out of sight. She thinks that if you do not struggle for it (work permit) you will never get it. She is a member of the FNV as well and pays her membership fee of 100 Euros. Aside from that, she does volunteer work at

123

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Stichting Bayanihan to help fellow Filipinos. Gen also cares for her aunt, who is a cancer patient. Gen sends part of the money she has earned to her family in the Philippines, which she considers part of Filipino culture. She does not worry a lot over them, but she explains that she has to work for this money. She says they can manage themselves and her mother knows how to spend it wisely. However, if a family gets sick, this causes problems and they ask money from her. If somebody is in the hospital, Gen feels that she cant refuse this, because it may be a life or death matter. In these cases she sends a small amount of money as a gift. She could not afford to give a big amount, because people would not be able to pay it back. She does not want people to say she did not help them in their hour of need. Gen explains that if you have a lot of money in the Philippines, a lot of people will approach you to ask for money. As a result, she never says yes immediately. She first asks borrowers what they will do with the money and then thinks about it for some time. In some instances, she even asks her sister for proof of where the money was spent, such as photographs or receipts. She says she does this because she wants to be able to trust them with her money. Sometimes she tries to find out discreetly who among them she can trust more with the money. Gen says that even if they are her brother and sisters she needs to know this; she is far away, and has not seen them for a long time. Even her father is not exempt. She sometimes asks what he did with the money she sent over. Gen divides her income between the Philippines and the Netherlands. She explains to people in the Philippines that in the Netherlands, everything costs a lot and she needs to spend for herself too. She also saves money for future needs. When she first arrived in the Netherlands, one cause of stress for Gen was the lack of a job. Another stressor was the lack of insurance. Because of this, she had to pay a lot of money out of her own pocket everytime she went to the doctor, who she paid in cash. These visits were frequent, since she has had a skin problem, even while in the Philippines. The condition improved with the help of one of the Dutch doctors treatment. Apart from this, Gen did not have many problems with her health since she came to Holland. A third stressor was her aunts cancer. Her aunt had been a widow for the past three years and her relationship with her daughter is not good. The aunt has also kept things from Gen and from her own daughter.

124

Gen tries to accept her aunt the way she is. She considers it her role to take care of a cancer patient, even if her aunt had been dishonest with her. She often prays to God for advice and consults other, more experienced, people. Gen tries to love her aunt, even though it is difficult. She often calls her aunt to ask how she is doing; she takes her to the hospital and takes care of her at home. It is hard for her that her aunt has a negative attitude and never shows appreciation for Gen, which makes it harder for her to accept her aunt. Her work takes her away from all the stress at her aunts house. Sometimes, she feels guilty because her aunt is left alone. The worries over her aunt are a big burden for her. However, she tries to stay positive by telling herself that she should consider herself lucky because she is happy and has enough money; there are many people in worse situations. One thing that makes Gen happy is regular communication with her family. She lives alone in her apartment and occasionally feels lonely and misses her family. She keeps in contact with them through online chats. Gen is busy all days of the week, which makes her happy. But, if she is tired, she listens to her body and takes a rest. She feels lucky to have her own apartment, where she could relax. Sometimes Gen prays for more strength if she is tired and wants to do something that is important to her. Faith and prayer are very important to her. Gen goes to church once a month, but attends bible-sharing sessions every week. She says she learns a lot from older Filipinas. Gen also reads a lot, which helps her deal with stress. She also likes to be inspired by the books she reads. Another de-stressor is talking with other people and doing good things for others, which make her very happy. In the winter Gen does not go out a lot, because of the cold. Temperature permitting, she sometimes goes to a fund-raising dance. She also likes to do karaoke (sing-along) during the weekend; she likes to sing, dance, laugh and go home with a smile. Another thing that makes her happy is when her boyfriend visits her when he has time. He is also a busy person and they each have their own lives. They see each other one or two times a week. She often goes to Amsterdam, but sometimes he comes to Rotterdam to meet Gens aunt. He often helps her out if they need to go somewhere by car. Her boyfriend is important to her, because he supports her and she feels he is someone she can lean on. Financially she does not need his support, because she has her own money. She met him three years ago through a Christian website chat room.

125

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Gen leads a very busy life, but tries to make time for everything and stay positive. She says it helps her to accept the situation as it is, and that a persons character and positive thinking are what matter. Her mobile phone is open 24 hours a day. She does not go home until she has accomplished her scheduled tasks for that day. At the moment, Gen does not plan to go back to the Philippines, because she is taking care of her aunt. She thinks it is Gods plan that she is in the Netherlands now. She plans to return to the Philippines and together with her boyfriend, arrange for her visa to come back to Holland. She also saved money for her visa expenses. She does not want rely on her boyfriend financially, she reiterates. Gen also plans to study, in the Netherlands or in the Philippines. Eventually, she wants to have her own property in Bacolod City. Gen thinks it is very important for Filipinas who go abroad to be able to connect with an organization or church. In these places, they can find a lot of other Filipinas who can help them. For Gen it was good that she knew someone who introduced her to these organizations and encouraged her to join them. She also thinks what is decisive are the persons will and ability to do something: if people dont take action themselves, nothing will happen. This is why she tries to encourage other Filipinas to go out and explore their life, go to Information Days events, and socialize. Gen used to be very sociable in the Philippines. This trait has never left her, which is why she finds it important to meet other people, compatriots or of other nationalities. She also thinks it is important for people that they dont stay alone in their house, because it contributes to their stress.

126

The Story of M

M is a 23 year old female from Davao in the Southern Philippines. Her parents are separated. Ms father does not live with them and her mother is living in with her boyfriend. Because of that, M lived with her four brothers, who she looked after for about six months at some point. She also has one sister living in Manila. M had just finished a two-year computer course but had trouble finding a job, when a cousin of her told her about being an au-pair. M read about it on the Internet and decided that it was what she wanted to do. Because there was an agency in Manila looking for au-pairs, M left Davao to stay with her sister in Manila. She felt excited to have the chance to go abroad. M felt she did not have a real home in the Philippines and it would be easy for her to go away. At the same time she realized that it might not be easy, reinforced by what her friends had told her as well. Mostly, she worried about her brothers because they were living alone. She was afraid they would not have a happy childhood and get into trouble. M always wanted to go to Europe, which in her mind, was both a modern but still traditional place, which was to her liking. She did not want to stay in the Philippines as a result of past experiences. While still a child, her uncle tried to sexually abuse her. She had a similar experience with a distant relative when she was in her second year of high school. The first occurred in her fathers province, the second in her mothers. As a result, M felt she had nowhere to go. She wants to support her family, but also make something with her life. She has no friends working abroad. Her family had no idea of what she was planning on doing, but nevertheless supported her decision. M initially thought she would be staying in Manila for a short while, but because of problems with the agency she ended up living in the city for a year. After registration with the agency, M did not hear from them for six months. When she phoned to find out what happened, it turned out that they lost her documents when they moved their office. She had to go to the agency a second time to follow up the documents. M suspected the agency was not registered. She also felt she paid them too much money. She had to pay about PhP 35,000 (570 euros) for one month of training. The training included swimming lessons, but at the end, she still did not know how to swim. Two of her ten fellow

127

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

participants could already swim and ride a bike, but had to pay for the training anyway. For herself, bicycling was a useful part of the training. M was however annoyed with the agency because they told her the training was compulsory and they would not send her abroad if she did not undergo it. Airfare was not included in the money she paid the agency. This was to be paid by the host family. M had to follow up all the papers and pay all expenses for her visa by herself. She thought the agency would assist her, but they only instructed her to transact everything with the embassy. Even the host family in the Netherlands was concerned why the agency did nothing. Paying expenses out of her own pocket landed M in debt, which she had to pay back out of her salary for the first four months in the Netherlands. While waiting for her papers to be finally processed, M did not have a job for six months. Eventually, she was employed as an inventory clerk at a bakery. However, because she had to take part in the agencys training, she had to quit her bakery job, which made her employer angry. For M, however, it was no great loss, since she had to work a 12-hour day, waking up at six in the morning and getting home at six in the evening. When M arrived in the Netherlands, no one was at the airport to pick her up. Her cousin helped her get in contact with her host. M was happy that she had a friend with her, who was in the same situation. Despite this, she could not contain her excitement. Her first host family a relatively well-off family lived in Huizen, which M describes as a place of solitude with big houses. The host mother was Russian, who was pregnant at the time, and her husband Dutch. Her charges were two boys, aged four and two years old. After two months the host-mother gave birth, which added an infant to the children she would look after. For the first two months M had a lot of free time. Her tasks changed when the baby came. When there were only two children to look after, she earned 400 euros (about PhP25,000), which is more than what au-pairs normally get, because she worked more hours. She thinks that maybe this is illegal, because the contract stated that au-pairs should not work beyond what was stated. However, M says she knows that many people work more than is stated in the contract. Ms host mother noticed that she was cleaning very well she used to take care of her four brothers- and asked her to do more cleaning. M grabbed the opportunity to earn more money. After the baby came she was cleaning the whole house and got 700 euros (about PhP43,000) for this. At that time the host mother was often at home surfing the internet. M started to think

128

that the situation was unfair and she was working too much. She realized that she was not happy. She already worked half days on Saturday and Sunday, but the family often asked her to work even more. In the beginning she always said yes, but later she started to dislike this. She started to feel lonely, because she was in the remote area of Huizen and could only meet her friends on Sundays. She also wasnt able to go shopping. Her host mother was a very silent person who did not like to talk. They would often have lunch and keep silent. M felt very uncomfortable with the situation and, after a while, stopped eating at the same time as her host mother. This experience had a negative influence on M and she started to be hesitant in speaking to others; it became hard for her to socialize. Because of the whole situation M decided that she did not want to stay with the host family after the one-year contract ended. She booked a flight back to the Philippines and started buying gifts for her family. On the day she was scheduled to leave, she did not make it in time for her flight and decided to stay in Holland. Although unintentional, M started to consider staying in the Netherlands the evening before her flight, as she was talking to friends at a party. M never had regrets about the decision she took. Through a female acquaintance, M was introduced to her second family in Den Haag. She describes them as socialites (people who only go to parties). According to M, they were a more bossy than the first host family. They had a child who was severely allergic to pollen. This was especially bad in the summer, so the child had to stay in the house all the time. M had to take care of and entertain him. She did not mind doing this, but missed the social interaction with other children and friends. M remembers one time she had a fight with the host mother. She would always wake up the host parents as she prepared the boy for school. However, one time the host parents had fallen asleep again after M woke them up. After dressing up the boy, she began to do her chores. However, she did not notice that the parents returned to sleep and that he boy was late for school. Seeing this, M went to her host mother to ask why he was not at school. The host mother blamed M for not waking her up. She also told the boy that it was Ms fault and called M an idiot in Dutch. M understood enough Dutch to know the meaning of the word and got very upset. She packed her bags straight away and left. She said she did not want to be treated like that and that it was easy to do this, because she did not have a contract. She knew the family would not report her, because they would get in trouble as well. M met her third and current host family through a friend. The family lives in Amstelveen and has three children (aged eight, six and four years old respectively) in the household. She describes

129

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

them as a very messy family with free spirits. In a way, M said she likes that because they do not tell her what to do and she is not afraid to make mistakes. They are very supportive of anything she wants to do. M describes the three children as very energetic. The eldest a daughter has attention deficit disorder (ADD) and is always running around and screaming. M said she often says bad things to her. She is also not toilet-trained, so M has to clean it up after her. While she says she needs a lot of patience with this child, M could accept the situation because she knows there is something wrong with the child. M is very happy with the family and she has lasted with them for a year. Recently the family got a new dog, which created more stress for M but she says she does not mind it. However, she has less free time now. She used to take on extra cleaning jobs with the neighbors, but she had to give it up because she no longer had the time to do it. In compensation, she got a raise from her host family. M now has Saturdays and Sundays off. The family always encourages her to enjoy her weekend. In her free time M likes to read books. M is supporting her family financially from the Netherlands, specifically two brothers one is in high school preparing for college and the other is in college. Ms concern at the moment is for one of these brothers to pass his examinations, because she is providing the money for his education. M says she is concerned about what happens with the money she sends. However, she does not send a lot and she never sends extra. She always sends money for specific purposes, like payment for bills and tuition fees. M is apprehensive that if she sends a lot of money, her family would just spend it all impulsively. In her first year in the Netherlands, M saved very little money, and consequently sent little to her family. She found it hard to save money and had to pay back a debt to the agency. Now she says she is more used to handling money and is able to send more to her family. M has some friends, part of the same batch that had undergone training in the employment agency. M has two good friends at the moment. Her best friends stay next door with the neighbors. She says this contributes to the fact that she likes her work right now and helps to relieve stress. M often uses Skype, even to talk to her friend next door.

130

She also likes to go out for bowling or dates with her boyfriend of six months. However she does not want her cousin to know about this, because she is afraid of such relationships and is very protective of M, partly because of her own past experiences. Ms boyfriend had wanted to settle down, but M was not ready for this. Even though M liked the boy, she decided to break off with him; she preferred to be independent. M finally told her cousin about this, with the expected negative reaction. M attributed this to Filipino culture, which is narrow-minded and dictating. M said this is one of the things she dislikes about the Philippines and thinks attitudes are better in the Netherlands. She also likes the fact that she can be independent in her host country and that everybody can work and study. M feels she has become more assertive since she came to the Netherlands. Her mother is surprised that now she always says what she wants. What she does not like about the host country, on the other hand, is that the kids often get too much freedom and lose respect for their parents. She also sees this in her host family, when the children (especially the oldest) curse at their mother. M is still an undocumented worker at present and she always has to be careful not to be caught. She tries to avoid getting in trouble and always has to do the right thing. She has no problem with this: she does not go out at night and does not get into trouble. At the moment it is not a problem for her that she does not have papers. However, she thinks it is better to go back to the Philippines because it might cause problems in the future. Even though M does not have papers she can still travel. In fact, she has been to France. At the start of her stay in the Netherlands, when she still had papers, she went to Morocco with her host family. However, that is not a vacation for her, because she had to take care of the children. She also goes on holidays with her current host family and, this time, it really feels like a vacation for her. M says she has not had major health problems. But if she does, she can get help from her host mother who is a doctor. Some time ago M had a bout of influenza and stayed in bed for four days. Her host mother helped her then. The host mother also helps her with contraceptives. M has a bad case of acne and very heavy menstrual periods. A pill dispensed by her host mother relieved her condition. In the Philippines, M says, people discourage the use of contraceptives, because people think that you have sex if you use that and that is considered bad. M does not agree with this; she thinks it is better to promote safe sex. M does not tell her Filipino friends that she is using the pill.

131

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

M also has insurance, managed by a private agency. M says she misses her family, especially her brothers, but she maintains regular contact with her family through Skype. The host family gave M an old laptop when they purchased a new one. She is also in contact with her sister. She does not know where her father is, so she has no contact with him. Her family is one of the biggest stressors for M at the moment. Before, with her first family, it was the loneliness. Now she is no longer lonely, because she is able to meet a lot of other Filipinas. M plans to return to the Philippines by December 2011. By that time she would have stayed in the Netherlands for four years. She will be 24 years old then and she plans to study psychology. Her sister, however, advised her to study something that could be applied everywhere. When she goes back, M said she would first work to fund her studies. She managed to save some money in the Netherlands. She is also taking swimming lessons. She says new skills might help her find a job in the future. Her host family supports M in these. M rates her overall well-being when she was in the Philippines (on a scale from 1 to 10) as a 5. At the moment if she does not think about the fact that she does not have official papers - her well-being is an 8. She hopes that after she will go back to the Philippines it will be a 10. M says she knows many Filipinas who have had a much tougher time than she has. For example, a Filipina from her batch was sexually abused by the host father. The girl is back in the Philippines, but the employment agency did not help her. Another friend is very homesick, usually a primary cause of stress. M also knows girls who complain about not having enough free time in their job. A friend complains about her host who accuses her of being only here for the money and tells her that if she will not do her job, she will not get the money. According to M, this is not the idea of an au-pair, who is here also to experience the culture. Another friend says the financial demands of her family in the Philippines is her primary cause of stress, since they call her anytime they need money and they want her to send money, even for something as small as a calculator. M thinks it is important for Filipinas to have the right information before they leave. She mentions her negative experience with the placement agency. Agencies should be transparent about work contracts and be honest about what the women can expect. Ms agency told her she had to get along with her host and that if any problems would come up, the au-pair should be the one to solve it. M thinks this is not fair, because a mismatch of an aupair and a host can always occur. Besides, many women from the Philippines would be afraid

132

to speak up to their host. M knows that many of her friends are afraid to say something they dont like to their host for fear that the host will be angry with them. Because of this, M also thinks it is important for the women to have someone they can run to if they have a problem. They should know that they have a lot of options if there is a problem. They should be informed before they leave, but also when they are abroad. M says it is important to have someone to talk far from home. This is also to prevent forming dependent and abusive relationships, where women have boyfriends because they do not want to be alone and then become dependent on the male partner, who sometimes turn out to be abusive. M says it is important for au-pairs to have a network of au-pair friends. If abuse or maltreatment occurs, everybody will know it. It will be easy to get the message out. In addition, M thinks it would be good to follow up on the women; to have someone who is informed and concerned. She would have liked to have someone follow her up, because she feels that nobody knows where she is or what she is doing. After coming back to the Philippines, M says that she will just do her thing. However, she would like to stay in contact with a support group in the host country, so she would be able to contact them if there are problems. With the Internet it has become easier to stay in touch, though many au-pairs do not have a computer. According to M, these women are more isolated and feel lonely.

133

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

The Story of Susan


Susan is a 22 year old female from Southern Luzon. The youngest of 10 children, Susans parents are farmers. Susan grew up mostly with her brothers, because her sisters were already married and lived with their husbands. Susan says that she grew up in a happy family. Before she came to Holland, Susan worked for two years in a small appliance store after finishing high school when she was 17 years old. She did not go to college. Susan liked working there as she could only do simple tasks. When she was 19, her sister and brother arranged for her to go to Holland to be an au-pair. They processed the papers for her visa without informing her. Through her sisters husband they had found a host family for her, with a Filipina married to a Dutch man. Susan only found out about this when they told her to get her passport and prepare for the trip to Holland. She was very surprised and thought it a bit strange that they had not told her. However, she was excited to go, because she wanted to travel and experience life abroad. She also got a positive impression of the family and she looked forward to learning about Dutch culture. She also thought it would be good for her future. In the Philippines, she would not be able to earn enough money to continue her studies. She originally planned to apply for work in Dubai or Canada, with her preference for the latter. She was grateful that the preparations had already been done by her sister. When her visa was ready, Susan had to go to the Netherlands embassy for an interview and payment of the needed fees. She says the process was almost the same as when one is hired as an au-pair through an agency. The difference with an agency is that she did not get any training. She did not have any idea what Holland would be like. She was told that her host family would explain everything when she got there. When Susan arrived in Holland, she met her host family for the first time. The family had three children (aged 17, seven and five years old, respectively). Her main responsibility would be to take care of the two youngest children: a boy and a girl. At first, Susan relates, the children were quite wild (they were crying and shouting a lot). Susan thinks this was because they did not get enough attention. During the first few months, it was hard to take care of them because of this behavior. Later on, under Susans care, they started to behave better. Initially, it was difficult for Susan to communicate with the children, because they spoke little English. Later on, they spoke more English and Susan learned some

134

Dutch. This helped her bond with them. Susan liked to take care of the children, because she loves children and always took care of her nieces and nephews. In the beginning, Susan was told that her main task was to take care of the children and help a bit in the household chores. However, later on she had to do everything in the house, which included occasionally helping her host-mother in her catering business. During the first few months Susan was happy with this setup. She liked the children and had a good relationship with the host-parents. As she performed more household chores, Susan had misunderstandings with her host-mother, who she says sometimes treated her badly. It was hard for her to take a day off from work and that she did not have freedom with her host-family. She was not allowed to meet with friends. She felt alone and liked to meet with other Filipinas. She had a friend who worked with a family nearby, but her host-mother did not want Susan to get involved with that family and told her it was better to stay at home. So, in the beginning she often stayed at home on her days off and ended up taking care of the children. She would usually wake up at seven in the morning and worked until eight in the evening, when the children were going to bed. After three months, when she became lonelier, Susan struck up friendships. With her newfound friends, Susan went out to the city centre and spent her evenings there. This strained her communication with her host-mother more, as the latter did not want her to have friends and go out. The host-mother told Susan that other people would manipulate or brainwash her. Susan tried to convince her otherwise, but that did not help. Behind her back, the host-mother started complaining about Susan to her family in the Philippines. She told them Susan did not listen to her and was behaving badly. Susan started to have a bad time with the family and often cried at night and confided to her friends about the problems with her host mother. She did not want to work for them anymore, but also did not want to go back to the Philippines. During that time, Susan found a new host-family in Norway and she began processing her papers to transfer there. She found the family through the Internet (at the site Au-Pair World) where she put up her profile. Susan then informed her host-mother about her plan to go to Norway, but the latter did not want her to go. Also during this time there was more misunderstanding between Susan and her host-mother, but Susan tried to stay focused on her work. After six months, when she was preparing the papers for her visa to Norway, the situation escalated. The host-mother wanted to go to Den

135

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Haag and secure the necessary paper work for her. However, Susan wanted to do it herself, because she wanted to be independent. She says she tried to explain to her host-mother in a friendly way, but the latter got mad. Susans temper also flared, because she planned to go with a friend that her host-mother did not approve of. On the day of Susans interview in the embassy in Den Haag, she left in the morning with her friend to do their business in Den Haag. They also went to the Dutch Immigration and Naturalization Service (IND) to get information about regulations on au-pair employment in Norway. She got back late at night and her host-mother was already asleep. The next day Susan told her about her visit to Den Haag. However, the host mother got mad at her because she thought Susan went to the IND to report her host-familys treatment. She did not belief that Susan went there to collect information. According to the host mother, Susan had been brainwashed by her friend into doing this. The host-mother told Susan perhaps it was better if she stayed with her friend and ceased to be part of the host family. When Susan called her friend share what happened, the host mother got even madder, very aggressive and drove her out of the house. For fear of what her host-mother could do to her, especially at night, Susan did not want to come back to the house. Susan did not have problems with the host-father, who had earlier informed her that her host mother had been hospitalized in the past for mental illness and was taking medication for it. Sometimes, Susan says, she loses her mind and thinks she is Mary and her son is Jesus. In total, Susan stayed with this family for eight months. Upon leaving the house, Susan decided it was best to stay with friends until her visa was approved. She stayed with different friends. In the meantime, Susan says her host-mother still spread bad stories about her, to her friends and her family in the Philippines that Susan had left the house because she was a lesbian and had a girlfriend. For one month after the fight with her host-mother, Susan did not have any contact with her family, because she did not have any money. The host-family had been sending all the money she earned directly to the Philippines. Her host mother had told her that it was better to do it that way. Because of that, Susan could not buy things for herself. Sometimes, her friends would buy things for her; at other times she got extra work for a few hours a week to earn some money. However, at the time the host mother sent her out she did not have anything. After a month she was able to contact her family again and explain the situation to them. Susan stayed with friends from Bayanihan for two months. They supported her and did not ask

136

her for any money. That was hard for Susan to accept, but her friends were very understanding of the situation and helped her to find a new job. Looking back, Susan says she never expected this to happen when she left the Philippines, especially because she had a good impression of the family. After two months, Susan found her current host-family with the help of the friend from Bayanihan. Housekeeping is Susans main responsibility with her new host-family. The family has two mature sons (aged 17 and 23 years old, respectively). She says this host family is very nice and she feels a part of the family. She feels safe and also has her freedom. The family follows to the regulations for au-pairs, even if Susan does not have papers to stay in Holland. She likes the work because they teach her how to do the cooking and cleaning; she is learning a lot. Because she is the youngest in her family in the Philippines, Susan did not know how to do these things before. At present, Susan feels much better and is learning through her new experiences. The longer she is in the Netherlands, the more she likes it. She hopes she can get the papers to stay in the country legally. Her undocumented status is difficult for her, because she always has to be careful and alert. Susan gets a monthly allowance from her host family, half of which she keeps for herself, the rest sent to her family in the Philippines. This time she sends the money herself. She is the only one of her brothers and sisters who is working abroad and supporting her family financially. Most of the amount sent to her family is spent on medicine, because both of her parents require medication. Her mother also goes to the doctor for monthly check-ups, which is very expensive. Aside from that, her parents spend for food and other living expenses. Susan never worries about how her family spends the money, because she knows that her mother is very smart at that. She is still not able to buy many things for herself, save for the basics. Susan is also saving up to continue her studies. Her parents are old and she does not want them to pay for her education. She wishes they would stop working, because they have worked hard their whole life and they are now both ill. Susan likes to spend her free time with friends. They would go to bars, restaurants, cinemas, and shops. This, despite Susans continuing apprehension about going out of the house.

137

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

At the moment, her former host mother is still looking for Susan, because she wants to send her back to the Philippines. This is why she does not go to the city very often. She would rather go to other cities where she also has friends. Susan does not have a lot of Filipina friends. Her only Filipina friends live near her old host family. Her best friend in Holland is a Cape Verdean girl living in Rotterdam. She prefers that this friend is not Filipina, because meeting compatriots reminds her of the bad experience with her Filipina host mother. Susan connected with Bayanihan through a friend who worked for the organization. She likes the organization, but at the moment she is not involved in their activities. Many people there know her host family and Susan is afraid that her host mother will hear of her presence there. She stays in contact with the organization, but not publicly. She knows that if she needed help to return to the Philippines, Bayanihan would help her with the documents. Susan had a boyfriend in the Philippines before she left, but she broke up with him, because he wanted her to come back and marry him. She thought it was too early to get married. She explains its more important to think about the future before settling down. Other people tell Susan that its time to get married, but she first wants to earn money for her future children and save up for their education. Her own experience taught her lessons about being poor and she does not want this for her own children. The break-up was a bit sad for her, but since she did not see him for a long time it was easier to handle it. At the moment she is happy to be single. Susan has not had any health problems since coming to Holland. However, she mentions experiencing a lot of stress due to the situation with her host mother. She suffered from headaches and loss of appetite. She felt helpless and did not know what to do about the situation. She did confide to her friend about the problem, who encouraged her to talk more about her problems and feelings, so she would feel better. As a result Susan says her mind is better. She also feels better after talking to her mother, who she really misses. At that time she would have liked to go back to the Philippines, but her host mother held her ticket and refunded it. At the moment, Susan sometimes misses her family and life in the Philippines. She stays in contact with her family mostly through the telephone. She cant use the computer, because her family does not have a computer in the province. When she is lonely, her new host mother tries to cheer her up. The new host mother is almost like a second mother to her.

138

Susan feels she has almost adapted to Dutch culture. She recognizes this in the way she talks; she is confident about what she wants. In addition, she likes the people and the food. The weather is a bit cold for her, but this is no problem. Susan thinks that she will not be able to go to Norway anymore since her former host mother had bad-mouthed her to the prospective host-family there. She told them that Susan was only working as an au-pair to find a husband. A problem with her visa also arose. Susan thinks that the family in Norway will stop the processing of the papers. For now, Susan plans to stay in Holland for a while to earn money. After three years, she hopes to go back to the Philippines to continue her studies. Susan plans to study accountancy, because it is easy to find a job with this background. She hopes to stay with the host family that she works with now. Susan rates her overall well-being in the Philippines (on a scale from 1 [lowest] to 10 [highest]) as a 9. She rates her time with the first host family as maybe a 4, because it was a really bad experience for her. At the moment, she rates her situation much better; i.e., an 8 or a 9. Susan is interested to work for an organization like Bayanihan. She likes the support provided by such a group and if she works there, she can help others as well. She says she wants to be active in the organization when she gets the proper documents to stay in Holland. Susan thinks that many other people like her would benefit from an organization like Bayanihan. Susan thinks that training before working abroad would help people to prepare better. She does not have experience with this herself, but she is willing to undergo such a process to learn things about the way of life, work and the culture in the country of destination. Susan thinks it is very important to cooperate and adapt to the culture in another country. In her case, it was important for her to learn how to ride a bicycle.

139

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Project Team
Overall Project Coordinator Project Coordinator (The Netherlands) Project Coordinator (Philippines) Project Assistant (The Netherlands) Maria Lourdes S. Marin Prof. Ivan Wolffers Raquel Ignacio Lia Van der Ham

Research Team Principal Investigator Statisticians Prof. Maria Theresa Ujano-Batangan Michelle Ong, Alvin Mejorada

Field Researchers

National Capitol Region (NCR) Luidia Plasencia Jasmin Necesito Nelia Quintanar Marites Reyes Sonia Tongco

Cebu Prof. Maria Fiscalina Nolasco (Field Coordinator) Alicia Mariblanca Hermenia Caballero Jocelyn Pacana

La Union Edna Valdez Elizabeth Alegre

Davao Ms. Bernadette Guillermo (Field Coordinator) Ana Urbano Marietta B. Simborio Lovely Mae Calig-onan

140

Focus Group Discussion (FGD) Participants Luidia Plasencia Zenaida Barbado Joelyn Baldoza Nenita Gonzales Rowena Austria Evelina Diego Erlinda Tosculas Melinda Tabio Amelia Dominio Dina Esperanza

Participants: Post Survey Consultation Workshop with Women Migrant Domestic Workers Aurarita Virey Aida Duplas Maria Cielito Unasco Amelia Dominio Ma. Rowena Tonedo Emily Argomido Zenaida Guinte Jovelyn Burca Florencia G. Balcita Elizabeth M. Duculan Girlie R. Carino Minda P. Galase Vilma C. Flores Evelyn M. Dulay Lilibeth D. La Torre Felma Edna M. Joson Erlinda A. Dumpit Corazon A. Dapig Margie B. Vinoya Arlene S. Belesario

141

WOMEN & MIGRATION: THE MENTAL HEALTH NEXUS


A Research on Individual and Structural Determinants of Stress and Mental Health Problems of Fili pino Women Migrant Domestic Workers

Key Informant Interviews


National Capitol Region Atty. Rico Fos Executive Director OUMWA DFA Ms. Marvi Ador Planning and Programming Development Division OWWA Dr. Venus Arain National Center for Mental Health Ms. Carol Jimenez SWOIII Social Technology Bureau, DSWD Ms. Fe Nicodemus President KAKAMMPI Ms. Liberty Casco Director Philippine Overseas Employment Administration Region I Ms. Esperanza Cobarrubias Chief OWWA RWO I Ms. Nonette Legaspi-Villanueva Chief POEA Regional Office for Norther Luzon Ms. Rose Bayan Coordinator Kanlungan La Union

142

Mr. Dominador Laruco President Timpuyog ti Agkabsat Region VII Ms. Evelia M. Durato Officer-in-Charge POEA Regional Center for Visayas Ms. Mae D. Codilla Officer-in-Charge OWWA RWO VII Region XI Erlinda B. Albay, Officer In-Charge Consegundo Fernandez Administrative Officer Regional Consular Office Davao, Office of theConsular Affairs, DFA Ms. Rosemarie Luntao Officer-in-Charge Program and Services Division OWWA RWO XI Lorna Mandin OIC Integrated Gender and Development Division Davao Local Government Unit Sr. Diane Cabasagan Director Center for Overseas Workers-Davao

143

Action for Health Initiatives (ACHIEVE), Inc.

www.achieve.org.ph

Action for Health Initiatives (ACHIEVE), Inc. is a non-stock, non-profit organization based in Quezon City, Philippines. ACHIEVE is engaged in the development and implementation of programmes and projects addressing HIV/AIDS, gender, sexuality, health and migration issues. It is currently engaged in reviewing HIV-related policies and legislation to address issues of stigma and discrimination and access to justice of people living with HIV and other key affected populations. Guided by its pioneering action researches, ACHIEVE has implemented framework-setting programme responses on migration, gender, sexuality and HIV and AIDS issues in the Philippines. Through the years, it has successfully implemented projects in partnership with government agencies, international institutions, local NGOs and CBOs and communities. It has also undertaken numerous capacity building activities and consultancies, locally, nationally and internationally. ACHIEVE is a member of the Coordination of Action Research on AIDS and Mobility in Asia (CARAMAsia), a regional network of organizations working on migration, health, human rights and HIV and AIDS issues in the Asian region.

For more information about ACHIEVE, Inc, please contact: Action for Health Initiatives (ACHIEVE), Inc. 162-A Scout Fuentebella Extension, Barangay Sacred Heart, Kamuning, Quezon City, Philippines Tel : (+63 2) 414 6130 Telefax : (+63 2) 426 6147 E-mail : achieve_caram@yahoo.com Website : www.achieve.org.ph