Maids are screened for TB

• TODAY (14 June 2010) : Maids are screened for TB
• TODAY (31 May 2010) : Health screening good enough?

Maids are screened for TB
- TODAY, 14 June 2010

In “Health screening good enough” (31 May), Ms Noorlina Senin asked about the comprehensiveness of pre-employment health screening tests for foreign domestic workers (FDWs), and whether the Mantoux test (skin prick test) should be done to check for tuberculosis (TB).

2. We would like to assure Ms Noorlina that the health screening measures for FDWs are adequate. New FDWs have to undergo and pass a medical examination within 14 days after arriving in Singapore, before they are issued with the work permit. The objective of the medical examination is to ensure that the FDW is generally fit to work and do not pose a public health threat, but it does not mean that she is free from all illnesses. Employers may send their FDW for other tests if they wish.

3. Screening for TB is included in the mandatory medical examination, in addition to HIV, Syphilis and Malaria. Screening for TB is done using chest X-rays. Applicants found to have active TB will not be issued with work permits, while those found to have lung scarring will be referred to the Tuberculosis Control Unit (TBCU) for further assessment. TB screening for FDWs is repeated two years after working in Singapore.

4. The Mantoux test (skin prick test) is used to screen contacts of active TB cases. A positive Mantoux test in a person with no symptoms may indicate the presence of latent TB infection, which means that they have TB germs but are not sick because the germs are not active. These persons are not infectious. It is possible that the TB germs may become active later but this happens in less than 1 in 10 such cases at some point during their lifetime. In addition, it is difficult to interpret the Mantoux test result on its own as persons who have had prior BCG vaccinations may also show a positive Mantoux test, even though they do not have latent TB. The Mantoux test is thus not an appropriate mass screening tool as it would be impractical to subject all persons with a positive test to preventive treatment, which can cause side effects in some people. It is more important and effective for persons with TB symptoms (such as a cough lasting longer than 3 weeks) to seek medical attention early.

5. MOM has increased the medical insurance coverage to $15,000 per FDW and foreign worker since 1 Jan 2010 to help employers manage potentially high medical bills. To keep premiums of mandatory insurance affordable, the coverage is kept to the basic requirements. However, employers who wish to better protect themselves may opt for additional coverage and a higher claim limit. Insurers should inform employers of the details of any exclusions so that employers can make informed choices. Employers who believe that their insurers have been negligent in conveying information about their insurance policies can consider lodging complaints with the General Insurance Association (GIA) and the Consumers Association of Singapore (CASE).

6. We are sorry to note that Ms Noorlina and her son have been presented with positive Mantoux tests after prolonged contact with their FDW. MOH is currently reviewing the TB screening done for Ms Noorlina’s FDW to ensure that the test results were accurate. We would also like to urge them to complete their treatment and wish them the best of health.

Health screening good enough?
- TODAY, 31 May 2010

I would like to question if the health screening foreign workers must undergo before being allowed to work in Singapore is sufficiently comprehensive.
I understand that foreign maids have to undergo a urine test and have X-rays taken before they are allowed to work in Singapore.

However, I feel the check-up will not be able to pick up some diseases, one of the most common of which is tuberculosis (TB).

I employed a foreign maid in January and her basic medical check-up showed that she was okay.

She then developed a persistent cough that lasted many months. A further check-up showed that she had TB. By this time she had been with us for more than five months.

I am sure I am not the only employer in such a situation.

Some employers may take the easiest way out by sending such a maid back to her home country. We could have done that too but it would also have been back to square one for us.

My husband and I decided to keep the maid after consulting the TB specialist and putting in extra precautions with regard to her contact with us.

This was after weighing the pros and cons of sending her back and taking in an unknown new maid.

A new maid would have meant that I would have to take more leave to train her and get young children to adapt to a stranger. There would also be questions about the health of the new maid.

It has been such a hassle for us because we have had to take leave on many days to send the maid for check-ups, not to mention the six to nine months of DOT (direct observed therapy).

My entire family has been exposed to this highly-infectious disease. I have very young children and my parents have diabetes.

The maid has put us all at high risk. My family has had to go through a painful skin-prick test to check if we were infected with TB. We have been hit financially, mentally and emotionally.

The situation has been made worse by the fact that insurance does not cover such things.

The Ministry of Manpower and the Ministry of Health should review such coverage.

Tests show that I and one of my sons have been infected with TB. The other two children needed to repeat the skin-prick test as their results are inconclusive. My entire family has had to take a nine-month course of preventive medication.

Could this have been avoided if the authorities had been more stringent with the health screening?

I have learnt from doctors that the skin-prick test can detect the bacteria even before it develops into the disease.

Why is it that the MOM and the MOH do not require this skin-prick test as a standard procedure for foreign workers?