Facebook Instagram YouTube Telegram

The First Cross Border Medical Evacuation amid Border Closure

A Singaporean citizen became stranded in Malaysia after Malaysia declared a Movement Control Order (MCO) to stop the spreading of COVID-19 in March 2020. Due to border closure of both countries, the Singaporean citizen was unable to return to Singapore for dialysis. Tzu Chi Johor Bahru had worked with Tzu Chi Singapore to liaise with various government agencies and department to bring the citizen back from Johor Bahru on 2 April.

MY20200402 CHA XXX 001
(Photo provided by Ali’s family)

“To stay or not to stay?” the question had lingered in Ali’s (not his real name) mind for some time.

On 16 March 2020, the Malaysian government announced its Movement Control Order to curb the spread of the coronavirus which was to commence two days later on 18 March 2020.

More than 100,000 Malaysian foreign workers who travel across the border to work every day were faced with the same dilemma. To secure their job, these migrant workers had to hastily prepare sufficient basic needs for their family to last a few weeks and arrange for their temporary accommodation in Singapore before rushing to the checkpoint. Unlike the migrant workers, Ali is a Singapore citizen, a permanent resident of Malaysia and his family members are all Malaysians. He has been living in Johor Bahru for a long time and he only crosses the border three times a week to have his dialysis in Singapore.

In fact, Ali had just returned from Singapore after having a dialysis in the morning of 16 March. It is a great torture for him to travel across the border by public transport each time, Ali had a below knee amputation on his left leg, suffers from poor vision and is dependent on hearing aids as he struggles with hearing loss in both ears. Furthermore, he must be accompanied by his family or friends each time he crosses the border while enduring the exhaust gas and body odour of the people around when queueing in the long line.

Surviving as a foreigner during a national lockdown  

After discussing with his mother for one night, Ali's son decided to let his father and mother travel to Singapore in the afternoon of 17 March before the lockdown begins in Malaysia. Despite being worried for the safety of his parents, he was unable to accompany his father to Singapore due to work.

No match to the thousands of migrant workers who were rushing to travel across the border back to Singapore, Ali and his wife wasted six hours on the bus towards the Malaysian immigration and custom checkpoint. It was getting late and the couple decided to head home as they were physically unwell.

On the way back home, Ali remembered being advised by the National Kidney Foundation and social worker to stay put in Singapore because the centre was aware of the epidemic situation in Malaysia which could lead to a lockdown anytime soon. However, Ali and his family were overly optimistic at that time. The 48-year-old has long been accustomed to traveling between Singapore and Malaysia, and the idea of a lockdown was beyond his imagination. In the end, he decided to return to his home in Johor Bahru.

Ali’s physical condition worsened after missing his dialysis for many days, and it became difficult for him to fall asleep at night, at times, he couldn’t even lie down at all. In order to let Ali undergo dialysis in Johor Bahru, his family had dialled more than 20 calls but to be told by the medical institutions in Malaysia that the medical resources must be reserved for COVID-19 patients and Malaysian citizens. Even if he has the ability to pay for the dialysis, Ali was not able to do his dialysis as it is a new national regulation that priorities are to be given to citizens amid an epidemic.

A kind act made possible thanks to cooperation from many parties 

On 25 March, Ali ’s eldest son took the initiative to contact the National Kidney Foundation in Singapore. After hearing about Ali ’s situation, the foundation’s social worker recommended him to contact Tzu Chi Johor Bahru to find out about the emergency hospital transfer procedure.

Ali and his family are no stranger to Tzu Chi. As early as the beginning of 2018, when Ali was waiting to get his transportation allowance approved by the National Kidney Foundation for dialysis, Tzu Chi Singapore was already subsidizing his transport allowance for three months. The family immediately contacted Tzu Chi Johor Bahru to request for help with applying for dialysis allowance and finding a suitable dialysis centre.

After missing his dialysis for 10 days, Ali was sent to Hospital Sultan Ismail for dialysis on 26 March. His condition stabilized after the dialysis, but he was still having difficulty breathing and signs of edema were visible on his face and hands. Two days later, Tzu Chi Johor Bahru contacted Tzu Chi Singapore to verify Ali’s identity. While Tzu Chi Johor Bahru was actively seeking for a suitable dialysis centre for Ali, Tzu Chi Singapore on the other hand was finding ways to bring Ali back to Singapore for dialysis.

After checking with the Consulate General of the Republic of Singapore in Johor Bahru, Tzu Chi Singapore found out about the procedures for bringing Ali back to Singapore and sought the assistance from the Ministry of Foreign Affairs of Singapore. The Ministry of Foreign Affairs responded that Ali could return to Singapore in principle, but he must meet with two conditions, firstly, Ali must find a hospital in Singapore that is willing to accept him and secondly, Ali must be COVID-free.

According to Malaysia’s Ministry of Foreign Affairs, this is the first international emergency medical evacuation after MCO kicked in. Ng Teng Fong General Hospital which was originally in charge of Ali’s case had immediately replied that they were willing to take Ali in and reminded that he needs to be in a stable condition to prevent any medical emergency during the transfer.

COVID test for none suspect cases

Although COVID-19 test in Malaysia costs only one ringgit, this price is only exclusive to people whom are identified as a suspected case. Otherwise, the person can only receive the test in private clinics which may cost between RM 600 to RM700, and it takes 24 to 72 hours to obtain the test result. Apart from the expensive fees, Ali could not wait for another two to three days due to his medical condition.

Under the circumstances where medical resources are limited, marginal groups like Ali are becoming isolated due to the directives in place. Ali's contact history and travel history do not render him as a suspected case, therefore, all hospitals and clinics refused to conduct the COVID test on him in order to not waste their resources.

In the afternoon of 30 March, Ali's daughter took him to a nearby clinic for testing, but again was rejected for COVID test. The physician advised Ali’s daughter to bring him to Sultan Ismail Hospital to treat his condition. Ali was subsequently admitted to the hospital in the early morning of the 31 March, to undergo his second dialysis in Malaysia at 7pm.

On 1 April, Ali's family arranged for an ambulance with a permit after obtaining a clearance letter from the hospital indicating Ali’s physical condition and low COVID risk. The Consulate in Johor Bahru and Singapore ’s Ministry of Foreign Affairs had each notified the checkpoint on both sides of the country that Ali would be transported from the second link to Ng Teng Fong Hospital on 2 April afternoon. Ali’s safe arrival back to Singapore marked the completion of the first transnational emergency medical evacuation.

"Thank you for helping my father. If it weren’t for your help to get my father back to Singapore, his condition would get worse staying here, as the MCO in Malaysia is likely to be extended,” said Ali's eldest son said.

MY20200402 CHA XXX 003
Ali sigh with relief after getting on the ambulance. (Photo provided by Ali’s family) 

A Ramadhan wish 

The day after, the government of Singapore announced the Circuit Breaker measures which will take effect on 7 April. Many Malaysian foreign workers rushed back to Malaysia before the 7th. Most of them are either engaged in odd jobs in Singapore or working in non-essential industries which are forced to temporary shutdown, forcing these workers to stop work or go on leave.

Ali might had been unlucky because he did not stay in Singapore before Malaysia entered into lockdown, but he was also fortunate at the same time because he had managed to return to Singapore before the Circuit Breaker started, with the assistance of the government agencies from both countries as well as a multinational charitable organizations. He is also lucky to have avoided the crowd which then lowered his risk of getting infected by COVID-19.

Khoo Jyh Hao, the supervisor in charge of Tzu Chi’s Charity Development Department had a video conversation with Ali after he was discharged from the hospital and he found Ali to appear completely different from what he saw from the photo, Ali has become more radiant. Although Ali is no longer a care recipient of Tzu Chi Singapore, Khoo said that the moment he received Ali’s request for assistance, he tried his best to help him because it was a matter of life and death.

“Just like what Master Cheng Yen had said, Ali might had forged a lot of good affinities in his past life, that is why he is able to get through the hardship with the help of so many people in this lifetime,” explained Khoo. As an international charity organization, Tzu Chi has a wide and close network with other organizations.

Ali's condition stabilized on 18 April and he had also completed his 14 days of quarantine order. He now resides temporarily in his brother’s house after returning from the hospital. Although he misses his family in Johor Bahru, he is glad that he had returned to Singapore to resume his dialysis. During Ramadan, Ali could still spend time with his younger brother, mother and second son who is working in Singapore. For now, he could only pray for the pandemic situation in both countries to improve soon so that he could once again travel back and forth Singapore and Malaysia.

Related Articles