On December 19, 2011, the day after International Migrants Day, I found myself on a plane from Almaty, Kazakhstan to Dushanbe, Tajikistan, for a business trip.  I was surrounded by Tajik laborers returning home to celebrate the New Year. Other than my three colleagues and I, the seats were filled with Tajiks bearing electronics, toys, and other gifts for their families.  Had it not been for my ignorance of Tajik or Farsi, I would have struck up a conversation with my neighbor to find out what life was like being separated from one’s family for work.  Instead, I reflected on my own family, descendants of immigrants not unlike my fellow passengers.

Migrants and medical officers discuss the TB situation in the region. Photo credit: Abt Associates,Tajikistan

On December 23, 1909, my 26-year-old great-grandmother, Auyoung Yee Lau, emigrated from China to Hawaii to join my great-grandfather, who had opened a successful shop in Honolulu.  Prior to his wife’s arrival, my great-grandfather sent home $45 each month to feed five adult family members.  I wonder what went through Auyoung Yee’s mind as she boarded the boat from Hong Kong to what she called “the land of the Golden Mountain.”  I would guess that her thoughts were on the unknown country she was about to make her life in and the three children that she had lost in recent years, two of whom died of preventable childhood diseases before the age of 3.

After my great-grandmother’s journey to America, her tragedy was overcome with the subsequent births of five boys, four girls, and finally, my grandfather, whose Chinese name translated into “Happiness Complete.”  Had my great-grandmother and her family been denied access to health care services in Hawaii due to their migration status, I wonder if my grandfather and his siblings would have suffered the same fate as Auyoung Yee’s first three children?  Would my great-grandmother’s happiness have been complete?

As the descendent of a migrant family and as a USAID health officer in Central Asia, I wonder about  access to health services in the countries that benefit from migrant labor and the effect this has on migrant health and the health of their families.  Each year, 5 million Central Asian labor migrants journey from their homes in search of their own “Golden Mountain.”  Many of them find opportunities as undocumented workers in Kazakhstan, Uzbekistan, and the Russian Federation.  According to the World Bank, in 2009, 35 percent of Tajikistan’s GDP came from recorded remittances sent back by these laborers, the highest percentage of any country in the world.  However, due to their immigrant status, migrants are often marginalized and endure poor living and working conditions in receiving countries in order to support their families.  Poor nutrition, overcrowded housing, and limited access to health care and prevention services put migrants at high risk for diseases such as tuberculosis (TB) and, especially in this region, multi-drug resistant TB.  Studies in nearby Europe have shown that TB prevalence is 50 times higher in foreign-born populations than in the indigenous population.  That is why USAID/Central Asia is supporting efforts to foster cross-border cooperation on TB control.

Central Asian republics have some of the highest multi-drug resistant TB rates in the world. Most migrants are unable to access the health care system because they are undocumented laborers, who lack proper identification documents required for health care treatment, and who fear deportation if their documentation status becomes known.  USAID is working in coalition with government and international partners in order to improve access to TB services and treatment for this crucial population.

On November 28–29, USAID’s TB CARE project hosted a high-level regional meeting in Almaty, Kazakhstan, on TB in migrant populations, the first of its kind in the region.  I was fortunate to represent USAID at this meeting and participated along with representatives of Ministries of Health, Labor, Internal Affairs, and Migration police from Central Asian countries and international organizations.  While all participants recognized how challenging it will be to tackle TB in such a transient population, I could not help but be excited about being a part of these first steps toward building mutual cooperation between the Central Asian countries on TB control and provision of health care services to migrant workers.  If my great-grandmother were still alive, I am sure she would be proud that her great-granddaughter is helping Central Asians to access the services that our family was fortunate to receive in America.