Judy Fitzpatrick
PHILIPSBURG--"I just want to work and live," said an emotional Elisabette Bernard as she related the story of her battle to survive and her fears of losing her job, her medical insurance and possibly her life.
Losing her medical insurance would mean that Bernard, a Room Attendant hired by Gubert Services N.V., which provides services to Sonesta Maho Beach Resort, would be unable to access the costly treatment she needs to survive.
"She can die within a few weeks if she stops treatment," said Internist Dr. Theo Jolles in describing the gravity of Bernard's predicament.
Bernard, a Haitian immigrant working for the same employer since 2006, was diagnosed in September last year with end-stage renal disease, a chronic kidney failure condition. Her kidneys have lost their ability to function and she needs to have dialysis thrice weekly or she could die from her accumulation of own body waste within a matter of weeks.
The problem is, 40-year-old Bernard said, that all indications point to her employer not renewing her fifth eight-month labour contract when it ends on March 5 because she is considered to be "too sick" to work. Her employer said this decision was still uncertain. Losing her job would mean she immediately would lose her Social Insurance Bank SVB health insurance coverage.
Several persons have decried this situation, saying Bernard falls into the large category of primarily immigrant workers exploited by some employers who take advantage of loopholes in the labour laws to bar hundreds of workers from permanent employment and thereby from sustained medical insurance coverage.
Critical
Bernard said she had been feeling unwell for a while, but had only sought medical assistance in September last year after she became very ill. Dr. Jolles said Bernard already had been in a critical state with severe bleeding in her stomach, heart failure and other critical conditions related to her renal condition when he started treating her.
After intensive treatment and four operations, Bernard was outfitted with a catheter for dialysis purposes. She is now much better, but her battle to survive is far from over. She has been in and out of the hospital since her diagnosis and had been unable to work. However, her doctor said that with continued treatment she would be able to perform "some type" of work "very soon."
Bernard, who has had five successive short-term contracts with Gubert Services, said her employer already had declined to seek renewal of her employment permit.
"He told me [last November] I was too sick," she explained. Her permit expired on August 25, 2009. This means that by the end of her contract she will have been "undocumented" for six months of her eight-month contract, an infringement that can attract a fine of up to NAf. 100,000, though this is seldom applied.
Bernard said she also had been told that her contract would not be renewed due to her condition, an assertion her boss Carlo Zambrini has denied. He said such a topic had never been raised with management and, at this stage, making a decision would be premature.
He said he needed Bernard's doctor to clarify certain issues before making a decision, because while Bernard had indicated that she might have been able to return to work by the end of January, her house doctor had said she has a chronic illness for which she needs to be treated thrice weekly.
Zambrini said Bernard having a chronic illness does not necessarily mean she will be unable to work, as he too has a chronic illness, but he still works. He also denied refusing to renew Bernard's employment permit, saying the company could only seek renewal when it received the documents from the employee and it was not something he handled directly.
However, he questioned whether it would be wise for the company to retain the services of someone who was or was likely to become a liability, adding that the company would evaluate Bernard's case this month. He also said that if her survival depended only on her job, the company must consider whether and with what expectations her services should be retained.
Nathaly Pieters, a social worker at St. Maarten Medical Center (SMMC), said the uncertainty was taking a toll on Bernard, who does not have any family members in St. Maarten and who hails from the section of Haiti recently rocked by one of the 10 deadliest earthquakes in history. Therefore, returning home at this stage is not an option.
Loophole
Even as Bernard is at her wit's end about her future, Workers Institute for Organised Labour (WIFOL) President Theophilus Thompson said Bernard was probably a victim of a system that allows unscrupulous employers to discard their employees when they do not need them anymore.
He said Bernard should not have to worry about contracts ending now that she is ill, as her years of service should automatically make her a permanent employee, enjoying the benefits of job security and, as a result, of sustained medical insurance coverage.
He said many employers used short-term labour contracts to keep their employees from benefiting from permanent employment status, a situation against which the union fraternity in St. Maarten has been lobbying for years and one that Labour Commissioner Hyacinth Richardson has promised to address.
Thompson explained that while the current labour regulations stipulate that workers should become permanent after a maximum of three consecutive contracts not exceeding three years and with breaks of no more than two months in between, employers used loopholes in the law to circumvent this requirement.
He said many companies, primarily in the hospitality sector, gave their workers short-term contracts, sent them home for three months when these contracts expired and then rehired them, so they never became permanent.
Contending that his union, which represents many hospitality workers, is very concerned about the abuse of short-term contracts, Thompson said Sonesta Maho Beach Resort was a "modern day slave camp" and a breeding ground for "gross exploitation" of workers. Thompson said the unions understood that short-term contracts could not be completely eliminated, but the abuse of these contracts in the hospitality sector must stop.
Zambrini, the Deputy General Manager of Sonesta Maho Beach Resort who also oversees Gubert Services, said St. Maarten's seasonal economy and Sonesta's occupancy figures determined how many workers were required and could be kept on the payroll during the "off" season.
He said Bernard had been given one six-month and four eight-month contracts since she joined Gubert Services. At the end of each contract she was "given a break" and called back after 2-4 months. He said that on one occasion she had not worked due to personal reasons.
"The employer has to deal with what is there to share in terms of occupancy figures and revenues," Zambrini said, adding that he too took breaks in "critical times."
Thompson argued that if the laboriousness of Bernard's job was an issue, her employer should be able to reassign her to less strenuous duties.
Dr. Jolles said that if Bernard lost her job and her medical insurance coverage, even with public aid she would not be able to afford the costly dialysis treatment she needed. Figures from SMMC show that it costs US $435.28 per dialysis treatment, which is $1,304.84 for Bernard's thrice-weekly sessions. This excludes cost for medication, supplements, regular blood tests, doctor's consultation fees, etc.
Most dialysis patients also need multivitamins, iron, blood pressure medication, and insulin and/or other diabetes medication, if they are also diabetic.
"The most expensive of all of these necessities is the medication to keep up the red blood cells in the body. This medication costs 1,300 guilders a bottle [in Bernard's case roughly 208 guilders] each time they dialyse," Pieters said.
Stemming abuse
Commissioner Richardson said he would be seeking legal advice and meeting with the Labour Minister soon to discuss how to stem the abuse of short-term contracts, as many workers were being affected. He hopes to spearhead a campaign to change the law to compel employers to permanently hire workers for jobs that are continuous.
He also said that companies dependent on the seasonal economy should be able to put into permanent service the minimum number of workers they needed to run their operations and only contract the additional labour they needed during the "high season."
A bigger concern
Thompson, Jolles and Pieters said Bernard's predicament was not unique in St. Maarten, as many employers tended to terminate workers when they were considered no longer of benefit to them.
Pieters: "People should not be treated like they are worthless because we do not have direct use of them to benefit ourselves. This is basically what is happening in our society in situations not only with illegal immigrants, but in everyday life. People no longer care for others who don't help them profit, and it's ridiculous."
"Many people come to St. Maarten to work and when something like this happens, everyone discards them and the responsibility falls on the hospital," she said.
The expense incurred by "self-responsible" patients is a long-standing concern for SMMC General Director Dr. George Scot.
Figures from the hospital show that 4.8 per cent of the 28.2 million guilders it billed in 2008 represented unpaid bills from uninsured patients, mainly undocumented residents who could not afford to pay or just never paid. Some 4.2 per cent of the 25.7 million guilders billed in 2006 was left unpaid and three per cent of 23.6 million guilders billed in 2006 represented unpaid bills from the uninsured.
Awareness
Bernard's predicament also highlights the need for more awareness about the severity of kidney disease and the importance of early preventative measures.
Jolles said most kidney patients could delay end-stage renal disease by "sticking to the rules": taking their medication and following-up on doctor visits.
"People usually have long episodes of pre-renal failure before they need dialysis and more than half of the people on dialysis could have delayed or postponed renal failure if they had stuck to the rules," Jolles argued. "People don't realise the severity of it until it's unavoidable."
Bernard's was one of those cases that could have been delayed, Jolles said, adding that he had detected signs of kidney disease when she first visited him three years ago, but she had never followed up with medication or treatment visits.
In an earlier interview, SVB Head Reginald Willemsberg had told this reporter that many immigrant workers tended to put work over their health, which resulted in their medical cost being much higher than that for the "average resident."
"They usually work very hard and don't take care of themselves. Even when they are sick, they continue working. When they do decide to go to the doctor is when their illness is at a critical stage and the cost to get them better is high," he said.
Thompson agreed with Willemsberg. "Even though they are sick, many workers are afraid to take care of themselves because of job insecurities, even though they may have been working for companies for years."
Jolles and Pieters said Bernard seemed not to be aware of the severity of her situation, probably due to the language barrier, among other things. During her interview with this newspaper Bernard was adamant about returning to work and said that if she had known the catheter would "cause all these problems, I wouldn't have done the operations." She said she just wanted to work. "I have to pay bills," the still weak-looking Bernard explained.
There are currently 34 persons with end-stage renal disease who dialyse thrice weekly at SMMC's Dialysis Department. One of these patients is from Saba and four are from St. Eustatius.
Jolles said the number of cases had been on the rise since the department started with one patient 20 years ago. In 80 per cent of the cases, hypertension and diabetes were underlying factors.
The study "How Healthy is St. Maarten" shows that hypertension and diabetes are two of the more prevalent diseases in St. Maarten and the main health concerns. Jolles stressed the need for people to be more health conscious.
Bernard, who moved to St. Maarten in 2004 for a better life, said she felt sad.
"I have no children, no husband and no one to help me. I am the only one who can help me and I want to work," she said.
Parties say the ball is now in her employer's court.
