I accompanied my helper of 28 years home for cancer treatment. It broke my heart

On National Day, my world was turned upside down.

It started the evening before, when our domestic helper M complained of a nagging pain in her chest. As the discomfort persisted into the early hours of Aug 9, my aunt – M’s employer – drove her to Tan Tock Seng Hospital.

What followed left us in disbelief. The staff at the emergency unit found a lump in one of her breasts that suggested cancer.

We were crushed.

M is family, having been with our household for 28 years. She came to Singapore at age 18 from her home in Nueva Ecija, a Philippine province nearly 200km from the capital Manila. Since then, she has been the backbone of three generations of my family.

She not only cared for me and my older sister when we were toddlers but was later one of the main caregivers for my grandmother who lived with Parkinson’s disease.

After my grandmother died in 2012, M has been a companion to my 69-year-old aunt. Her contributions to our family are incalculable, and she has been a stalwart presence in our lives through the highs and lows.

The thought of losing M, now 46, was unbearable. With doctors suspecting breast cancer, she was moved to a ward, and a flurry of tests and scans ensued.

Grappling with the diagnosis

The next day, my aunt and I visited her in hospital during my lunch break.

When M and I met each other’s gaze, tears flowed. We were terrified. For one thing, I knew the road ahead would be fraught with tough decisions.

A doctor rang the following day with the dreaded diagnosis: M had stage 4 breast cancer that we later learnt had spread to her lungs and chest bone. At this stage, the illness is no longer curable but can be controlled with treatment, including chemotherapy.

There was some hope, though.

Five-year survival rates for patients with stage 4 breast cancer range between 25 per cent and 32 per cent, based on data from England and Australia.

Still, that the cancer was not discovered sooner saddened us deeply. There are much better survival rates for patients whose cancer is discovered at the earlier stages. At stage 2, for example, 90 per cent survive for five years or more, said the London-based Cancer Research UK, citing figures for women diagnosed between 2016 and 2020.

Frustration and hope

With the diagnosis handed down, a barrage of questions and emotions washed over us.

We were frustrated that M did not tell us about the growing lump, which she had apparently discovered more than a year ago. Her explanation was that it was not painful initially, so she ignored it.

Screenings for breast cancer are not mandated for or commonly done among domestic workers.

Ms Bhing Navato, a 50-year-old domestic helper who like M had been working in Singapore for nearly three decades, returned to the Philippines in June after being diagnosed with stage 2 cervical cancer.

She told me that many helpers fear speaking up, even though they know something is wrong with their bodies. “Most of them ignore the symptoms, just like what happened to me, because they are worried they would lose their jobs,” she said.

Amid the whys and what-could-have-beens, two things were clear: M needed treatment without delay, and we wanted her to get the best possible care. But first, we faced a major predicament: Where would M get treated?

We weighed all the options. These included having her treated in Singapore, which M had said she wished to explore.

While the selfish side of us wished to keep her close, we knew the trajectory of advanced cancer is unpredictable.

There was also the issue of who would care for her during treatment, which could trigger side effects such as nausea, fever and fatigue. As I am at work during the day, it would be hard for my elderly aunt and parents to be her caregivers.

Treatment for late-stage breast cancer is lifelong and would likely cost hundreds of thousands of dollars in Singapore for a foreigner like M. Healthcare subsidies for foreigners were withdrawn in 2008.

Her insurance plan, renewed in 2022, was also woefully inadequate. It had a $15,000 yearly claim limit for hospitalisation and surgical procedures, and coverage of up to a mere $1,000 for outpatient cancer treatment.

The authorities have since mandated improved insurance coverage for S Pass and work-permit holders, including domestic workers. The yearly claim limit has been

raised to $60,000

for policies bought or renewed from July 1. The Ministry of Manpower estimates that more than 99 per cent of hospitalisation and surgical bills will fall within this limit.

The ministry encourages employers of workers with policies effective before July 1 to move them to the enhanced scheme early. This, though, is not mandatory until the plans are up for renewal, and has not been widely publicised.

The Foreign Domestic Worker Association for Social Support and Training, a charity better known as Fast, said most domestic helpers “would choose to return home for treatment, or their employers would send them home due to the high costs of treatment in Singapore”.

Most helpers would also choose to be with their families, especially if the cancer is at an advanced stage, it added.

After weeks of discussion – at times heated and emotional – my family and M decided that she should get urgent treatment in Manila, where she can be closer to her family. Given the intensity of medical care needed, being treated back home would also be more affordable with the subsidies she could get as a Philippine citizen.

Leaving Singapore

My mother, aunt and I flew to Manila with M in early September, about three weeks after she received her diagnosis.

For M, it was heart-rending to leave Singapore. After all, it was her second home, where she spent nearly two-thirds of her life. Besides her native Tagalog, she speaks English and a smattering of Mandarin and Hokkien picked up from my grandmother and aunt.

As we touched down at Ninoy Aquino International Airport in Manila, I put an arm around M as we walked through the terminal towards immigration.

It felt surreal: M had come to care for us, but in a sudden turn of events, we found ourselves seeking care for her back in her home country.

It turned out to be a trip of many firsts.

For the first time, we met her younger sister, who lives about 40km from Manila. She had come to accompany us to M’s first appointment with an oncologist.

It was only after we arrived in the Philippines that I learnt M belonged to a group endearingly termed OFWs, or overseas Filipino workers.

There were an estimated 1.83 million Filipinos working abroad between April and September 2021, most of them women, figures from the Philippine Statistics Authority showed.

A friend of my mother’s, whom we met in Manila, called workers like M the Philippines’ “true heroes” who uproot themselves to provide for their families.

The oldest of four children, M supported not just her parents and siblings back home, but also her nephews and nieces later in life.

In the Philippines, where the wealth gap is widening, cancer is seen by many as a death sentence, given the steep costs of treatment. A 2018 study of 909 Philippine cancer patients showed that 40.6 per cent of their families ran into “financial toxicity”, or financial difficulty, owing to high treatment costs.

Navigating the Philippine healthcare system

Visiting the public hospital where M was to receive treatment was also an eye-opener.

Patients connected to large oxygen tanks and tubes lined the main corridors, and the tumour clinic – where M was scheduled to meet her oncologist – was bloated with patients. There was so little room in the waiting area that patients fanned out into the corridors as the staff inside cleared still more patients waiting to register.

As part of M’s pre-chemotherapy tests, she needed a two-dimensional echocardiogram to check her heart function.

The hospital’s wait list for an echocardiogram was bursting, so we had to go in search of a private provider. M’s cancer could not wait.

After a visit to a nearby provider and a string of calls, we discovered that most private testing centres had a wait time of four or five working days for the results. M needed hers within two working days so she could start chemotherapy.

Thanks to my mother’s friend, M secured an appointment with a private provider that could meet this schedule. She underwent her first round of chemotherapy two days after receiving the results.

As heart-wrenching as it was, I was glad to have made this trip with M. It allowed us to spend quality time with her and get her ready for the fight against cancer.

As we said our tearful goodbyes before boarding our flight home, we knew this was not farewell and we would be back soon.

“I will miss you, Kenneth,” M texted me after we parted ways. “Thank you so much.”

I miss you too, M.

Thank you for everything.