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Last month, four Indonesian domestic workers in Hong Kong were arrested for violating their visa conditions and providing dental services despite having no experience. On their days off, the four had rented a room to provide scaling, trimming, fillings, and braces to fellow Indonesians for between HK$200 (S$34) and HK$2,000.

A spokesman for the Hong Kong Immigration Department told the media that practicing dentistry without a license was a danger to health and safety in the Covid-19 period.

“The situation is absolutely unacceptable,” the spokesman said.
However, in Indonesia, many street dentists who are self-educating and called ‘tukang gigi’ or ‘dental workers’ legally offer their services to the people who find professional alternatives too costly and out of reach, and are protected under the national constitution.

With these workers or tukang a thriving informal industry offers all sorts of services, from car repair to men’s toiletries and the massage of the country with 270 million and over 17,000 islands. The residents of Jakarta will show how children and adolescents on their streets when they rain with umbrellas, offering small fees to the pedestrians.In the informal industry, government statistics reveal approximately six of ten Indonesian workers. Experts point to the fact that the pandemic of Covid-19, which kept their customers at home, has particularly disadvantaged them through social distances and has not spent money.

Self-taught Dental Workers
Image Source: Times Higher Education

MEET THE ‘DENTIST’


Muhammad Tohir, 28, is a self-taught dentist with a bachelor’s degree in economics. He’s been working out of a run-down shop on a busy Jakarta street near a railway track since 2016.

Muhammad attends to demands such as teeth scaling and whitening from 9 a.m. to 10 p.m. every day. He wouldn’t say how much he paid, but said he made at least 5 million rupiah (US$350) a month, which was enough to support his family despite his income plummeting at the start of the pandemic.According to a 2018 governorial regulation, a permanent filling of the public medical facility costs up to Rupia 50,000 (USD 3.50) per tooth. Private dental hospitals in Jakarta cost an average of at least 150,000 rupiah (USD 10.40). The minimum monthly wage for the city is US$305.

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“I don’t do braces or tooth filling because they are permanent. My services are limited to follow the law,” said Muhammad. “I also make dentures but only from acrylic, because they are easy to make and follow the rules set by the Health Ministry.”

The dentist claimed that he had been licensed by the Ministry of Health, but admitted that he did not complete or take any action to gain a permit.In Madura, the island of East Java, Muhammad had been brought up into a family of farmers. Dentures also came from his father and uncle for neighbors and family who, when he was at school, then passed on the knowledge to him.

In 2012, he moved to Jakarta to the university, and his second year as a friend was a dentist, he became interested in dentistry.
“So I learned dentistry from medical books published by the University of Indonesia. I borrowed them from a friend who studied there,” Muhammad said.

“I also learned from YouTube videos made by foreigners. Dentures brands usually create videos about how to make dentures, featuring dentists in their tutorials,” he said.

“Apparently making dentures is not hard. The explanations in the books are more complicated than in practice,” he said. “I realised this was where my passion lay.”

Muhammad borrowed money from his parents after graduation to start a dental clinic, though calling it a clinic is a stretch.He doesn’t have a sterilisation kit or an X-ray machine, so making a decent set of dentures could take “up to six appointments,” he said.

Self-taught Dental Workers
Image Source: South China Morning Post

“My goal in the next few years is to have those equipment so I can be more professional,” Muhammad said, adding that he was keen to study dentistry serious if “the passion is still there” in the future.

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More immediately, he said he was looking forward to the rebound in business that he attributed to “the public’s dwindling concern about Covid-19”.

“I’m happy when I get paid,” Muhammad said. “It means people are happy about my service, which makes me feel useful to society.”

PROTECTED, BUT CONTROVERSIAL


The presence of tukang gigi (informal dental workers) is contentious in Indonesia, where the government attempted to outlaw their services in 2011 after receiving complaints about dental risks posed by tukang gigi. The workers, however, needed to be covered, according to the constitutional court, since they were a conventional health service that was normally passed down through generations.

According to the court, the Indonesian School tot Opleiding van Indische Tandartsen, which was founded in Surabaya in 1928, was a dental school long before the first academy. The court also considered employment as “an alternative in South East Asia’s biggest economy to receive affordable dental services.”

“As long as the government is not able to provide affordable dental services to the public, any violations carried out by dental workers can be resolved through development, licensing, and monitoring [programmes],” it said. “The constitutional court does not agree with any regulations that hinder dental workers.”

The decision was a huge setback for licensed dentists, who had fought for years to get the informal shops supervised. The Indonesian Dental Association said it was waiting for a response to a memorandum of understanding it signed with the police to clamp down on the shops and avoid giving licenses to anyone who broke the law.

“We have always asked the authorities to regulate these dental shops, but the police say they will investigate only if there’s a report from the public,” said Iwan Dewanto, the association’s deputy secretary general.

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Self-taught Dental Workers
Image Source: Newpark Orthodontics

“People are subjected to dangerous risks if they seek treatment from dental workers instead of dentists, as they are not educated in dentistry and there are no [standards of practice] to ensure patients’ safety,” he added.

Between August 2016 and July 2019, the association received 1,191 public complaints about dental staff, including issues with braces, dentures, and tooth bleaching. The Indonesian domestic workers in Hong Kong were most likely entrepreneurial, seeing their services as filling a void in healthcare demand from migrant workers, whose needs are often overlooked by policymakers in host economies.

Eni Lestari, Speaker of the Hong Kong Coordinating Body for Asian Migrants said that a demand was being made for cheap, unlicensed services as domestic workers have limited insurance cover. According to government statistics from last October, there are approximately 375,000 foreign domestic workers in Hong Kong and about 42% are Indonesians. In Hong Kong, the monthly minimum wage of HK$4,630 is currently fixed for foreign domestic workers.

“Most employers procure health insurance for their domestic workers that only covers illnesses caused by their jobs. The insurance does not cover teeth, eyes, or cancer,” Eni said.

“So when they’re sick from common symptoms such as fever, they would seek alternative treatments from unlicensed physicians or go to massage clinics. The physicians could be their friends, or Chinese traditional clinics.”

In Hong Kong, many domestic workers aspire to develop their skills beyond household tasks, and pursue their passions in music, design, languages, computers, and health care, Eni added.

“But their passion will never turn into a profession as regulations in Hong Kong are quite strict for domestic workers. If you came to Hong Kong as a maid then you will forever be a maid. A maid is barred to earn money from other avenues,” Eni said.


Source: South China Morning Post

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