Anish, a migrant worker in Kuwait, has been struggling with insomnia and loss of appetite for several weeks. The 25-year-old construction worker from Nawalparasi district, who went to the West Asian country a year ago, complained that he no longer wishes to stay there, nor does he want to return home, as his family's financial woes remain unchanged.

“He has had trouble sleeping and is struggling to continue on his job,” said a doctor at Bir Hospital who attended the patient via the hospital’s telemedicine service. “The tough nature of the job and his family’s financial plight increase his stress level. We recommended some medications and provided counseling through experts, which have shown positive results.”

Anish was among three dozen people who came in contact with the telemedicine service run by the Secretariat of the Foreign Employment Board and Bir Hospital on Monday.

Doctors say hundreds of thousands of Nepali migrant workers in foreign lands may be suffering from multiple health problems, but only a few have access to healthcare in their host countries. Also, very few come in contact with telemedicine services run by the Nepal government.

Bir Hospital, which started telemedicine service targeting migrant workers two years ago, said that every day, an average of 30 to 35 migrant workers contact doctors at the hospital via telemedicine service to consult about their health issues.

“The number of Nepali migrant workers suffering from mental health issues is significant,” said Dr Sanjay Dharel, a medical officer serving in the telemedicine service of the hospital. “Those who do not have easy access to healthcare services in foreign lands or find it difficult to communicate about their problems with local healthcare providers contact our telemedicine service, which is free of cost.”

Although access to healthcare is a pressing issue for migrant workers, it hasn’t received the attention it deserves.

Khursed, 22, working in Malaysia, has difficulty concentrating. Susma has amenorrhea (absence of menstruation) and vomiting. Tirtha, a security guard in the Maldives, has chest pain; Mitralal, 37, who works in a rubber factory, complains of a persistent foreign body sensation in the throat; and Sima has ongoing skin problems. All patients were counselled or consulted by the doctors from their respective departments on Monday.

Doctors said many migrant workers are found to have insomnia, anxiety and lethargy, as well as alcohol abuse problems. Some suffer from loneliness and homesickness. Many were found to be struggling with suicidal thoughts. Some complained of excessive fear for no apparent reason.

“Many migrant workers cannot reveal their health woes to their employers, as they fear they would be sent home if diagnosed with health problems,” said Dharel. “Some complain that their companies do not let them return home even after they tell the employers about their health issues.”

Pre-employment medical check-ups, which examine physical fitness and infection of contagious diseases, are mandatory for all Nepali youths seeking jobs abroad. But these screenings overlook mental health issues.

Moreover, many people reach foreign lands on visit visas and start working without proper work permits. Doctors say such individuals are vulnerable to exploitation and are often deprived of healthcare rights. They were also found to have refrained from seeking treatment because of high costs.

“Due to a lack of mandatory screening of many health conditions and easy access to healthcare, a lot of our youths have been suffering in foreign lands,” said Dr Basudev Karki, a psychiatric consultant at Nepal Mental Hospital. “Some lost their jobs and were rendered penniless.”

Since the money remitted by migrant workers keeps the country’s economy afloat, experts say the government needs to pay equal attention to their well-being. They say migrant workers’ health and well-being can have a far-reaching impact, not only on their families but on their communities and society as a whole.

They suggest making telemedicine services more effective to address the growing healthcare issues of the hundreds of thousands of Nepalis toiling away in foreign lands.