India’s Outsourcing Blues

After eight months in a high-paying business process outsourcing job, 21-year-old Anurag Verma’s life metamorphosed completely. The onetime middle-class, bus-commuting college kid was earning big money, had acquired a flashy new car and a Blackberry and was dreaming of investing in a condominium.

His euphoria was short lived. A vortex of stress, late-night shifts and sleep deprivation whittled down his weight by 10 kilograms in a few months and triggered migraines, dizzy spells and killed his appetite. One day, Verma collapsed at his desk from exhaustion, raising panic among his colleagues.

This is the flip side of an outsourcing revolution that has legions of alarmed office workers terrified of losing their jobs in the west. Verma isn’t an aberration. Far too many of India’s youth are being sucked into a work culture that promises one thing and delivers quite another. Indeed, behind the promise of a good salary (about US$800 per month, India’s average salary for a whole year), outsourcing jobs involve grueling work schedules straddling multifarious time zones and cultures, tight deadlines, ambitious targets, phones that never stop ringing and rude and demanding callers.

Cumulatively, this is spiraling into a burnout phenomenon for many of India’s 7 million-plus outsourcing workers. The industry calls it BOSS -- Burn Out Stress Syndrome. According to doctors, BOSS affects a third of call center workers with symptoms that include chronic fatigue, insomnia, alteration of biorhythms, loss of appetite, gastrointestinal problems and others. Physical problems like back pain and shoulder pain are also common and -- with excessive exposure to computers, headphones and other such equipment -- many ear and eye-related ailments.

This was a scenario just waiting to unfurl. Over the past few years, India has been the epicenter of outsourcing as multinationals across the world farm out services and back-office operations in sectors including travel, education, hospitality, audit and accounts to India’s plentiful, highly skilled, English-speaking and cheap workforce.

That has resulted in impressive industry growth, rising by 40 percent this fiscal year alone to achieve US$8.5 billion turnover against $6.3 billion in fiscal year 2005-06. According to a recent NASSCOM-Everest survey, India’s outsourcing sector will earn $11 billion in export revenues next year and is poised to be a $50 billion-enterprise by 2012.

But success hasn’t been without its share of pitfalls. Many recent health surveys have highlighted the heavy toll that the outsourcing work culture is extracting from its employees. In a first-of-its-kind survey conducted in December 2007 by the National Institute for Mental Health and Neurosciences (NIMHANS) among Bangalore’s IT professionals, a whopping 36 percent of the respondents were found to be "probable psychiatric cases," 10 percent were diagnosed with mental distress, one of 20 regularly considered suicide, 28 percent were constantly under strain, 22 percent couldn’t pursue any hobbies and 300 of the 900 men and women in the study battled infertility problems.

In another study, New Delhi’s Safdarjung Hospital observed 181 outsourcing workers and confirmed poor sleep patterns and high substance abuse among most of them. The study – which was also reported in the Indian Journal of Sleep Medicine in May 2007 -- revealed that outsourcing employees have markedly different sleep patterns than otherwise-employed individuals. "Not only were (outsourcing) workers sleepier,” reported the study, “but the analysis of the data revealed that the employees were more depressed and suffered from anxiety disorders.”

Owing to their lifestyles, the use of stimulants like tea and coffee was also significantly higher among the respondents. Some 40 percent were smokers and the abuse of narcotic drugs found among 27.6 per cent.

Doctors have witnessed a direct correlation between poor sleep and depression, stress, alcohol abuse, narcotics and cigarette smoking. In fact at a conference on sleep disorders in 2006 in India, Dr Lim Li Ling, deputy director of the Sleep Disorders Unit of Singapore General Hospital observed that sleep-deprived youth working in Indian outsourcing firms were most likely to undergo premature ageing. “Heavy food during nights, skipping breakfast, eating lunch in the evening - all such irregular habits affect their health," she warned.

Experts also say that young workers often fall prey to what’s called Circadian Rhythm Sleep Disorders (CRSD) triggered by, among other things, the sleep timing. “Those who put in more than 10 hours of work every night are unable to get adequate sleep during daytime no matter how hard they try,” says Dr. Anupam Mittal of Max Hospital. “This causes a cumulative sleep debt leading to significant sleep deprivation, fatigue, mood swings, lack of concentration etc.”

In view of the staggering impact outsourcing jobs are having on workers’ health, the Union Minister for Heath, Dr. A. Ramadoss recently announced the formulation of stringent health guidelines and a new health plan for the sector.

Indeed a new health plan -- that factors in a more conducive work environment and a heightened sensitivity towards workers’ health on the employers’ part – would especially benefit women, who form a third of the sector workforce. Doctors have often highlighted problems like menstrual disorders and hormonal disturbances amongst women employees due to imbalances in melatonin and cortisol, two hormones that govern sleep and stress.

In fact a study by the Seattle-based Fred Hutchinson Cancer Research Center, in association with the National Cancer Institute in 2001, highlighted that women who work night shifts – commonplace in India’s outsourcing industry -- face enhanced risk of breast cancer of up to 60 percent.

“Sleep deprivation and exposure to light at night interrupts melatonin production, thereby stimulating the body to produce more estrogen, which is a known hormonal promoter of breast cancer,” explains Mumbai-based gynecologist and obstetrician Dr. Swati Bhargava.

The negative fallout isn’t just restricted to health. Psychologists report that demanding outsourcing jobs are also straining employees’ social and family life, occasionally leading to relationship breakdowns. Difficulties are particularly acute for women with child-care responsibilities.

In addition, according to surveys, female call center employees also often report stress, panic attacks, depression, relationship troubles and eating disorders. Disquieting as it is, more and more working women in Kolkata (east India), report fertility researchers, are turning up at clinics with stress-induced infertility problems that could be eliminated with a healthier lifestyle and closer companionship with their spouses.

"A peculiar problem that has developed over the last few years is a rise in the number of temporary infertility cases,” says Dr. Bini Deb, a Kolkata-based gynecologist. “Work-related stress damages the endocrine system leading to temporary infertility." Deb says that young women working night shifts are so stressed out that they find it tough to lead a healthy sex life. This leads many to believe that they are infertile. Other pitfalls of stress? Miscarriages, abortions and underweight babies.

Thankfully, with widespread corporate sensitization and reports in the Indian media about the unhealthy work culture, some call centers have started addressing their employees’ health problems. A few have brought in psychologists. Some outsourcing companies that require night shifts are also providing facilities like good canteens, transportation to and fro from office, ergonomically designed office furniture, frequent breaks and nutritional guidance. Others are offering gyms, yoga workshops, counseling sessions and a library to help de-stress its workers. Work is being made more “fun” by organizing weekend movies, picnics and social outings.

Oracle, for instance, has workshops targeted specifically at reducing worker stress. Flextronics provides medical insurance for spouses, children and parents. To tackle the common issue of back problems, the company organizes lecturers. Similarly, at Quatrro, there’s a `health corner' which provides food under the guidance of nutritionists and a gymnasium/yoga center.

“Creating a healthy work environment is a win-win situation for both – the employers and the employees,” says Priti Bansal, a human resource development manager at WorldView, a call center in New Delhi. “After all, healthy employees are happier and more productive.”

The government, in the meantime, is being asked to urgently announce a promised new health policy for outsourcing workers as a prerequisite for worker satisfaction and productivity to restore the sheen to India’s `sunshine’ industry. Till then, dark clouds loom over its workers’ health.