This is an article from outlook: Raghu Karnad
Nothing about Vijaykumar's daily schedule suggested any kind of health risk. For a young man, still pushing 33, he seemed to have an impeccably balanced lifestyle. He woke in the morning to drive to the Bangalore offices of IT major Cisco, where he worked as a programmer. He spent eight or nine hours at his computer, steadily tapping out code. His was a serious workday, but not an oppressive one, compared to the 14-hour shifts call centre workers clocked in over on Bannerghata Road. When he had time, he swam a few laps in the pool, and headed home to spend time with his family. In 2003, however, something changed. CRI strikes not just those who work 15-hour days, who have been working for years, are old or arthritis-prone... "It was a numbness in the hand," he recalls. "Then a cold sensation from my shoulder to my palm, and sometimes my hand became paralysed." We're all getting older, he thought, gritting his teeth, and this must be the beginning of the inevitable wear-and-tear. And so he swam more to stay limber, tried yoga, ointments and pranayam to ease the pain. He relaxed his pace of work, moved the mouse from his right hand to his left. But that only shifted the pain to different places. The orthopaedist he consulted told him not much else could be done. The condition progressed. A year ago, Vijaykumar stopped driving his car. Then he discovered he could not lift his kids-one and three years old-and carry them in his arms. "Five months ago, people started telling me I looked thin and worn out," says Vijaykumar. "And I realised I was living with a lot of pain, and barely sleeping at night. So, I had to take indefinite leave, and hoped the problem would die down." It wasn't till he was home one afternoon, browsing the web, that he came across a website that described his symptoms perfectly, and he realised it was his computer doing the damage all along. ...It afflicts even those who are young, fit, starting their first computer-dependent job. Average age: 27. In the computer-intensive sectors of the Indian economy, bad ergonomics and work habits are more the rule than the exception. Businesses operate out of rented spaces, pre-equipped with shoddily designed desks and flimsy chairs. Hands, elbows and torsos lock in crooked formations between monitors, keyboards and mouses. The glaring screens look like they were installed to kill flies. Our bodies can endure a certain amount of repetitive stress and bad posture before muscle, bone and nerves begin to come apart at the seams. Computer-related injuries (CRI) can be classified three ways: visual damage, orthopaedic trouble resulting from bad posture, and most prominently, repetitive stress injuries. Symptoms can appear anywhere in the body-from the eyes and the fingers, to the lumbar disk and the feet, so they are usually dismissed as the benign aches-and-pains of overwork and ageing. But in reality they have the potential to do acute damage to bodies and careers. And they are the fastest-growing occupational health hazard in India. Naturally, it is in Bangalore, the hub of the country's it-bpo sector, that the scale of the problem first came to notice. According to the first comprehensive study, conducted by Dr Deepak Sharan of RECOUP Rehabilitation Centre in Bangalore, of the 27,000 knowledge workers it examined in the city, as many as 75 per cent reported musculo-skeletal symptoms. A smaller study in the National Capital Region, published in the Indian Journal of Occupational and Environmental Medicine, examining 200 IT professionals, found musculo-skeletal symptoms in 78 per cent, and visual problems in 76 per cent. The geographic spread of this statistic increases as computer-intensive jobs move to other metros and Tier-II cities, where it may well be called the Bangalore Epidemic. What makes this epidemic alarming isn't just its prevalence, but how acute the injuries can be. While most repetitive stress injuries can be fixed, the risk of relapse is permanent, and exacerbated cases can develop into Reflex Sympathetic Dystrophy (RSD), which means lifelong damage and pain. "RSD can be crippling," explains Dr Sharan. "Apart from the loss of your job, many simple activities you take for granted-buttering your bread, holding a teacup or turning a doorknob-can become impossible." Myths about CRI tend to disguise the onset of the problem: naive ideas that it strikes only those who work 15-hour days, who have been working for years, who never exercise, who are older or prone to arthritis from the outset. In fact, says Dr Sharan, it is frequently a problem for high-ranking managers and CEOs, and people in entirely different industries and professions, be it journalists, bankers, lawyers, academics or students. Over 50 per cent of Dr Sharan's patients were injured within a year of starting their first computer-dependent job. You don't have to invest in that Rs 60,000 Herman Miller's Aeron chair, small adjustments make a huge difference. Many visit the gym daily, and the average age of his patients is 27. Troublingly, CRIs are beginning to strike children as well-RECOUP is treating 55 children injured by their use of computers, video games, mobile phones and iPods. There is evidence too that eye-strain from computer use may be advancing the age at which children develop myopia. Nitin Kauvalkar A long-distance runner, this Bangalorean can lift a 40-pound barbell with his left hand but can't switch to second gear. He had to stay at home for two to three months. Nitin Kauvalkar's is an instructive example. Working for Hewlett-Packard in Bangalore, he was anything but a brittle specimen. "I'm a long-distance runner," he stresses. "It's a barometer of someone's health when they can run a full marathon." He saw his CRI coming early-tingling pain in his elbows and palms-and he made adjustments to his workplace to stave it off. But on a site visit in Boston, it came back and hit him like a wall. "I was using my laptop and I couldn't stick to the advised ergonomic routine," he says ruefully. "That's when it hit me really bad-so bad I could only type my username and password before pain stopped me from doing anything else. Since most people over age 25 have mild spondylitis that shows up in X-rays, CRI pain gets attributed to that. " Kauvalkar had to stay at home for two to three months, suffering a hundred small indignities. "I can lift a 40-pound barbell with my left hand but I can't switch to second gear," he tells us. "The very thought of having a driver is agony, because I hate being dependent." Moral of this story? You may be young, fit, non-obsessive about work, aware of the problem, and still at risk if you're making small, common mistakes at your computer. Medically speaking, CRI is an arbitrary category-the pain can be the result of a score of different pathologies. What they have in common is the circumstances of their origin and the nature of the solution: the workstation. In this case, prevention isn't just better than cure-they are the same thing. The major step towards treating non-acute CRI is fixing the bad ergonomics and work habits that caused it. Visual problems, for instance, hinge on a fairly innocuous activity: blinking. "The main issue is the wettability of the eye," explains Prithie Rekhi, a Chennai optometrist. "Blinking keeps the ocular surface wet, and we need the next blink before the tear-film ruptures." On an average, he adds, "we blink 20 times a minute, which reduces to about 10 when we are paying attention to a conversation or a book, and falls to six when we are in front of a computer screen." The angle between the eye and the screen affects the blink rate: when you are looking down, as you do while reading a book, the eyelid shuts easily. It takes more effort when you are looking up, as when a monitor is placed too high, so the blink rate falls. Bad lighting reduces it further and leads, over time, to dry-eye symptoms like irritation, redness and vulnerability to infection. "People come in with some weird symptoms," says Rekhi, "but when you just tell them how to blink, half their problems are solved." A similar principle applies to musculo-skeletal symptoms. "The key is removing those precipitating factors, and changing the repetitive stress in terms of time and extent," says Dr Ranjan Pushpendra of the Indraprastha Apollo Hospital in Delhi. "I could show you the stretches you need right now," he tells me as he flexes and extends his wrist in the air. A stretch in time could really save nine-nine weeks off the job and nine hours a week in physiotherapy. It is only once the injury crosses a certain threshold that it requires specialist treatments or tertiary care. But awareness is still lacking among general practitioners-like the doctor Vijaykumar first consulted-who are likely to diagnose CRIs as rheumatoid arthritis or, most often, spondylitis. Companies which heed CRI: MNCs whose parent companies have been sued, Indian ones whose honchos suffer. Since the majority of people over age 25 have low-level spondylitis which shows up in X-rays, the pain gets attributed to that. As a result, rather than fixing the problems back at the workplace, doctors address CRIs as symptoms of ageing, sometimes making surgical interventions. "Ortho surgeons typically want to operate on anything," says Dr Sharan, "but this is rarely something you can repair with surgery." "I've picked up a good number of people roaming around with an X-ray, who have been told they have spondylitis," agrees Dr Rajinder Prasad, one of the less scalpel-happy neurosurgeons in Delhi. "It's only when that tingling becomes a burning that they end up in front of someone who can diagnose it." Vijaykumar His troubles began with numbness, and turned to pain. He stopped driving his car, then couldn't lift his kids. That was when he approached Dr Deepak Sharan, treating him below. Fortunately for Vijaykumar, he identified his CRI and found a specialist to treat it. He is also lucky to be working for one of the few companies in India that are sensitive to the problem. Cisco was generous with his medical leave, and allowed him to change his job profile to reduce his computer time. Their office furniture is all adjustable. But there is no question of the company paying compensation or covering his medical bills. "It is up to individuals to take the initiative to manage their health and convey their problems to the management," feels Vijaykumar. "It is awareness that's important-that would improve even if the company were to send a mail, or put up a notice, but they haven't looked into that." In an industry full of ostentatious gestures towards employee welfare, it is not surprising that some companies have adopted impressive best practices. This means pricey ergonomic furniture, customisations on an employee's first day at work, full ophthalmic checkups, regular workplace assessments by ergonomics experts, workshops on self-monitoring, and free weekly on-campus medical consultations. The new Tata Consultancy Services facility in Siruseri, Tamil Nadu, is being built with such meticulous consideration that they say they've applied ergonomic standards not just to the workstation but even to the design of doors, staircases and rest rooms. "Initiatives like this help improve employee morale, a feeling of being cared for by the organisation," explains Allen Matthew, senior director, HR, at Oracle India, a company which is cited for its comprehensive programme. "It is a fact that a healthy employee is a more productive employee." Naturally, it is easier to afford, and also more awkward to ignore, CRI programmes if you are a gigantic multinational corporation. "Two kinds of companies typically show interest," says Dr Sharan. "MNCs whose parent companies have been sued abroad, and Indian companies whose senior managers have been affected severely, and learnt to appreciate the importance of prevention." The rest of the industry, protected from litigation by the limited scope of the Workman's Compensation Act, 1923, and little concerned with generous gestures in these days of fast employee turnover, are looking the other way-that is, at costs. Herman Miller's Aeron chair, which feels like a religious experience after enough time on your standard-issue wheel-about, costs Rs 60,000. But it simply isn't necessary to invest in top-of-the-line products and indulgent schemes to address the basic problems that are hobbling computer workers. Small adjustments make a huge difference: making sure HR managers are approachable, and employees are informed and given the time to break and stretch. "Usually nobody tells you not to get up every half hour, nobody tells you not to stretch," says Dr Pushpendra. "But call centre employees don't have that option, because their employers monitor their rate of calls. That can be pretty bad." Not just chairs, desk design too should avoid these common mistakes: screens placed on the side so the head is always turned; keyboard trays so small that the mouse has to be placed on the table-top, keeping the wrist flexed; office chairs whose height cannot be adjusted; and poor lighting. Bad lighting, especially reflected glare from windows or lights, is the main culprit behind slow blink rates and eye strain. "Lighting turns out to be more important than what we had thought, so office design is critical," says Rekhi. He has on occasion prescribed baseball caps for patients to wear at work-if it fixes the glare, it fixes the problem. But poor design can foil even the simplest fix. "I could not believe it, but many offices actually have flat glass-topped counters with the monitor below and the keyboard on top," Rekhi says. "When I walk into some of these places, I want to tell them they have things in the worst arrangement possible." In an encouraging sign of cross-industry awareness, nasscom held its first training event on CRI prevention earlier this year. For the time being, though, managers are still staring fixedly at the bottomline, ignoring the fact that many of their employees are working in daily discomfort or pain. The longer it takes to rouse them to reality, the more likely it is that CRI will become a perennial hassle for HR departments and a busy corner of occupational medicine. And for those who spend long hours at a computer, an affliction that could cripple their bodies and their careers. To unsubscribe send a message to [EMAIL PROTECTED] with the subject unsubscribe. To change your subscription to digest mode or make any other changes, please visit the list home page at http://accessindia.org.in/mailman/listinfo/accessindia_accessindia.org.in
