young worker holding sweater
This interview was conducted by Proteeti Ahmed, an undergraduate student at BRAC University. Ahmed interviewed Dr. Ratu Rumana, who has treated garment workers in Dhaka, Bangladesh throughout her medical career. Dr. Rumana provides insights on the impact of factory conditions on garment workers' health and the detrimental factory pollution on the environment and public health. Dr. Rumana's husband, Dr. Siddiqur Rahman, is a retired military doctor and was present at the interview. His occasional comments are included in the transcript. This interview has been translated from Bengali to English.

Proteeti Ahmed: Thank you so much for giving us your time today. For starters, if you could please tell us about yourself, an introduction - about your career - and how you have met and treated garments workers.

Dr. Ratu Rumana: I am Dr. Ratu Rumana Binte Rahman. I worked as Professor of Gynecology at Sir Salimullah Medical College. Now after going into retirement, I am practicing in a private (non-government) medical college. When I used to work at Sir Salimullah Medical - that was on the bank of the Buriganga river - and now I'm working on the bank of the Turag river. At East-West Medical College I am working as Professor of Gynecology, as well as Academic Director.  

doctor visits workers

PA: How far have you come in contact with garments workers or treated them as patients or-

RR: They used to come there, to Sir Salimullah Medical College, but more of them come  here - here at East-West Medical College. There are more garments factories by the Turag River - at Ashulia - because there are a lot of garments factories in Ashulia so - well, garments workers come in with all kinds of problems - a lot of garments factories in Ashulia - in this area - so what I see here is - the problems that most patients who are garments workers have - those which I see as a gynecologist are - they get Pelvic Inflammatory Disease. It’s a kind of infection, if it occurs elsewhere in the body it tends to end up here or it just directly happens here. It happens because the garments workers beside the Turag -

Dr. Siddiqur Rahman: No, this happens more because of the dense population or - living in unhygienic conditions - dense population is also a -

RR: Yes.

SR: Their living conditions, that is also a factor.

RR: This is also for their poor personal hygiene or for living in densely populated areas and they do not have high living standards for these reasons they can get Pelvic Inflammatory Disease. Apart from that, they come in with more diseases, like gastrointestinal diseases, diarrhea, dysentery. The water that they use, it is not that clean or pure and - some of them come in with respiratory tract diseases because the toxic waste that is thrown out often emits some chemical gases. Those go into their lungs and often cause so much harm that they come in with respiratory tract diseases. Again, some people, for bathing in that kind of water, some come in with skin diseases.

PA: From what we can see and read, sometimes even watch on TV, about the working conditions of the garment factory working conditions, and how difficult they are - from a doctor's perspective - would you talk about these working conditions and how it impacts their health? 

woman masked in street

SR: Personal hygiene comes into play here and of course working conditions as well because where they have to work, there is inadequate ventilation. Then they - there's a lot of dust. No matter where they work in the factory, they have to work through the dust, a whole lot of it. But in order to prevent the dust - the measures that can be taken - they don't have much idea about those, so they end up not taking them. As a result, through their breathing they can contract airborne diseases quite easily.

RR: And as a gynecologist what I actually see is that they cannot maintain menstrual hygiene because they don't have enough bathrooms - and even if they do they have insufficient facilities and they - they have to work right from dawn to dusk and for this prolonged period of time they'll use, say, just one sanitary pad or just one - they tend to use cloth - just one of those for the whole day. They might not even have the facilities to change it or anything and - their menstrual hygiene is just really bad. So they end up having more reproductive diseases - more diseases of the reproductive tract.

PA: If someone works in a garments factory like this, then what kind on injuries may they be susceptible to while working - how probable are they and what are they like - and - what kind of on-the-job injuries might doctors see, what would they have to treat?

RR: The on-the-job injuries that I see in the hospital mostly include them coming in with needle pricks, or what happens sometimes is the needle will break off and a portion of it will get stuck and it will have to be removed. So the needle or other cutting equipment might cause injuries for them. Apart from that, in some factories there are medical officers present on site, I've talked to one of them and they say that they - say someone is pregnant, they'll give them antenatal checkups - this is more recent though, as in what I see nowadays, I did not see this previously. They'll give monthly checkups to the pregnant girls - apart from that, other than OB/GYN problems, what I see is - they mostly come in with injuries. Injuries caused by cutting materials, basically, is what they come in with. Right? I mean apart from that -

SR: something else that can happen is - in their factories - in case of emergency - like fires - sometimes there maybe won't even be a real fire - there will be rumors and then chaos will ensue. As a result of this - maybe they have really narrow stairs or the stairs are blocked because of all the people - in this situation someone may just jump off, some try to rush down narrow stairs and then - a stampede basically - and someone falls underneath it all, they might come in with such injuries. And if there is a real fire, then they'll have burns or respiratory tract problems because of all the smoke. They'll come in with problems like that and well, those are serious injuries.

PA: Okay. In your experience, what is the age range that you see of the garments workers who come to you? 

young garment worker

RR: Their ages range right from being teenagers to around 50 years or so - for the women. The women are in their teens to around 50 years of age or so is what I see.

PA: So that means -

SR: Mostly teenagers, though.

RR: Yes, most of them are teenagers and young.

PA: The age they enter the industry and the age they leave - could you say?

RR: They enter... usually in their teens they’ll enter the workforce. After that maybe, who continues for how long - some might stop working after they get married, some might continue even after getting married. Again, maybe someone got divorced after marriage and then joined afterwards - Everyone doesn't necessarily enter the industry at the same age.

PA: So, over time - you say they start from their teens right up until they're 50 - so, how does the nature of their problems evolve over that course of time? Someone in their teens - and then over time - how do their health problems manifest?

RR: Their injuries that they get from working with their tools and equipment - those don't change in nature. Those don't depend upon their age. But the gynecological problems, those tend to differ with age. For example, someone might have menstrual problems due to being undernourished - most of them stay in their own homes. But they don't get the time to cook, even if they do cook it's not like they consider nutrition facts much - mostly, these health problems are caused by malnourishment - growth problems for the teenage girls, and then because of these growth problems we see that these girls have problems with development, because of those problems, we see with the bone right here - the pelvic bone - that they have problems like obstruction during childbirth and delivery. I mean, the delivery-related problems, if she were even a normal homemaker of a similar age or economic condition, she wouldn't have had to face this many problems, but she suffers from malnourishment more so - Apart from these, like I said before, Pelvic Inflammatory Disease - they are more prone to infections, because of poor hygienic conditions. This is applicable for all ages, for teens up until -

young boy garment worker

SR: there's also violence

RR: Violence is something that is very common among them, yes. I mean violence by their husbands. I mean, home - what is it called? Yes, domestic violence. They are the victims of so much domestic violence. So much. Yes, I really don't understand this - they are working women, they have their own income. Even then I see a lot - many of them being a victim of domestic violence. Maybe one is pregnant, she comes in and says that the baby won't move. Why? Their husband kicked them. But, I mean, for some reason they are subjected to so much domestic violence.

PA: Would you say that many garment factory workers leave the industry because they are physically no longer able to maintain the pace of work? Is it common for workers to leave the industry with chronic illness or injury that makes it difficult for them to find alternative employment?

RR: One reason I see for them leaving their jobs is childbirth - at the time of delivery they leave the job. Also, when they face the issues of who will look after the child and take care of it, that is when they leave the job. But sometimes they do leave their job due to chronic illnesses. Because when they contract chronic infections, their quality of life decreases. They can't work like they used to anymore, so they have to leave their job. And if they contract any chronic diseases - basically for these reasons I see them leave their jobs. And -

PA: What kind of chronic illnesses do they contract? And how do they get them from the workplace?

RR: Oh well, from the workplace - it's all related really, even if not directly, it is indirectly. For example, so many suffer from malnourishment and poor personal hygiene that they can be affected by basically any chronic debilitating disease. Starting from Tuberculosis to any chronic disease. They can get affected anywhere in the body and -

SR: Because they have decreased immunity.

RR: Yes, immunity decreases due to malnourishment, so they can get chronic infections anywhere. As a result, I see a lot of them not being able to cope with work anymore, so they have to leave.

SR: Occupationally, they are susceptible to more respiratory tract problems. Because of the dust, right, and - so they have problems like asthma, and similar chronic diseases of the respiratory tract like chronic bronchitis and asthma.

RR: I'll get patients like, both them husband and wife, both of them working in the same factory, After the baby is born, the husband doesn't leave his job but the wife does. Because where else will she leave her child to go to work, and this is a reason for many of them losing their jobs.

PA: Do they contract such kinds of diseases that make it difficult for them to find other work in the future too?

RR: Yes. Because of these chronic debilitating diseases, it becomes harder to find work for them- and if they don't have physical fitness, they won't find work in the future either.

PA: Are employers held responsible for injury and illness caused by factory work? And, you said before how there is often a doctor on-site, apart from this, what kind of healthcare is available to them?

RR: A medical officer is often there, this much I know. They are also given medicine, those who are expecting are given iron tablets, that too I don't think is the norm everywhere, just some places. Some places give these workers this kind of cheap medicine.

PA: Are these paid for by the government or -

RR + SR: No, no.

PA: So their employers then?

RR: Yes, from their employers. That too not in all factories. I have one or two colleagues who work there part-time and they tell me that some medicine is provided. And... what they say the most is that, if there were provisions for something like a daycare, so that someone could look after their kids, they could continue working. Another thing is, they work inhumanly hard. Sometimes they'll try and get me to write a false prescription or certificate. They'll ask me, "Madam, please prescribe seven days of rest for me". That particular illness might not require seven whole days of rest, maybe two days would suffice. But they work so inhumanly hard that they think if a doctor writes down a few more days of rest, it would help a bit.

medical worker at garment factory

PA: For these problems of theirs, is their employer ever held responsible?

RR: Employers don't always take notice about these because - well, very recently, I had a patient, a young girl who had stomach cancer. I operated on her at East-West Medical. In the process, I realized how her colleagues, the other employees, tried so hard to secure enough money to pay for the operation from their employer. Now, the money was raised, the operation happened, but now - she's a cancer patient, she has so many more expenses to come - she needed chemotherapy, so I referred her to the cancer hospital [referring to the National Institute of Cancer and Hospital] where the treatment costs would be much lower - minimal compared to a private hospital. So one day later, one of her colleagues came in and I asked her if the other girl (the cancer patient) went to the cancer hospital - since she needs regular chemotherapy from there. She replied no, saying she won't get the time off from work - so she's basically remained half-treated. I did her surgery, but she can't get the chemotherapy after. Because she can't get off from work, but also the minimum costs she would need - she can't secure that either. Maybe this isn't applicable in all cases, but where this young girl worked, it was the case. So the girl got treatment, but half of it. She couldn't get the chemotherapy after all.

PA: In terms of worker safety, have there been significant improvements made since the Rana Plaza tragedy of 2013? What improvements still need to be made?

RR: Whether it has been significant or not, I don't think so, but some improvements have been made. Some things have happened. For example, after the Rana Plaza incident they can come to us now. If the medical officer on site isn't enough, they are referred to us. This, I didn't see before the Rana Plaza incident. You know how I talked about the medical officers, well if the problems are under their jurisdiction they don't refer them to us, but if specialist treatment is required, in that case, they do, and the worker gets that day off, so they can go and see the specialist. But this is still insufficient, and the reason is, suppose I see them today and tell them I need to run some tests tomorrow morning and they have to be on an empty stomach - That's it. That is something they can't do. "No, madam, I've only got the one day off, they won't give me time off again tomorrow morning." I mean, it's just, insufficient. It's an improvement from before, but it's still not enough.

PA: What more improvement could be done -

RR: Improvements - a person can't be treated in a single day. Suppose someone comes today, I'll need to take their blood sugar, but they've already come on a full stomach. I need to take their blood sugar in the morning on an empty stomach. But they won't get tomorrow morning off of work in order to come in. Then I'll need to follow up. Maybe the next day I'll need to do an ultrasound, maybe an injection the day after that, but they won't be able to continue their own treatment. What has improved from before is that the medical officer on site can now see to them and refer them to us if need be - this referral system is an improvement, but treatment needs to be consistent and that doesn't end up happening.

older woman garment worker

PA: As a doctor, what else do you think the industry could do to bring some change?

RR: Well, the medical officer understands when they should refer a case to us, these referred cases - it has to be ensured that the entire course or term of treatment for them is completed, then that will be a good thing. They do what they have to do up to the referral, but after the referral they have to go through a course of treatment, right? Before the illness and treatment are allowed to take their course, they go back to work, or - they can't continue the treatment for whatever reason - financial troubles - or they simply can't be present. Because if they don't show up to work, they don't get paid, which is an important reason. So since they don't get paid if they don't show up to work, they come in for that one day, and as soon as they feel a little better, they rejoin work and don't come back.

PA: So they aren't getting sick leave, then?

RR: No. As far I can tell, quite possibly if they take too many days as sick leave they aren't paid.

PA: Coming to the next question, do you know of any organizations that are effective advocates for the safety and health of garment workers?

RR: I've heard of some. I can't recall any specific names right now but I have heard of one or two of them.

PA: What kind of work do you know them to do?

RR: They look at the health-related side of things, there's one that works with violence against women and sees to domestic violence and such things. I also know of one which provides legal support to the women, sees to their legal situation. For firing them over no apparent reason and what not, they see to matters like this. It is a female lawyers organization, I believe. [Unconfirmed]

PA: Ok, well so far we’ve been talking about the impact of garment factory employment on the health of factory employees. Now can you speak more broadly about the impact of the garment industry on public health, in terms of the pollution emitted by the industry, and its impact on air and water quality?

RR: It impacts those who live in the surrounding areas, who live nearby, Because the waste is always dumped in the rivers, and those who live by the side, they don't necessarily have to be garment workers, this also includes other people who live there. They suffer from more gastrointestinal diseases, respiratory tract infections, gynecological infections too, also skin diseases. The general public who live there suffer from these, not just the garment workers, obviously. It definitely impacts them too.

SR: If you don't build these factories in a properly planned way, then whatever problems are supposed to happen will happen. And most of them are unplanned. As a result of this, the problems that happen are - the factories' waste management isn't right so - the environment gets polluted. So what you get is,

RR: Air pollution. Water pollution.

woman and child in streets

SR: Yes, if there is a water body - that gets polluted, and centering these factories, slums are created. And in these slums, there is no health education, there are no ways of living there properly. So because of this, the problems that are caused by dense population, health problems and such, those occur. They often don't have enough water, or good bathing facilities, waste management isn't right, and due to these conditions, the number of health problems that they can cause all happen to the people who live there. And, what did you say? About the local people? Well, yes, and basically, around the factories you will always find a kind of slum And in these slums, since workers sometimes live here, well, either they have land, or sometimes grab land for setting up those living areas - and they offer these places to other people as well, for low rent. Because of this, these areas also see an increased tendency of social crimes being committed.

PA: Do you know of any environmental organizations in Bangladesh that are advocating for stricter environmental regulation of the garment industry?

RR: We hear of a couple names but we don't see much being done -

SR: It isn't significant enough. Local, foreign, international organizations and representatives will come and visit and inspect -

RR: They take some data

SR: They give some advice. But how much actually gets done -

RR: We don't see much that is effective enough to catch our eyes.

SR: No, we don't. But, they do exist. These kinds of organizations, they do exist, and we sometimes hear about what they do, they publish their demands and advocate for their cause, but I do not think factory owners are eager to realize these, or be sincere.

women protesting garment industry

PA: Okay, we're nearing the end so now, this interview will be seen by American university students who are concerned about the conditions in which their clothing is made. Is there anything else about the impact of the garment industry on worker and public health that you think they should know about?

SR: The girls who work in our country, we can definitively say that because the products of these factories that they make are up to standard, they are being exported to Europe and so many other countries of the world. Now, the people who are behind these products, these garment workers, if the standard of living and learning of these workers can be improved, there will obviously also be an effect on the products produced as well. Then the country will benefit, along with the buyers, who will get a quality product.

RR: These are sincere workers, there's no doubt about that.

SR: Yes, they are sincere and, another factor contributing to the flourish of the garments industry in Bangladesh is the very cheap labor. But just because it's cheap doesn't mean they have to be exploited, that's wrong. The people who are behind these huge profits, if a portion of that went into their health, environment, housing, if their overall entire standard of living could be improved by spending even a little, then this industry will definitely go far. The workers will be benefited, as will the owners, and the country.

PA: Do you think concerned clothing consumers can do anything to help in addressing these situations and public health crises?

SR: Yes, of course they can. If they create enough pressure - pressure the owners into ensuring a minimum standard otherwise they won't buy from them - and this has happened in the past. Wasn't it America that imposed a restriction once? What do you call it, when they chose to no longer prioritize Bangladeshi imports, there was something about not giving subsidies, or taking them off a list of special treatment, Bangladesh is no longer on that list and - that could only happen from all the pressure that was put on them. Saying, if they didn't improve things, they would stop buying from them. And no special priority would be given. So like this, at different times in different situations if the consumers and international organizations pressurize the owners and buyers, then they will obviously be bound to contribute to the improvement of the lives of the workers.

women march together for garment work justice