Abstract
Sri Lankan apparel factories claim to be at the vanguard of ethical production on the global supply chain. Both to produce this image and to project their status as fair employers, industrialists offer health services at factory settings. This article focuses on two factory sites that have permanent qualified nurses to attend to illness and injuries, and medical doctors that visit twice a week. While on the face of it, these efforts are commendable, what my fieldwork signalled was that occupational health issues were inseparable from the creeping privatization of health care systems. Injuries or illnesses not treated within a ‘reasonable’ time frame were invariably referred to the private clinics of medical doctors. Ironically, this pattern is bolstered by the proliferation of what one worker described as ‘imaginary’ illnesses – that is, illnesses that workers concoct as a form of respite from the intense pressures of working in this sector. In this paper, I examine the ways in which workers get treated and how it is connected to an increasingly unregulated privatized landscape of healthcare. These shifts also show how the perspectives of citizenry change, despite the social welfare achievements around health and longevity of Sri Lankans.
Highlights
Many managers had spoken with pride of their medical facilities when I interviewed them as part of a research project focused on Sri Lankan apparel factories (Ruwanpura and Wrigley 2011), I had not expected to make visits to their in-house medical centres/clinics as part of the research
My cases suggest that as Sri Lanka’s low-income groups enter the labour force as manufacturing workers, they are confronted with a public health care system that has not adapted to the cadence of working classes nor to the recurring health problems discharged by new forms of employment
Limited entitlement to sick days coupled with long working days means that accessing the state sector becomes prohibitive because of the likely time they will need to spend at outpatient clinics during working days
Summary
Many managers had spoken with pride of their medical facilities when I interviewed them as part of a research project focused on Sri Lankan apparel factories (Ruwanpura and Wrigley 2011), I had not expected to make visits to their in-house medical centres/clinics as part of the research. The country’s entrance into the lower middle-income bracket is recent, yet for a “developing” nation Sri Lanka has always stood out for its remarkably impressive health indicators and care provisioning (Russell and Gilson 2006, Jayasinghe et al1998) These achievements testify to the early Sri Lankan state’s commitment to socio-economic development, and has been the subject of academic debate around the possibilities of social development and low growth (Sen 1998, Humphries 1993). How low-income classes access healthcare facilities (Russell and Gilson 2006), their ability to build trusting relationships with different kinds of health providers (Russell 2005), and inequities embedded within it (Jayasinghe et al 1998), underpin how social structures and relations shape Sri Lanka’s transition to a public-private health care system under the auspices of neo-liberal policies. Prior to presenting, discussing, and analyzing my ethnographic findings, the section offers the reader a sense of my time in the field and the fieldwork methods employed
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