Hesperian Health Guides

Hesperian Health Guides

Getting good care at a clinic or hospital

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HealthWiki > Workers' Guide to Health and Safety > Chapter 25: Access to health care > Getting good care at a clinic or hospital


Workers often have a hard time getting good health care. Hospitals and clinics may charge a lot for services or medicines, be difficult to get to, be crowded or not open when you can go, or be unfriendly to migrant workers or women.

Illness due to work creates additional problems, since many health problems are not easy to see or to prove were caused by work. For instance, strain and overuse injuries from repeating the same movement too many times without rest, and short- and long-term effects from chemicals are caused by work and can be lessened or stopped when work conditions are improved. But most employers refuse to accept that workers’ back pain, headaches, skin rashes, breathing problems, and cancers are caused by their jobs. Most doctors and nurses do not learn about occupational health or know about conditions in export factories, so workers do not get good treatment.

Often workers who are disabled or injured from work receive no support from their bosses. They might be fired and if their sickness is chronic and they need medicine or special equipment, they often are forced to pay for it themselves. Many cannot afford to do this.

2 women speaking in a group.
The health workers are nice but they really don’t know anything about our work. They don’t even know where to look up the chemicals we are working with to see if they are dangerous.
Yeah. I started getting headaches when we switched chemicals but the doctor keeps saying there’s nothing wrong with me!

Contents

Recognition of work-related injuries and illnesses

Some doctors tell workers that their health problems are not related to the work they do. They blame the worker by saying she had a previous condition that caused the problem, or the problem is due to her bad habits or home life, or is a result of unhealthy conditions in her community. But work injuries and illnesses are caused by poor working conditions, exposure to dangerous chemicals and machines, lack of training, and no access to emergency care.

a man speaking.
We made big posters about our co-workers who were killed in the factory. We talked about who they were, how they died, how their families are suffering now. We take the posters to city events, parades, company picnics, and to churches on Sundays.

Find out how occupational diseases and injuries are defined in your country. This may be useful to you and your group in convincing health, employer, and government authorities that they must recognize injuries and illnesses as work-related, cover the costs of treatment, and include them in workers’ compensation systems.

The right to be compensated for injuries caused by work
The ILO Employment Injury Benefits Convention (No. 121) says governments should provide care, rehabilitation, and compensation to workers who suffer from occupational diseases, including:
  • diseases caused by dusts.
  • diseases caused by exposure to particles in the air.
  • diseases caused by exposure to chemicals.
  • problems and injuries caused by noise, vibration, and other dangers.


Also see the ILO List of Occupational Diseases Recommendation (No. 194).
The Employment Injury Benefit Convention also says that governments should offer compensation for:

  • workers who can no longer work because of their disease or injury.
  • families of workers who lose their life at work or because of work.


The benefits provided must cover the medical care and rehabilitation of the worker, but should also include cash benefits, depending on the injury or disease.

The roles of the UN, ILO, and other international organizations that promote workers’ rights are explained in Appendix A.
Our clinics are funded — not owned — by the employer
a woman speaking.
We worked with many workers and organizers to address the distrust that they had of company-paid clinics like ours. We showed them how the doctors and nurses work for us, not the boss. Even if the boss pays us to let workers use the clinic, the doctors and nurses are independent.

Many organizations in Bangladesh offer affordable and accessible health services. But many people who work in factories cannot use these services because they do not have time or permission to leave the factory. To reach them, the Marie Stopes International organization established "factory health services." These clinics operate within the factory and are funded by the factory owners, though they remain independent. Workers can seek medical help as they need it but the clinic also offers regular checkups and monitors workers’ health while they work at the factory. The clinics are open long after the workers finish their workday and the boss pays for every worker to have free service at the clinic. Many more people now have access to health services.

Workers with special needs

All workers are different and we bring these differences to work with us. Usually the workplace is made more productive by our differences. When our health needs differ, we have to make sure everyone gets the attention they need. Workers with HIV can continue to live healthy, productive lives when they have access to the medicines, nutrition, rest, and respect they need (see Chapter 30: HIV). With medical support and job flexibility, workers with disabilities also can continue to work productively for many years.

Women workers and women’s health

Even though women are half the population, and often most of the workers in a factory, women’s health needs often are not considered part of basic care nor occupational health. Since many chemicals affect women’s reproductive systems, pregnant workers need to have checkups (prenatal care) to find and care for problems with the mother’s health and with the baby. If work cannot be made safe, many countries give pregnant women the right to transfer to jobs that are safe for them or grant them paid leave if no safe job can be found.

Women’s Health Express
The Chinese Working Women’s Network (CWWN) has created new ways for women factory workers in China to meet and talk about health issues. They started the Women’s Health Express, a mobile van that stops outside factories in the Pearl River Delta industrial zone. Women who visit the van are checked for signs of many illnesses and given general health information and treatment, as well as information about health problems caused by dangers at work. Staffed by women health promoters, the Women’s Health Express is a place where women workers feel comfortable talking about their concerns and problems.



The right to health care
The UN Convention on the Elimination of Discrimination against Women says men and women must have equal access to health care information and services, including family planning. To learn more about the conventions to eliminate discrimination in the workforce, see The right to equality.


Several ILO conventions (Nos. 102, 121, 130, 183) say governments must provide for the health, health care, and social security of workers and their families, including:

  • medical care for workers, their partners, and their children.
  • paid time off for illness.
  • medical care in case of injury at work.
  • rehabilitation services to help a disabled worker return to her previous work, or a suitable job for her ability.
  • injury benefits paid to workers who are hurt or made ill by work.
  • disability benefits paid to workers who are injured and cannot work, or who earn less money than they did before the injury.
  • survivor’s benefits paid to the family of a worker who dies.
  • recognition of work-related illnesses and injuries, including diseases caused by chemicals, dust, noise, vibration, and other dangers.
The roles of the UN, ILO, and other international organizations that promote workers’ rights are explained in Appendix A.


Get better care

Health workers are trained to recognize signs of illness, identify problems, and treat them. But many health workers have never been inside a factory. Health workers may know very little about factory work and the conditions that affect workers’ health. If possible:

  • arrange for them to visit factories and see conditions for themselves.
  • take health workers to visit people’s homes and community activities.
  • organize a meeting or workshop where factory workers tell or act out their stories to help educate health workers.
At the Clinic

The doctor, nurse, or health worker who sees you should ask about the problem you are having now and about your past health. Try to give complete information, even if you feel uncomfortable, so the health worker can learn as much as possible about your health. Always tell the health worker about any medications you are taking, including aspirin or family planning methods, because some medications affect how other medicines work. These questions can help you prepare to explain your problem:

a woman showing a health worker how she reaches down into a cart at the factory.
HEALTH
CLINIC
Most health workers are not trained to treat illnesses and injuries caused by factory work. Show the health worker exactly what you do at work.
  • When did you first notice the problem?
  • What signs made you think something
    was wrong?
  • How often do you have these signs?
  • Have you ever had these signs before, or has anyone in your family or community had them before?
  • What makes the signs better or worse?


If you suspect that your problem is related to chemicals at work, bring as much information as you can: the chemical name or brand name; what it is used for; its color, smell, or texture; and anything else that might help the health worker find out what it is (see Health problems caused by chemicals).

You should also ask as many questions as you need to make a good decision about how to solve your health problem. Make sure the health worker explains so you understand:

  • What are the different ways this problem can be treated? Are there home remedies?
  • What will the treatment do? Are there any dangers?
  • When will I get better?
  • Will I be cured? Or will the problem come back?
  • How much will the tests and treatments cost?
  • Are there home remedies?
  • Why did the problem happen? Can I prevent it from happening again?


Many doctors and nurses are not good at giving information. Or they may be busy and not want to take time to answer your questions. Be respectful, but firm. Do not feel intimidated by them — your health depends on the services they provide, and you should be satisfied with the services you receive. They should explain until you understand. If you do not understand, it is not because you are not smart enough, but because they are not explaining well.

The health examination

In order to know what is wrong with you and how serious your problem is, you may need an examination. The exam may include looking at, listening to, and feeling the part of your body where the problem is. For most examinations, you need to uncover only the part of your body where the problem is.

  • If you would feel more comfortable, ask a friend or family member to stay in the room with you during the exam.
Tests

Tests can give more information about a health problem. Many tests are done by taking a small amount of urine, stool, or coughed-up mucus and sending it to a laboratory. Or, a needle is used to take a small amount of blood from your finger or arm.

  • Ask the health worker to show you and explain how he will take the test.
  • Ask about cost before you have any test.
  • Ask what the health worker will learn from the test and what would happen if the test is not done.


Health care with respect

All people who give health care should do their best to provide you with:

  1. Access: If you need medical care you should be able to get it, no matter where you live or where you come from, how much money you have, your religion, your language, your age, your skin color, your political beliefs, or what health problem you have.
  2. Information: Your health problem and the possible treatments for it should be explained to you. Your health workers should help you understand what you need to do to get better, and how to prevent the problem from happening again.
  3. Choice: You should be able to choose whether or not you are treated, and how. Also, if there are different choices, you should be able to choose where to go for treatment.
  4. Safety: You should be given information to avoid harmful side effects or new problems that result from treatment.
  5. Respect: You should always be treated with respect and courtesy.
  6. Privacy: Things you say to a doctor, nurse, or other health care worker should not be overheard by others or repeated to anyone else. Exams should be done in privacy, where others cannot see your body. If there are other people in the room, you should be told who they are and why they are there. You have the right to tell them to leave if you do not want them there.
  7. Comfort: You should be made as comfortable as possible during an exam. You should have a good place to wait and not have to wait too long.
  8. Follow-up care: If you need more care, you should be able to go back to the same person, or be given a written record of the care you have received to take to a new doctor, nurse, or health worker.