Pakistan's gleaming surgical instruments, export tarnished by child labor

by Hans Greimel, AP

12/08/2006 1:26 am GMT | The Associated Press

The ceaseless sound of tapping metal echoes through these muddy, garbage-strewn alleys where thousands of workers in crumbling brick hovels churn out one of Pakistan's most successful exports surgical instruments.

Home to more than 2,000 instrument makers, this city is one of the world's top producers of high-precision scalpels, forceps and retractors, almost all of which are bound for emergency rooms in the United States and other rich countries, where they help to save lives.

Yet, most patients a world away are unaware that the gleam of these spotless tools are often tarnished by the toil of child workers slogging away in dank workshops clouded with metal dust and earning just a few dollars (euros) a month.

That is starting to change, thanks to a United Nations-backed industry initiative to put child laborers back in school.

While the program underlines Pakistan's growing determination to tackle one of its biggest social scourges, it highlights how difficult eradicating child labor can be in a country where per capita income is only US$736 (euro553.51) a year.

"I like to work," says 12-year-old Kabir Qadeer, who has done odd jobs at a dental instrument maker for the past year-and-a-half for 1,100 rupees (US$18; euro13) a month. "I had no interest in school and quit. So my mother told me to get a job."

Today, Qadeer is back at school albeit for only two hours a day after his seven-hour shift under a program sponsored by the U.N. International Labor Organization and the Surgical Instrument Manufacturers Association of Pakistan, or SIMAP.

Launched in 2000, the program is modeled after a similar initiative that has won international acclaim for reducing child labor in Sialkot's booming soccer ball and sports equipment industry, which supply companies like Nike and Adidas.

When the program wraps up its second phase on Dec. 31, it will have taken more than 2,600 of an estimated 5,000 child laborers out of the surgical tool industry.

The next phase, through 2008, will target the remainder.

"We felt it was our responsibility to do something," said Syed Waseem Abbas, senior vice chairman of SIMAP, and chief executive of Professional Hospital Furnishers.

No children are employed by SIMAP's 2,300 members, according to the ILO.

The problem, however, lies with subcontractors that do as much as 70 percent of the finished product for bigger companies in town. There are 2,000 of these tiny workshops, sometimes employing only a couple of people each and often operating below the radar of monitors. Precision work on heavy equipment such as lathes is not usually done by children, but they are routinely employed in jobs such as cleaning and sorting.

Nike's recent clash with its Sialkot supplier of hand-stitched soccer balls shows how child labor often slips through the cracks. Last month, Nike canceled orders from Saga Sports after accusing the company of farming out work to subcontractors that used underaged workers.

International outcry about surgical instruments is quiet, by contrast, partly because Sialkot's medical goods are resold countless times by international wholesalers.

Sometimes equipment made here is even stamped "made in Germany" at the request of middlemen worried about Pakistan's image further obscuring their origin.

Sialkot's roots in surgical instruments stretch back centuries to the Punjabi swordsmiths of the Mogul empire. But it got its modern boost during World War II, when British colonial authorities called on the city's craftsmen for badly needed medical supplies.

Nowadays, the city pumps out 100 million instruments a year, and the United States and Germany are its biggest markets. International buyers may pay Sialkot suppliers US$2 (euro1.5) for forceps that eventually fetch upward of US$60 (euro45) when sold to a hospital, Abbas said.

The gap is part of the problem, say some labor rights activists.

Fairer trade would give Sialkot companies a bigger slice of the final sale and allow them to raise pay and improve working conditions of their employees.

"The solution lies in purchasers promoting fair trade, rather than a simple 'we won't buy child labor.' This only makes the poor poorer," says Mahmood Bhutta, a doctor in Britain who has written on surgical instrument labor and is trying to set up a fair-trade supplier.

But many poor Pakistani families rely on incomes from their children to get by. UNICEF, the UN's child agency, estimates there are 3.6 million working boys and girls under age 14 in Pakistan, mostly engaged in carpet weaving, brick making, agriculture and deep sea fishing.

"The problem with our country is that we accept child labor as a way of life," said Fazila Gulrez, spokeswoman for the Society for the Protection of the Rights of the Child. "There's not a single economic sector in Pakistan where children are not employed."

Twelve-year-old Qadeer is among those apparently satisfied with the status quo.

Gathering half-finished dental probes from the grit-covered factory floor, he says he can't wait to turn 15 so he can graduate to the grinders, lathes and other machines reserved for his elders. His boss, who started work at 14, has promised 100 rupees (US$1.60; euro1.2) a day then.

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