Along with American jobs exported overseas, individuals’ personal data is often sent to countries that lack consumer privacy laws.

A growing number of U.S. medical and financial-services firms are shifting information-processing work to lowerwage countries that lack tough privacy laws, leaving their consumers vulnerable to identity theft and possibly other crimes.

According to Gartner, offshore business process outsourcing services, which typically require the transfer of personal data, grew 38 percent last year to just under $2 billion.

Concerns include overseas call-center workers being able to view or manipulate personal records stored in U.S. data centers and having databases of information on their citizens physically located in a foreign country and operated by a third party.

“Outside the U.S., medical privacy doesn’t really mean anything,” said California Sen. Liz Figueroa, who wants to bar offshore outsourcing of medical and financial records. She is sponsoring bills to require California employers to notify the state and employees if they plan to move 20 or more jobs overseas and to prohibit state contracts from being fulfilled offshore.

Sen. Dianne Feinstein (D-Calif.) has asked the U.S. Comptroller of the Currency to investigate whether banks that process customers’ financial data offshore have safeguards to protect that data from unauthorized use. In Arizona, proposed legislation would bar companies from shipping financial data outside the country without written permission from consumers. A proposal in South Carolina would prevent companies from giving “financial, credit, or identifying information” to a callcenter representative abroad without the individual’s written permission.
Executives who are counting on offshore operations to lower their costs say safeguards are in place to protect individuals’ privacy. Critics say privacy cannot be guaranteed in offshore settings. According to privacy advocates, contract language and security technology are not enough to protect the confidentiality of personal data that has been moved offshore.

For example, last year, a disgruntled Pakistani worker upset about back pay threatened to divulge data about patients at a San Francisco hospital that sent its transcription work abroad, according to Information Week.

Most Vermont politicians and business leaders have long been boosters of the state’s participation in the global economy, arguing that openness to world trade offers bright opportunities for job growth.

Lately, however, Vermonters have been seeing the dark side of globalization. Recent instances of public and private “outsourcing” are heightening awareness that involvement in a rapidly shifting international economy can also lead to loss of jobs in Vermont. Workers at National Life and other firms have learned through bitter personal experience that competition for jobs from lowwage countries is no abstract threat.

So which is it? Does Vermont win or lose from taking part in the global economy?

It’s a bit of both, according to most economists and state officials. But they conclude that on balance world trade does generate significant benefits for Vermont. “It’s easy to identify those who get hurt by globalization,” says Richard Heaps, publisher of the Vermont Economy Newsletter. “Those who are helped aren’t as easy to see. If you can buy your t-shirts for 25 cents less as a result of world trade, you don’t get to be on television.”

The media can effectively dramatize the misfortunes of a Vermonter whose job is outsourced to a call center in India, advocates of world trade note. Not as well pre-packaged for the nightly news, they argue, are the stories of an estimated 11,600 Vermonters who are working for companies headquartered outside the United States.

It’s the actual and potential losses of Vermont jobs to overseas competitors that have dominated discussion of globalization in recent months. In March, there came the revelation that a food stamp initiative undertaken by Vermont and six other Northeastern states has resulted in some jobs being exported to India. Earlier in the year, the Montpelier-based National Life insurance company announced that it was outsourcing 158 information-technology jobs to Keane Inc, a Bostonbased company, that will, in turn, ship some of that work to India.

Many of the affected employees at National Life were devastated by the news. “Workers were weeping at their workstations,” says Tim Abraham, one of those hit hard by the company’s decision.

“Many have not slept through the night since the day of the announcement,” Abraham said at a Montpelier forum in March organized by Congressman Bernie Sanders, a leading opponent of outsourcing. “Many are under the care of physicians. Some have resigned without severance and many are looking to get out from under the grasp of a company that has so crudely dismissed them.”

Abraham, a Killington resident, isn’t just complaining about his own plight; he has formed an advocacy group to address the larger issues and impacts of the economic dislocation associated with global trade.

“As a result of this outsourcing initiative, a significant piece of the fabric, that we in Vermont call community, has been ripped to shreds,” Abraham said. “Life in Montpelier and this state and this nation has changed dramatically because CEOs, hot-shot consultants, clueless economists, and hip-pocket politicians are trading our country’s middle class benefits for corporate profits.”

Heaps and other defenders of globalization acknowledge that Vermont’s integration into a changing world economic system will not be a painless, riskfree process. But they say that retraining programs sponsored by the state will help prepare workers like Abraham for new, and perhaps better, jobs.

“It’s not necessarily the end of the world for these individuals,” says Heaps. “Many of them will move on and find other jobs.

“We at the Agency of Commerce are trying to provide training options for Vermonters who do get displaced,” adds Kevin Dorn, the head of that agency. He suggests that these efforts may enable affected workers at National Life “to compete at a higher level.”

For the sake of the state’s long-term economic health, Dorn continues, economic development officials in Vermont “need to look toward the jobs of the future and help prepare our folks to qualify for them.” That’s a more effective approach, he says, than “looking backwards to jobs that have left the state and that we can’t compete for anyway.”

Vermont would only damage its own economy if it tried to isolate itself from the world economy, state officials argue. “The pace of change keeps accelerating,” Dorn says. “And at the end of the day it’s the ability to be nimble that will attract the greatest amount of investment.”

“One of the strong suits for the US economy, in comparison with Japan and the European Union, is that we’re more flexible,” Heaps adds.

All this may be true, or at least inevitable, in regard to private enterprise, say some opponents of outsourcing. But they draw a sharp distinction between the job-siting decisions of forprofit companies and those made by government agencies.

“As a matter of state policy,” says Burlington Mayor Peter Clavelle, “we have to put Vermont first. We have to adopt policies that support the creation and retention of jobs in Vermont. And one very modest step would be to stop state government from outsourcing contracts and using taxpayers’ dollars to pay for jobs overseas.”

Clavelle, the Democratic candidate for governor, was commenting on the Agency of Human Services’ food-stamp outsourcing move. He was also speaking in response to Governor James Douglas’ support for a World Trade Organization agreement, which, opponents charge, could result in state contracts going to companies in Central America rather than in Vermont. (See accompanying story.)

The City Council in Burlington had attempted in March to pass a resolution that would have prohibited city contracts with contractors who send jobs outside the United States. The council eventually tabled the motion unanimously, despite Clavelle’s support, because of the complicated nature of rule.

The debate over outsourcing shifted to the state government’s role due to Vermont’s $450,000 payment to Citibank as part of a multi-state deal’ intended to update administration of the food stamp program. The New Yorkbased financial giant subcontracted with a company in Wisconsin which then arranged for some of the contracted work to be performed by a firm in India.

Protests over the state’s role in sending jobs overseas led to demands for an accounting of which other Vermont government agencies might have entered into contracts with firms in other countries.

Administration Secretary Michael Smith uncovered only a few such cases, some of which appeared readily justifiable. The Department of Tourism and Marketing, for example, was found to be using British and Canadian firms to promote Vermont as a tourism destination in Britain and Canada.

Smith notes that he has not yet received a report from the state Treasurer’s office regarding functions it may have outsourced.

“But I’ll bet apples to donuts that some of their financial contracts do involve ‘Operations overseas,” Smith says.

In today’s economy, he adds, it is virtually impossible for any large-scale organization, public or private, to avoid arrangments that entail the off-shoring of some jobs.

“If you’re running Microsoft products or just about any type of software, the chances are that if you need help late at night your call is going to be handled by someone in an office overseas,” Smith notes. “These sort of IT integrations are in place throughout our operations.”

The larger point, according to Smith, is that, “Vermont is actively engaged in the global economy and extricating ourselves from it would be very difficult and costly as well.”

It’s not necessarily bad that some administrative functions of the Vermont food stamp program have been shifted to India, adds economist Heaps. The state is presumably saving money by having this work performed at wage rates significantly lower than those prevailing in Vermont, he says.

“So that allows the state to free up money that could be returned to the taxpayers of Vermont or that could be used for other priorities, like maintaining roads and bridges,” Heaps argues.

But it’s not just state government that feels mounting political pressure to keep current jobs in Vermont and to give Vermonters preference for emerging opportunities, regardless of how much more ‘cheaply the work might be done elsewhere.

Southwestern Vermont Health Care, a medical center based in Bennington, recently bowed to both internal and external demands to cease its dealings with an Albany, NY, company with operations in India.

At issue was a growing medical transcription workload that could not be shouldered by the 14 dictation-takers employed directly by the hospital. Instead of relying on the Albany firm, which would have sent some of the new work to India, Southwestern Vermont will seek to fill the available transcriptionist positions through a training program at Vermont Technical College.

SO I WOKE UP AT NOON in the darkness of my room. I went out into the blinding midday light and looked across the street into Tompkins Square Park; there were already a couple hundred kids skating and standing around for the Emerica Wild in the Streets day. Tompkins is this torturous, supposedly “warm-up” spot right on my corner. When I wake up and straggle over for coffee, I usually resent its existence. It’s not until after I drink some caffeine and do some ninja kicks that I’m able to face any kind of social situation.

In the park, the kids were skating the flat bars and some launch ramps–Suski and Reynolds were doing some sweet jumps and Spanky was entertaining his fans. This really wasn’t a demo, though. Emerica got together with Autumn skateshop in the East Village and KCDC in Brooklyn to hold a city-wide skate jam. It wasn’t about what pros were doing what, it was just shredding. Anyone was welcome to skate.

Keeping it green from the Emerica team were: Andrew Reynolds, Leo Romero, Kevin Long, Bryan Herman, Tosh Townend, Aaron Suski, Heath Kirchart, and Braydon Szafranski. Besides the Emerica dudes, Robert Lopez Mont, Billy Rohan, Brandon Westgate, Taji, Harold Hunter, Allan Russell, and Phil Ladjansld were notably ripping on the scene.

AFTER A FEW HOURS AT THE TF, some kind of silent alarm went off and everyone barged down Avenue A to Houston Park. I rode the BMX bike that Jamie Reyes had left in my apartment, with Spanky in tow. He held on to a string attached to my handlebars; it was funny at first, but I had a huge heavy camera bag and the kid refused to push. Spanky is like the new Axl Rose or something–and I mean that in a bad way: “Ohhh, I’m tired, pull me to the demo …” Before the demo, Spanky was wearing a mink coat and kilt! Then he wouldn’t skate until one of his gear roadies found him his scarf. He fell on a Nollie Enward which some kid was filming, so Spanky dove into the crowd and started kicking his ass. He had the worst Satan face, crying “You can’t control me anymore! I’m the number-one skater in the world, better than Muska!” I was pulling him off, like, “Stop Spanky, that’s not your father!”

Besides that one bad apple it was so cool seeing such a huge mob of skaters all skating down the street at once (insert the nostalgic “can’t we all just get along” skateboard writing here).

Houston park is where things got crazy–the six-stair in front was heavily shredded. I got a bat signal from Andrew that said “gnarly status,” so I went over to the Half-Life section where Andrew did the most gangster frontside wallride. It was one of those things that I don’t think anyone has ever done, even though it’s been sitting there as long as the place has been a skate spot. It just solidified the fact in my head that Andrew Reynolds is one of the gnarliest dudes ever born. If Andrew woke up and said “No more gaps or rails, I’m only going to skate vert and do wallrides now,” he’d still be one of the best skaters in the world.

AFTER ANDREW DID THE WALLRIDE three times in a row, I raced over and shot some photos of dudes killing the ledge to bar. Billy Rohan did a big-spin front board, and Leo Romero did a kickflip 50-50 … what it is!

After that I rode my bikeset over to the Brooklyn banks, where dudes were schralping the wallride. As for the rail, Suski Smithed it and Robert Lopez Mont pulled salad grinds and frontside feebles. Most epic … I forget what else happened on the scene there; it was basically just a big crowd of kids siting around watching, and an occasional skater stepping up and getting broke while trying for the glory of a hammer situation.

Over at KCDC Amy Gunther was making me some food! Oh wait, not just me–that’s where the last stop of the day was, as well as a BBQ and a bunch of ramps on the closed-off street. Oh, and raffle tickets were on sale, with all the money going towards John Cardiel’s medical bills. A ton of skateboard companies donated product–it was the hugest stack of boards I’ve ever seen in my life. There was so much stuff that I think everyone who bought a raffle ticket for a dollar got a board.

That about sums up the situation on the scene. After the raffle I got in one of the Emerica ewwyerweird vans and we went to Albany for a demo. Yeah, I roll with the hot crew these days … owww!

In April of this year, McDonald’s CEO Jim Cantalupo unexpectedly died of a heart attack. Two weeks after the company’s board of directors appointed Charlie Bell to succeed him, Bell was diagnosed with colorectal cancer. And, just weeks ago Apple Computer CEO Steve Jobs underwent surgery to remove a tumor from his pancreas.

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These recent events highlight the need for executives to stay proactive when it comes to issues of their health. As one of the most important assets a company has, top executives owe it to their shareholders to take care of themselves.

Although many recent advances in medical science have led to the increased ability to detect and prevent many illnesses, busy executives may still find it difficult to make the time to attend to their health. Seeing a need, South Florida’s hospitals and medical centers have rushed in with a plethora of health care options targeted at busy executives. Armed with an understanding of the time constraints involved with setting appointments for tests and exams, these programs offer streamlined approaches to care. These top-of-the-line health care options include executive physicals offering VIP treatment for total-body health assessments. The technology is often cutting-edge: clinics and hospitals throughout the area continue to update both their equipment and facilities. The following is a round-up of the array of options available for the busy South Florida executive. Stay well.

Aventura Hospital and Medical Center has just completed the first phase of its $130 million North Patient Tower expansion project, part of the hospital’s plan for enlarging and renovating its entire facility. The hospital moved this June into the first four floors of an 11-story building, which includes a new 28-bed, 17,000-square foot, emergency department with all private rooms and two new intensive care units with 42 beds. The second phase, which will open in the fall of this year, will provide an additional 35 beds and a new surgical center with 10 operating rooms (two dedicated to open heart surgery), new registration and waiting areas with enhanced security. There will also be VIP rooms on each floor and two VIP suites with family living rooms.
Baptist Outpatient Center’s Executive Health and Wellness Program offers full examinations in a private, elegant setting. Amenities include a business center with Internet access, continental breakfast, plush terry robes or warm-up suits and 24-hour international patient assistance. Most examinations are completed during a half-day visit to the Baptist Medical Arts Building. The program’s multidisciplinary team provides a comprehensive medical evaluation, with results available on the same day. The physician also sends a follow-up letter to the patient, outlining areas that may need attention and recommendations for follow-up examinations.
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Bascom Palmer Eye Institute landed the top spot in US News & World Report as the best eye institute in the US this year. When asking ophthalmologists across the nation where they would send a family member if price and distance were no object, 78.5 percent chose Bascom Palmer. It is the institute’s third time in 10 years to be ranked No. 1 in the magazine’s annual medical institution rankings. What put Bascom Palmer Eye Institute on top? “The excellence and the care that we provide to each and every patient every day. And it’s the same care for all CEOs and all aspiring CEOs,” says Marla Bercuson, director of marketing. Bascom Palmer is also the University of Miami’s department of ophthalmology. Miami www.bpei.med.miami.edu (305) 243-2020

Bethesda Memorial Hospital has a Benefactors Pavilion that offers a VIP suite that is more like a hotel room than a hospital room. A minimum donation of $50,000 qualifies a donor for a lifetime membership in the Benefactors Pavilion Society, required for access to the suite.
Broward General Medical Center’s new seven-story parking garage is just the first phase in the hospital’s 400,000-square-foot expansion. Scheduled for completion in 2005, the expansion will feature state-of-the-art surgical suites, new critical care units, outpatient facilities, a 38,000-square-foot emergency department and a trauma center, as well as a new Heart Center of Excellence–the hospital’s specialized heart care center. Fort Lauderdale www.browardhealth.org (954) 355-4400

Cedars Medical Center has an executive physical program. It is targeted to international business people, and is offered in conjunction with Kendall Regional Medical Center and Aventura Hospital. An individual can come to any of the hospitals and have a complete physical starting at $795. It is a two-day process, which includes approximately 15 different tests. Miami www.cedarsmed.com (305) 325-5511

The Center for Preventative Medicine and Wellness at Memorial Regional Hospital was designed for busy executives and their families, and focuses on prevention. Lily Gusman, with the center’s Executive Physical Program, says the center believes that “healthy professionals create healthy organizations because they have a healthy approach to commanding the company. If they don’t take care of [themselves], the bottom line of the company suffers.” Special coordinators make all appointments for the patients, and on the day of their exam, a host escorts the patient to and from all appointments. Each patient is counseled by a physician on lifestyle and early detection of health problems. The center claims the cost is the same as a regular physical. The program started a year ago and is especially popular with international executives,
The Cleveland Clinic Florida’s half-day executive physical includes a complimentary lunch and a full slate of examinations and tests (from eye exam to a chest x-ray). Patients are guided from appointment to appointment, with a general practitioner coordinating it all, and a computerized medical record following them. Approximately five days later, patients receive a customized medical report with recommendations. If a hospital stay is necessary, the clinic is attached to Cleveland Clinic Hospital, where the rooms have wood paneling (to conceal medical equipment), refrigerators, closets, desks and Internet access. The hospital was the first in South Florida to acquire the da Vinci Surgical System for heart surgery. It uses a digital camera and robotic arms to enter the chest cavity through tiny incisions, thus avoiding cracking a patient’s ribs and leaving a long scar. The system allows surgeons to work on a beating heart during bypass surgery without the use of a heart-lung machine.
Coral Gables Hospital has one VIP suite, which features a living room, an entertainment armoire with a television and meals that are a cut above the standard hospital fare.
Coral Springs Medical Center has a new Women’s Diagnostic and Wellness Center, designed to meet the health care needs of women at every stage of life. At this new center, women have access to services including mammograms, ultrasound, non-surgical stereotactic breast biopsy (which is performed on an outpatient basis), breast self-exam training, bone densitometry test for osteoporosis, second opinion consultations and obstetrics pre-registration.
Hollywood Medical Center has a program called “Golf Again” for avid golfers with injuries to their shoulders, knees, back, and/or ankles. “Golf Again” is run by Florida-licensed physical therapists with special training in golf-related injuries. By combining a comprehensive physical evaluation with an evaluation of the individual’s body mechanics during his or her golf swing, the therapists develop exercise routines designed to get the patient back on the golf course. The “Golf Again” program consists of an initial evaluation and 16 one-hour sessions held over eight weeks.

With the birth of his son, Quincy, last spring, Phillip Williams took a six-month paternity leave from his job. “I wanted to experience the birth and the early days. I wanted to exhaust all of the resources I had to spend time with [him],” explains Williams, who was working as executive producer of BET.com at the time. According to the 2000 Family and Medical Leave Act (FMLA) survey, which was conducted by the U.S. Department of Labor 75% of workers took some kind of leave from their jobs in 1999.

Many employees are conflicted about taking extended leaves. Most are fearful of losing their jobs. But under the FMLA, employees are allowed 12 weeks a year of unpaid leave and a guarantee that they will have the same or equivalent job (in terms of pay, benefits, and other employment terms and conditions) if they work at a company with 50 or more employees, have worked at the company for at least 12 months, and have worked at least. 1250 hours over the previous 12 months: Requirements can vary from state to state.

Beverly Kaye is the co author of Love It, Don’t Leave It: 26 Ways to Get What You Want at Work (Berrett-Koehler Publishers; $17.95) and the founder and CEO of Career Systems International, a consulting firm that specializes in talent management. Kaye says that although many employees are reluctant to take leave right now, more will be willing to take time off as the economy improves. Kaye also says that progressive employers who want to keep talented workers will make it easy for their employees to do so.

Kaye advises workers who intend to take family or medical leave to plan for their departure as far in advance as possible. In preparation for his absence, Williams, who was responsible for the overall creative production of the Website, met with senior management to set up a plan that included dividing his duties among other staff members. While he was away, he would call in about once a week to see how things were progressing. But the positive reports he received were “somewhat discouraging,” he says. He began thinking that perhaps he was no longer needed.

But when Williams returned to work, he realized that instead of feeling threatened, he felt empowered. Williams firmly believes that the proof of a good manager is how well employees perform in his or her absence. “There were certain parts of my job I was comfortable letting others handle,” he says. “I felt like I had graduated. I wanted to take on new and more responsibilities.”

Upon your return to work, Kaye suggests meeting with your employees or co-workers to ask them about what they’ve learned, the skills and abilities they’ve developed, and the opportunities they’re ready to pursue. Meeting with them serves two purposes: It lets them know they’re valued, and it gives you the opportunity to get the information you need to resume your duties.

WASHINGTON — Medical debt is more common among families with full-time workers than among families whose members work part-time, according to University of Iowa researchers at the annual meeting of the American Public Health Association.

“Medical debt can result in credit problems and force people to file for bankruptcy,” said Matthew Levi, who is a graduate research assistant in the department of community and behavioral health at the university.

“These problems can be worsened if an individual stops going in for care and using prescription drugs, because untreated problems can prevent a person from returning to work. People with medical debt also report increased levels of stress and anxiety,” he said.

The researchers looked at Urban Institute data from interviews with more than 1,400 residents, some done in person and some by phone.

Subjects were located either in low-income areas of Des Moines or in surrounding Polk County.

Data came primarily from a single question in the survey asking whether the subject or their spouse was paying off any medical debt, although a few other responses also were included.

Surprisingly, people with full-time jobs were more likely to report medical debt, said Anne Wallis, Ph.D., of the department of community and behavioral health at the university.

“We suspect this reflects having full-time employment, but without health insurance, or with inadequate health insurance,” she said.

Families with private health insurance were more likely to report medical debt than families without such insurance. However, this result may have been due to the way data were collected, since Medicaid data were reported separately. “So [it may just show] that families with private health insurance are not adequately insured,” Dr. Wallis said.

Another surprising finding had to do with the household incomes of people reporting medical debt.

“We see almost an upside-down ‘U’ shape where, with increases in income, up to a point, people are more likely to have medical debt,” Dr. Wallis noted at the meeting. “They’re less likely to have Medicaid or some other type of coverage, and more likely to be among the working poor.” Respondents on welfare also were more likely to have medical debt, she added.

More than one-third of households with children reported medical debt–but without correlation to the child’s health status, Dr. Wallis said.

“Where parents reported their child’s health as being poor, 100% reported medical debt, in addition to 50% who reported debt if their child’s health was fair,” she said.

“But even when the child’s health was good or excellent, medical debt approached 40%.”

The researchers did not find a lot of differences in the amount of medical debt reported when comparing the ages of children in the house; however, there was a dip in the percentage of debt reported by families with preschool-aged children.

“We’re not really sure what that’s about, [but] a lot of children in this sample are Head Start children, so they would be receiving some services and referrals,” Dr. Wallis noted.

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It’s a hard issue to wrap one’s head around. Free market champions, such as the likes of Microsoft and Dell, tout outsourcing and offshoring as the logical developments of a global economy based on accelerated innovation and technology; the “invisible hand” surfs the net. American trade union leaders have made the issue their cross to bear, portraying it as the ultimate betrayal of the promises made for the overseas flight of manufacturing jobs. And Third World workers don’t understand why anyone should be angry in this free market world–after decades under “austerity” measures, this is their just reward for life with neoliberalism.

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There are many players in this puzzle adding their own perspectives, and sometimes their own math, to the national debate on outsourcing. There are two diametrically opposing poles of opinion on this highly political and racially-charged issue. One: end all business outsourcing until every American has had their pick of the jobs. And two: allow companies to be competitive by permitting them a free hand at diminishing labor costs while increasing profit margin. Absolute protectionism vs. absolute liberalization.

For progressives, the issue is knotty because we are being asked to stand up for workers on the basis of nationhood. Do we bash outsourcing when Indian workers at Microsoft in Bangalore are telling us they make three times what they would normally make? Do we support outsourcing when we know American workers have lost high-paying software development jobs and are now working at Wal-Mart? In order for us to decide where we fall on the spectrum of solutions, we first need to understand the underpinning issues affecting this debate.

The Jobless Recovery

Though no one source can pinpoint the exact number of jobs lost to offshoring, it is estimated that roughly 300,000 to 995,000 jobs have been lost in the U.S. to offshoring to-date. According to Goldman Sachs, up to 6 million white-collar jobs will be lost over 10 years. The United States has a workforce of 140 million workers. Companies are outsourcing to gain a labor cost savings of 70 percent, according to CIO.com, an online magazine for chief information officers of high-tech companies. The top five U.S. employers in India today are General Electric, Hewlett Packard, IBM, American Express and Dell. According to Todd Tollefson of TechsUnite.org, an online community for high-tech workers affiliated with the Communication Workers of America, “The jobs in jeopardy of being outsourced and offshored are basically any job done with a computer.”

The first outsourcing of work was in low-level “back office” production–help desk, call center work. Today high-level administrators, program developers and engineers are also being outsourced. The outsourcing of jobs is taking place not just in the high-tech sector, but also in healthcare (where transcription, medical records and radiologic imaging is at risk), as well as in the public sector. Even patent lawyers have been put on notice.

Coupled with news of offshoring, Americans are also bombarded with reports of the jobless recovery. In August, The New York Times reported that the Department of Labor found worker layoffs occurred at the second fastest rate on record during the first three years of the Bush administration. It also found that the layoff rate reached 8.7 percent of all adult job holders. In the same month the Department of Labor reported that only 32,000 new jobs were created in July. The facts may be dizzying, but the end result is an American populace inundated with bad news about jobs and the economy.

The actual number of offshoring jobs lost may seem insignificant compared to the overall size of the U.S. workforce, but the loss becomes more significant as wages and standards for workers in the U.S. continue to decline. Along with the flight of white-collar jobs, Americans contend with another substantial threat to their livelihoods. What has been infamously dubbed the “Wal-Martization” of jobs is a real, accelerated trend among U.S. companies to race to the bottom by rolling back wages and employment standards. A recent UC Berkeley Labor Center study by Arindrajit Dube and Ken Jacobs revealed that taxpayers in California are subsidizing Wal-Mart to the tune of $86 million a year by providing public assistance to thousands of Wal-Mart employees unable to afford healthcare. Wal-Mart employs a million workers in the United States. Even though workers at the giant chain work more than full-time hours, they are still unable to afford healthcare for themselves and their families. Offshoring and the low-waging of America, combined with recent memories of the loss of manufacturing jobs, leave the American electorate incredibly sensitive about protecting jobs in the United States.

Hot Under the White Collar

For many workers, offshoring seems like a new face to an old enemy. In the ’70s and ’80s the American worker movement experienced incredible hardship when companies began to move operation to the Global South. General Motors went to Mexico, the GAP went to Indonesia, electronics production grew in Taiwan and Japan, while U.S. companies imported steel from Korea and Japan–all resulting in the cost of production reduced and profit margins increased. The deindustrialization of the American manufacturing sector meant many Americans were out of jobs, and their labor organizations were faced with grave reductions to their memberships. “The loss of jobs to foreign countries during the period of the ’70s and ’80s occurred mostly in the manufacturing sector, which had high union density. Jobs in those sectors were a source of decent incomes for workers with a high school degree. The social basis for a labor response to the loss of jobs was very strong,” says Steven Pitts, an economist with the UC Berkeley Center for Labor Research and Education.

What we find today is that the sectors highly affected by outsourcing are mostly unorganized and were, at times, the most resistant to unionization attempts of the past. However, these high-tech service jobs represented the kind of jobs displaced manufacturing workers in the ’80s were told to train for–these were the American jobs of the future. “American workers are angry because they were told to accept the loss of blue-collar manufacturing jobs because these jobs will be replaced by better white-collar service jobs,” Pitts continues. “Now those jobs are being lost as well.”

The anger toward outsourcing among American workers has also revealed racial underpinnings in the national debate. Numbers of chat rooms and websites created by displaced high-tech workers air some of these sentiments. Far from the global unionism expressed by union officials, lie the very nativist and xenophobic sentiments of some of their rank and file members. Some of these sentiments spill into anti-immigrant racism against Indian workers here in the U.S. One website called “Texas Labor Champions” posts messages from displaced tech workers. One such techie wrote, “Being a woman, I would not hire an Indian either, because of their views towards women. Having said all of that, we have to remind ourselves that this isn’t a issue of discrimination, it is more an issues of Nationialism … even if they were the sweetest people on earth and really were smarter/harder working than Americans.”

That same website suggests that foreign workers at call centers are potential agents of Osama bin Laden, using their access to sensitive private information of consumers such as social security numbers and bank account information as a means to fund Al Qaeda. Though some of this might seem outrageous, the public has entertained these views by supporting legislation requiring call center workers to identify themselves and the country in which they live. Proponents of this legislation say they want consumers to be able to assess the risk involved with providing foreign workers their private financial information. Presidential hopeful John Kerry supports this measure as well by adding it to his national jobs reform platform. Though the unions that speak for these workers claim to hold a an anti-racist globalist approach to these issues, the reality is that on the cubicle floor, workers are using a racial and nationalist reasoning to define the cause of their displacement.

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Treating someone with a traumatic wound in a sterile environment can be stressful. Cover the patient with mud and add enemy fire and ice-cold rain and the experience can be downright daunting-even it the wounds and incoming fire only seem real.

For medics of the Texas Army National Guard’s 56th Brigade Combat Team, this was business as usual as they prepared for their Iraq deployment last . month at the Joint Readiness Training Center ORTC) at Fort Polk, La.

The soldiers have less than a month to refine their medical skills using training aides and simulated patients before they have to treat actual wounds on the battlefield.

Capt. James D. clay, a JRTC medical officer, said such training is making possible an evolution in Army field medical treatment. The plan is to reduce the number ol wounded soldiers who die en route to field hospitals by providing more trauma care on the battlefield.

“We’re changing the way we do things from the past,” clay said. “We’re now focused more on the frontline level of care ior our soldiers.”

The training at JRTC, where little is simulated, provided the 56th’s medics with a realistic sense what to expect in Iraq, he said.

Spc. John L. Westbrook still had crimson-red fluid on his hands minutes after performing a battlefield amputation on a mock patient under fire. He knows the next time the mixture ol food dye and vinegar could be the real thing.

Westbrook, however, has treated the same type ol wound in his civilian job as a firefighter. After the training, he is confident that he and the other medics will do their jobs in Iraq.

“As medics, treating injured soldiers is still our main priority,” he said. “That is what we do, that is our calling.”

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AS AN AGEING, wealthier and more demanding population grows to expect more from the NHS, politicians are belatedly waking up to the huge role technology will play in delivering on their promises. For the first time the government and the medical technology industry are attempting to hammer out a common approach that will benefit the health and the wealth of the nation.

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Over the next few months the recommendations of the Healthcare Industries Taskforce (HITF), a joint initiative between ministers and technology providers, are due to begin filtering through to tangible policy. Ministers are talking up the twin benefits of bringing new technologies into the NHS and stimulating growth in a sector that could deliver hi-tech jobs and export revenues for the UK. The industry itself is unsurprisingly delighted by the government’s attention, but is also keen to stress the urgency of acting on the recommendations.

John Wilkinson, director general of the Association of British Healthcare Industries, said a strong relationship between technology providers and the NHS was a vital component of a successful UK sector. This relationship has been erratic at best so far. According to Wilkinson, the NHS has often been a slow adopter of medical technologies. As the biggest single provider of healthcare in the world, this was hardly helpful to UK businesses operating in the sector. ‘It’s difficult to have a good industry base when you haven’t got a dynamic customer,’ he said.

That the NHS is a slow and difficult environment in which to introduce new technologies is hardly a surprise. As successive governments have discovered, imposing rapid and decisive change on the monolithic organisation makes turning around the proverbial oil tanker look straightforward. But if the HITF programme produces results, the NHS’s very size and purchasing power could turn a weakness into a significant asset, potentially changing the UK into a hotbed of advanced medical technology with a vibrant development base and an awesomely influential prime customer.

So what changes are planned? All sides agree that a quick and effective process for evaluating the performance and cost-effectiveness of new medical technologies is vital to the NHS and the industry alike. To this end, a new Device Evaluation Service (DES) will be developed that HITF hopes will deliver improvements over the current system. An important element of the plan involves moving the existing DES from its home inside the industry’s regulatory body and making it part of the NHS’s procurement operation, bringing it closer to those who decide whether to buy in to a new technology.

It is clear that the NHS’s purchasing and supply practices present a bewildering obstacle to external companies seeking a foothold for their innovations inside the health service. HITF hopes to establish a framework for procurement at regional level, giving technology developers a single point of potential access to more hospitals.

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HITF also recommends measures to stimulate a culture of innovation, including the establishment of a new innovation centre and a fund to promote the development and exploitation of new products and procedures. Allied with familiar commitments to strengthen ties with academia, create centres of excellence and focus more on R & D, the HITF programme has nothing anyone could object to in principle. Those in the medical technology sector are counting on it delivering practical results.

The ABHI’s Wilkinson, whose members include some of the big guns of the sector such as Johnson & Johnson, Smith & Nephew, Smiths Medical and Tyco Healthcare, claimed the very fact that the government had engaged with the industry proved it was moving on to the radar of policy makers. The prospect of closer co-operation between the NHS and the medical technology business should help it to emerge from under the shadow of the pharmaceutical sector and establish its credentials as a [pounds sterling]4.5bn industry in its own right, earning [pounds sterling]3bn in export revenues. ‘The HITF report is very significant,’ said Wilkinson. ‘It is the first material engagement between the government and this industry as a whole.’

Despite his enthusiasm for the HITF programme, however, Wilkinson knows that no reform of medical technology uptake in the NHS can succeed without the support of doctors and nurses, who will be its end users. ‘We believe clinicians have been disengaged from the process and want to pull them back in,’ he said, adding that ‘tussles’ over procurement between clinical specialists and managers were frequently unhelpful.

Wilkinson also expressed fears that senior doctors would be too stretched ‘doing the day job’ to be able to contribute to the R & D process needed for the successful introduction of new medical technologies.

Despite these concerns, Wilkinson said senior doctors are increasingly aware of the huge opportunities presented by advances in medical technology, and the implications for their career prospects. ‘Technology is producing huge shifts away from certain skills and towards new skills,’ he said. ‘Surgeons, for example, are using technology that requires a completely different skill set from what went before. The medical community is realising that if they don’t use the leading-edge technology, their reputation is in danger of slipping.’

For HITF to bring decisive impetus to the UK’s medical technology sector, however, it will have to reach beyond the big multinationals and make an impact on the growing number of SMEs operating in the area. According to estimates quoted in the HITF report, 85 per cent of healthcare companies in the UK have an annual turnover of less than [pounds sterling]5m.

If the major players, with their multimillion-pound marketing budgets, have problems introducing new technologies to the NHS, the situation is harder still for businesses that may comprise no more than a few dozen highly skilled technical staff.

Diana Hodgins, managing director of European Technology for Business (ETB), a developer of advanced engineering systems for the medical sector, said of the HITF agenda: ‘The intention is right and the words sound good, and we should be positive. However, the questions I always ask about these things are: how and when?’

Hodgins said that HITF at least represents a statement of intent that medical technology SMEs can use to fight their case when presenting innovations to healthcare buyers.

Smaller companies are also aware of the benefits of banding together to give themselves extra weight in the sector. Hodgins is a leading figure in Medilink East, a body set up to represent medical technology SMEs in the east of England that now numbers about 130 members. ‘We’re growing and we’re starting to get a bit of clout,’ said Hodgins. ‘With that type of scale you begin to command far more attention than a little company on its own.’

Either via HITF or the efforts of SME innovators to push their case, the UK’s medical technology sector is determined to raise its profile. Whether the vagaries of the NHS will allow it to reach its potential remain to be seen, but all agree that this is crunch time. ‘We have a two-year window,’ claimed Wilkinson. ‘We’ve got a vibrant sector with the potential to deliver high value-added jobs, but the government hasn’t always been aware it’s there. As a country we have to have an industrial base, and we are arguing that this sector is a highly promising one.’

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NANCY Aossey has had little time to sleep. With devastation in South Asia still front-page news last week, a flurry of phone calls was swamping the offices of international Medical Corps, the aid organization that Aossey has headed since 1986.

The Santa Monica-based group was already working in the Indonesian province of Sumatra when a massive earthquake triggered the tsunami on Dec. 26, so it was able to put a team on the ground quickly in some of the hardest hit areas.

Aossey has been directing the group’s response from her offices, focusing in on the urgent need for clean drinking water and sanitation.

Although the scope of the disaster is staggering, it’s familiar territory for the Iowa native, who has spent years traveling to some of the most dangerous and impoverished countries around the globe.

In fact, the International Medical Corps, founded in 1984 by a Los Angeles emergency room doctor, has sent workers to more than 40 countries. Its niche: providing health care services in high-risk countries, including Afghanistan, Iraq and Somalia. Aside from providing direct health services, the group specializes in long-term training to build up local health care systems.

Question: So who are all these people calling in?

Answer: When there is an emergency and it hits the newspapers there is an outpouring of support. People call and they want to help. Often they want to make a donation. Sometimes they want to volunteer here in our offices and a lot of times they want to go overseas and volunteer. We talk to a lot of people during emergencies like this to see how we might use their assistance.

Q: Can you actually find a use for people off the street?

A: Some of the hardest people to find are people with good logistics experience, communications experience, administrative skills, finance skills, management skills. Those are tough skills to find, especially to ask people to work in a war zone or in a natural disaster. We do get a lot of health professionals who are interested and we put them through a process where we evaluate whether or not they are needed, how they might fit in the local culture and how much time can they spend in a particular country.

Q: Do these people have jobs?

A: Some are retired doctors. Some people are in the prime of their careers. We have a trauma surgeon in Kansas who will shut down his very lucrative (plastic surgery) practice. He will go overseas for a month or two and volunteer his time.

Q: Whom do you have in Indonesia right now?

A: We have 130 people on the ground. Many of them are local Indonesian health care professionals, people we have worked with for many, many years. We are communicating with them and sending them supplies. Indonesia is very large. We were working on several islands. We had a presence in Sumatra, but we were not in Banda Aceh.

Q: Are things as bad as the pictures make it seem?

A: Yes and probably worse. We are getting daily reports from our teams and they are witnessing major devastation–entire villages gone, people in a state of shock. IMC will focus on what we think we can make the greatest impact.

Q: And what might that mean?

A: We will be focusing on securing the water supply, hygiene and sanitation. The water is contaminated. There is a need for water purification tablets. People do not have the right medicines. There are a number of injuries where the right antibiotics are not available. We are going to have to transport them in. We are looking at putting together mobile clinics, vehicles typically. IMC has experience with that. We are looking at trying to help put together health posts. We also will assist rescuers, providing body bags.

Q: Will this be your biggest disaster response ever?

A: I make it a point of never comparing suffering, but yes. We have been involved in a lot of significant disaster: genocide, ethnic cleansing. We have been there and seen it all. This one is unique in that it’s huge and sudden. Sometimes man-made disasters (such as civil wars) occur over a period of weeks or months. A number of workers lost family members and friends and are pitching in. Can you imagine how hard that would be?

Q: Are you seeing record donations like other groups?

A: So far we have raised about $1.2 million in private donations. It’s a record for this period of time. We’ve got it online, phone calls, checks. We have had people walk up to our office and drop a check on, our desk. We have set our goal at $5 million.

Q: How can you make sure you are not duplicating efforts of other agencies?

A: We know everything that is being done on the ground. If we are in an area that is well covered we will set up in an area not well covered. A lot of the coordination is done in the field.

Q: Will you be going there yourself?

A: If I need to be there because I can help IMC I will go. I am very sensitive to the fact that when I travel somewhere I am taking up resources and people’s time.

Q: What have you done in some other situations?

A: In Mogadishu, Somalia in the early ’90s we were the first American-based organization to work there. It was complete anarchy: bombings, shootings, guns on the street. We saw people shooting at the heads of children as target practice. For a local infrastructure, we had doctors and nurses who stayed behind to help their people, but who had no experience with trauma. We took doctors who didn’t have a lot of trauma training and we gave them new surgical techniques.

Q: It sounds like you have seen some really grim stuff.

A: I’ve seen some very horrific stuff. In Somalia, security was so bad we actually had to have armed guards. There was this really nice, nice man that we worked with, his name was Jackson. We were at the airport. He came to watch us load up the airplane, and all of a sudden we hear these gunshots. I looked up and watched him die. A guy came up behind him with an AK-47 and shot him four times in the back. It was some kind of a blood feud.

Q: Doesn’t it haunt you?

A: Well, I am human. After Somalia, I did have nightmares for a long time. It’s tough. You try to separate what you see from what it is you need to do to get to work.

Q: What keeps you going?

A: I see the very, very worst side of human nature, truly evil, and I see the very, very best side. There is not a lot in between. In many of the countries where we work the leadership lies in the hands of people who care a lot about power and money.

Q: How did this organization get going?

A: The founder, Dr. Bob Simon, made the first trip into Afghanistan as a private citizen in 1982 and 1983 after it had been invaded by the Soviets. He noticed that all the relief organizations were on the border working in refugee camps and no American organizations were inside Afghanistan. So he sold his house in Malibu to raise $80,000 or $90,000 to found the organization. He still chairs our board.

Q: What did the organization do?

A: We started a medic training program that lasted nine months and taught lay Afghans how to treat 85 percent of the injuries and diseases that they saw. We sent them with supplies and they opened up clinics in their regions and they started providing medical services to the civilian population.

Q: You were there during the Taliban. How was that?

A: Tough, very tough. Scary too. Because Afghanistan is very tribal and to some extent the power centers are remote, there were certain areas in Afghanistan where we could operate a little bit more freely. We also had a very, very good strong local staff there.

Q: You were one of the first aid agencies into Iraq too. What’s it like there?

A: (She clinched her lips shut.)

Q: So mum’s the word?

A: It’s very bad. The security situation is very bad. We are carrying out programs in large part through working with our local Iraqi staff who are the unsung heroes.

Q: How many workers do you have there?

A: About 12 non-Iraqis. They are outside of Baghdad. They are spread through the north. We have over 1,000 Iraqis. They are doctors, nurses. We run a lot of nurse training programs. The nursing system was totally devastated when we went in. The problem is a lot of times they are targeted because they are working with international organizations, or just because they want to help their people. We worry a lot but we have managed.

INTERVIEW

Nancy A. Aossey

Title: President and Chief Executive

Organization: International Medical Corps

Born: Cedar Rapids? Iowa, 1958

Education: B.A. and MBA, Northern Iowa University

Career Turning Point: Learning about International Medical Corps from friends and being offered the job of chief executive

Most Admired People: Native people who overcome tragedy and devastation to work with International Medical Corps in their home country

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