Twenty-one-year-old Anurag Verma has one of those jobs that tend to come up in the conversation when Americans are talking about U.S. unemployment: He works in India’s burgeoning business process outsourcing (BPO) industry. He makes very good money—about $800 a month, which is 12 times the average Indian salary. He uses a BlackBerry and doesn’t have to ride a crowded bus to work because he owns a car. He was planning to put money down on a condo until one day he collapsed at his desk and had to be taken to the hospital. In the weeks leading up to his collapse, he had been suffering from dizzy spells and migraines; he’d lost his appetite and 22 pounds.

Anurag had been on the job for eight months, and in the industry his problem is known as BOSS—Burn Out Stress Syndrome. Symptoms include chronic fatigue, insomnia, loss of appetite, and gastrointestinal problems. Back and shoulder pain are common, as are ear and eye ailments. Experts say that BOSS affects about one-third of India’s 7 million BPO workers. In the city of Bangalore (known as the “Silicon Valley of India” because it’s the country’s leading information technology exporter), a study of IT professionals conducted by the National Institute for Mental Health and Neurosciences (NIMHANS) found that one in twenty workers regularly considered suicide and classified 36 percent as “probable psychiatric cases.”

“Those who put in 10 hours of work every night are unable to get adequate sleep during daytime no matter how hard they try. This causes a cumulative sleep debt leading to significant sleep deprivation, fatigue, mood swings, [and] lack of concentration.” —Dr. Anupam Mittal, Max Hospital, Delhi

“You are making nice money,” reports 26-year-old Vaibhav Vats, whose weight ballooned to 265 pounds after 2 years at an outsourced IBM call center, “but the trade-off,” he warns young people just entering the industry out of college, “is also big.” Those trade-offs typically include long night shifts and disrupted eating and sleeping schedules, and a common result, according to doctors, is the alteration of biorhythms—the patterns by which our bodies adapt to the patterns of day and night. One study, for example, found that BPO workers tend to develop markedly different sleeping patterns. According to researchers, they were not only sleepier but were “more depressed and suffered from anxiety disorders.” Explains Dr. Anupam Mittal of Delhi’s Max Hospital: “Those who put in 10 hours of work every night are unable to get adequate sleep during daytime no matter how hard they try. This causes a cumulative sleep debt leading to significant sleep deprivation, fatigue, mood swings, [and] lack of concentration.”

There are also physiological repercussions. Women, for instance, suffer from menstrual and hormonal disorders when disrupted sleep patterns create imbalances in melatonin and cortisol, two hormones related to sleep and stress. “Sleep deprivation and exposure to light at night,” says Dr. Swati Bhargava, a Mumbai gynecologist, “interrupts melatonin production, thereby stimulating the body to produce more estrogen, which is a known hormonal promoter of breast cancer.” Bhargava’s diagnosis is supported by research showing that women who work nights have a 6 percent higher risk of breast cancer.

Case Questions

1. What similarities and differences likely exist between the jobs described here and business process jobs in the United States?

2. What steps might you take to avoid these kinds of problems in your own career?